The Truth Test
Question: After learning certain Truths regarding a local Healthcare community, as told through the experiences of one individual,
do you have it in you to pass a critical Test of Truth about yourselves?
by James R. Caputo, M.D.
"All that is necessary for the triumph of evil...
... is for good men to do nothing."
- Edmund Burke
March 3, 2013
What you are about to read is a genuine testimony which is intended to present a serious moral Test for all who read it, especially those who reside in the Central New York region and really our State as a whole. Many may have arrived here by the ad in today’s Post Standard, while others have been contacted via email or direct mailing. Nonetheless, you are free to disseminate this information to anyone and by any means you choose since a wide audience is what is intended.
The sum and substance of this Test is based solely on what seems to be dreadfully void in our world today…and that is Truth and Virtue. This presentation is a shocking personal account regarding certain aspects of healthcare in this community which has substantial implications for virtually everyone, particularly who we wish to be as a people. This narrative is aimed at leaving the reader then asking themselves how they should respond. In other words, do you care? Does what you will read matter to you? Are you concerning at all about how this might apply to your own life or that of your family? Will you stand for this sort of thing in your community? The questions that will be raised are numerous and the issues no less sobering. The answers, however, are ultimately up to you, Central New York. This, essentially, is the Test. The biggest question of all is, will you pass?
Just so it is clear, every single thing presented here is factual with a material basis for verification. There will, no doubt, be vehement opposition to what you will learn with those directly involved scrambling to somehow cover over the outrageous actualities of their actions along with the widespread implications thereof. So as to establish the authority of the heretofore information source, just know that regardless of whatever might be offered up in resistance, the foundation for this message has been build on an infallible rock and is more than capable of withstanding the storms of criticism as well as the most ardent scrutiny. And that even includes the personal attacks and character assassination towards this author that have already been plentifully done thus far and are sure to intensify. Much has been experienced and will no doubt continue, which will be interesting to see. Yet, all the excuses and disparagement to what is described here simply will not stand in an open forum when clear and convincing attestation is at hand. Behind closed doors with no rule of law or oversight, sure. This has been the modus operandi of those involved for years. Anything and everything imaginable has been personally witnessed under such covertly dishonest conditions, but public disclosure is a totally different animal. And when verifiable truth is being spoken, it cannot be considered libelous or slanderous. In other words, if there is any doubt whatsoever as to the veracity of what is contained in this writing, please feel free to challenge it at any level.
With that being said, here are a few additional angles to the above questions for anyone reading this to ponder before this matter is unfolded, since they are important to the discussion and moreover, the Test. What exactly is Truth and Virtue and do they even matter to anyone anymore? Are we, as a people, so self absorbed with our own needs and what ultimately benefits our personal lives that we simply could care less about such trivialities as honesty and morality? What is it that you supposedly teach your children when it comes to character, integrity, truthfulness and righteous living? Furthermore, do you even practice it yourself or are you living a double-minded life of hypocrisy like much of the world today where one represents himself as being principled but behaves in a most immoral manner? These are some pretty blunt questions that need to be asked and might very well be operative in your own life as well as being a major component of why we are seeing such an incredible level of moral decay in our society. These queries are most certainly applicable to the information below and in particular, the individuals involved.
Well, the following is an exercise on multiple levels to see just how important Truth and Virtue is when certain facts are revealed, especially when it involves differing levels of a community. In fact, when taken in totality, this ethical exercise has application to all of humanity since the fallen nature of those in this particular example is really reflected across the entire spectrum of mankind. This point will become much clearer at the end of this writing. Why do I even bother doing this? First, the matters at hand are just plain wrong and need to stop. Far too many of my brothers and sisters in medicine as well as patients themselves have been victimized by behavior that is so morally repugnant that it simply has to be brought to light. Further, I am certain that there are many within the medical community both local and beyond who have plenty to say but have been afraid to speak out because they know all too well that there is a thin line between being able to pay your mortgage and being out on the street. I’ve lived both sides of that fence. But all that aside, I honestly go to this length out of love. Love across many aspects – love of people, love of community, love of Truth, love of doing what’s right. Sometimes love is tough and needs to be in order to bring about change that is necessary and righteous. This effort is surely a lesson in such an application.
The setting for this narrative, and the Test if you will, is Syracuse, New York. The persons involved are that of a subgroup within the medical community, although much of what will be described here extends into many other individuals and areas of this region (and State for that matter) as well. The subject matter is that of an inconceivable level of human depravity, immorality and abuse of power that apparently pervades the ranks of hospital medical executives who in turn have great influence on your health and welfare. When these elements are present, this dangerous combination can be implemented in pure Machiavellian form where uprightness and decency is of no interest so long as the ends justify the means. As is often the case, such practices can be seen amongst a certain faction of individuals who have a self-driven agenda, even though they might very well sit in places where they are entrusted to serve the interests of the larger public consortium. So long as they decide to go outside their scope of decency in secret without any oversight, they can essentially sidestep the rules, assert their will and enjoy an utter nonexistence of accountability. Hasn’t this, in one sense, become the American way?
Yet, as we shall see in this example, the widespread danger of such a practice is very real and a microcosm of how awful man’s nature can actually become, especially when there is no moral compass guiding him. And what’s even more incredible is that this hideous conduct has once again reared its proverbially ugly head. What may have been the party line at one particular hospital in this city has proven to be a customary practice at yet another whose community stance has ironically been one of piety in the name of deity. This is really disappointing to say the least. As you read, what might appear on the surface as a malevolently focused agenda towards a given individual can actually have far reaching implications for an entire community. What’s more, when such depravity and abuse of power are uncovered a bit more, it is plain to see how, when combined, they can shockingly jeopardize the wellbeing of a most precious population within the community; and most incredulously, how such iniquity could actually lead to the premeditated murder of a newborn baby in order to avoid financial liability in the face of unspeakable negligence. Yes indeed, you did read that last statement correctly. If you want to know all about such a travesty, you need make some coffee and take the time to read a bit to understand how this devastating fact was discovered and how it became entwined into The Test.
As alluded to above, The Test itself for this city and anyone else reading this is…do you even care? Do you even care that a deplorable level of dishonesty and immorality pervades this community and that such practices brazenly and repeatedly occur without so much as the slightest bit of oversight or accountability, not to mention constitutionality? Has our world gone so mad as to simply brush off these realities when confronted with them because we need to attend to our own mundane needs that add little to nothing to our lives other than acting as distractions to the reality of what has gone on around us, resulting in our communities, our States as well as our Nation being on the brink of disaster on so many levels? Have people become so afraid to speak out for fear of reprisal that those who continue to operate in lawlessness continue to have their way unabated? Or does the revelation of such goings on actually stir up an inner sense of right and wrong so that something is finally done to definitively bring about a change for the good that is too long overdue? You are all being indirectly affected by this corruption that has incredibly ascended to the notion of being “business as usual.” Is this what America was founded on? Not as far as I ever learned. It’s up to you Syracuse. It’s up to you, New York State. It’s up to you, America, to finally make a stand for something based in Truth. As for me, I know where I stand. I am simply bringing forth what needs to be known as a test of just how honorable and principled you, as a people, truly are. Have these lines of reasoning been made clear by my repetition? This is the intention.
One last point, it has long been an observation of mine that adults behave ten times worse than the children they are instructing not to behave exactly the way they are. “Do not lie.” “Do not cheat.” “Do not mistreat others.” The list goes on and on and yet, from what I have sadly seen in adulthood, very few, themselves, ever faithfully live up to what they expect from their own children. And society wonders why there is this repeated cycle of corruption and deception that saturates every fabric of our world? This is why this test must be put forth since it involves these very principles. Too many lies, too much deception have gone unchecked. The reaction to this writing is going to be a sort of litmus test of what amount of goodness actually resides amongst the citizens of Central New York who must now go about their healthcare business with this knowledge now on their minds.
Now, after that introduction, I am going to take the reader through a series of events (a journey of sorts) that will illustrate precisely and concisely the nature of the serious issues at hand. Much of this account is based on personal experiences that will illustrate the subject matter that affects us all. Of course, after having been the one who unwittingly became the recipient of the abuses that will be described, I have a personal interest in how it has affected my life. That being said, as you will see, this is a much bigger issue and I feel it an honor to have endured what I have in order to finally bring such matters to light. Certainly, on some level, there will be many who simply could care less about the person involved, (that being myself), since not only has a good job been done already to discredit anything emanating from this individual, but also, the tendency of man is to simply think of their own issues. “What do I care? That’s his problem. If it doesn’t affect me, then I need not be bothered by any of this.” I readily accept this and really don’t want or need anyone’s sympathy. What my aim is for there to be awareness and hopefully long overdue change. So, despite the experiences being personal, the ramifications of what you will learn are far reaching and should cause everyone to stop and ask themselves if they think this is acceptable for their own community. If it is acceptable, then you already possess it. Yet you just might not be aware of such an “endowment” in your midst. If this, however, doesn’t jive with what you expect and desire, then what say you? In other words, this is The Test.
Brief Personal History
Since the information in this writing is so revelatory, it is imperative to establish the veracity of the individual penning it and the person himself. This is no more important now given the lengths that have been taken in order to discredit anything that might be uttered from this man. As noted in his series on “Suppression of Dissent”, the author, Brian Martin, points out several tactics that are used by those in power to stifle the Truth by essentially destroying the one delivering it. It is no different than an attorney desperately trying to defend his guilty client by attempting to annihilate the trustworthiness of an eyewitness on the stand in the minds of the jury. I have personally experienced an astounding level of adverse treatment ranging from ostracism, dismissal, blacklisting and the spreading of rumors. As you will see, these pitiable tactics are the only responses able to be offered and will be pointed out below as the story continues. Anything else completely fails when confronted out in the open.
So who am I really? On the level of humility, it really doesn’t matter, since I really don’t personally need any recognition. I prefer to remain meek in my service to others by what I have been blessed with in order to do so. Yet, when considering the magnitude of what was experienced and discovered and the attention I wish for it to bring, it is important to know who was involved. With that in mind, this is who this author is. I was blessed to be born into a solid family with two incredible and loving parents and four excellent siblings. After experiencing the joy of five children myself, I have been able to look back on my upbringing to see just what it was that made me who I am and what perhaps brought me to this (completely unexpected) point in my life since certain characteristics most definitely played a role. Even though I was raised in an all Italian Catholic family, we were not very involved in church or the things of God. Yet, this did not stop my parents from instilling in all of us an intense sense of moral values and respectable living. This is one important foundation to why I have been so immovable in my stance concerning what has happened.
There have been several other noteworthy aspects of my life that have left the most lasting impressions, all of which contributed to this experience in one way or another. They are the following. First, the integrity of one’s name was pretty huge. While this might sound a bit cliché, my father made it very clear that if I was ever going to put my name on anything, then it better be worthy of the label since there had been several generations of Caputo’s who took this admonition very seriously. For a young boy who just loved his dad and looked up to him in every respect, this was a profound thing to have instilled. It didn’t hurt that my father was as tough as nails and super smart (perhaps the most intelligent and well read man I have ever known) as well. What I got from my mom was the trickle down from what can only be described as an absolutely beautiful soul. She is the most giving and self-sacrificing woman I think in existence. Anyone who has ever met her would agree. She was a nurse for about fifty years and was my inspiration for a pursuit in medicine. I am so blessed to be her son. In fact, I breaks my heart to have seen the pain that this entire thing has caused both of them as they too experienced every bit of what their child had to endure.
Being the middle child of five, I most definitely manifested much of the typical phenomena of such a position. I was such a driven child to overachieve that for much of my young life, it truly got the best of me. My initial canvas was that of scholastic achievement. I literally had to see that “100” on every paper or it was just not acceptable. This motivation then extended into sports, music and virtually anything else I would choose to pursue. It wasn’t that I necessarily had to be “the best” over anyone else in particular. It was that I needed to be “my best”. There is no doubt, as an adjuvant to these efforts, that being afflicted with alopecia areata at a young age (5) changed me dramatically. While developing an internal ambition to be my very best, I also developed an incredible degree of personal perseverance and a wonderful heart of compassion and empathy towards others. When I got into high school and discovered that there was this thing called a social life, much of this push for personal perfection settled into a much healthier form that would then carry and motivate me through a successful college and medical school experience.
Both grandfathers also made lasting impressions as well. My maternal grandpa, Tony, was (and still is – God bless him) a very disciplined man with a distinguished military background who took me aside one day and taught me the importance of being well rounded. Again, this term is used loosely in the world for those who might possess a few adjuvant skills outside of that which they do on a regular basis. What he illustrated was different. I remember the conversation even to this day and boy did I really take it to heart. My paternal grandpa, Mike, was a mason (and all round creator) who was just amazing with his hands. What I saw in him was his utmost standard for accuracy and precision. There was little to no margin for error in anything that he did. I just loved this about him, not to mention that he was as strong as an ox and set a ridiculous standard for the term, “hard worker”. Additionally, growing up, I loved to take things apart, learn how they worked, restore them if necessary and then put them back together again. I remember as a teenager taking this riding lawnmower that didn’t work and dismantling it into several hundred pieces without any manual. Every single part was restored and then reassembled by memory whereafter it served our family’s needs for years. These pursuits extended into auto mechanics, extensive home improvements, athletics and anything at all (eventually surgery) where I could use my mind along with my hands.
By these experiences, I made it sort of a life mission to be able to do many things across an extremely wide range, and try to do them as well as (and as precisely as) possible. This mindset extended deep into my medical education and training. When entering the discipline of Ob/Gyn, it was clear that the specialty offered an incredibly wide range of options for practice. While many colleagues choose to keep their clinical scope to a narrow focus, the breadth of options available to become adept at was very appealing. In essence, I wanted to be very good at all the specialty had to offer. As will be seen, by indeed accomplishing this desire, it may very well have been my downfall.
One more point, and this is difficult to describe. For some reason, the manner in which all things in my life have been approached has been on a very micro-analytical scale. In other words, and perhaps others possess this as well, everything I do is taken down to the smallest of units of whatever it is and studied, examined and assessed and then brought back to a more macro application. It is a level of detailed analysis that enabled me to not only see things but also understand things on an entirely different level – especially in medicine. Then add upon all of this an exceptional residency training program in the specialty of Ob/Gyn in Metro Detroit and I was now quite equipped to take all of this into the real world. It is critical to understand just how focused this residency was on excellence. It would become all I knew and what I believed to be the objective everywhere. Right? There was so much emphasis on performance and outcome that anything short of this was unacceptable. You will also learn that despite this very appropriate agenda for excellence that my medical educational experience was founded on, it too would prove to be an “undoing” of sorts, especially upon landing in Syracuse, N.Y.
Certainly many individuals can provide a similar testimony of those who had great influence on their lives as a component to their life successes (and even failures). This is what marks the richness of life in general. I make mention of all of these factors in my own life as a foundation for what would, in fact, follow as part of a career in and even more so, my understanding of medical science. It is imperative that I do so in order to be able to sit here writing what I am about to write since so much effort has been put forth (as briefly mentioned above) to discredit the one imparting this information. Again, in any formal legal setting, whenever a critical witness takes the stand, one side establishes his/her authenticity and veracity as one to be believed while the other side does anything possible to impeach that very same individual’s testimony in order to avoid the ramifications of the Truth that might in actually be revealed. Throughout all of my life experiences, I learned one significant thing about myself and that is, I love Truth. There is nothing better. In fact, this journey would ultimately teach me many lessons in the essence, the value and the pursuit of ultimate Truth. Much more on this at the end.
So, to get right to the point, despite more than enough material data to the contrary, my record as a physician and my character as a man have been the recipients of this very ploy to undermine any sense of credibility, in an effort to distract the listener from what might actually be revealed. While I could honestly care less (for reasons that will be clear by the conclusion of this writing) what is said about me, it serves a greater purpose here and now to set the record straight. In spite of what one may have heard from another (this is called hearsay); despite what might be posted on-line either in newspaper articles as well as the Department of Health’s own website (this is called false witness); despite what one wants to negatively believe in their own hearts, you have been deceived.
By the grace of God, the certifiable truth is that my clinical record and entire body of work as a physician is in one word – exemplary. For the sake of the argument, the following practice performance attestation is offered. It is all verifiable should anyone question the accuracy of what is written. Sadly, it had to be constructed as a consequence of what will be further delineated as part of this overall experience. So before anyone wishes to ascribe any sort of label that this physician is some sort of a “hack” or “incompetent”, the actuality of what I have been humbled to be blessed with as far as skills, knowledge and performance as a board certified physician would be able to stand up against any Obstetrician/Gynecologist in the State as well as the most intense inquiry – that is, of course, if it were done in an open and forthright manner, which we shall see can be far from reality when those with the delegated authority to do so and a will to abuse that authority have an untoward agenda to obfuscate the Truth. If there appears to be a bit of an attitude when making these past few statements, then you are correct. I am human remember.
Welcome to New York
The journey starts here which is essential to impart in order to have a complete understanding of this entire matter. After finishing my training in Ob/Gyn in Metro Detroit, I returned to my home State of New York in 1997. I landed in Rochester which is my hometown and where I had dreamed of one day practicing medicine, since my entire family was there. It wasn’t long before that “welcome home” became my first harsh lesson into how nasty the world of medical-politics could actually be. I had lived a relatively sheltered life from this element up until now. The details of this experience will be disclosed in another section of this exposition (if I ever get to writing it). While it is important to the overall Truth challenge as it applies to a larger area of the State, for the purposes of this section, let’s just say that it was such an awful and dishonest experience that during a time where I thought I had finally “arrived” in the world of medical practice after twelve years of grueling studying and training, I would have to endure an eight month run of working full time without a paycheck due to what was done to this naïve young physician. Looking back, that experience pales in comparison, as a veritable cake-walk, to what lied ahead.
Nonetheless, there were several interesting things that were learned as part of my fifteen months there. One was a colleague of mine asking me if I had ever heard of OPMC. I was like OP who? “OPMC”, he said. “The Office of Professional Medical Conduct.” Not really sure what that even meant, he went on to advise me that they were, in other words, a malevolent arm of the Department of Health in Albany that prosecuted doctors for misconduct, often times unjustly. He said that pretty much every doctor was well aware of them and if they weren’t, they needed to be. OPMC was described as being very abusive with their power and that “If they get your name, look out. You’re in for trouble.” I was taken aback by such a warning since I was completely unaware of such a thing in medicine but figured that I should be fine since I had been extremely well trained and I was such a stickler for practicing with as much accuracy and precision as possible. I did find it troubling to soon thereafter see this agency literally publically destroy the career (at that time at least) of a local Ob/Gyn doctor who I had gotten to know through the department for what seemed to be petty reasons. Now I do not pretend to know all the details of that case but he was considered by his peers to be a solid physician. He lost everything, though, and was relegated to working on an Indian reservation somewhere in order to sustain himself. I would soon enough learn a lot more about the agency and just how they operate such that the dark description I was given would certainly come to light.
Welcome to Syracuse
Given the circumstances that my young family found themselves in Rochester back in 1998, I eventually landed an opportunity to practice in Syracuse, where I had gone to medical school. What a blessing to be able to step right into a prestigious practice with two distinguished Ob/Gyn’s. It wasn’t long before I was busy and moreover, capable of establishing my abilities within the field and community. I worked very hard for this practice and put out an excellent product in keeping with their already established reputation. As part of this writing, I have decided to withhold the actual names of those local players who have been party to all of what will be disclosed. They know who they are and if anyone is that interested in their identities, then it can be figured out. This entire writing is really not about the individuals at all (since they unfortunately operate in darkness and know not what they do) but really about the entirety of what the culture of this town has proven to be and whether this community wishes to continue operating in such a manner once the Truth is presented to them. Yet, because of the absolute love I have for one person I was so fortunate to know and work with, I mention him here. His name is Omar Rashid, M.D.
For the first year at this practice, he and I worked side by side since he was the only one (of the two doctors in the practice) doing Obstetrics. We fast became very close and I still consider him my defacto brother. I learned a great deal from him as did I from the practice’s founder, Dr. Fathi Jishi, as well, since I probably assisted him in at least one hundred cases during my time in this office. What I also found out was that even though these two had achieved great success and moreover, respect from their peers and the community, there was a small element within the hospital’s Ob/Gyn department with whom they had historically been at odds with. I was told that this was because they did not “lower” themselves to the pressures and controlling overtures exerted upon them by a power hungry division of high risk Obstetricians known as the Perinatal Center. Despite some efforts having been made to disrupt the practice of Dr’s Jishi and Rashid by those who sought to do so, they remained relatively immune given their overall standing in the community.
However, now that I was part of the practice, these same political elements involving people I had no real acquaintance with were now thrust upon me. At the time, I did not have a full grasp of the magnitude of such wranglings as I do now. Nevertheless, it wasn’t long that I would be introduced to just how willing and to what extent those who operated in such shadows would go in order to have their desires fulfilled. It was also during my first several months practicing at Crouse Hospital that I noticed some surprising clinical shortcomings as well. This was namely within the setting of Labor and Delivery and particularly involving the resident physician staff (in other words, those in training).
Did I really hear that right?
As alluded to above, after having been in practice in Syracuse for about six months as part of a busy practice, I was shocked to see how cursory some of the medical care was being rendered to patients on labor and delivery. I was already aware of several cases within the department where pregnancy outcomes were unfavorable. Further, basic resident duties were repeatedly falling short as they applied to my own patients such that it was just incredible to think that such occurrences could and would actually happen at all. All I had to go on by comparison was my own training where there was absolutely no tolerance for such things. It certainly didn’t help that the resident staff was essentially operating with little to no direct supervision or anyone really nurturing their educational experience on how to properly manage the unit, other than nurses. In my opinion, it was only a matter of time before a major complication was going to happen as a result of such carelessness.
Sooo, as a response to these observations, I felt it necessary to try and bring the subject up for discussion at the end of one of the monthly department meetings. Again, my previous experience from my year in Rochester was that this was the time that such issues were raised and discussed. In fact, it was quite refreshing to see how seriously the members of the department took quality of care at Highland Hospital when I was there.
To establish a little more perspective of what the department meetings were then like at Crouse as opposed to everywhere else I have experienced, it would be generous to say that perhaps fifteen physicians from a total of approximately fifty would even show up. In order to effectively run a department, it is imperative to have a full representation of the members. Not at Crouse. It was not mandatory to attend while at Highland, (and pretty much most places) you were not allowed to miss more than a certain number (three in their case) meetings a year without excuse. With that said, it was evident that the same individuals seemed to be the only ones in attendance and thus the primary players in setting the tone (and standard for that matter) for the Ob/Gyn department at Crouse. A certain few of these individuals (the very ones who had been the bane of the two doctors with whom I was in practice with) would soon prove to be the very ones capable of extraordinarily underhanded actions as it applied to my life and career.
After I simply brought up some specifics of patient care within the department that should have immediately been met with alarm and a need for further discussion, the response to my concerns was not what I had expected. Instead of what, frankly, should have been the instantaneous reaction from my own training experience as “Really?! These things are going on?”, the response by the Chairman was, “So, does anyone have anything good to say about the place?” as he glaringly looked around the room at the others in attendance. No one said a word. Stunned by such a statement, my only reaction was an internal thought, “Did I really hear that right?” I submit that no one dared say a critical word to those who were in control out of fear given their very unseemly capabilities I would soon realize myself.
Decades of Underachievement
I really should not have been surprised by the utter disregard of the serious deficiencies I tried to bring to a discussion that day. This department, and training program for that matter, had been mired in mediocrity and underachievement for decades. When I graduated from medical school and was contemplating various training programs for my chosen field of Ob/Gyn, the one in Syracuse had been surviving through another period of probation by the governing body who oversees such matters nationally. It just did not have a good reputation at all which is why I ranked them dead last on my list of places where I had interviewed.
Please understand that these statements are not made to belittle the program in general. And it is certainly not an indictment of the State University of New York in that the program is forever destined to be an underachiever. The chronic shortcomings of what I have personally observed are a direct result of certain individuals who have been entrenched here for far too long and who, themselves, serve no good purpose in bringing this place into the potential realm of distinction that it ought to enjoy. In other words, the substrate necessary to make this program superlative does indeed exist, yet, unless it is executed with the same pursuit of excellence that I came to know from my own experience in Michigan, it will never achieve it. And this is absolutely not just me who has seen the deficiencies of this residency. For years, the Ob/Gyn rotation for the local medical students has been the subject of numerous complaints, only to have their concerns fall on deaf ears.
There is an odd saying I came to know over the years that sums up what I have observed with this place. “The eye don’t see what the mind don’t know.” In other words, unless you actually cognitively know something in your own mind (in this case that you just are not measuring up), then you will never be able to see it. I have seen so many (not all) first year residents come into this program with all the innocence and hope that one would expect only to notice a transformation into a pompous, arrogant, insensitive, mediocre physician with superficial skills at best by the time they are done. This is the culture. What’s even sadder is that most of them have no clue what their training experience could or should be like. Hence, the aforementioned quote once again. As an illustration of the extent of the problem, I learned that at the conclusion of one resident class’s training, three out of the five residents failed a written board exam that is designed for passage so long as you minimally showed up and paid attention for four years. To put this into a little more perspective, when I finished my residency in 1997, there was something like a seven to eight year run where no single resident had failed the written board exam. Certainly, no one wanted to be the first either. Personally, I easily passed mine without an ounce of studying since I was engrossed with moving my family back to New York during the time I would have had available to do so.
If I had to describe just what it is that I have observed time and again is that there is an utter lack of critical thinking being imparted to these otherwise unsuspecting young physicians. There is this palpable deficiency in being able to cogitate deeply into patient management. What results is that the sum and substance of patient care turns out to be that of reactionary instead of proactionary. Instead of being able to discern present conditions in any given patient that may lead to a potential crisis situation, the crisis almost always has to occur before any action is taken. I cannot tell you how many instances of this have been witnessed during the weekly case presentations by the residents. After the case would be presented and whatever discussion is offered, it would rarely occur to anyone that at point A, B and C, there was ample warning that X, Y and Z was imminent to happen whereby steps could have easily been taken to avoid the consequential calamity that ensued. This lack of critical analysis occurred quite a bit within the Obstetrical arm of the specialty and was totally consistent with what I had tried to discuss at that now infamous department meeting. What’s even more astounding is that whenever these salient teaching points were attempted to be made, the effort to stifle them was resounding. So much so that it became futile to even try. So much for medical education. The eye don’t see what the mind don’t know.
So frustrated was I at one time with how underachieving and discombobulated this residency was that I wrote a formal problem and solution list to the Dean of the Medical School whereafter I actually sat down with him to discuss it. I also sent a copy with a letter to the President of Upstate as well. In it, I tried to address the more obvious deficiencies as I perceived them to be. When discussing this matter in person with the Dean, it was completely ignored while I was politely disregarded. Why did I even bother or why did I even care? Because it is in my nature for quality to abound all around me. Besides, this community deserves better. The residents deserve better. The integrity of Upstate Medical University deserves better. That’s why. Why should you care, Syracuse? Does your eye not see what your mind doesn’t know? Because those who are in charge of this division are the ones who not only set the tone for quality in this community but are also responsible for producing the vast majority of physicians who end up staying here to deliver your healthcare. In essence, you reap what you sow.
[To be fair, the department is under newer leadership, yet by one of the old mainstays. It is "optimistic" to think that perhaps something might change for the better as far as recent decades of performance history is concerned. Certain relics have been relegated to lesser roles and even are in line to retire while other more competent (I think) physicians have been placed in certain academic positions and new ones are being hired. Even though many changes have been made, only time will tell since what is needed is a complete cultural and mindset overhaul. I am prayerful that somehow things are transformed down a road of distinction. I won't, however, hold my breath.]
The immediate (and expected) response to my past criticism of this residency training program along with the department itself is likely to be that I am simply a condescending know-it-all and disgruntled physician who has never had anything good to say about the place with these “spiteful” attacks. As for the first few descriptors, I certainly do not know it all and any negative analysis offered is based on repeated observation both personally and by departmental cases presentations. This reality saddens me in many ways since I honestly feel deep down inside, everyone here wants to do good work and there are many who do. As for the latter adjective, on many levels they are right, I am disgruntled. Given what you will read below with what I have experienced from the ilk who run the place, I am most certainly not pleased with what such individuals with unchecked power and connections did, in fact, do to me, my career and my family as a result of what I represented as a physician in this community. So in response to that position, they are correct on one level. But despite what was done to me, I am totally at peace with it all, which will make more sense far below. It does not change the fact that patients have (and continue to be) unnecessarily harmed as the result of a tradition of performance mediocrity that seems to have settled into this Ob/Gyn department and community for decades. One of the most respected Internists in this town once told me that the entire primary care community has long recognized the inherent weakness of the Ob/Gyn care available. Not my words, but his.
Again, and very importantly, this is not to say that there isn’t quality Ob/Gyn medicine being practiced here by some, (and there are a number of very good ones, even within the Perinatal Center) but from what I have seen too many times in weekly case presentations within the department, as well as patient testimonies who have come into the office, there is no doubt that behind the scenes, there is a stark reality that the Obstetrical and Gynecological medicine in this community leaves something to be desired with many dissatisfied patients and far too many questionable outcomes. What’s all the more interesting is that it appears as though there is a will to keep it that way since often times less than desirable outcomes are brushed aside and even gain a pat on the proverbial back as a “job well done”. I have seen it. And so few, if any, ever dare show up or ever speak up (for that matter) with critical analysis.
Now, one has to realize that this marginal performance issue is the case in many communities since the range of quality in medicine (across all specialties) has been startling to bear witness to since becoming a physician. Just because one had the moniker of “M.D.” after his/her name does not necessarily confer competence. It is staggering to see how low the standard is set in many instances despite all sorts of self-assigned rhetoric about quality. In fact, a simple google search on American healthcare performance illustrates just how low the bar for favorable results has become in so many segments of our country as we rank dead last in many studies when compared to all other industrialized nations. Still, I personally lived through an incredible standard for quality where I trained. Yet, from what I have thus far experienced here, it falls short – and it need not be. In essence, one might even say that such a lower standard benefits those who operate at a higher level since patients tend to acclimate to such providers – so long as they can stave off any would-be attempts at ousting them for sticking out in that sea of mediocrity. Nevertheless, in typical political fashion, the double standard that exists which enables bad medicine to continuously evade rightful correction is solely a measure of how closely tied to or how well one rubs elbows with those who hold the power to make a positive change. It should be no surprise to learn that many who are in need of some of the greatest application of disciplinary action and/or clinical correction are the very ones who sit in the positions of authority to impose it. Hasn’t this too become the American way? A close colleague of mine from within this Ob/Gyn community, who is an excellent practitioner in his own right, actually said to me after I experienced the consequences that will be detailed below, “Jim, the reason you have had all these problems is that you came into this town and set the bar too high.” Imagine that. It's like saying, "Hey LeBron, you're a really good player and all, but we can't allow you into the NBA because you make everyone look bad."
All of the above commentary was gleaned as a result of being a member of this medical community for over ten years. However, early on, after I stood up that one fateful day in the department meeting to express my concern over quality issues with patient care, along with the response I received, there is no doubt that I became a marked man. This veritable bull’s eye that now rested on my back was result of several components. First, is the fact that I was in the practice with the two gentleman and scholars noted above who had already been the obsession of this malignant element for years. Second is the fact that I had the audacity to actually try and raise a discussion about quality within a department run by a constituency of men who, for forty years, had demonstrated the will to sustain their power by any means. They were not going to let some young “whippersnapper” come into their world and “expose” them for what they knew they were when all I sought was to talk about how such concerns could be openly discussed and addressed. And lastly, (not that I even knew of this requirement in the first place), I apparently did too little to formally acknowledge their Excellency. [I was made more aware of this expectation by my dear friend Omar some years later as I would regularly visit him to bring him some of his favorite Scotch, while together enjoying some good conversation and a fine cigar.] Thus, over the first three years of being here, repeated attempts were made to essentially bully me with an Ob case here and another Ob case there. I would be called into the chairman’s office and confronted on my “management” of a particular patient. What’s interesting is that they would be for patients that had been cared for at least six months prior to when they were now being presented to me.
To help appreciate the players a bit more, you must understand that the then Chairman was really nothing more than a figure-head as far as I am concerned. I mean him no disrespect although it certainly comes across that way. I am just telling it like it was, given significant foundation from personal experience. He possessed a very narrow scope of clinical knowledge and even less so in Obstetrics – having no practice experience in this area of the specialty for over thirty years. Yet, he was the Chairman. He relied completely on what he was being told by the two powers within the Perinatal Center and therefore carried out all their bidding at their behest. One can say that it was a mutual relationship of enablement. You see, those two within the high risk division possessed a great deal of power throughout an enormous region of New York State while not possessing the academic credentials to ever hold such positions in any real University setting. This was while the chairman was also devoid of any true clinical acumen to legitimately hold such an office as well as effectively lead the department and training program (both of which he was the head of) into any area of academic distinction. [Again, to be fair and balanced, one of the two Perinatologists would eventually obtain his board certification in Maternal Fetal Medicine several years after having finished his training – perhaps because of the glaring absence of these compulsory credentials while at the same time leading a University Division. Out of respect, he does possess a substantial amount of knowledge and experience. Still, how he chose to utilize his departmental position adversely in my case proved highly disappointing.]
There was a symbiosis that worked for both parties and they each ruled with an iron fist – ready to destroy anyone who dared jeopardize their individual little kingdoms and the riches they enjoyed as a result. What aided their ruse was that they were able to achieve certain limited accolades within the community and the field itself which they would then utilize to advance their self-serving power, control, position and the “appearance” of clinical supremacy. Yet, were one to actually examine the clinical outcomes of incidental aspects of their work, the quality standard that they would have no problem imposing on anyone they chose to make trouble for could never be favorably applied to them. This is because they are the implementers and thus are above reproach. This double standard is so pervasive throughout this community that it must be dealt with at some point in history and thus is an integral part of the Test that encompasses this writing. More on this ahead, for sure.
To give you one small example of the type of egotism we are dealing with, the one individual who was most central to what would be dastardly done to me just so happened to somehow find himself in the position to write the foreword to a past edition of the famed book, What to Expect When You’re Expecting. Now certainly, this was clearly an honor to have been asked to do, so I laud him for this occasion. Yet, when such an opportunity manifested as it did in this man, then one can plainly see the form of arrogance and pride that fueled all efforts at maintaining his power as well as (mis)directing his influence. I submit that many might otherwise be humbled by this privilege to have their written words read by so many. I would be. Yet, there is nothing humble about walking into a patient’s room at the hospital that you do not know and who does not know you and upon seeing the book on her side table offering to autograph it for her. It was the “foreword” for crying out loud. Autograph? Haven’t all of us known someone like this? When this type of persona combined with puffed up “credentials” is, therefore, in the position to wield unchecked power and influence, you will see just what devastation can result when there is an agenda to abuse it.
So, when these individuals tried to “trip” me up with the occasional Obstetrical case, I obliged their questions and concerns with the facts of the cases, the pertinent standards of care and the actuality that in each example, there was always a good outcome. Knowing full well what they were trying to do, (because remember, I had already been warned about them by the two men with whom I initially worked upon coming to Syracuse), I did not play into what they were trying to accomplish. I must admit, I was a bit put off by what they were doing and surely it showed somewhat in my demeanor. Looking back, this did not help, I am sure. I was much younger, a lot less wise to properly submit even to this form of authority, was not well versed in medical-politics but most importantly, really saw such actions as very childish and wanted no part of it.
What in the world are you doing with that scalpel?
Do any of you have certain moments in your life that you can look back and recognize as being pinnacle and life changing? Oddly, I have many of them. Some being not so good, hence the writing of this discourse. Yet, I can remember one extraordinary Friday afternoon as I was sitting idle at the office just waiting to go home when Dr. Rashid came in to say goodbye for the weekend. In his gentle and distinguished accented voice he uttered, “See you later, I’ve got to go do surgery.” I asked what it was that he was up to. He said, “I’ve got to do a cerclage.” [For those reading this and not knowing what a cerclage is, it is a stitch that is placed vaginally around the uterine cervix as a means of bolstering its strength as a preventative measure against premature delivery in an at risk Obstetrical patient.] Not doing anything myself, I asked if he needed help since it was a surgery that demanded adequate exposure which two extra hands could supply. Of course he said yes, so off we went to the surgery center.
As he was beginning to perform the procedure, I noticed him grab a surgical blade and begin to cut into the vaginal tissue covering the upper part of the cervix. I immediately exclaimed, “what in the world are you doing?” “I’m doing a cerclage,” he said. “What kind of a cerclage is that?” I responded. His answer, “A Shirodkar.” I was stunned and amazed. In all of my training, in fact, in virtually all training programs in the U.S., the only style of cerclage that is utilized is one known as the McDonald type. The Shirodkar (up to this point in my life) was this mysterious mystical procedure that was done in ancient times before the age of modern medicine, right? I couldn’t even describe how it was done if one were to ask. Yet, right before my eyes I was witnessing the Rashid modification of a Shirodkar being done by a man who possessed such unique skills that (looking back) this was a moment ordained from above for me to be part of. I was blown away.
Not only was it a technically challenging procedure, it was right up my alley since it became immediately obvious to me that such a method was far superior to the standard McDonald cerclage. From this day on, it became part of my armamentarium whereafter I would go on to successfully perform nearly one hundred of them without a single complication. However, the momentous circumstances that would surround the implications of this new found technique did not stop there. If you recall what I wrote above about how I study and analyze all circumstances in my life on a very small scale, this cerclage technique was a hugely missing component of what I had previously identified as a big problem that bothered me and that I had already begun to try and figure out. And this was the scourge known as premature birth.
Being part of a busy high risk practice, personally performing upwards of twenty five deliveries a month, I had a tremendous amount of substrate to draw a lot of analysis from. One event after another would then be encountered in order to provide another piece to the puzzle. It wasn’t long before I was able to formulate not only a hypothesis, but also a substantive protocol in order to both test it as well as provide a definitive means of prevention and ultimately, favorable outcome. With each pregnancy that was enlisted, more and more information was gleaned and slight adjustments made to the protocol in order to improve upon what was already in place. With the eventual occurrence of what I have come to call the Lynch-Pin case that provided the most authoritative proof for why women deliver prematurely, it wasn’t long before I was totally convinced of what not only caused premature birth but also how to literally stop it in its tracks.
However, I needed to test it against the most at risk type of patient in order to see how it held up. This was the multiple gestation – in other words twins or greater. With a premature delivery rate of more than fifty percent, this was the true test. In my practice at the time, we got perhaps two, maybe three sets of twins per year. The memory of this one particular day is still as vivid as ever. We had not had a set in several months and I really wanted a multiple gestation for this purpose, along with the fact that they are a lot of fun and an excellent challenge to care for. Talking to a few of my staff, I stated the following, “You know, we really haven’t had a set of twins in a while. What’s up with that?” Well, as another supernatural component of this entire experience, before we knew it, we had not one but ten sets of twins all pregnant at the same time that would come in over the next several months. Ten sets! What a test. And wouldn’t you know that with the exception of a couple of patients who developed maternal complications necessitating an earlier than desired delivery, all successfully managed to reach a gestational age far beyond that which is statistically ordinary considering the total number involved. The protocol was rightfully credited for this success. As the methodology was further fine tuned, during the last six years of my Obstetrical practice (before the wrecking ball of medical politics would come crashing down), premature birth was essentially eliminated.
The reason this account is given here is for a few reasons. One it provides the reader with an insight into what was a terrific clinical practice for the community and region by what we offered and provided. And this is just a sampling of the total performance across both disciplines of Ob and Gyn that successfully served thousands of patients who we were so entrusted for their care. The treatment, mischaracterization and eventual destruction of such a good thing were never deserved. Secondly, it shows that this scourge of premature birth actually does have a cause and that there is an effective treatment, if anyone actually wishes to learn of it. And lastly, but certainly not in the least, this information will serve to better understand some of the nefarious activities that are going to be disclosed upon reading a bit more. These activities are major components of the Test that is now before you, Syracuse. So please pay close attention.
$700,000 and a dream.
After I was at the initial practice in Syracuse for one year, Dr. Rashid took an early retirement due to chronic arthritic illness. It was a great loss. This left me as the only Ob provider. For reasons that are really not pertinent to mention, it became a difficult setting after he left given the nature of that office’s management. I thus sought other opportunities within the community. This is when I met another member of the Ob/Gyn community who indicated that he was looking to sell his practice and retire. So, upon examining this situation, I entered into a contract to buy his practice for around $700K to be paid out over five years. He would then stay on for a minimum of sixteen months as part of the transition before retiring. I added Obstetrics and decided to move the office out of a nasty old house and into a new space right across from the hospital. I spent hundreds of hours personally designing the entire space as well as planning every aspect of how we were to carry out our mission for the community as part of my long term dreams and aspirations. Before long, this relatively modest practice was screamingly busy and hugely successful. We were gaining hundreds of new patients each year while enjoying a near zero attrition rate. We even had patients coming from several hours away which was such a blessing given how hard we worked to provide the highest level of medicine and surgery in an otherwise incredible setting for all of those who were a part of it.
The doctor who I bought the practice from was supposedly having so much fun with all the changes that he asked to stay on at least until the buyout was complete. Since he was a huge earner and we had become “friends”, it was a logical decision to approve of. It wasn’t long before we had literally outgrown the sizeable space we already had. Therefore, we fortunately came upon an opportunity to expand the office into newly available adjacent space as I was preparing to add more doctors once the buyout was complete. This did not sit well with the former owner since it stood to cut into his already enormous earnings. His negative opinions did not deter me and the resultant space was a glorious addition to the practice which made the office more efficient and so much more capable of handling our growth. I remember sitting in my office on many occasions in disbelief that this is what had become of all our hard work along side a mission to simply treat patients in a manner that we would all like to be treated. Nothing really too golden about that. It was all done out of love, service and a desire to bring glory. That’s all and every patient felt it. Yet, the “friend” from whom I purchased it had other plans. I would experience a form of betrayal that epitomizes the character of many others with whom I have interacted in this town. More on this below.
From Kinkos to salvation.
When I left the first practice in March of 2000 and entered into the buyout of the second, I needed to get a new business card, of course. So I went to the then Kinkos store to do so. It was on this monumental day my life and eternity changed forever. I was standing at the counter reviewing my proof. To my left was a heavy-set woman who was immersed in what appeared to be a flyer for a Jewish function of sorts. Being a bit overly curious, she then nudged her way closer to me and noticed my business card proof and came right out with, “Are you a doctor?” Upon answering in the affirmative, she then went into this mile a minute verbiage about a problem they were having in trying to find a doctor to serve a huge need for their congregation that literally went right over my head. I would eventually gather what she was talking about.
The rest of the story is such an incredible testimony that I hope to find the time around writing all of this to share. The long and short of this encounter is this. She was a life-long non-practicing Catholic who wound up marrying an Orthodox Jewish man whereafter they both came to salvation in Jesus Christ. To this biblically illiterate Catholic boy at the time, I was pretty weirded out by it all. It was only after I helped them out with their need that the gospel was revealed to me and I came to know ultimate Truth. I will not get too much into a religious exposé at this point since my goal is to have the reader remain focused on components that make up the Test. I bring this up because there will be a component of this exercise where the significance of this encounter will be fully manifest.
Targeted for destruction.
I hope I have laid out a fairly good foundation as to my Syracuse experience thus far. On one level, the clinical practice was marvelous and all I had ever dreamed of. On the other hand, however, was a small faction within the department whose wily nature was all too apparent and regional power and influence was all too much. It is here that I will start to get into some of the meat of what this is all about. I fully recognize the seriousness of what I am about to disclose but it must be seen for what it is.
Up to now, I have only alluded to the devastation that was brought upon my life and career. The remainder of this writing is going to reveal just what was done and how corrupt it all was. However, if one were thinking correctly as they read this account, the logical question that should come to mind is “Why would they do this to him anyway?” In other words, what was the motivation? I know it would be one of the first thoughts I would have when reading something as ridiculous as you are about to read. So what motivated those with such power and influence and connections in high places to set out to literally destroy my career as a physician? The answer turns out to be a number of things. I will briefly review the ones already apparent, while adding in a few others that really are quite petty but most certainly contributory. The two big reasons will then be revealed separately as the chronology of these events unfold. It will be quite clear from them that I would thereafter need to be targeted for destruction. Hang on, it’s all coming. The more important question is, will you be able to handle it?
First, as already stated, I was associated with the two doctors mentioned above. Second was that I dared raise issues of quality. The label that apparently is the industry term for such a person is that of a “whistleblower”. I don’t agree that I was actually doing anything outside of what should have been the goal in general. However, the term is what it is and many undeserved lives have been ruined for speaking up on any sort of issue that conflicts with those who hold the power. Interestingly, my dear friend Omar enlightened me to one odd reason that he believes may have also contributed to why I became the object of desire for the primary perpetrator of these dubious activities. And that was the fact that I possessed an advanced skill and ability to use a form of operative vaginal delivery known as Obstetrical forceps. As you shall see, this dying art is central to this entire saga. What he told me was that this one man was so resentful of anyone who held such aptitude that it fueled his passions for causing them trouble. Is this not so petty? Again, it is the same man who felt it necessary to offer up his autograph, as illustrated above. In fact, even Omar was targeted by this very man years earlier whereafter he was forced to defend himself at the State level because of similar efforts to inflict harm. This was at a time where the State had not yet “perfected” their schemes such that Omar was able to learn of who was responsible. Fortunately for Omar, he was able to escape the trappings of such an exercise against him.
Nowadays, the system is so much more scandalous and designed so that anyone can anonymously reign anyone else in (right or wrong) and enjoy the unaccountability that such cowardice enables. Thus, this ability to actually devastate the career of any physician rests within a system of peer review that has built-in capabilities to do so coupled with an official State agency who, in some respects, has a need to justify and sustain their existence (at tax payer expense, mind you) and therefore chooses to ignore Truth in order to place another notch in their so-called belt of policing the doctor world. I elaborate a little more on these few examples in a separate writing composed last year. This document was penned as a means of invalidating (with great detail) each and every count and allegation that was brought by the State of New York and their OPMC as depicted in their Determination and Order on the matters I would eventually find myself involved in. I knew that this document was going to be essential to have spent the countless hours creating. I will provide a link to it below as I get to that portion of this dissertation. There will also be a link to the actual Determination and Order since the rebuttal was intentionally written so as to be able to line them up side by side in order to see just how erroneously invented the entire thing is.
180 degrees and not part of the big money game plan.
This now brings me to the first of the “big” reasons I believe there was motivation for me to be ousted from this community, primarily by the then leadership within the Perinatal Center. As you have read, I certainly did not endear myself given the account above, even though at the root of every single action on my part was that of seeking quality and nothing more. Still, what created an even larger problem for me was linked to the work I had done (and which was also described previously) in the area of premature birth. You see, this division within the department that oversaw the high risk Obstetrics for the community has an excessive amount of power, authority and influence across an area of the State that is just enormous. They essentially control all such cases all the way up to Canada, down to Pennsylvania, half way to Albany and half way to Rochester because Crouse Hospital in Syracuse is the only one in the region with a high level Neonatal Intensive Care Unit (NICU) to be able to handle pregnancies threatening to deliver below 32 weeks gestation. I have come to learn that no doctor in any of these outlying areas is allowed to initiate treatment for any patient who is at risk of premature delivery without first going through this division in Syracuse. Certainly there are primary actions taken so as to stabilize any given patient but anything beyond that, all Obstetricians are under the control of the Perinatal Center (PNC for short).
Just to illustrate a few examples of what element we are talking about here, the following are offered. After I was the recipient of what is described below and found myself out of work, I wrote to various practices and institutions in several outlying communities seeking any sort of open opportunity. I received a very kind card back from one physician who essentially said that I did not want to come there because, in his very own words, “this place is a snake pit held hostage by the Perinatal Center.” So clearly, there are others who know full well what the situation is. A different colleague of mine and I were talking one day years ago about this very subject. Over the years, he had worked part time in the North country where they had a need and got to know many of the doctors up there. He learned that on one occasion, our “autographing” member of the Perinatal Center was asked to participate in a grand rounds presentation in one of these Northern communities. When speaking on a particular subject, one of the local Obstetricians apparently took an opposing view of what was being imparted. Shortly after this exchange, this otherwise unsuspecting doctor found himself suddenly being investigated by OPMC with his license and career now in jeopardy. Is anyone seeing a pattern here? It shall soon be crystal clear.
Getting back to the specific subject of preterm labor and the threat of premature birth; the overbearing influence imposed by this division on those physicians who found themselves with a patient in such a circumstance manifested itself even within Onondaga County. Pretty much every Ob provider was expected to either consult with the PNC or moreover, turn the care of the patient right over to them. In fact, since nearly every Ob doctor in this community trained here, such a thing had become engrained into their minds and medical practices, not to mention the manner by which the patients would ultimately be managed – which is critical to understand as part of this entire mess.
Enter Dr. Caputo into this longstanding “tradition”. Not only was my training program emphatic about being completely knowledgeable concerning the care for the most critical premature labor patient, but we were also encouraged to maintain that management in our own practices as well. [I can still hear the voice of Dr. David Moses echoing in my mind. God bless that man who was a true inspirational scholar.] Sure, in Michigan, it was customary to obtain a consultation as a means of collegiality. In doing so, this rarely created a discrepancy between what one provider wished to do for the maintenance of that pregnancy when compared to what the high risk doctors would recommend as part of the care that should be rendered. This is where fundamental principles of what is proper in the management of such cases comes into play and how patients in Syracuse were treated 180 degrees from how I was trained. Thus, by involving the PNC even in consultation, it would likely create a situation where their recommendation would conflict in the medical record with what I desired as being best for both the patient and particularly, the baby. In addition, Dr’s. Jishi and Rashid just so happened to also share a similar approach and philosophy as mine when it came to premature labor.
We are not talking about anything earth shattering either. The bottom line objective was that for any patient threatening to deliver prematurely, it was imperative to do whatever possible to sustain that pregnancy for as long as possible without placing either the mother or the baby at any undue risk. Is this not logical? Another way of looking at it is this. As part of my training, the simple adage that was taught to us was that whenever you are confronted with a management decision in an Obstetrical patient, you must ask yourself, “Is the baby better off in than out or better off out than in?” Again, pretty basic wouldn’t you say? I submit that for any baby who was threatening to deliver prior to 35-36 weeks gestation, (in the absence of any other cofactor that negatively altered the risk to either the baby or mother) it was better for that baby to be in than out. This scenario and practice philosophy comprises the vast majority of all such cases of preterm labor at risk for premature delivery. This is not how the PNC seemingly saw it. Their approach, in general, was to apply whatever techniques necessary to hold the patient off from delivering prematurely so as to be able to administer a course of beneficial steroids, after which the efforts to sustain the pregnancy were marginal at best. If they delivered, they delivered. Heck, that’s what we have the NICU for. The vast majority of Ob physicians in this community, by handing their patient over to them, would therefore subject unborn baby after unborn baby to this hazardous approach given what would otherwise be more beneficial to them by staying inside the womb.
Therefore, when faced with what to do with my own preterm labor patients, I simply chose not to involve the PNC at all with their care. Would you believe that I was actually called one day at my office by the “autograph” doctor who demanded that I consult him concerning a triplet pregnancy I was managing. I was stunned at how brazen this command was from someone I barely even knew. To be fair, I did readily consult the Perinatal Center for certain cases over the years that were of a high risk nature that I felt was more appropriate for them to either care for or provide additional input (i.e. HIV, Fetal Anomalies, etc.) Yet, when it came to patients with preterm labor, I was more than capable of handling these cases by myself and have a body of work in this area alone that is superlative. My approach, however, was the antithesis of how it had always been done here – at least since 1998 when I arrived. My philosophy was simple. So long as the baby was at a gestational age whereby I felt it was not going to be able to both breath on its own (since the lungs are the last thing to fully mature) and moreover, be able to go home with its mother as usual upon her discharge from the hospital, then I was going to do whatever was necessary to reach these goals. This was nothing excessive and certainly not rocket science. It was common decency for both the baby and the parents. Did it take a lot of work in some cases? It sure did. Did I have to come to the hospital every day to see the patient (in some cases) for more than ten weeks? Yep. Was it worth it to put in all that work on the front side in order to keep the baby in the womb so that I could see the joy of that mom leaving the hospital with her baby in her arms? You betcha. There is nary a patient who would testify that having to visit their baby in the NICU as opposed to having it home with them was anything they enjoyed. This could never be any truer than when the baby is so severely premature that such a daily routine can extend into months as the unit of measure.
What’s interesting is that in many instances, my style of management was so counter to what the culture (nurses especially) had come to know that it was many times perceived as being wrong. Again, it comes back to the better in that out argument. Yet, all they were able to see is what their collective minds had been conditioned to know. Not one patient or baby was ever hurt by doing everything possible to keep the mom pregnant. And this included some pretty radical applications of medications and adjuvant treatment efforts to sustain the pregnancy in order to reach our goal. There have been many brave mothers out there who have endured some trying circumstances. In fact, when there was a lengthy hospitalization necessary, “cabin fever” invariably got to every one of them whereby I would have to spent that one to two hours at the bedside reassuring them that although they were going to need to persist in this manner in order to reach the objective, it was only a small amount of time in the totality of their lives, yet with huge dividends as a result. Once they got past this certain point, many will attest that when eventually having to leave after their delivery, it was a bittersweet moment for them since they had grown accustomed to the staff and their daily routine. Nonetheless, they went home with their baby. The whole point of this is that sustaining a pregnancy is doable for sure. However, it does require a daily commitment on part of the Obstetrician to do so. In some cases, it can be a lot of work. Like the PNC, how much easier would it be to just let them deliver and have the NICU deal with the issue on the backside. As for the parents having to fret over all the implications of prematurity, the atitude is, "Well, that’s their problem, not mine. Next…."
The PNC might offer a rebuttal to this method of patient management as not being realistic with the types of patients they care for in this same realm of premature labor and delivery. When it comes to premature delivery, the mechanism is the same for all patients. The cases whereby I have had repeated success are no different than any they would or could see. This included multiples and the most extreme cases of cervical incompetency. They just have far more potential cases (numbers wise) given their referral base. Remember, there was a reason why I mentioned above all the work I had done in this area of Obstetrics concerning premature delivery. Not only was it a blessing to be able to develop a definitive protocol for my patients such that it proved successful, virtually without fail, but it also was given as a means to demonstrate without equivocation that there is a better way of managing these cases if one were to be interested in what’s absolutely best for the baby. Bear in mind that despite being a practice that cared for all of its own high risk patients, premature delivery had all been eliminated for the six years prior to by practice being destroyed by those with an agenda to do so.
Ok, I know what you, the reader, might be thinking. If this method of keeping moms pregnant as long as possible for the benefit of the baby was so advantageous to the overall outcome, then why did the PNC not subscribe to this same approach? Why was their management style so different such that they had an abysmal rate of premature deliveries, especially for multiple gestations? The answer is coming. If they are the experts, then why is it that Syracuse, (of all places) has consistently ranked as the one city in New York State (including NYC) with the highest rate of premature birth? Is there something in the water? Hardly. This top rate was the statistic just a few years ago and it stands to reason that it hasn’t changed much. I submit that any region’s premature delivery rate statistics are a direct reflection on the very leadership who sets the standard of practice for that community. With that said, what does that say about this place?
For years, even though I did my own thing for my patients, it always puzzled me as to why such little effort went into trying to sustain the litany of pregnancies they were entrusted to care for. One of the reasons I heard cited was that their management was based upon a journal article that essentially concluded that when a pregnancy reaches 28 weeks gestation, so long as you get steroids on board, it is appropriate to just let them deliver. Long term statistics indicated that babies faired well when this was the case. True, morbidity free survival (that is survival without any long standing disease or harm from the fact that they were premature) is around 90-95% when 28 weeks of gestation is reached. Regardless of this statistic, it still required the baby to be subjected to varying intensities of treatment for that prematurity depending on how many weeks they actually achieved. The entire matter comes back to the question previously raised, “Is the baby better off in that out or out than in?” I don’t care what any study says about future statistics, no baby at 28 weeks, 30 weeks, 32 weeks, etc is better off out than in when there exists legitimate treatment options for the "alternatively crazy notion" of keeping the baby where it belongs. You know, in its mother. Hello? This is not to say that ALL pregnancies can successfully be brought to the desired point described above. However, when faced with a case of prematurity remote from term, every single day counts towards the potential outcome of that baby not needing this level or that level of intensive care upon delivery. So even if it means putting in the effort to sustain it for a few days longer or even a week when the intention is to get as far as possible, the benefit to the baby is always a positive one. Always. So, this ridiculous article has served to drive many a case whereby little effort to sustain the pregnancy was put forth as soon as a course of steroids was given. Isn’t it now incredible to see that several recent studies have found that when a baby is delivered prior to 33 weeks gestation, (regardless of what technology is in place to be able to handle them upon arrival that early), there is a several fold increase in the incidence of future learning disabilities amongst those babies. So again, is there really any legitimate argument that can be raised to negate the fact that all efforts should be utilized to sustain a pregnancy as long as possible so long as both mom and baby are not subjected to any undue risk? I don’t think so.
Another reason I believe that patients are not given maximum effort at prolonging their pregnancies is the work factor. Like mentioned above, it does require a daily commitment to go and see the patient. It’s not that they aren’t already in the hospital every day. In fact, the residents are the ones who write the majority of the notes on the PNC patients. It is likely a factor of just not wanting to be bothered.
The problem with all of these reasons for why there would be little effort to keep these patients pregnant as long as possible is that, while they may be true, what would be the motivation not to try since it should be obvious to anyone that the longer the baby is in, the better. Well, just as pretty much everything in our society that doesn’t seem to make much sense when the most logical doesn’t gel with the actual, there has to be a connection somewhere. Whenever there is this much contradiction in an otherwise upright purpose, one must always remind themselves to follow the money trail. So, where does such a trail lead us in this example? If you haven’t been able to guess, it leads to a department (the NICU that is) which is by and large the biggest money maker for the entire hospital. You could say that it is the golden goose for the institution.
Allow me to put things into perspective a bit. Let’s take, for example, a 28 week gestation that is at significant risk for premature delivery. If that patient is managed in the same manner as my approach, then it very well might result in that patient being admitted for weeks on end whereby the hospital would certainly make a decent amount of money since one day alone in the hospital is not cheap. It might garner upwards of $500-$1000 a day – give or take when considering such intangibles as medications and various testing needs. Over the course of say, seven weeks, the hospital could stand to make close to $50K on that one patient. Now take that same pregnancy and stop the patient’s labor long enough to get a course of steroids on board and then really put forth a nominal effort thereafter to eek out as many days as possible such that you place a 28 weeker in the NICU. Given the intensity of the treatment necessary and for how long it is needed, such an admission stands to bring in hundreds of thousands of dollars. By comparison, it doesn’t take a rocket scientist to see the fiscal advantage of having some premature babies around.
Consider the following as this is beginning to settle in. At Crouse Hospital, (at least for the ten years I was there as a reference for this material), they did around 3,700 deliveries a year. Where I trained, we did around 5,500 deliveries annually. This represents approximately 50% more. We had the same level intensity NICU as does Crouse with just as active a high risk service. With that many more deliveries, I would say that during my four years there, our NICU would average about 14-15 babies on any given day. Some days there would be maybe seven and on other days over twenty. At Crouse Hospital, however, during my entire time on staff there, there was hardly ever a day where they did not have less than fifty (50) babies in that unit. And the vast majority of them were from prematurity. Not only is such a stat staggering to consider, could you imagine how many families, parents, mothers had to needlessly visit their babies day in and day out because they thought that this was just how it was – never realizing that in most cases, it didn’t have to be that way. The enormity of how wrong this entire thing is cannot be quantified as far as I am concerned. To think that there could ever be an agenda to profit at the expense of premature babies is just gross and very telling as to where our society has placed its values. Plus, consider how many healthcare dollars have come out of the coffers of the various insurance companies in order to fund this scam. This apparent profiteering through your premature babies is a very large component of the Test that you are now being asked to take Central New York. Knowing that such a thing does actually exist, is this what you want for your community? If so, you already have it. It doesn’t matter how “nice” anyone taking care of you might seem or how much rhetoric is offered as a means of convincing you that this is how Obstetrics goes sometimes, there is an effective and proven alternative and it has now been described for you.
It stands to reason that there would be incredible opposition to what you just read, especially by those who work within this unit and field in general. My bet is that aside from personal interests, since they make their living within this world, there is also likely to be a degree of cultural bias due to the fact that, again, this is just how it has always been here.
On an added note, I am not so sure that this golden market of premature babies hasn’t come into the conscious awareness of the entire medical industry. Much like what has been coined the “Cancer Industrial Complex”, there is just too much money to be made (across so many facets) for those on the receiving end to ever want to see it change – even if that change was beneficial to mankind. I don’t want to believe this but the love of money is indeed the root of all sorts of evil. What stumps me along these lines is that it would eventually come to pass (supernaturally I might add) that I would be able to compile scientific data and statistics concerning the effectiveness of my protocol for the prevention of premature delivery. When trying to then communicate this information as one of several hundred potential poster presentations at the annual meeting for the American College of Ob/Gyn, my application was rejected two years in a row. Considering the fact that many of the poster presentations are for some of the oddest things, such a revelation on what has been written about numerous times in the press as being one of the biggest scourges on humanity, (premature birth) apparently wasn’t worthy.
So, with the NICU supplying the biggest influx of revenue for the hospital, it would be “ideal” to be able to sustain this level of volume. The primary source of their prematurity cases has always been, (you guessed it) the Perinatal Center. So long as they were able to maintain a monopoly on those cases both from within the hospital and local community as well as those being referred from the outlying regions, their management style would serve to keep the flow coming. What they didn’t need was a “risk” in their midst who not only didn’t turn over his patients to them but someone who also took a “radically” different approach to what they had long established as the standard for that region. If somehow the notion got out that preterm labor patients could actually be kept pregnant, then this might indeed stem the tide of product for the NICU. Therefore, those in control of this stream would have an incentive, a motivation, an agenda to eliminate any such element that stood to potentially expose their game plan even if that individual was just practicing with the best interest of his patients in mind while not being at all aware of what they were doing – at least at the time. Now, I could be completely wrong about all of this. Then again, it would be interesting to see how any of these facts and data could be reconciled outside of what seems to be glaringly obvious, especially to a veteran clinician who didn’t just step into the arena yesterday to know differently. But considering that it’s true, who were the ones in control of this source of premature babies? Wouldn’t you know that they just so happened to be the very same two who would ultimately take it upon themselves to use their connections and influence both within the department as well as the State to eliminate that risk (yours truly) for good. Their agenda had to be based on something. It sure wasn’t anything to do with my clinical abilities since my department record was untouchable. They most definitely had their people in high places. They just needed something, anything, even a real good lie in order to ram it through the process in inconceivable fashion in order for their ends to justify the means. Yet, as you will see, once they formally initiated the plot, subjugating the Truth took longer than they expected – six and a half years in fact.
Of course, the responses of the PNC will be multiple. On one level, they might say that it isn’t feasible or practical to hospitalize all those women in order to sustain their pregnancies for the benefit of the baby. The only argument that could hold water at all along these lines is that there could be a bed availability issue. But still, this is no reason to forgo what is best for the unborn baby. Another response might be that I am attacking them because of some personal vendetta or something along those lines such that I must now condemn what they will no doubt consider good work. Well, as far as sending premature baby after premature baby into the NICU, they are exceptional at it. It is commendable that they have the decency to at least administer steroids to the mom in order to mitigate the consequences of prematurity for the baby. Their intention along these lines has never been in doubt. But let’s get this straight again. This is not personal. For reasons that will be much clearer at the conclusion of this writing, I wish them no harm over these matters. I really don’t. Yet, it doesn't change the fact that wrong is wrong.
The BIG CASE
If by now you haven’t figured out that there was a reason for wanting me out of here, you have not been paying attention. It is important to realize that my present day understanding of these motivations was not fully appreciated for a long time. It was a late stage comprehension. For the longest time, I was so engrossed with what was done as the initiating event against my livelihood which then caused me to now have to take a confrontational stance that I really didn't realize the totality of the entire action that was being planned. When thinking about all that I have written thus far, I must stop and make something absolutely clear. First, my inherent demeanor throughout all of my time in this town and as a physician in general (outside of the few occasions I was called into the office and PRIOR to the character assassination that would eventually follow my pushing back against what was done) has always been that of complete collegiality. I had such a good rapport with literally everyone – other doctors, nurses, ancillary staff, housekeeping, etc. For anyone who truly knows who I am, it is my utmost nature to have fun and be light hearted while putting out an excellent product. The only individuals with whom I have had any true conflict with has been the four power players within the department’s administrative ranks – and this was only after they decided to harass me.
There were most certainly very few instances where I was inclined to pull a resident aside and professionally express dissatisfaction over the manner in which they were carrying out their duties as it applied directly to one of my patients. I was encouraged to do so by a colleague after he witnessed the futility of my attempts to discuss such matters before the department that day. And frankly, this is medical education. A resident is supposed to be subject to instruction, even if it is in the form of constructive criticism. Yet, it was apparently unacceptable for Dr. Caputo to ever choose to do so. In fact, to illustrate just how much the chairman was put off by my mere presence in the department, I was told an interesting piece of information by a resident who had decided he no longer wanted to be part of the program and therefore was transferring out. It seems that the chairman would make it a fairly regular practice to convene the residents in order to evidently “warn” them about me. Looking back upon hearing this, it did not surprise me. The behavior thus far experienced by the so-called leadership was so juvenile that this account was wholly consistent. As a result, it was truly astonishing to see the countenance of so many residents change towards me as they advanced through the program. Initially, their attitude would be one of tremendous gratitude as a first year since I would always show patience with them especially in the operating room for c-sections. It turns out that as fresh interns, they were constantly getting yelled at to go faster and rarely taken under any sort of wing to learn proper technique from the start. I remember one young woman telling me that they were forbidding her to use her dominant left hand for surgery whereafter my response was to rightfully encourage her otherwise. I cannot even remember how many times I would be thanked for simply not being mean to them as well as actually teaching them. This offer of positive instruction was always foundational to my interaction with the resident staff– at all levels. It was truly sad to see how much their attitudes would change. After hearing this account from the departing resident, it all made sense as to how it came about.
So with all this appetite on part of the power in the department to somehow wield in my direction that which they sought fit to abuse, they still needed some sort of catalyst in order to do so. This now brings me to the case that would ultimately change my life, not to mention the couple with whom it also involved and who I have such affection for. I am not going to go into great clinical detail for this case since it gets plenty of attention in the repudiation I wrote concerning the State’s Determination and Order after my several year interaction with them. As stated above, I will provide a link to both a little bit below so that there can be no question whatsoever as to the facts of each and every case I would eventually be prosecuted on.
The basic clinical facts are as follows. This is a patient who was pregnant with her first baby. During the pregnancy, as I do with all my patients, I became close with both the patient and her husband. At just over 36 weeks gestation, she developed an infection in her right leg that involved the entire extremity, thus necessitating hospitalization for antibiotic therapy. For the prior two weeks, she had been experiencing repeated episodes of painful uterine contractions that were debilitating for her. Numerous times she was seen either in the office or in labor and delivery for assessment. Each time, significant contractions were documented but her cervix had not changed at all. In order for her to obtain any rest, she required the occasional Tylenol with codeine. Now that she was in the hospital for the leg, her contractions continued just as intensely. So much so that not only were these episodes documented numerous times in the chart but she had to be given Demerol on more than one occasion in order to alleviate the pain from them. The entire time, the baby was found to be fine.
After she had been in the hospital for nearly a week, her leg was better for her to be able to go home. However, on the would-be day of discharge, her contractions were now significantly worse. Her cervix was checked and she now had shown definitive change with the diagnosis of early labor. Now at 37 plus weeks gestation, she was sent up to labor and delivery. Her water was eventually broken and she progressed steadily. She did require a nominal degree of labor augmentation via Pitocin but only 4mu per minute (for those who understand how little this is). She got an epidural and within an hour had a major fetal heart rate deceleration. Though sometimes this sort of thing can be seen shortly after an epidural, this was more than what would be expected. This was a concerning event and therefore commanded close surveillance.
At around 1am, she was fully dilated. At this time, it was noted that the baby was experiencing repetitive and significant fetal heart rate decelerations with each contraction. No doubt this represented compression of the umbilical cord, by definition. Most likely, it was around the neck as are most cases. In fact, a cord around the neck (nuchal cord) is encountered in approximately 30% of vaginal deliveries and is usually a benign circumstance. Because the patient was so far from delivering due to the position of the baby’s head being what is called occiput posterior, there was legitimate concern that the baby would not tolerate these repeated decelerations due to how significant they were and how long it was going to take for the patient to push. She was therefore given options at facilitating delivery. Those included either cesarean section or forceps assisted delivery. The latter was something I not only was adept at doing but really the only practitioner in the department who was teaching it as well. The patient chose the forceps as an option.
Therefore, after conditions were met to proceed, the forceps would eventually be used to bring the baby’s head to the point of crowning thus eliminating the two plus hours it would have taken her to do so on her own. It is here that the forceps are removed and the mother finishes the delivery in normal fashion. To emphasize for future reference, the forceps were not actually used to "deliver" the baby, but just to bring the head through the birth canal. The baby’s heart rate was checked intermittently throughout this process and was in the normal range. Over the course of two contractions, the baby’s head was delivered. At this point, a nuchal cord was indeed noted, except that it was extremely tight. At this point, there are two schools of thought. One is to clamp the cord in two places and cut between the clamps in order to release the cord from around the neck. The other is to simply deliver the shoulder of the baby and slide the intact cord down the baby’s body as it delivers. I have always chosen the latter since it doesn’t interrupt the blood flow connection between the baby and its placenta. In this case, I did just that. However, upon completed delivery, the baby was pale and flaccid. This was counter to what would be expected by the heart rate just minutes prior. A resuscitation team was called but after several minutes of effort, the baby expired.
It was a horrible experience and scene in that room. This was and still is the only baby under my care that did not go home completely healthy. The big question was, “what just happened?” It turns out that the baby was missing about 75% of its blood which is why it was not able to be revived. But where did the blood go? The placenta had not prematurely separated for the baby to have lost its blood that way. Could the forceps have traumatized this baby somehow? It didn’t seem possible since the delivery was as straight forward as these sorts of applications go. Well, within two days, the entire thing would be elucidated when the autopsy was complete.
The autopsy showed that there was no undue trauma at all from the forceps. There was no internal hemorrhage to account for the missing blood being there. So where did all that blood go? The only physiological conclusion was that it was in the placenta. But was this possible? In fact, yes. Unbeknownst to me and every colleague in the field I spoke to, no one had ever heard of a baby literally bleeding to death into its own placenta. Yet, this is what can happen in extreme cases of a tight nuchal cord. As an Obstetrician, we all encounter tight nuchal cords. However, this one was really tight indeed. So tight that as the baby descended to a crowing position, the three vessels in the cord were subject to compressive forces because of the cord being wrapped around the neck an being pulled tighter. The two arteries that deliver blood from the baby to the placenta are inherently more resistant to compression and therefore still allow blood to flow away from the baby. However, the one vein in the cord is flimsy and thus easily compressed and therefore occluded. This occlusion in turn prevented any of the blood from the placenta to return to the baby. Even though I did not clamp and cut the cord upon delivery of the head, which would have negated any chance for reperfusion back into the baby, what delay there was in cutting it thereafter was still deleterious to the baby given how much blood had been trapped in the placenta. Even though I had never heard or read about such a thing, this was the only explanation. I could not find anything describing such a thing in any Ob textbook. It was not until I stumbled upon a brief description of this phenomenon in a Neonatal textbook did the hypothesis receive validation. (this link has the pertinent text boxed but may not be visible with an online pdf viewer) I would later find a handful of articles in the world literature, one of which would specifically compound my understanding and conclusion as to what happened to that poor baby. All in all, it was a fluke. Literally, if one were to ascribe statistical odds to that ever happening, it is most definitely more than a million to one. I was so sad and sorry to the parents for this happening to them. They understood even though it was a devastating experience.. Although it was a terribly difficult thing for everyone involved, honesty, truth and integrity was at the forefront in honoring the memory of that child. No doubt this delivery changed me and that couple forever. In fact, we drew closer as a result. I would eventually go on to deliver their next two children, while other family members also became patients of mine. I was truly honored by this.
Sham Peer Review? Really?
It didn’t take long for news of this delivery to spread throughout the department, especially since one of the two Perinatologists referred to above was on that night and actually stepped in, at my request, to assist me in concluding the case given all the chaos and woe that ensued. It is interesting to note that a couple hours after the delivery, this Perinatologist and the Neonatologist having both reviewed what little there was available that night spoke to me stating that they concluded that there was no negligence involved with the case. While that was encouraging to hear from colleagues, it just wasn't clear at the time.
Even though the autopsy would eventually prove definitive just two days after the delivery, (formally concluding it to be a "cord accident"), nine days after the event, I got a call at nine o’clock at night by my chairman. It was here that he told me that I had essentially been tried, convicted, sentenced and sanctioned for killing a baby with forceps. Incredulous, I made it clear that this simply was not true. That the forceps had nothing whatsoever to do with that outcome. They were merely an incidental component of that delivery. He wanted no part of my explanation of the facts and said that this is how it was going to be. It was here that I said that there would be no choice other than to challenge this summary judgment as unmeritorious. What’s all the more sad is that the facts of this tragic case were so distorted across the community that at St. Joe’s Hospital, which is only a few miles away, the rumor that was going around there about what happened was so inappropriate that it bears not mentioning.
Even so, back at Crouse, while I didn’t know it yet, what had just been done to me was a malignant form of peer review that is designed to punish any unsuspecting physician by denying due process and due cause. I was taken aback by just how dishonest it all was, including the clinically feeble case review that was put forth by the fourth member of the gang of four. It would eventually be learned that there was a name for what was being done. It is called Sham Peer Review. When reading about it online, it gave me chills to see that there was literally a recipe that was to be followed in applying this destructive process to anyone so unfortunate to be targeted.
I wish to conclude this part one of the story right here in order for the reader to take some time to not only digest the totality of what has been learned so far but to also further familiarize yourself with the entity known as sham peer review. This will be important to have a working knowledge of as you read what is to come. The following links (1, 2, 3, 4) will provide ample information about just how dreadful this practice is and how it has literally reached epidemic proportions all across the country. Please also check out and perhaps "like" the Stop Sham Peer Review facebook page. Of course, physicians are the primary victims. However, every patient that loses their doctor as a result of this monstrous activity is consequently a victim as well.
In part two, you will learn that this corrupted abuse of the peer review system is alive and well in Syracuse. You will see that when an agenda is at hand, it can then be carried out by a State level agency and how that agency allows itself to be used as an instrument of destruction. Also, you will find out just how depraved your local medical community leaders can become in an effort to cover over an unspeakable example of negligence. This disclosure will no doubt be the cornerstone of the Test that is being presented to you as a community. All of this will lead to a series of current events where this culture of dishonesty and power abuse appears to be not just limited to one medical institution in Syracuse. It is just incredible to continue to bear witness to and you will ultimately decide how you deal with it. Will you stand for this sort of condition in your own town? The conclusion of this writing is perhaps what I am most eager to present. Your attention to the end is my greatest desire.
Look for part two on Monday morning, March 4, 2013. God bless. -JRCMD
Here is Part 2