DrugBuyers.Com: Robert Weitzel, MD - Case, Web, and letter

DAY 6
Hello, all.

Today's trial went well, once again. Our hostile nurses came off as just that: vindictive and biased. The people who were gathered to watch and listen were unanimous in saying, "I don't see how the jury could miss the truth, with the obvious hatefulness" exhibited by the Gang of Three. Interestingly, none of them said anything about any negligent behavior, much less reckless or criminal behavior.

Of great import was the testimony of the other state medical examiner, Maureen Frikke. I thought her testimony was forthright, at first, when she admitted that any of several causes of death were possible for the one patient she examined, years after burial. Then things got a little weird for her. We didn't challenge her much on her failure to find the well-documented rectovaginal fistula seen on gynecological exam, during hospitalization, and she admitted that nurse Earline Cozzens must have left on two Duragesic patches that I had ordered removed; they were found on the body at autopsy. What was odd was her reaction to being contradicted on her assertion that this patient, Mary Crane, had been on nothing but "non-prescription" pain medications before coming to the Geropsych Unit. We'd had copious testimony over the previous few days of not only patient Crane's daily Lortab for the past four years, but also that she'd had morphine for headache.

Dr. Frikke had stated that she made her findin of Crane's manner of death having been "undetermined" because she said she couldn't rule-out opiate overdose as cause of death in what she characterized as an "opiate-naive" patient. Confronted by the facts, she became extremely defensive. This was odd, because my defense attorney Tara Isaacson pointed out that the it was the state lawyers who had failed to provide her with all of the information she needed to understand the patient's prior history, and thus had victimized her similarly to how they have victimized the patients' family members. During all of this the state lawyers stared stonily ahead, while the jurors gave them knowing looks of disapproval, and in at least one case what resembled frank disgust. Not only did this boomerang on the prosecutors, but also on Todd Grey, the "chief medical examiner," who evidently based his determination of Judith Larsen's manner of death having been "homicide" mostly on what he read in the newspapers, not any objective medical science criteria.

Speaking of newspapers, did anyone notice the faux pas perpetrated by the Salt Lake tribune's Steve Hunt in yesterday's rag? He stated that the medical examiner had certified Mary Crane's death as having been a homicide, when in fact it was Judith Larsen. What a bonehead; too lazy to get it right. Hunt is evidently a total suck-up to the prosecutorial types. I'm told he's never met a defendant he doesn't dislike, and always takes the state's side in any lawsuit. You'd think he was on a different planet from the way he misreports the trial. None of the huge points we are scoring are mentioned. So it goes.

I don't understand it, to tell you the truth. "Doctor kills patients" is a good story for the sensationalizers, I'm sure; better than "man bites dog," but this is a story of foul and corrupt prosecutorial misconduct, yet the press completely misses it. (Except for the reputable and well-respected likes of media like CBS "60 Minutes.) The press corps has really sunk, in my estimation. Being in my current position has demonstrated to me the shortcomings of our popular media. NEVER trust them to get it right.

Trial is going just as scheduled, much to our surprise. It looks like the prosecutors will rest their case tomorrow, and we will begin Monday. Next week we may just use MWTH, and then Friday could well be closing.

Well, I hope everyone will come out to see what Brad Hare pulls out this time. It can't help but be interesting to see him try to deal with the fact that the very man who he recommended as having been the best palliative-care specialist in the region is now leading the experts for the defense. Thanks to all of you who came today; I really appreciate your support. I'm sure it helps to see people wearing the little blue tags. Keep coming back!

I do hope for acquittal. If the jurors vote the way their faces indicate they feel, this nightmare will end soon. I hope all of you will take care, and please write.

Yours,

Robert

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DAY 7

Dear Friends,

I must tell you, you had to be there to believe it. The state's case completely fell apart on them on Friday, and we had some hopes that the judge would grant a motion for directed verdict. (Legally, he should have, but this case is now far to politicized for him to take that action.)

The state called geropsychiatrist/internist Byron Bair first. He came off just like the junior faculty member he is. A know-it-all who spoke hurriedly and with a hint of desperate fear in his voice (he could see the local physicians in the gallery who had gathered to hear him make a fool of himself) he wasted no opportunity to display his "expertise" with the unnecessarily polysyllabic pronouncement or the gratuitous and nit-picking criticism. He claimed that all of the patients were delirious when they entered the unit, and that without his recommended grab-bag of aggressive and intrusive interventions, they were bound to die. Ignoring the big picture, that these patients were terminal and their families had given strong and unequivocal orders that no further interventions be attempted but rather they be allowed to die in peace (and with adequate analgesia), Dr. Bair repeatedly picked apart the care as provided, with ivory-tower, bookish complaints that were completely beside the point. He evidently just didn't get it. When referred on cross-examination to the numerous documents that show that all of the families were completely on board with the palliative care being given, his surprise and chagrin were palpable. He then attempted to avoid all of Mr. Bugdens very simple questions with the answer, "I can't answer that with just a 'yes' or 'no'." Finally he compounded the problem by changing that to: "I can't answer that without confusing the jury." - you can be sure the jury found that statement to be resoundingly complimentary of their intelligence - and he ended up by admitting that he really didn't think that morphine caused the death of any of the patients except perhaps Ennis Alldredge, who he claimed had been overdosed by a last injection of morphine given at 9:20; Mr. Alldredge died at 9:36. What Dr. Bair missed was that this injection was never given - the nurse held it. She was there and saw that he was about to die and didn't need the injection. Dr. Bair's small and misbegotten critiques were shown up in the full glory of their ignorance and irrelevance.

Next the inimitable Dr. Bradford Hare walked boldly to the witness stand. He repeated his familiar litany of: "He gave him those psychiatric drugs ('central nervous system depressants' -oooohh...scaaarrry...) and weakened them, then finished the off with MORPHINE... He also claimed that all of the patients were just fine - "medically stable" - when they walked in the door. Of course this completely contradicted the "expert" just previous to himself, and thus illustrated the inability of the state lawyers to even get their story straight.

The best part of the day was when Mr. Bugden had Hare admitting that he was not an expert in geropsychiatric dosing. Mr. Bugden then asked the witness why he was there, then. He went over and put his hand on state lawyer and head prosecutor Melvin Wilson's shoulder and said, "This man hired you to complain about Dr. Weitzel's geropsychiatric dosing, but you admit you're not an expert in that field?" Wilson rose to object, saying, "That calls for speculation on why I called this witness, your honor." The judge got a huge laugh from the jury (and about one half of the spectators) by looking over his glasses at Wilson, with what looked like a mixture of amusement and contempt, and drawling, "I think the jury and everyone here knows why you called this witness, Mr. Wilson. Objection over-ruled."

We will begin our defense 8:30 Monday morning. Tuesday will be the usual day off, then we resume on Wednesday. I look forward to the very distinguished and somewhat impassioned experts we will call, true experts, not the uninformed sorts that the state lawyers procured. I invite everyone who lives close enough to come wear a blue badge and hear the other side of this case.

We will most likely finish up on Friday in time for closing arguments on that day. I am hopeful that I won't have to spend this Thanksgiving in a six by eight foot cell with a guy with the nick-name "Beast", like I did after the other trial.

I have included below a reprint of an article on the case from DRCNet, published yesterday on the Internet. Although local newspapers have reported the case in a way that makes me wonder what trial they attended, this article is more indicative of the true nature of the trial.

Thanks to all of you for your support, prayers, and donations of time and money to the defense. It means everything.

Yours,

Robert Weitzel MD

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The Week Online with DRCNet, Issue #263 - November 15, 2002

Phillip S. Smith, Editor,
David Borden, Executive Director, [email protected]">[email protected]
David Borden, Executive Director, http://www.drcnet.org/signup.html

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13. Newsbrief: Pain Doctor Weitzel Retrial Underway in Utah

Salt Lake City psychiatrist Robert Weitzel is in court this week defending himself for a second time against state charges that he killed patients under his care in 1995 and 1996. Prosecutors accuse Weitzel of causing the deaths of five mentally and terminally ill elderly patients by treating them with psychotropic drugs and morphine while working for the geropsychiatric unit at Davis Hospital and Medical Center (http://www.drcnet.org/wol/255.html#weitzel).

Weitzel was originally charged with murder, but a jury found him guilty of manslaughter in 2000. He served six months of a 15-year sentence before being released after an appeals judge found the prosecution had not disclosed evidence that would have vindicated his medical judgment.

He maintains his innocence and has assembled a strong defense team that has, according to his daily e-mails to supporters, effectively cross-examined prosecution witnesses. The defense will present its case next week, with Weitzel scheduled to take the stand November 22.

Although Weitzel at first received little support from his colleagues in the Utah Medical Association, concerns over unwarranted prosecution in his case seem to have inspired the association to pass a resolution condemning such practices last month: "The Utah Medical Association opposes the criminalization of medical care and sees unfounded accusations of physicians in criminal court and the criminal trial of physicians' professional judgment and quality of practice as a serious threat to patient care in the State of Utah and an unreasonable burden on the medical profession," read the resolution.

Then, in an implicit reference to the Weitzel case, the resolution added: "We believe that when a medical expert admonishes a prosecutor against filing a criminal complaint, it behooves the prosecutor to reconsider his position and at least seek the opinion of the Utah Medical Association, the Physicians Licensing Board, or some other regularly established and constituted panel of medical peers. Neither Utah's physicians nor their patients can afford this type of judicial embarrassment. It is a serious threat to good patient care for all Utah's citizens."

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"Whosoever is spared personal pain must feel himself called to help in diminishing the pain of others." Dr Albert Schweitzer

From: ROBERT WEITZEL

Reflections on being tried for murder

I have recently had the misfortune of being tried for the "untimely deaths" of five of my patients, not just once but twice. (They did not die twice, rather I was tried again after the first trial was set aside, when it was determined that the prosecutor had improperly withheld exculpatory evidence.) In each of the two trials I learned a great deal about the judicial system, some of it positive and illuminating, and some of it quite distasteful. It was certainly positive to finally have my innocence vindicated but definitely unfortunate to have spent every last cent, and six months in the penitentiary.

The first trial lasted five and a half weeks, while the prosecution tediously presented volumes of trivial detail and irrelevant minutia that not only confused the jury but also left them bored to distraction. The first jury refused to convict me of the charge of first degree murder, as requested by the state lawyers, but compromised with a verdict of guilty on three counts of negligent homicide and two of manslaughter, leading to a sentence of fifteen years in prison. The second trial of three weeks was conducted in a much more expeditious and concise way, and the defense witnesses were knowledgeable and informative in their testimonies, while the state witnesses were just a bit more circumspect. The jury in this trial returned verdicts acquitting me of all five deaths.

Prior to my arrest, none of the patients' families had filed a complaint with the hospital, state agencies, or the medical societies, nor apparently had any even met with a lawyer during the three years after the deaths. I can only imagine the scenario, but there was a day when a state investigator knocked on the doors of each of these families to announce that their loved ones had not died natural deaths but had been murdered. One can easily imagine the rush of emotions that each of these individuals must have felt, running from fear, to guilt, to anger, and pain. The loss of the departed had already been grieved, the dead had been buried, and the pain had been accepted and resolved. Then the prosecutors arrived with requests to exhume the bodies. The dead had left their veil of tears, but their survivors were now given a new and grisly burden to bear. The exhumations raised again the grief of their loss, not this second time to be so properly borne, endured, and buried.

As I sat there listening carefully to the learned explanations of the experts on both sides, the whole significance of our system of trial by jury became clear to me. As I had watched the families of the alleged victims sit through every pretrial hearing and both courtroom trials, waiting impatiently for the justice they felt they deserved, I felt dismayed that they had become so righteously indignant over care I had provided, care I believed was appropriate and ethical.

I listened with hope that after these family members had heard the facts and the expert explanations, they would feel relieved. I hoped they would find some peace when they learned that their decision had been a rational and wise one; to have me withdraw active, interventional medical care from their dying, demented loved one and to replace it with compassionate comfort care. After all, these severely demented patients' ages were 72, 83, 90, 91 and 93 years.

It is now clear that the second jury did indeed hear the message. Justice was done, although at great expense to the state. The parade of experts provided a thorough explanation for those family members who were open to hearing it. This opportunity to hear a full disclosure of all the relevant facts is the true intent and meaning of justice, so that those who continue to harbor inner conflicts or ill will may be able to reach closure, after a fair and well-conducted trial.

Among those less well informed, and especially those unable to attend my last trial, I have no doubt that there remain many questions, suspicious, and unresolved issues, many of which I believe arise from our wide spread ignorance about the process of dying. Our society has essentially denied the reality of death. Most people have very little contact with death, and with our prolonged life expectancies we are not touched by it as closely or frequently as were people only a generation or two past.

The Latin term used in Medicine, in extremis, denotes not simply a state beyond which nothing further can be done to save the life, but in addition it describes a process through which the body passes as it prepares to shut itself down, permanently: The process of dying. (An explanation of the natural processes involved in dying was provided the jury and the family members attending the trial, and these insights should be shared.)

Lewis Thomas in his book, Medusa and the Snail, has a chapter entitled, "On Natural Death," which contains ideas so important to this subject it should be included in every pamphlet or instruction provided by hospice services. Thomas describes a process that takes place in the mouse at the instant it is caught by a cat. He writes,

".peptide hormones are released by cells in the hypothalamus and the

pituitary gland; instantly these substances, called endorphins. [Exert]

the pharmacological properties of opium; there is no pain."

He ends with,

"Pain is useful for avoidance, for getting away when there's time

to get away, but when it is endgame, and no way back, pain is

likely to be turned off, and the mechanisms for this are wonderfully

precise and quick. If I had to design an ecosystem in which creatures

had to live off each other and in which dying was an indispensable

part of living, I could not think of a better way to manage."

Thomas then quotes the 16th century French philosopher Montaigne, who had had a near death experience which led him to write,

"If you know not how to die, never trouble yourself; Nature will

in a moment fully and sufficiently instruct you; she will exactly

do that business for you; take you no care for it."

It should certainly serve to support the faith of those who believe in a merciful Creator to know that with all the violence built into the law of the jungle, prey are provided with this mechanism to guarantee a gentle and merciful demise. And this mechanism is fully active in humans.

During my second trial the various end-of-life experts discussed the notion of delirium, which is commonly seen in the demented. Since the five patients who died under my care were all in advanced stages of dementia, there was also substantial testimony about both the nature of dementia and the meaning of delirium. Dementia, a disease condition of the brain, results in destruction of large amounts of brain matter, leaving the afflicted individual trapped inside a tangle of non-functioning brain structure. In the later stages of dementia the process also leads to a general wasting of the entire body, eventually and inevitable leading to death. It is not in any way the same as psychiatric diagnoses such as phobia or neurosis, which are conditions of the mind, not the brain. Of course, the mental state can deteriorate into a depression or other psychiatric condition on top of or as a result of the dementia, and depression itself has a biochemical component to it.

Delirium is rather difficult to define, but it is an altered state of mind that may incorporate hallucinations or other reality distortions, frequently associated with wild swings in brain activity. Delirium can be either pleasant or tragic. The endorphins provide a kind of quiet, pleasant delirium, but dementia can result in a delirium that is wild, frenzied and destructive. The experienced caregiver knows it when she sees it, just as the knowledgeable and experienced caregiver can recognize the dying process when she sees it.

The demented individual presents many difficult problems for the caregiver, but one of the most frequent and perplexing is the inability of the demented to be able to identify and describe physical pain. The destroyed brain not only does not allow effective communication, it frequently does not even give the demented patient a correct interpretation of the problem, so they may not even recognize that they are in pain. Such patients may exhibit wild agitation or bizarre behavior in their response to unrecognized, painful stimuli, which the demented elderly frequently experience. Since we have no "pain-o-meter" or blood test to measure the symptom of pain, we can sometimes only make a diagnosis by giving an opioid to see if the patient's behavior improves.

Although Thomas titles his chapter, "On Natural Death," this is not the usual use of this term, which commonly refers to a death due to natural causes, and yet it sounds like an oxymoron to speak of a "normal death." Still, that is what Thomas was referring to. In the normal, natural death, passing is made gentle and pleasant by the brain's release of its own natural endorphins. Although we know of the severe pain many cancer patients suffer, once the dying process begins their pain is often relieved. In many of the demented, however, there appears to be the worst of all possible worlds, since the brain seems to be both unable to discern the pain and unable to release nature's merciful endorphins. This necessitates the employment of powerful pain relievers in generous dosage to help nature do what the disease process has forestalled, if one is to be as merciful as we have seen nature to be when death is natural.

Our country is currently experiencing something just short of a war occurring between the regulatory agencies and those physicians responsible for compassionate pain control. The knowledge gained just in the past ten years about the proper use of opioids has been significant, and the new knowledge suggests that much of our past use of opioids has been stinting and insufficient. Now that bureaucrats, managers and lawyers have an ever increasing involvement in the way health care is delivered, innovative modalities and changing treatment practices are challenged almost everywhere, as one might expect. Perhaps the successful outcome in State v. Weitzel will help to further assertive and compassionate palliative care; I hope so.

I am very happy that I have been acquitted and that I may once again look forward to regaining my livelihood and respectability, but my greatest happiness comes from knowing that a jury of laypersons can and did hear the message; saw the bigger picture. Although all my own assets have been spent, as well as considerable funds provided by donors, I still feel my optimism has been redeemed, and I am hopeful for my own future as well as that of conscientious and compassionate physicians everywhere.

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"Whosoever is spared personal pain must feel himself called to help in diminishing the pain of others." Dr Albert Schweitzer