Psychopathic Medicine and The White Wall of Silence

Today I’m deviating from the subject of psychopaths and love, and delving instead into psychopaths and medicine, for good reason: so you can protect yourself and your loved ones when you seek medical care.

Law enforcement is known for having a “blue wall of silence,” the unwritten rule that exists among police officers not to report on a colleague’s errors, misconducts or crimes. In medicine, there is a white wall of silence. Because of this white wall of silence, knowledge of a physician’s incompetence is often kept from the public, while the physician continues to practice and to harm patients.

If you look at the CDC’s list of the top ten causes of death, you’ll see this:

  • Heart disease: 611,105
  • Cancer: 584,881
  • Chronic lower respiratory diseases: 149,205
  • Accidents (unintentional injuries): 130,557
  • Stroke (cerebrovascular diseases): 128,978
  • Alzheimer’s disease: 84,767
  • Diabetes: 75,578
  • Influenza and Pneumonia: 56,979
  • Nephritis, nephrotic syndrome, and nephrosis: 47,112
  • Intentional self-harm (suicide): 41,149

This is not accurate. The actual third leading cause of death is missing. The correct list looks like this:

  • Heart disease: 611,105
  • Cancer: 584,881
  • MEDICAL ERRORS: 200,000+
  • Chronic lower respiratory diseases: 149,205
  • Accidents (unintentional injuries): 130,557
  • Stroke (cerebrovascular diseases): 128,978
  • Alzheimer’s disease: 84,767
  • Diabetes: 75,578
  • Influenza and Pneumonia: 56,979
  • Nephritis, nephrotic syndrome, and nephrosis: 47,112

That’s right—200,000 people die each year from medical errors, and some experts think the actual number may be as many as 400,000. Why don’t we know for sure? Because no one is keeping track of it. “Our collective action in patient safety pales in comparison to the magnitude of the problem,” said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine. “We need to say that harm is preventable and not tolerable.” No, really? What an astounding idea!

Another one million people in the U.S. are harmed by medical errors each year. I was one of them. My surgeon made errors, refused to provide any evaluation or treatment, denied my problems could have anything to do with his surgery, and falsified my medical records in an attempt to cover up his errors. I got two second opinions, and both doctors quickly and easily determined what errors were made (and they were errors that required surgical repair). I filed a complaint with the hospital’s risk management department, and despite the evidence they denied that malpractice had taken place. I contacted dozens of attorneys, and none would take my case because it wouldn’t bring them enough money to make it worth their time, even though I had a valid claim that could be easily proved. A complaint to the medical board is pending, but I know it won’t do any good. The Inspector General at the U.S. Department of Health and Human Services reported that medical boards, typically comprising doctors and a lesser number of laypeople, imposed “strikingly few disciplinary actions” for physician misconduct.

In the U.S., a lawsuit is often the only hope for patients who’ve been harmed (or for their surviving family) to recover losses, hold the healthcare provider accountable, obtain justice, learn the truth about what happened and ensure the problem is corrected. And it’s the only way to avoid paying the bills for having been harmed (imagine owing hundreds or thousands of dollars for botched surgery—it happens all the time). But a 2013 Emory University School of Law study found that 95 percent of patients who seek an attorney for harm suffered during medical treatment will be shut out of the legal system, primarily for economic reasons. Most attorneys would not accept a case – even one they might win – if the damages likely were less than $250,000. Conservative reforms have severely limited patients’ options for holding doctors and hospitals accountable for bad care, which is the goal. Lawyers are a big impediment to disciplining bad doctors.

Doctors and hospitals know they probably won’t be held accountable for errors that harm patients, so there is no incentive for them to apologize, reveal details about what happened, or report errors that might unveil a pattern. They will simply deny and defend.

No incentive? What about medical ethics? Morality? Honesty? Wanting to do what’s right? What about the human being who was harmed? Shouldn’t those things be enough of an incentive? Apparently not. It seems that our medical system has become psychopathic. 

According to the ProPublica article Ten Patient Stories: When Attorneys Refused My Medical Malpractice Case, “The medical malpractice system often discriminates against certain patients, particularly those with low incomes. Those who can’t get representation ­— often women, children or the elderly — are sometimes called the ‘hidden victims’ of medical malpractice. Studies show that the problem isn’t limited to states that have strict limits on malpractice awards.”

“You can have all the rights in the world, but if no one will take your case, then those rights mean absolutely nothing.”

~ Stephen Daniels, a research professor at the American Bar Foundation, a legal research institute.

From the mother of one victim:

“My daughter passed from medical harm. I did at one point have a signed contract with an attorney. He had a friend in the medical field that he felt could review her 2,500 pages of medical records. However, when his friend explained that because she was an infant who went in for heart surgery, you’d require two specialists to review my daughter’s chart and testify. I was told it would cost roughly $50,000 to $75,000 per specialist. This doesn’t include normal costs for the attorney. It didn’t take long for the attorney to send me a letter stating he couldn’t help me. I added that letter to the other dozen all stating we had a good case, but the financial limits made it impossible for them to take it. It was business.

Although it was heartbreaking, I do understand the attorneys cannot lose that kind of money on a case. I even asked if it were possible for me to sign an agreement stating the attorney gets everything above expenses. I didn’t want the money. I just wanted the hospital to have to own the mistakes.

As you read this, don’t assume she passed because of her heart. The surgery was successful, as expected. It was the aftercare that killed her: Avoidable infections, overdose of heparin, lines becoming dislodged, a doctor collapsing her lung while removing a drain tube. It seemed endless but was only 95 days. One heart surgery with a 99.9 percent success rate and a week of recovery in the hospital turned into three heart surgeries, an exploratory abdominal surgery and seven hospital associated infections and 95 days later, her death. I wish there were a medical court (of sorts) that patients could go to without an attorney. They could file a complaint and sit in a room with the doctor, nurses, specialists and a panel of “judges” and plead their case. Ask their questions. No attorneys. No ‘specialists.’ Just a place to get answers, and, if needed, monetary compensation. Personally, I just wanted answers.”

It’s sickening to think of the pain this infant suffered, and the anguish her mother went through, along with being left powerless and helpless to do anything about it.

It is interesting that she says “I wish there were a medical court (of sorts) that patients could go to without an attorney. No attorneys. No ‘specialists.’ Just a place to get answers, and, if needed, monetary compensation.” There actually is such a place where that happens: Denmark. Medical injury claims aren’t handled by the Danish court system but by medical and legal experts who review cases at no charge to patients. Patients get answers and can participate in the process whether or not they ultimately receive a monetary award. Filing a claim is free. Patients are assigned a caseworker to help them through the process. The hospital or doctor is required to file a detailed response, which patients may rebut. Patients have access to their complete medical record and a detailed explanation of the medical reviewers’ decisions. All of this is available for patients and their families through an online portal, which alerts them when there are developments in their claims process. Compensation is awarded if reviewers determine the care could have been better, or if the patient experienced a rare and severe complication that was more extensive than the patient should reasonably have to endure. It sounds like a good idea to me.

You might expect to get bad care here, but would you expect to be lit on fire and burn to death in the operating room at Vanderbilt?

There is often no way to know if the doctor or surgeon you’ve chosen is a good one. 

A USA TODAY investigation found that thousands of doctors who have been banned by hospitals or other medical facilities aren’t punished by the state medical boards that license doctors. That means you’ll never know who these doctors are, and you might just end up with one of them.

The research shows:

• Doctors disciplined or banned by hospitals often keep clean licenses: From 2001 to 2011, nearly 6,000 doctors had their clinical privileges restricted or taken away by hospitals and other medical institutions for misconduct involving patient care. But 52% — more than 3,000 doctors — never were fined or hit with a license restriction, suspension or revocation by a state medical board.

• Even the most severe misconduct goes unpunished: Nearly 250 of the doctors sanctioned by health care institutions were cited as an “immediate threat to health and safety,” yet their licenses still were not restricted or taken away. About 900 were cited for substandard care, negligence, incompetence or malpractice — and kept practicing with no licensure action.

• Doctors with the worst malpractice records keep treating patients: Among the nearly 100,000 doctors who made payments to resolve malpractice claims from 2001 to 2011, roughly 800 were responsible for 10% of all the dollars paid and their total payouts averaged about $5.2 million per doctor. Yet fewer than one in five faced any sort of licensure action by their state medical boards.

Are these terrible medical professionals psychopaths? No doubt at least some of them are, such as the two below:

Dr. Christopher Duntsch, MD, PhD, Neurosurgeon

“‘It’s a completely egregious case,’ Leigh Hopper, then head of communications for the Texas Medical Board, told The Dallas Morning News in June. “We’ve seen neurosurgeons get in trouble but not one such as this, in terms of the number of medical errors in such a short time.”

But the real tragedy of the Christopher Duntsch story is how preventable it was. Over the course of 2012 and 2013, even as the Texas Medical Board and the hospitals he worked with received repeated complaints from a half-dozen doctors and lawyers begging them to take action, Duntsch continued to practice medicine. Doctors brought in to clean up his surgeries decried his “surgical misadventures,” according to hospital records. His mistakes were obvious and well-documented. And still it took the Texas Medical Board more than a year to stop Duntsch—a year in which he kept bringing into the operating room patients who ended up seriously injured or dead.

Duntsch is now being held in jail without bond on charges that he purposely maimed and killed these people.


  • July 24, 2012 – Duntsch performed surgery on Floella Brown at Dallas Medical Center. He ‘knowingly’ positioned the plate to the left on her spine, injuring her vertebral artery, which led to her stroke and her death.
  • July 25, 2012 – Duntsch misplaced a device into Mary Efurd’s spine while performing surgery on her at Dallas Medical Center. He ‘drilled multiple holes’ in her body while trying to install screws, damaging her nerves and causing her to be in severe pain. She no longer has control over her foot.
  • Sept. 20, 2012 – Duntsch performed surgery on a man at South Hampton Community Hospital in south Dallas. Duntsch cut the patient’s spinal cord, causing him to be paralyzed.
  • May 6, 2013 – Duntsch performed surgery on a woman at University General Hospital of Dallas. He ‘knowingly selected and installed’ a screw that was “far too long” – 75 mm instead of 45 mm. The screw was pushed through the patient’s major vein, causing severe blood loss of 2,400 milliliters. The surgery damaged the patient’s psoas muscle and nerve roots.
  • June 10, 2013 – Duntsch performed surgery on a man at University General Hospital. During the procedure, Duntsch ‘dissected a piece of the complainant’s esophagus’, leaving a hole and causing the patient to have trouble breathing, swallowing and eating. Duntsch’s ‘unacceptable surgical technique’ led to damage to the patient’s vertebral artery, which supplies blood to the brain. The patient lost 1,300 milliliters of blood and suffered spinal nerve damage. Duntsch also left a surgical sponge inside the man’s body, causing a severe infection with lasting effects.
*According to the Dallas Police affidavit

No one bothered to tell them—and there was no way for them to know—that their doctor had left others seriously injured, paralyzed or dead. Until their cases are resolved, doctors—even those accused of the most heinous malpractice—can continue to practice. Even the fact that the board is conducting an investigation remains confidential until the investigation is over.

After maiming and killing people at Baylor Hospital—which administration was aware of—when he applied at Dallas Medical Center, Baylor sent them an email saying that there were no issues with Duntsch’s performance, and that he’d voluntarily resigned.

Dr. Robert Henderson, another neurosurgeon at Dallas Medical Center, was assigned to do the repair surgery on Mary Efurd who woke up in horrible pain and barely able to move her legs after Duntsch operated on her. A CT scan found that the metal spinal fusion hardware, meant to be placed on the patient’s spine to keep the vertebrae from moving, was sunk into the muscles of her lower back, inches from her spine. Henderson went in to remove it. He had been a neurosurgeon for 40 years and what he saw inside Efurd’s back shocked him.

“I couldn’t believe a trained surgeon could do this,” Henderson said. “He just had no recognition of the proper anatomy. He had no idea what he was doing. At every step of the way, you would have to know the right thing to do so you could do the wrong thing, because he did all the wrong things.”

Physicians who finally complained about Duntsch to the Texas Medical Board and to the hospitals he worked at described his practice in superlative terms. They used phrases like “the worst surgeon I’ve ever seen.” Another doctor compared Duntsch to Hannibal Lecter three times in eight minutes.

(Read More: “Anatomy of a Tragedy,” Texas Observer)


Charles Cullen was a critical care nurse who admits to killing up to 40 people, but experts familiar with the case believe that number is low, perhaps by several hundred. If they’re right, he is the most prolific serial killer in American history.

The murders took place over 26 years in seven different hospitals. There were suspicions at nearly all of them that Cullen was harming patients, yet none of them passed that information on to subsequent employers.

In Cullen’s case, all his victims were patients assigned to hospital units where he worked as a nurse. They ranged in age from 21 to 91. Some were critically ill. Others were ready to be discharged when Cullen injected them with drugs that would kill them. It was a pattern that began 26 years ago at St. Barnabas Medical Center in Livingston, New Jersey, Cullen’s very first nursing job.

Cullen would work at eight other hospitals and be suspected of harming patients at six of them, but those suspicions never reached subsequent employers and Cullen continued to murder patients with virtual impunity.

Experts state that the reason Cullen was largely able to move from facility to facility undetected, was because of the lack of requirements to report on suspicious behavior by medical workers, and inadequate legal protection for employers. New Jersey and Pennsylvania, like most states, required health care facilities to report suspicious deaths only in the most egregious cases, and penalties for failing to report incidents were minor. Many states did not give investigators the legal authority to discover where a worker had previously been employed. Employers feared to investigate incidents or give a bad employment reference for fear that such actions might trigger a lawsuit. According to detectives and Cullen himself, several hospitals suspected he was harming or killing patients, but failed to take appropriate legal actions. A number of hospitals had individual workers contact nearby hospitals in secret, to alert them that they should not hire Cullen.

“At St. Barnabas, they could’ve had my license investigated and probably revoked at that point in time.”

~ Charles Culen


“No Dignity, Compassion or Respect” 

A patient who kept a recorder on while he was anesthetized and having a colonoscopy was shocked and humiliated to hear what was said during the procedure. He was able to sue successfully, and won a $500,000 settlement. It’s disturbing that treating patients without any dignity or respect at all—and with contempt—when they’re anesthetized is considered commonplace and acceptable in the medical world.

Many people balked at the amount of the judgement, wondering what harm was done. I think the judgement was right on target. The crass, callous and abusive behavior of the anesthesiologist—Tiffany Ingham, MD, pictured on the left—was way outside of her professional bounds. We are never more vulnerable than when we’re anesthetized. How many people would knowingly put their lives in the hands of a despicable, disrespectful person who felt utter contempt for them?

Among her comments while the patient was sedated were:

“After 5 minutes of talking to you in pre-op, I wanted to punch you in the face and man you up a little bit.” Court papers show that during pre-op, the patient had told Ingham that he had passed out once while having his blood drawn.

“I’m going to mark ‘hemorrhoids,’ even though we don’t see them and probably won’t.” In fact, Ingham later included a false diagnosis of hemorrhoids in the man’s medical chart.

“People are into their medical problems. They need to have medical problems.” Ingham reportedly made this statement after declaring the sedated patient a “big wimp.”

“One of the nice things about being an anesthesiologist is… making people shut the hell up.”

Dr Ingham also mocked the patient’s anxiety about seeing the placement of the IV line. “Well, why did you look then, retard?” she was heard to say. She also expressed a desire to put a gun in the man’s rectum and pull the trigger.

Ingham was fired and moved to a different state.

The ASA’s ethical guidelines note, “Anesthetized patients are particularly vulnerable, and anesthesiologists should strive to care for each patient’s physical and psychological safety, comfort and dignity. Anesthesiologists should monitor themselves and their colleagues to protect the anesthetized patient from any disrespectful or abusive behavior.”

Professional societies didn’t mince words about the ethical breach. “There’s really no excuse” for Dr Ingham’s behavior, J. P. Abenstein, MD, president of the American Society of Anesthesiologists. “There’s no reason to express those opinions in a professional setting,” he said, adding, “If you don’t have anything good to say, just keep your mouth shut.”

He said that even if the physicians were frustrated or annoyed, they were duty bound to treat the patient with dignity. And, he said, “In a perfect world, someone in that room should have attempted to divert the conversation. The AMA cannot condone when physicians surrender to petty and unprofessional conduct in violation of ethical obligations to the patients they serve.”

(Medscape, Anesthesiologist Loses Lawsuit for Mocking Sedated Patient)


How can you stay safe as possible when getting medical care?

  • Check the links below.
  • Check your doctor’s background (malpractice claims, disciplinary actions) as best you can.
  • Get a recommendation from a doctor, nurse or other health professional; they may have have inside information.
  • Read up on your condition, if you know what it is, and find out what the recommended treatments and procedures are.
  • Always get a second opinion before surgery.
  • When in the hospital, have a friend or family member stay with you as much as possible. (See the links below on how to stay safe in the hospital.)
  • Take notes. Keep a notebook with you during doctor visits and when hospitalized. People tend to respect stuff that’s written down. And if the doctors and nurses know you’re on it, they will be more accountable.
  • If possible, take a friend or family member in with you when you see a doctor. This is especially important for post-surgical visits.
  • I’d go as far as to suggest recording every conversation you have with a doctor. Check the laws in your state to see if you can do this without their consent, or if you’re especially assertive, tell them you’re going to record them so you can remember their instructions or advice.

How to Find a Doctor’s Medical Malpractice Suit Track Record

How to find out if your doctor is in good standing

CONSUMER REPORTS: How to find a good doctor (9 STEPS)

MAKING THE CUT: Why choosing the right surgeon matters even more than you know

Is Your Doctor Board Certified? Find Out Here

A Patient’s Guide: How To Stay Safe In a Hospital

Five Safe Surgery Tips for Patients

Why Doctors Stay Mum About Mistakes Their Colleagues Make

How Denmark Dumped Medical Malpractice and Improved Patient Safety

A Trail of Medical Errors Ends in Grief, But No Answers (“Paula Schulte couldn’t survive a cascade of medical mistakes. After that, her family couldn’t get accountability”)

Thousands of doctors practicing despite errors, misconduct

♥ Stay healthy, and when that’s not possible, stay safe!


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