Pathological

by Henry Cordes

  They would see Garcia struggled mightily over the previous decade to get his medical career off the ground. And in most of his professional failures, Garcia’s firing from Creighton University often loomed large.

  CHAPTER 14: THE TRIGGER

  In July 2000, the heavy-set 27-year-old doctor arrived at Creighton University, a 122-year-old Jesuit institution that traced its history back to Omaha’s frontier days. He went through two days of orientation. He was issued a beeper and a badge that gave him privileges at St. Joseph Hospital, the Catholic teaching hospital adjacent to the university’s near-downtown campus. And he was issued two white lab coats embroidered with his name: Anthony Garcia M.D.

  Dr. Garcia was one of three first-year residents hired for the new academic year in Creighton’s pathology department. If all went well, four years later, he’d complete his training in this medical specialty, pass his national exam and become a board certified pathologist — his ticket to a lucrative medical career.

  Early on, Garcia sent photos home to his proud parents, one of him standing in his bleached white coat, another of him peering into a microscope. “Here are some more pictures of me at work,” he wrote.

  It appears the budding pathologist’s studies at the school got off to a decent start. Garcia received an outstanding review during his introductory monthly rotation. The Creighton faculty member overseeing the young doctor called him diligent and hard-working, glowingly concluding that he “has made the transition from ‘clinician’ to ‘pathologist.’”

  The records showed Garcia did particularly well in another early rotation — hematology, the study of blood.

  But as the Omaha detectives would learn years later, it didn’t take long for Creighton colleagues to begin seeing troubling signs in this new doctor.

  During conferences with supervising Creighton faculty, Garcia would cut up like a middle-schooler, making noises and rudely carrying on. He listened to no one. When Dr. Chhanda Bewtra one day asked the jerky resident to get out of the conference room, he refused. “I don’t feel like it,” he mocked. “I’ll do what I want.”

  For someone who’d graduated from medical school, this was shockingly unprofessional behavior. On top of that, Garcia’s work in the lab was found to be severely lacking.

  The doctor showed a lack of basic medical knowledge and seemingly little interest in his chosen field. When it came time for Garcia’s six-month review, a couple of his supervising physicians declined to even fill out evaluations, one later acknowledging he feared putting something so negative down in writing.

  But Dr. Bewtra didn’t hold anything back. She was always very frank and honest in her dealings with residents, focused on closing gaps in knowledge and performance. And she was quite blunt in her evaluations of Garcia. Her first official review of Garcia in the fall of 2000 was scathing, rating his attitude, knowledge and performance as simply unacceptable.

  “Very passive-aggressive,” she wrote. “Dr. Garcia showed marked lack of initiative and interest. He took no responsibility for his cases. His knowledge ... is very poor. When specifically asked to read up on certain topics and report back, he never did.”

  This whole Garcia mess ultimately landed on the desk of Bill Hunter. Dr. Hunter had just weeks earlier taken over as program director of the pathology residency program. He’d been asked to assume the post by Brumback, who himself had not long before arrived from Oklahoma as the pathology department’s new chairman. As residency director, Hunter’s job was to oversee the faculty evaluations of the residents’ progress and serve as a mentor.

  Hunter knew little about Garcia, the resident having been accepted into the department under the previous administration. But as Hunter looked into the background of this problem student, he began to wonder how Garcia had gotten into Creighton at all.

  Hunter could see from Garcia’s file that while he graduated from the University of Utah’s medical school in 1999, it had taken him five years instead of the normal four. He three times failed a test on the basic science underpinnings of medicine, an exam medical students must pass before they can continue on to their third year. And the reviews of his critical internal medicine rotation were damning.

  Hunter would years later learn of another black mark on Garcia’s resume, one that was unknown to him back in 2001. The Creighton residency was not even Garcia’s first. He had previously been drummed out of a family practice residency in Albany, New York.

  The reports out of Bassett St. Elizabeth Medical Center in 1999 suggest Garcia was not only a bad doctor, but a dangerous one. He several times prescribed inappropriate medications for patients, once ordering a sedative for a patient whose chart said in big red letters DO NOT SEDATE. He took an afternoon nap while overseeing maternity patients who were in active labor. He lied about how completely he’d examined a patient.

  Garcia always blamed others for his mistakes. Words that Bassett faculty members used to describe him would have certainly had a familiar ring to those who met him later at Creighton: lack of basic knowledge; lazy, lax and uninterested; surly and unreceptive to correction; arrogant and inappropriate behavior around staff and patients. “At the present time, you appear headed for disaster,” the residency director wrote to him.

  There also would be indications in the New York records that doctors there felt Garcia had some type of documentable personality disorder. The residency director put him on suspension and ordered him into counseling, suggesting he would need neuropsychological testing and therapy for any possible “underlying medical disorders.”

  It’s unclear whether he underwent that evaluation. But his antisocial personality is what finally got Garcia bounced out eight months into the residency. His ouster followed an incident in which he yelled at a radiology technician.

  “Don’t give me your shit!” he screamed in front of a 12-year-old patient when the technician asked why he wasn’t responding to her. Garcia chose to resign rather than face a disciplinary hearing on the incident.

  Alarming as the New York revelations sound, Creighton didn’t know anything about them. Dr. Garcia failed to disclose the previous residency in his application to the school. Still, such a one-year time gap in a resume always suggests possible problems. Hunter believed it was a red flag the previous administration should have caught and explored more deeply.

  Looking back, Garcia’s past indeed does beg the question: Exactly how did he get into Creighton? “That’s what I keep asking,” Hunter would lament in an interview years later.

  Not only were his credentials poor, Creighton’s typical interview process for new residents — in which several faculty members and current residents have the chance to meet with the job candidate — had not been followed in his hiring.

  Hunter would later have his speculations as to what happened. As a small medical school far from the coasts, Creighton at times had difficulty attracting top-flight American medical school grads. In those years, it would often instead fill some residency openings by falling back on graduates of foreign medical schools.

  Such international med school grads were most often solid doctors but at times came with their own challenges, including language barriers. And at the time Garcia was accepted at Creighton, the school’s pathology program was heavily populated by such foreign residents. Hunter surmised the previous department chair decided to fish at the bottom of the domestic candidate pool rather than accept yet another foreign resident. But it was a horrible decision. Hunter wasn’t the only one in the department who would find it hard to believe Garcia was ever hired by Creighton.

  Still, regardless of how Garcia had landed at the school, Hunter in 2001 also knew that Garcia had now become Creighton’s problem. And Hunter was committed to doing what he could to help the resident succeed.

  Hunter by his nature was a humble, caring and good-natured man who tended to see the good in people. In the medical school, he was known as a student-cen
tered educator who advocated for his students. He was always willing to go the extra mile for them. For that reason, he was beloved among students and had won several teaching awards.

  When it came to weak or struggling residents like Garcia, Hunter’s philosophy was to work patiently with them during their first year and give them time to correct any deficiencies. He found they usually took their issues to heart and eventually got up to speed. If serious problems persisted into the subsequent years of the four-year residency, that’s when Hunter felt it was time to draw the line.

  One of the few people who didn’t care for Hunter’s ways was his boss. Brumback, the department chair, told Hunter he didn’t think he was strict enough with residents. It would become a regular source of conflict between them. Hunter simply disagreed with Brumback’s more stern approach.

  True to his nature, Hunter sat down with Garcia in January 2001. He kindly noted all the problems reported by Bewtra and others. He gently prodded the young doctor, suggesting Garcia show more enthusiasm for his work.

  Hunter wasn’t impressed with the resident’s response. Garcia seemed paranoid, believing his evaluators were out to get him. This guy has a real chip on his shoulder, Hunter thought.

  From there, Garcia’s problems only escalated. As Bewtra gave Garcia another bad review during a February conference, Garcia launched into a belligerent tirade, calling her names. Bewtra argued that Garcia should be immediately put on probation for possible termination. “Bill, how many more documentations do you need?” she asked Hunter in a note.

  Garcia claimed Bewtra was the one in the wrong, saying she had many times “humiliated, degraded and insulted me.” He sent a letter to Creighton’s chief resident threatening to file a lawsuit. “Bewtra hounds you by saying, ‘you should know this’ and ‘why don’t you know this,’” he wrote in another email to Creighton officials. “She uses her position to verbally abuse residents she works with.”

  Despite Garcia’s protestations, Hunter trusted Bewtra’s reviews. He knew her to be a tough but fair and level-headed educator. And Hunter had also recently observed firsthand an incident in which Garcia was contentious, defensive and disrespectful after another faculty evaluator who oversaw a Garcia autopsy pointed out the resident’s faulty technique and misdiagnosis.

  “This guy needs an attitude adjustment,” the colleague told Hunter afterwards. Hunter agreed. He, too, now believed Garcia had some type of personality disorder.

  Then just days later, Garcia made an error that proved a major embarrassment to Creighton. After an autopsy, he’d left the body of a woman face down overnight, disfiguring her face. The outraged funeral home director registered a complaint with the school.

  Brumback was furious. He called Garcia into his office and read him the riot act, accusing him of mutilating the body. Amazingly, Garcia didn’t seem to understand why they were making such a big deal out of this.

  Hunter was now in agreement with Brumback and Bewtra. He wanted Garcia gone. But Hunter still wasn’t ready to kick Garcia to the curb.

  For one, it was legally hard to fire a resident. They practically had to murder someone before you could boot them out mid-year. Second, he believed if Garcia could make it through the year, a change of scenery might do him some good. He had previously seen residents flourish in such circumstances.

  But the biggest driver in Hunter’s thinking was this: In medical circles, it was a huge black mark to be dismissed from a residency program. For a doctor, it could well be a career killer.

  Instead, Hunter’s hope was that Garcia could get through the rest of the academic year and walk away with a certificate for a full year of training. He could then seek a medical future elsewhere. It was the “humane thing to do,” Hunter thought.

  So as Hunter and Garcia walked out of Brumback’s office after the autopsy incident, Hunter told him the school would probably not be renewing his contract for the second year. He needed to be looking for another job. Hunter cautioned him to keep his nose clean until the school year ended in June. “You’re digging your own grave here,” he told him.

  Garcia seemed at first to take the decision as an affront. Hunter wasn’t sure how he would respond. “I hope he takes our offer to go quietly, otherwise he’ll have trouble finding another position,” Hunter wrote soon after to a colleague.

  Despite Garcia’s initial reaction, it seems the non-renewal notice did ultimately get his attention. Because the doctor soon after expressed a desire to stay at Creighton and resolve his problems. “I will change to be the resident the faculty wants,” he pledged in writing to Hunter.

  Hunter sat down with the young doctor and again counseled him, urging him to work with his teachers. He also asked him to apologize directly to Dr. Bewtra. Hunter put the terms down in writing, and Garcia agreed to them. “I am sorry if any of my words have insulted you, a teacher whose efforts shape the future minds of pathologists,” Garcia awkwardly wrote to Bewtra in mid-March.

  For the next two months, Garcia’s performance did somewhat improve. In mid-May, the Creighton doctor overseeing his latest rotation gave an encouraging review. Garcia had interacted well with others and gave well-received presentations. It seemed to Hunter that Garcia might be able to squeak through after all.

  But just two days later came an incident that finally forced even Hunter’s hand.

  While the chief resident was in the midst of taking a high-stakes national exam that would determine whether he would be licensed to practice medicine, someone called his wife and said he was urgently needed at Creighton. If he didn’t report right away, the caller claimed, he’d be fired.

  Creighton officials saw the incident as, at the very least, harassment, and at worst, a deliberate effort to sabotage the resident’s exam. And they quickly determined Garcia was behind it. He and another resident had been overheard conspiring over the deed in Creighton’s “gross room,’’ the aptly named lab where pathologists dissect human tissue samples.

  That was it. Hunter the next day prepared a lengthy memo documenting Garcia’s litany of failures. University attorneys got involved. Then on May 22, the doctor was summoned to Brumback’s office. Hunter read aloud Garcia’s official letter of dismissal.

  Garcia denied any knowledge of the harassment incident, even after he was confronted with the fact he’d been overheard masterminding the plot.

  Hunter gave Garcia a choice: He could immediately resign, or he would be fired. Garcia chose to be fired, doing so to enable him to appeal the decision to the dean of the medical school. A school security guard was there to escort Garcia out, but it was unnecessary. Garcia was docile and passive as he left the pathology department for the last time.

  Both Hunter and Brumback subsequently testified during a hearing on Garcia’s appeal, which the dean denied. His firing became official on July 12, 2001. While a number of pathology residents in the past had failed to have their contracts renewed, or had been convinced to leave voluntarily, Garcia was the first Hunter could ever recall who was outright fired.

  Garcia contemplated suing Creighton. But, in the end he left quietly, with no further fuss. Then, amazingly — thanks in large part to Hunter — Garcia actually landed on his feet.

  Just two months after his Creighton dismissal, Garcia was accepted into another pathology residency, at the University of Illinois College of Medicine in Chicago. The ever-gracious Hunter had written a generic letter of recommendation for Garcia and then vouched for him to his counterpart at the school. Hunter expressed his belief — seemingly hoping beyond all hope — that Garcia could still succeed. “I was probably over-optimistic,” Hunter would say years later of his final effort to help Garcia. “But I thought maybe in another environment, he’d be OK.”

  Garcia was also helped by the fact the Chicago school had a pathology opening as the academic year was starting and a quota to fill. But if Hunter or anyone was optimistic about Garcia’s third
residency, it wouldn’t be borne out. The administrator who hired Garcia would later say it was the stupidest decision he ever made. Garcia wouldn’t make it through two years in Chicago.

  If Garcia suffered from some kind of personality disorder at Creighton, it appears in Chicago he fell into a deeper mental health abyss. He was plagued by migraines, depression and poor health that caused him to take long leaves of absence. Records would later show he racked up $80,000 in medical bills, many of them to neurologists and psychiatrists.

  In failure, in 2003 Garcia drifted back home to his parents in Walnut, California, a well-off suburb in Los Angeles’ inland valley. Under a mountain of medical debt, he filed for bankruptcy in 2005. According to a Garcia email the Omaha detectives obtained, Garcia worked at home fixing cars and debated whether he wanted to try to continue in medicine.

  But again, Garcia somehow was able to resurrect his medical career from the scrap heap. In 2007, he was accepted into a psychiatry residency at Louisiana State University Health Sciences Center in Shreveport.

  There had been no mention of LSU in the Creighton records Mois had originally viewed. But on June 12, Herfordt received records he had requested from Bassett. In those files was a recent application by Garcia for a medical license in Kentucky that listed the LSU residency.

  Herfordt requested the LSU records, too. When those records came in days later, the detectives could see the LSU residency proved no more successful than Garcia’s previous three. And significantly, they also saw that his Creighton firing — and Garcia’s efforts to conceal it — were at the center of his undoing.

  Garcia received a temporary license to practice medicine in Louisiana while the state medical board reviewed his credentials. As was typical in such reviews, the board contacted previous schools to verify the training Garcia listed on his application. They reached out to Bill Hunter at Creighton.