By JACK DOLAN And MIKE McINTIRE
The Hartford Courant
May 01, 2000

No one ever told Diane Hadzopulos just how her mother died.

Until this month, Hadzopulos never read the nurse's account of Dr. Syed Jamal struggling for 90 minutes to insert a pacemaker while her mother turned blue.

She wasn't told that another nurse wrote another critical memo after another of Jamal's patients died, or that a supervisor said Jamal lacked "the skills necessary to become a good cardiologist."

And she didn't know that Hartford Hospital terminated Jamal's cardiology fellowship several months later.

"Nobody at the hospital said anything," Hadzopulos said. "I can't believe they wouldn't tell me."

But the hospital's reticence is not that surprising. Although officials knew Jamal would pursue his goal of becoming a cardiologist elsewhere, Hartford Hospital also failed to take the one step guaranteed to warn future employers: notifying the National Practitioner Data Bank.

The data bank, a highly confidential computerized registry created by Congress, was set up expressly to let state regulators, hospitals and HMOs share information about problem doctors.

But the nation's hospitals, which stand to benefit greatly by being warned of potential liabilities, are the least candid about reporting to the data bank, studies show. And Connecticut hospitals rank dead last in reports to the data bank per thousand physicians.

The reasons why are the subject of a national debate that has drawn the attention of federal regulators and patient advocacy groups. Sixty percent of U.S. hospitals have never reported a doctor to the data bank since it went online in 1990, and although health experts expected 14,000 disciplinary reports a year, the annual average to date has been less than 1,000.

Defenders of Connecticut hospitals have a simple explanation for their dead-last ranking: The state has the best doctors in the country.

"I just don't believe that we're somehow under reporting," said Michael Eisner, a New Haven lawyer who represents several hospitals in the state. "Connecticut hospitals are almost all nonprofit; we?re up here in the Northeast, where the education pool is so strong. I honestly don?t think we get the same kind of problems other places get."

At least three studies in recent years have concluded that hospitals are either deliberately not reporting problem doctors, as they are required to by law, or are exploiting legal loopholes to avoid it. A 1999 federal health department inspector general's report cited "a cultural aversion to reporting a colleague" as one possible cause.

"I think the original drafters of the law never fully realized how difficult it would be to get doctors to discipline other doctors," said Teresa Waters, who studies the data bank for the Institute for Health Services Research and Policy Studies at Northwestern University.

"There are so many holes in the current law, a doctor has to do something pretty egregious to force his peers to report him," she said. "We know these things happen, but we have no idea how often."

In a system rife with secrecy, no information is harder to get than hospitals' records of actions taken against doctors.

Alone among licensed professionals, doctors are given exclusive authority to scrutinize decisions made and actions taken in the hospital setting. And in Connecticut, as in most other states, the outcomes of those 'peer reviews' are protected by law not only from public view but also from disclosure to regulators.

Nonetheless, The Courant was able to examine two cases that raise questions about whether the hospitals involved reported to the data bank doctors who left after their actions came under fire. Each case came to light through a search of court records.

In one case, a Bristol obstetrician, Dr. Brian Hennessey, left Bristol Hospital in 1993, about the same time he faced an internal peer review related to a difficult childbirth, according to sources familiar with the incident. The birth is now a subject of a malpractice lawsuit.

Physicians who voluntarily relinquish hospital privileges during or because of a peer review must be reported to the data bank. But the Courant's analysis of the data bank found no Connecticut surrendering hospital privileges who fit Hennessey?s description.

Hennessey now has privileges at Bradley Memorial Hospital in Southington.

In Jamal's case, Hartford Hospital administrators say they did not have to report him to the data bank because doctors who are interns or residents are exempt from reporting requirements. They said because Jamal ?? who was eight years out of medical school at the time ?? was at the hospital as part of a cardiology 'fellowship', he fit the exemption.

For Noella Hadzopulos' daughter, that explanation offers little solace.

Diane Hadzopulos said she had no idea there were any questions about the quality of medical care her mother received until The Courant showed her internal hospital memos describing in detail Jamal's handling of her mother, who died Feb. 23, 1993.

"There's no excuse for them to keep that a secret for all this time," she said. "If they told me, I wouldn't just let it rest. Maybe that's why they never told me."

Trainees Don't Count

Two loopholes helped Hartford Hospital avoid reporting Jamal.

Instead of revoking his privilege to treat patients in February 1993, shortly after Hadzopulos died, Hartford Hospital waited five months, for his first year of a three-year cardiology training program to end.

"There was no reason to report him to the data bank because we didn't take any disciplinary action against him. We just didn?t renew him," said Jeffrey Kluger, the Hartford Hospital cardiologist who supervised Jamal.

Second, reporting disciplinary actions taken against doctors in training, no matter how advanced, is voluntary.

Of the 31,221 license suspensions, license revocations and clinical privilege restrictions reported against physicians to the National Practitioner Data Bank since 1990, only 93 were filed against interns and residents.

Only one resident from Connecticut has had a disciplinary action reported to the national data bank.

Jamal's troubles in Connecticut would have remained secret if he hadn't sued the hospital for wrongful termination.

In order to prove there was cause to get rid of Jamal, Hartford Hospital attorneys introduced memos from nurses who witnessed Jamal's treatment of the two patients who died. Dr. David Waters, the former head of cardiology at Hartford Hospital, said in a statement submitted by the hospital that the memos demonstrated Jamal was "not effective in emergency situations and looking after common cardiovascular problems."

Waters also noted that Jamal "disagreed violently" with the decision to end his fellowship and concluded, "He will attempt to find a cardiology position elsewhere to pursue his training."

According to one of those memos, written after the death of 71-year-old Rupert Blade in January 1993, nurses paged Jamal repeatedly over the course of several hours to help them with Blade. When Jamal finally arrived, nurses wrote he stood with a "blank look on his face" while they scrambled to figure out how to treat Blade, who was in the middle of cardiac arrest.

At one point, after Blade's heart rhythm was stabilized, Jamal ordered that his medication be increased, which, the nurse wrote, sent Blade?s heart back into distress. Blade died within hours.

The memo on Hadzopulos' treatment said nurses once again spent hours paging Jamal to come help them. When he finally answered the call, he launched into a painstaking effort to thread monitoring and pacemaking wires to Hadzopulos' heart through veins in her neck and chest, but ignored the nurses' pleas to put a tube in the woman's throat to help her breathe. At the time, Hadzopulos was blue from lack of oxygen.

"Requests for patient intubation were made by this nurse citing above symptoms with worsening mental confusion. Patient stated "she felt like she was going to die -- Please kill me" over and over. "Dr. Jamal disregarded all of the above for reasons unknown or unexplained to me. I felt very frustrated," read the memo, signed by two nurses.

In the two weeks that 70 year old Noella Hadzopulos survived after the procedure by Jamal, Diane Hadzopulos never saw her mother conscious again. The most she could get out of her was a squeeze of the hand.

"I always wondered why my mother was asleep all the time after that first time I visited her. But nobody at the hospital said anything. I can't believe they wouldn't tell me," Hadzopulos said.

Several times in the past 10 years, Hartford Hospital officials have told patients or their families about medical misadventures, said Alfred Herzog, vice president of medical affairs for Hartford Hospital. But he said it's a tricky decision to make.

"When someone is very sick from a disease, or more often from multiple layers of a disease, it's very difficult to say one thing or another caused that. I mean, if somebody gives a patient the wrong medicine, or 10 times the right dose, and the patient dies, then it's simple. It's not pleasant, but you tell the family. But certainly nothing that clear happened in this case," said Herzog.

Jamal's case was settled out of court after Hartford Hospital reluctantly offered to give him academic credit for the one year he spent in training -- despite the well-documented concerns about his skills. The credit allowed him to continue studying cardiology and practicing medicine at a string of hospitals in Massachusetts. Jamal is now believed to be out of the country.

Jamal's lawyer, Danny Smolnik, said Hartford Hospital required a confidentiality agreement barring either side from discussing the facts of the case as a condition for the settlement.

The state Department of Public Health, which regulates both doctors and hospitals, was never informed about Jamal's dismissal.

Doctors Under Duress

Officials at Bristol Hospital will say almost nothing about their investigation into Nicholas Caswell's traumatic birth, or the departure of obstetrician Brian Hennessey.

"Dr. Hennessey relinquished his privileges roughly five years ago, and it was voluntary. That's all we can really say," said Mary Pat Caputo, a spokeswoman for Bristol Hospital.

But their is no record in the data bank of a physician fitting Hennessey's description having surrendered his clinical privileges in 1993. The data bank reports that two Connecticut doctors did surrender privileges that year; The Courant was able to verify that neither was Hennessey.

Nicholas was born on Sept. 6, 1992, with a fractured skull and blue from lack of oxygen. Witnesses said Hennessey made several panicked attempts to get Nicholas out of the womb with a pair of metal forceps, and several more attempts with a vacuum hose before the baby was finally born.

On the scale of 1-10 that rates the health of a baby at the time of birth, Nicholas was a 2. The boy has had some lingering difficulties.

Hennessey surrendered his privileges at Bristol Hospital in July 1993, sources familiar with the incident say. Fellow doctors at Bristol Hospital were conducting a peer review of Hennessey?s role in the Caswell delivery as late as June of that year, according to the sources.

Hennessey now practices with reduced privileges at Bradley Memorial Hospital in Southington, where he is not allowed to deliver babies.

"The way the law is supposed to work, a hospital can't just turn to a doctor under duress and tell him if he goes quietly, he won?t be reported to the National Practitioner Data Bank or the state," said Stanley Peck, who prosecutes doctors for the public health department. ?"But in the real world, we know it happens. It's almost impossible to prove."

Details of the Bristol Hospital inquiry are unavailable because such investigations, known as peer reviews, are immune from outside scrutiny. Doctors say that without the extraordinary degree of protection, fear of malpractice suits would silence staff and potentially correctable errors would never be examined.

But the veil of secrecy surrounding Hennessey parted slightly in summer 1995, when Hennessey's marriage fell apart.

That's when Judy Caswell got the first of a series of chilling phone calls from Adrienne Hennessey, who said her husband had been drinking heavily at home while he waited for Caswell to go into labor.

Adrienne Hennessey repeated that charge in a sworn affidavit during a state public health department investigation of the incident.

Caswell says Adrienne Hennessey also told her that Bristol Hospital's personnel files on Brian Hennessey included medical records that proved he had a history of serious drug and alcohol abuse, and the hospital knew about it.

The Caswells filed a malpractice suit against Hennessey, and the state department of public health opened its own three year investigation.

Hennessey's lawyers fended off a subpoena for his medical records from Bristol Hospital, which were never turned over to the state department of health. In the end, the Connecticut Medical Examining Board ruled that the health department had no credible evidence to support the charge that Hennessey had been drinking before the delivery. The only witnesses were Adrienne Hennessey and her mother.

Instead, the board reprimanded Hennessey and fined him $2,000 for writing a prescription in his mother-in-law's name for Ergoloid Mesylates, a drug used to treat reduced alertness, poor memory, and confusion in the elderly. Hennessey took the drugs himself. A record exactly matching the circumstances of the reprimand was found in the database.

The Caswells' malpractice suit against Hennessey is pending.