Five pathologists slipped into the microscope lab at Martin Luther King Jr./Drew Medical Center, steeling themselves to act after months of deepening suspicion.
They'd seen enough. They were convinced that their newest colleague, Dr. Dennis G. Hooper, was making dangerous mistakes. And on this August afternoon in 2000, they were prepared to turn him in.
Dr. Brian Yee had caught the first hint of trouble in April. Rechecking a 27-year-old man's blood work, he noticed that Hooper, a pathologist with 16 years' experience, had missed signs of leukemia.
Over the summer of 2000, the pathologists believed, Hooper had misdiagnosed at least four other patients.
One was Virginia Jackson, 75, known as "Mama Jackson" to her adoring 117th Street neighbors. In early July, Hooper had said she was cancer-free — having failed to spot the malignant cells in her urine.
Six weeks later, another pathologist, Dr. Theresa Loya, found invasive bladder cancer in a subsequent biopsy. The cancer would eventually kill Jackson, a mother of 16 and grandmother of 39.
About the same time, Dr. Hezla Mohamed was asked to recheck another of Hooper's cases. Hooper had seen "no area of malignancy" in the swollen neck tissue of a 59-year-old man, medical records show. Mohamed suspected that it was thyroid cancer — a finding that an outside lab would later confirm.
At a certain point, "you start to wonder if the person knows what he's doing," said Mohamed, now pathology chairwoman at the Los Angeles County-owned hospital.
In the microscope lab that August day, Hooper's colleagues worked out the details of a warning letter to the hospital's chief medical officer and his associate.
The letter said Hooper, in his first six months on the job, had lost specimens and at times cut tissue so sloppily that he could not make an accurate diagnosis. It meticulously charted his alleged failings, listing each by case number, and cautioned that his work "puts all of us and the institution at risk for medical malpractice."
Soon afterward, Mohamed recalled, the pathologists met with the hospital's medical leaders, who said they would investigate the complaints and keep an eye on Hooper.
Further entreaties brought no response. Tension gave way to bitterness as the colleagues realized that this was the hospital's final answer: silence.
"Here you had five pathologists signing a letter listing cases and telling administration in no uncertain terms that this pathologist has competency problems, and there was no response," said Dr. Timothy Dutra, who signed the letter.
Worse than that, he said, the hospital's medical leaders later denied ever receiving the letter, "even though I know it was given to them on three separate occasions."
Hooper continued working, whipping slides through his microscope with a speed some colleagues considered irresponsible. The tall, paunchy pathologist, once eager for their friendship, kept more to himself now, listening to the music of Yanni on his headphones and saving his charm for their boss, Dr. Irene Gleason-Jordan.
Even when confronted with mistakes, some co-workers recall, Hooper seemed indifferent to the life-or-death importance of his job. Though pathologists rarely see patients in person, they issue crucial verdicts based on blood or tissue samples. Depending on a pathologist's report, patients can return home to a normal life, require surgery and other treatment, or face the reality that their lives are ending.
Six months after the pathologists sent their letter, Johnnie Mae Williams, then 40, went to the public hospital in Willowbrook, south of Watts, for a seemingly minor gynecological exam. Hooper determined that she had cancer of the uterine lining, and surgeons quickly gave her a radical hysterectomy, taking out all of her reproductive organs.
Hooper was wrong.
He had seen cancer — but it wasn't hers. His findings, it was later determined, were based on a slide from another patient, who had brain cancer. In his report, Hooper raised the possibility that the slide had somehow been mislabeled, but medical records show no evidence that he investigated where the slide came from.
When Mohamed examined Williams' excised organs 2 1/2 weeks after her surgery, she found no evidence of cancer, according to Williams' medical records.
A uterine-cancer expert said that what Hooper saw on the slides should have made him wary. The cancer that he diagnosed is uncommon in a woman of Williams' age, and one cell type necessary for Hooper's finding was absent, said Dr. Lora Hedrick Ellenson, a professor of pathology at Cornell University's medical school, who reviewed Williams' medical records for The Times.
"Everything about this case should have raised all kinds of red flags," Ellenson said.
Mohamed informed at least five other doctors at King/Drew, including several involved in Williams' care, that she did not have cancer, the records show.
But no one told Williams.
She did not learn of the misdiagnosis until more than two years later, when a Times reporter — unaware that she didn't know — sought her out for an interview.
After the operation, "I felt like I wasn't even going to be a full woman anymore," she said, her hands shaking.
The mother of three had wanted to have more children. But she'd taken solace in being a cancer survivor, and she'd been grateful to King/Drew. "Everyone kept calling it 'Killer King,' " she said. "I used to say, 'No, that hospital saved my life.' "
Hooper, 55, has repeatedly declined to discuss the case and others cited in this article.
His attorney, James Andrew Hinds Jr., wrote in a Nov. 5 letter to The Times that the criticisms of Hooper amounted to "innuendo" and were "without factual substantiation." In fact, he said, Hooper cleaned up "an administrative mess at the hospital." Hinds also indicated that the doctor was precluded from commenting because of patient confidentiality rules.
As much as they scrutinized Hooper's performance at King/Drew, his fellow pathologists knew little about his past. The same was true, apparently, of hospital officials.
Had they looked into it more closely, they might not have hired him in the first place.
An unseen cancer When Roberta Nesbit got the results of her biopsy back from a San Diego lab in 1995, she had reason to celebrate.
The mole on her groin was benign, according to Hooper, who was filling in for another pathologist at the lab. She was cancer free.
Actually she wasn't. Over the next 15 months, the melanoma would grow underneath her skin, becoming a massive tumor. She had a second biopsy, which revealed not only that she did have cancer, but also that it had spread to her lymph nodes.
Nesbit sued Hooper and the lab for malpractice.
In court papers, the pathologist's own attorneys conceded that even a second-year medical trainee would have spotted the cancer in the mole. But Hooper, they said, was not at fault: He must have looked at a slide from another, healthy patient, mislabeled by a technician as Nesbit's.
Nesbit's attorney, who dismissed Hooper's defense as specious, negotiated a $450,000 settlement with the doctor in 1998.
Less than a year later, Nesbit was dead at 57.
"We're not talking about some trivial error here," said Nesbit's lawyer, Richard Binder. "We're talking about something that cost someone her life."
Hooper moved on. By late 1997, he was filling in at a Reno medical center operated by the U.S. Department of Veterans Affairs and tending to private medical laboratories he had opened in California, Nevada and Wyoming. (He eventually operated at least six, at various times.)
At the VA medical center, former co-workers remember him in rumpled khakis, singing along with Elvis recordings during autopsies or lamenting the ban on the diet drug combination fen-phen. He'd hurry through dissections and slides, then make phone calls related to his outside businesses, they say.
As at King/Drew, it wasn't long before the quality of his work came into question.
In May 1998, a surgeon discovered that Hooper had failed to notice one of two tumors in a section of colon she had taken out, according to VA documents that The Times obtained through the federal Freedom of Information Act. Another pathologist determined the growth to be cancerous.
After a second physician expressed worries, Hooper was found to have made at least two more serious errors, VA documents show.
Ultimately, hospital administrators opened an investigation and sent slides from 346 of Hooper's cases to the nationally renowned Armed Forces Institute of Pathology for a comprehensive review. Of these cases, nearly a third contained mistakes. The institute found that Hooper had made major errors in 10 cases and minor errors in 104 more. Major errors typically require remedies such as chemotherapy or surgery.
According to a published study and two experts, the standard error rate for major mistakes by a general pathologist such as Hooper is less than 1% when all cases are reviewed.
Hooper's rate was nearly three times that.
His contract as a fill-in at the hospital was not renewed, VA officials said.
"I would not hire him ever" again, said Dr. Paul Jensen, former chief of pathology and laboratory medicine at the Reno facility. "Wouldn't even consider it."
But the VA kept Hooper's litany of mistakes to itself — never alerting the Nevada Board of Medical Examiners.
Dr. Thomas Barcia, the hospital chief of staff, said VA lawyers advised him that Hooper's errors fell within acceptable industry norms.
To this day, if another hospital called to inquire about Hooper, the VA would give him a clean reference, Barcia said, adding that "the data I have does not show he was a substandard pathologist."
In 1999, the year after the VA's investigation of Hooper, another arm of the federal government sanctioned him for lapses in his private Reno laboratory.
The Health Care Financing Administration determined that Hooper had falsely claimed the lab was accredited by the College of American Pathologists. In fact, he had never applied for such accreditation, government records say.
The regulators also found that Hooper closed the lab to avoid an inspection. The government banned him from owning or operating a pathology lab anywhere in the United States for two years.
Even before these sanctions, some associates had serious doubts about the quality of work at Hooper's labs.
One of them was James Champa, a Wyoming orthopedic surgeon and former medical school friend.
"I realized something was wrong," he recalled, "when my male patient got a positive pregnancy test from the lab Hooper ran here in Jackson."
'On the fast track' From an early age, Hooper sought to make his mark in the world of science.
After high school, he left tiny Ely, the dusty east Nevada mining town where his father was postmaster. While pursuing a PhD in microbiology, Hooper attended medical school at the University of Nevada in Reno.
He told admiring classmates that he'd been asked by medical school officials to teach microbiology, but felt it would be awkward to instruct his peers.
"He was on the fast track," Champa recalled. "I was awed."
Hooper trained as a pathologist in the Navy and leaped over colleagues to become chairman of the laboratory department at the Naval Medical Center in San Diego.
Then, in 1994, his nearly 15-year naval career came to an abrupt, and somewhat mysterious, end.
Hooper resigned after he was investigated for allegedly using government resources improperly, according to his own testimony in a 2002 court hearing. The Navy would not discuss the inquiry.
Hooper rebounded quickly. He captivated friends and colleagues in the mid-1990s with ideas for lucrative diagnostic and research labs.
They recall his saying that he was on the hunt for an HIV vaccine and that he had a patent on his research. He planned to sell the idea to a pharmaceutical giant.
But first he needed money. Many friends — and their families and their friends — invested with Hooper, some handing over hundreds of thousands of dollars.
Hooper, who had been active in his Lutheran church, came across "as a person who is really dedicated to medicine and especially to HIV," said Father Frank Hoffmann, a Catholic hospital chaplain in San Diego who invested $8,000 of his retirement money. "He looked honest, sincere. With me he would always bring up the religious part."
Colleagues and other investors say Hooper appeared to be the high-rolling businessman, entertaining them in casino suites and fancy restaurants.
He would disarm them, they say, with funny asides punctuated with high-pitched giggles.
He seemed to handle the pressures of business well, his associates said, though they noticed that he chain-chewed Pepcid AC and Tums, bought in bulk at Costco.
Before long, however, his enterprises crumbled. The promised profits never materialized. And Hooper, once so solicitous, stopped returning investors' calls.
Hal Forseth, a Montana obstetrician who interned with Hooper in the Navy, recalled the pathologist's sending a brisk form letter saying Forseth's investment had been lost: "Just, it tanked . Adios, amigo. That was hurtful. He was a friend."
Hooper filed for personal bankruptcy in 1999 — a year before King/Drew hired him — listing 28 pages of creditors. Two groups of investors sued, accusing him of swindling them out of nearly $1 million in all. In court papers, he denied the allegations.
In one suit, investors alleged that Hooper had coaxed them into funding labs and research destined to fail. They contended that he knew his HIV vaccine didn't work and that, contrary to his claims, it had not been patented.
"You're looking at him and you're thinking, 'This is the nice guy next door who will help my mom across the street,' " said Dr. Thomas O'Gara, a Reno family physician and medical school classmate of Hooper.
O'Gara's family won $70,000 in a court judgment last year, but he said they had yet to collect anything. With interest, the award had grown to at least $95,000 as of October 2003, according to a court filing.
"He didn't just take me," O'Gara said. "He took my mother, my dad. He took my brother."
The second suit, filed by eight other investors — including Father Hoffmann — is pending.
Robert Mallon, a Yuma, Ariz., pathologist and former Navy colleague of Hooper, said he hoped to recover at least some of the $167,000 he invested.
"If we get a judgment against him, I'll follow him to his grave," Mallon said.
Red flag after red flag The investor suits are among several items in public records that document Hooper's legal and professional troubles in the years before King/Drew put him on staff.
Evidence could also have been found at the Nevada medical board, to which — as a doctor licensed in that state — he was required to report the Nesbit settlement. Other information was in the U.S. government's Laboratory Registry and in federal bankruptcy filings.
And these are just the public documents. More could have been gleaned from private reference checks.
Los Angeles County health officials said King/Drew did a criminal background check on Hooper and searched his malpractice record on a national registry. County spokesman John Wallace said he could not discuss the registry results because they are confidential. Hooper had no criminal history, Wallace said.
It is unclear whether King/Drew knew of Hooper's federal lab sanctions or the investor lawsuits, Wallace said. Physician applicants at the hospital are not required to disclose bankruptcy filings or lawsuits unrelated to malpractice.
But a hiring expert said a responsible hospital should make every effort to learn if there had been any.
Any business should be wary of a bankrupt applicant who is being sued by his partners, because he might be more concerned with his legal woes than the job at hand, said William Greenblatt, chief executive of Sterling Testing Systems, which performs background checks on hospital job applicants and others.
"You would have to know that he had lawsuits," said Dr. David Shenton, who added that he lost $15,000 in one of Hooper's ventures.
"You'd see some red flags, and then you'd call references," said Shenton, who helps screen physician applicants at his Billings, Mont., hospital. "It just seems sort of odd that [King/Drew] didn't catch it."
Impassioned campaign In the pathology lab at King/Drew, Dr. Dutra knew only what he saw: a colleague who shrugged off his mistakes — when he acknowledged them at all.
"He would make these casual diagnoses that were wrong, and they didn't seem to bother him," Dutra recalled.
While the other pathologists sank into bitter disappointment at management's seeming indifference to their concerns, Dutra embarked on an impassioned campaign. He made angry phone calls and wrote pleas to county Supervisor Yvonne Brathwaite Burke's office, county auditors and health department leaders and the Medical Board of California. He listed new diagnoses by Hooper that he considered questionable, including case numbers and dates.
He sometimes began his letters with sheepish apologies for his earlier vehemence.
"The truth of the matter is that we're only seeing the tip of the iceberg," Dutra wrote in May 2001 to Dr. Gail Anderson Jr., the health department's acting medical director who oversaw King/Drew. "Who knows how many other time bombs Dr. Hooper has out there, waiting to show up sometime in the future with their misfortune?"
Dutra's frustration clouded his professionalism at times, he freely acknowledges. One day he ranted against Hooper so loudly in the pathology department hallway that Hooper called him later and, in obscene terms, told him to "shut the up," Dutra said.
County auditors, spurred in part by Dutra's effort, began asking questions about Hooper in November 2000. Stymied by what they saw as hospital officials' slow responses, they didn't complete their report until September 2001.
Their conclusion: Dutra and his colleagues had been right all along. Hospital leaders had known of Hooper's failings and done nothing.
The 16-page report faulted Dr. Edward Savage, the former medical director to whom the pathologists had addressed their letter, and Gleason-Jordan, the department's chairwoman, for brushing aside the warnings.
The audit urged disciplinary action against Hooper. But by this time, he was on disability leave, claiming harassment and stress, the audit said. He formally left county service in July 2002. Hooper was never disciplined, county officials recently confirmed.
Others faulted in the audit still contest its findings.
"They don't know what they're talking about," said Savage, who retired under pressure but now works at the hospital part time. "We did everything according to the rules."
Gleason-Jordan was replaced as chairwoman the month after the audit was released, and she later retired.
In an interview, she defended Hooper's performance and accused her former staff of lying.
Dr. Thomas Garthwaite, who became director of the county Department of Health Services in early 2002, said the Hooper case was his first signal that King/Drew suffered from grave medical and management problems.
"I was just struck by the nature of the errors and by the relatively casual way it was handled," he said recently. "It was very clear to me we needed new leadership."
Garthwaite could not explain, however, why he did not act against Hooper.
An independent expert who reviewed the audit, the pathologists' letter of warning and other records for The Times said Hooper's ongoing mistakes pointed to broad failures in leadership at the hospital.
"Certainly his bosses were not doing a good job in preventing these errors," said Dr. Hector Battifora, former chairman of pathology at City of Hope National Medical Center in Duarte. "When errors like this happen and they are reported and nothing is done that is absurd. And the administration should have been aware of it, and they should have done something about it."
Dutra distinctly remembers one administrator's response.
Anderson, the health department's acting medical director, chastised Dutra in a letter for "releasing confidential, patient-specific information" to the medical board and Burke's office.
In the final paragraph, however, Anderson briefly commended Dutra's concern for patient safety.
Reexamining 2,000 diagnoses Administrators finally did something about Hooper — after he was gone.
They paid Mohamed and another pathologist thousands of dollars to comb through all his nearly 2,000 diagnoses.
Mohamed said she had not kept a precise tally of misread tests, but had referred cases as she found them to the hospital's risk management department. She said recently that she could remember just one significant case beyond those the hospital already knew about.
According to court files, Maria Aparicio, now 66, learned after the review that Hooper had missed her breast cancer two years earlier. Aparicio, who required surgery and follow-up treatment, sued and collected a $25,000 settlement from the hospital.
California authorities did not try to discipline Hooper until October 2003 — three years after the pathologists wrote their letter — when the state medical board accused him of mishandling the care of six King/Drew patients, including Williams, whose reproductive organs were removed unnecessarily. He is contesting the board's accusation.
Dutra took no solace in his group's ultimate vindication by county auditors. He left King/Drew in July 2003, disgusted, he said, with its leadership. "Even when you win, you don't win anything," he said.
By the time the medical board filed its case, Hooper had left the state.
Today, he is a staff pathologist at a large private hospital in San Antonio.
"Dr. Hooper is a member in good standing of our medical staff here at Baptist Health System," spokeswoman Karen May said. "And that's the information we're prepared to release."
Times researcher Scott Wilson contributed to this report.