When Joseph Branda underwent surgery three years ago to have a fingernail-sized tumor removed from his bladder, he and his wife, Loretta, knew there were risks associated with such major surgery. But they never thought that one of them would turn out to be an anesthesiologist who was an impostor.
During the operation at Walson Army Hospital in Ft. Dix., N.J., Branda stopped breathing. That went undetected for three minutes because Abraham Asante, the man hired by the hospital as its sole anesthesiologist, had not hooked Branda to a heart monitor.
By the time Branda's condition was noticed, he had gone into cardiac arrest and had turned blue from head to chest. Branda, then 46, was revived, but his brain had been robbed of oxygen for too long. He emerged from the operating room in an irreversible coma.
It was only then that the Army discovered that Asante was no doctor.
Asante was tried, convicted and sentenced to 12 years in federal prison.
"You hear stories (of cases like this) but you don't think twice about them. And then it happens to you," Loretta Branda said in a telephone interview from her Medford, N.J. home. "How could the Army do such a thing? How could they allow that to happen?"
Medicine has a long history of bogus doctors, crafty impostors who don white coats and win the trust of patients and physicians alike, deploying a polished bedside manner that often masks their limited expertise.
Some have done quite well at it. In Orange County, a high school dropout treated patients for 18 months in an urgent-care center, pulling in an annual salary of $98,000 until he was caught earlier this year.
Patients Can Check
In many cases, impostors--former medical corpsmen, failed medical students or simply very polished con men--take on the identity of living or deceased physicians and stay on the move, keeping one step ahead of suspicion. In other cases, they use their own names and fraudulent documents.
Authorities say detecting impostors is fairly simple. They recommend that patients check a physician's credentials with medical associations and licensing agencies. A newly enacted federal law, aimed at policing incompetent doctors as well as impostors, mandates the creation of a clearinghouse, which should make that task easier.
"But no system can guarantee there won't be impostors out there," said Dr. James S. Todd, senior deputy executive vice president of the American Medical Assn.
"No matter what you do, there are always going to be impostors," he said. "You'd be surprised how many times we get inquiries about a certain doctor and, when we look him up, our files say he has been dead for X number of months or years."
Estimates of the number of impostors are hard to come by. "Nobody knows," said Ken Wagstaff, executive director of California's Board of Medical Quality Assurance, which oversees the licensing of the state's 65,000 doctors.
Only a handful a year get caught; yet even one impostor has the potential of causing harm to many people. "It certainly is a significant problem," Todd added.
Typically, impostors are caught only after they have made some grave, possibly deadly, error. One of those is Gerald Barnes.
Barnes moved to California in the mid-1970s, about the same time he lost his Illinois pharmacist license after working at several Chicago-area drug stores. In California, he began impersonating a Stockton surgeon with the same name.
A one-time amateur actor in Illinois, Barnes carried on the impersonation for 3 1/2 years in Southern California, until he made a fatal error while working at an industrial medical office in Irvine in December, 1979.
A 29-year-old man had come to him, complaining of dry mouth and lips, sudden weight loss, dizziness and insatiable thirst--classic symptoms of uncontrolled diabetes. Barnes ordered blood and urine tests but sent the patient home with a prescription for the dizziness.
Two days later, the patient, John McKenzie, was found dead in his Anaheim apartment.
Cynthia Mitthauer, 32, was luckier. Seven years ago, struggling to support herself and a small son after a divorce, Mitthauer decided to bypass her well-established--and costly--specialist when her troublesome right ear developed another problem.
Instead she went to an Irvine industrial medical clinic with which her employer had a low-cost insurance plan. She was seen by Barnes, for only $4.
Cyst Behind Ear
He diagnosed an ear infection and prescribed medicine. But the ear did not heal and, despite repeated visits, Barnes would not refer her to a specialist who would have been covered under her insurance.
Six months later, still in pain and suffering from a hearing loss, Mitthauer went to her specialist. He found a cyst growing on the bone behind her ear.
If it had gone unchecked, "it could have grown into the brain," she said. Mitthauer underwent two surgeries, paid for by Medi-Cal.
"Now I know I can go to the library and check on doctors, find out what schools they went to," said Mitthauer, who now lives in Van Nuys. "Now I check with friends and relatives about the doctor. Then I ask the doctor a lot of questions, to see if he really cares about me as a patient."
But even while awaiting trial in the 1979 death of the diabetic patient, Barnes was busy applying for jobs as a physician in Los Angeles and Milwaukee.
Barnes was convicted and served three years at the California Institution for Men at Chino. After he was paroled, he again worked as a physician, in West Covina and East Los Angeles clinics.
This time he was caught after authorities were tipped off by his former receptionist, who recognized Barnes when, coincidentally, he applied in person for a position at an Anaheim medical office where she was then working. In 1984, Barnes pleaded guilty to two counts of grand theft (for taking money from patients who believed that he was a physician) and six counts of writing prescriptions.
After a return to Chino, he is on parole again. He declined to be interviewed for this article.
Ruth Rosewitz, a 52-year-old Fountain Valley woman, also had a brush with an imposter. She lived to tell about it.
For 1 1/2 years, a Dr. Alvin James Stewart set broken bones, sutured wounds and performed physical exams at urgent-care centers in Fountain Valley and Westminster. He behaved so convincingly that the medical director and other staff members were stunned when investigators revealed him in April to be Enrique Herrera, 36, a former Navy medical corpsman.
"He was very charming, very personable, like a soft teddy bear. He had an easy, relaxed style," recalled Rosewitz, who two years ago had a broken toe set improperly by Herrera. Months later, unable to walk without pain, she sought out an orthopedic surgeon, who repaired the toe with a bone graft from her hip. But Rosewitz, an educational therapist at the Veterans Administration Hospital in Long Beach, said the specialist could not undo all of Herrera's damage. She has been told that the only way to relieve the pain is amputation.
Herrera had been hired after he presented the medical director with a resume, the state medical license number of the real Stewart, and Stewart's Drug Enforcement Agency card, which is necessary for physicians to write prescriptions.
Herrera easily could have been exposed as a fraud then, Wagstaff said, if only the medical director had asked a few questions: Where was his diploma? What about references? Did he have staff privileges at any hospitals? If not, why not?
'The Hard Way'
A call to the Board of Medical Quality Assurance, Wagstaff added, could have revealed telling biographical information, such as Stewart's birthdate. Stewart was 65; Herrera was 36 at the time of his arrest, although he had claimed to be about 50.
The urgent-care center's medical director said it did not occur to him to ask Herrera for references or additional information. "I guess I learned the hard way," Dr. Francis Foo said a few days after Herrera's arrest, adding that Herrera's "technical skills were so good . . . how was I to know?"
It was a slip by Herrera that put investigators on his trail. He had neglected to check a box on Stewart's license renewal application, which was filed late. An alert clerk later telephoned the real Stewart to discuss the application and was told that the physician had retired.
Herrera, who did not finish high school but received an equivalency certificate before partly completing a physician's assistant program, was sentenced to 16 months in state prison.
In a statement to a probation officer, Herrera said he had acquired Stewart's credentials by paying the retired Oxnard physician $1,000 a month. Stewart has fled the country, according to medical quality board authorities.
The problem of phony doctors could be kept in check easily, licensing and medical association officials say, if hospitals, medical office managers, doctors and patients investigated the credentials of their physicians.
"A good deal can be prevented by the exercise of a little common sense," said Joseph Fisch, executive director of New York's Office of Professional Discipline. "Institutions should be checking on the authenticity of credentials. . . . It's absurd in its simplicity."
His investigators recently were called to a Long Island hospital, which had just hired a physician to work part time in the emergency room, he said. The physician had said he was a graduate of a London medical school, but on his first day he was so unfamiliar with basic medical procedures that other staffers reported him to authorities, Fisch said. Investigators found that the doctor never had been licensed.
"But it does not end there," Fisch said. In probing the case, investigators tried to interview the fraudulent doctor's supervisor, a physician who had worked at the hospital for many years, he said. But the supervisor kept canceling appointments, Fisch said.
Their suspicions raised, the investigators then checked the supervisor's credentials and found that he, too, was not licensed. He was a graduate of a medical school in the Philippines but had repeatedly failed the foreign graduates' exam and had forged documents to gain employment, Fisch said. The supervisor fled, and New York officials are still looking for him.
In California, hospitals are required to check the credentials of physicians before they are granted staff privileges, Wagstaff said. Failure to do so can result in a misdemeanor charge and can jeopardize the hospital's accreditation and liability protection.
Not Bound by Law
Urgent-care and other outpatient walk-in medical care centers, however, are considered doctor's offices and are not bound by law to check credentials.
Fisch said there is no such requirement for hospitals in New York.
Under a just-passed federal law designed to uncover bad and phony physicians, all hospitals in the country soon will be required to routinely check staff physicians with a yet-to-be-created clearinghouse. The central data file will list the names of all licensed doctors and note whether they have been disciplined by hospitals or state licensing boards or whether they have had malpractice judgments against them. The registry will also list the names of phony doctors who have been detected.
How do impostors get away with it? One common denominator that keeps suspicion at bay, authorities said, is their superb bedside manner.
"The practice of medicine is both an art and a science," Todd said. "While we tend to emphasize the scientific end, the art is to get along with people, to fulfill their psychological needs, to be supportive and understanding. All those things go into the proper practice of medicine and can be quickly learned. What they (impostors) lack in science, they make up in people power."
They can be so successful at it, patients and legitimate doctors have been known to rally to the defense of impostors, even after they have been unmasked, authorities said.
'Blows My Mind'
"It blows my mind, every time I come across a case," said the Federation of State Medical Boards' president, Dr. William E. Jacott.
Fraudulent doctors also tend to set up practice in independent outpatient clinics, where there is infrequent interaction with hospitals and a rapid turnover of patients, authorities say.
"There they see a high volume of patients without the opportunity to develop long-term relationships," said Todd. "Patients there have one or two visits . . . and then never see him again."
One of the most successful and most publicized impostors ever was Harold Kenneth Rain, who assumed the identity of Dr. Samuel Pike Hall more than 30 years ago and practiced medicine for seven years in eight states in the Midwest, South and East.
Using the name of a reputable California physician and tapping knowledge apparently gleaned from attending medical school classes without registering, he examined patients, delivered babies and performed hysterectomies and other gynecological and obstetrical operations (one of them nearly fatal). He also took out hefty loans, bought fancy cars and snappy clothes, read the Journal of the American Medical Assn. want ads and left town as soon as physicians around him became suspicious.
Fined $50 in Texas
Rain had left such a trail that eventually the weekly journal warned all physicians to be on the lookout for a fraudulent Dr. Samuel Pike Hall.
Rain was caught by Texas licensing authorities, fined $50 for practicing without a license--and moved on.
Finally, in 1953, authorities caught up with Rain after he tried to sell the story of his fraud to the Saturday Evening Post. The Post eventually told Rain's story--but without his cooperation. He was sentenced to three years in prison.
More recently, Leo Newton, a former Los Angeles chiropractor, was found guilty of practicing medicine without a license, a felony because he had inflicted serious injury, according to California licensing authorities.
Newton had performed plastic surgery in Tijuana on transsexuals and handled one case so badly that a breast implant later fell out, said Steve Wilford, assistant executive director of the state medical board.
Newton was sentenced to five years' probation in 1983. He then moved to Las Vegas, changed his name to Leo Newton Maxwell and began presenting himself as a physician and surgeon and began soliciting patients from the Hollywood area for in-office plastic surgery, according to Jacqueline Fitzpatrick, assistant chief deputy in the Nevada attorney general's office.
Authorities caught up with Newton last year when a woman who wanted her breasts enlarged and abdomen stretch marks removed went into a coma and died, apparently because of inappropriately administered anesthesia, Fitzpatrick said.
Charged with first-degree murder, Newton pleaded guilty to involuntary manslaughter and two other charges. On April 28 he was sentenced to 18 years, the maximum sentence, Fitzpatrick said.
And then there is Abraham Asante. His bogus Czech medical degree had been uncovered in the early 1970s by the U.S. Educational Commission for Foreign Medical Graduates, but nothing more came of it at the time, according to attorneys on the case.
The commission refused to issue him a certificate, a prerequisite to taking licensing exams in all but three states, according to former Assistant U.S. Atty. Donald J. Fay, who prosecuted the case. Asante took the licensing exams in those three states and failed them repeatedly.
Yet he began practicing medicine anyway, apparently drawing on techniques gleaned by sitting in on continuing education courses for physicians, said Fay, who now is in private law practice.
Asante eventually found employment with the Army, working at various locations before landing at Walson Army Hospital as its sole anesthesiologist. He presented medical documents in Czech, but they too late were determined to be forgeries, said Ft. Dix spokesman Richard Dowling.
Army Looks Again
"Clearly, with hindsight, someone somewhere along the line could have and should have done a better job of guaranteeing that Mr. Asante was who he said he was. There will always be a lingering question as to who exactly should have borne that responsibility," Dowling said.
In the aftermath of this incident and others elsewhere involving the validity of foreign medical credentials, he said, the Army has "looked again" at the documentation of its medical personnel.
The Army, Dowling said, was "indeed the victim of an individual who presented himself fraudulently as an anesthesiologist."
Asante's other victim, Joseph Branda, died on June 23 after spending nearly three years in a vegetative state.