Doctor Who Made Fatal Error Continues to Work : Health: Physician who misdiagnosed woman’s heart ailment is practicing medicine in Florida. Issue raises question of whether one who surrenders his license in one state should be allowed to practice in another.

For seven days before her death, Olga Kulp, 64, suffered classic symptoms of a heart attack--symptoms her doctor misinterpreted.

She saw her doctor twice and spoke to him after the two office visits, still complaining of pain that radiated up her arm to her left jaw.

Dr. Brunildo Herrero, then director of UC San Diego’s Internal Medicine Group, conducted two electrocardiograms on consecutive days and each time told the retired schoolteacher that she had no reason to worry. It was probably arthritis, he said. When the Rancho Bernardo resident continued complaining about the searing pain, Herrero prescribed Tylenol with codeine.

On that day, Sept. 23, 1988, Kulp died of a heart attack--she collapsed one hour before her appointment to see another doctor for a second opinion.

Experts with the Medical Board of California established that Herrero missed a subtle red flag on the first EKG and one day later, “misread or misinterpreted” the second electrocardiogram, according to medical board records.

While the first test showed subtle damage to her heart, the second one showed that she had already suffered a heart attack, said Dr. Richard Ikeda, Medical Board of California’s chief medical consultant.

“Obviously, it was grossly negligent and incompetent--there was evidence that there was heart-wall damage and he still did nothing,” said Ikeda. “This is very basic--a woman comes in with chest pain, up the jaw and down the arm. That’s stuff a third-year medical student would know. Thank goodness he’s not practicing with a California license.”

Herrero, 58, who has tended patients for more than 30 years, surrendered his license to practice medicine in California in December, after being charged by the medical board with gross negligence and incompetence--a process that took more than three years. The attorney general’s office pursued the case on behalf of the medical board.

Today, Herrero practices at the Watson Clinic in Lakeland, Fla., where he had worked for 17 years before joining UC San Diego.

Some medical experts and Olga Kulp’s husband, Fred, believe that Herrero’s inept EKG reading contributed to Olga’s death, which might have been prevented had she received appropriate treatment. Kulp’s anger over his wife’s death is fed by his rage that Herrero is still practicing medicine.

“If a doctor in California murders somebody--maybe that’s too strong a word--and goes to Florida where he gets away with a slap on the wrist, is that right?” asked Kulp, 77, in tears. “My hope is that the man will not be allowed to practice in Florida anymore.”

But Herrero, who acknowledges that he made a mistake, said he, too, has suffered anguish over the incident, as well as spending $30,000 in legal fees.

“Fundamentally, it was a very unfortunate situation where a mistake was made on the EKG. Mrs. Kulp died later,” Herrero said.

“The question really is can you make an error without having to die for it? Are doctors perfect and are they always 100% correct? The answer is ‘no.’ It’s a very, very unfortunate situation and one that has given me three years of sleepless nights and pain,” he said.

“I have had enough suffering. I don’t want to think about it anymore but obviously Fred (Kulp) hasn’t gotten enough, he wants more of my flesh.”

When Kulp’s attorney told UC San Diego that Kulp was considering a malpractice suit, the facility paid $125,000 in an out-of-court settlement.

“There was no question on the part of Dr. Herrero or the (UC San Diego) committee that investigated the matter that there had been an error made in reading the electrocardiogram,” said Dr. Paul Jagger, medical director of UC San Diego Medical Center. “Unfortunately, I think that may well have contributed to Mrs. Kulp’s death.”

Herrero initially told UC San Diego’s internal investigators and those from the state medical board that he had no contact with Olga Kulp after her second office visit--which was contradicted by the prescription for the Tylenol with codeine, said Jagger and sources familiar with the investigation.

Herrero’s statement that he had no contact with Olga Kulp on the day of her death “was simply an untruth,” according to a confidential memo by the state medical board investigator.

So far, the incident involving Olga Kulp has not derailed Herrero’s career--Herrero has since been named to the American Board of Internal Medicine, which reviews and awards credentials to doctors in the specialty.

Dr. Boyd Honeycutt, medical director of the Watson Clinic, said he readily employed Herrero when he requested his job back. “He is a caring physician who has an excellent record,” Honeycutt said.

Herrero, a graduate of the University of Florida College of Medicine, has also held a research position at Johns Hopkins Hospital, and faculty appointments at Duke University and Yale University.

“Herrero was a good, caring physician and was not somebody who was careless or sloppy. Physicians are not infallible and can certainly make mistakes,” said Dr. Gerard Burrow, dean of the UC San Diego Medical School and vice chancellor for health sciences.

The question at the center of the controversy is whether Herrero--touting a 32-year track record of tending patients--should continue practicing medicine after making a potentially deadly mistake. And should a doctor who surrendered his license in one state be allowed to practice in another?

In Herrero’s case, the California Medical Board did not want him to practice in the state after Olga Kulp’s death, said Janie Cordray, board spokeswoman. “In California, one mistake--especially if it kills a patient--is enough.”

In Florida, the medical board’s Department of Professional Regulation is reviewing Herrero’s case. Surrendering a doctor’s license in another state is grounds for possible disciplinary action in Florida, according to state law.

Ethics experts say a medical board must draw the line to ensure public safety--even if it means ending a sterling career.

“I don’t mean to be indifferent to a career lost on the basis of a tragic error but sometimes the error is egregious enough to pull somebody out,” said Arthur Caplan, director of the Center for Biomedical Ethics at the University of Minnesota.

“You don’t only punish the individual but you send a message to the rest of the profession that they must strive as hard as they can--so there is not only punishment but there’s deterrence,” said Caplan.

More than 100,000 Americans are injured or killed annually in hospitals as a result of negligence, says Dr. Sidney Wolfe of the Public Citizen Health Research Group.

One problem, some critics say, is that a doctor in trouble can leave one state and practice in another because each medical board can take several years to review and adjudicate a case. To prevent this, consumer activist Charles Inlander advocates a national licensing system.

“The (state) medical board has acted in their eyes and protected the people of California from this guy. Now the question is: ‘Will Florida do anything?’ ” asked Inlander, president of the Pennsylvania-based People’s Medical Society, a consumer advocacy group.

California has been criticized for being sluggish in adjudicating cases such as Herrero’s. Statistics from the medical board show that these kind of cases take an average of 2.8 years to resolve.

The medical board says it is hopeful that it will soon take less time as the attorney general’s office directs more resources toward pursuing errant doctors.

Three years after Olga Kulp’s death, Herrero said the California Medical Board’s proceedings against him mean little now. Board officials said accepting Herrero’s license surrender was the fastest way to stop him from practicing in the state.

Herrero said he surrendered his license, which was expiring, because he intended to return to Florida. Herrero was not asked to leave UC San Diego--though he did leave 10 months after Olga Kulp’s death, said Burrow.

“The charges were being reduced, and the charges were being dropped, my license expired in California and I left the state of California with no intention of ever returning,” Herrero said. After surrendering the license, “that was the end of the case. There was no discipline, no charges, no penalties. I thought the whole thing was over.”

Cordray said: “We agreed to drop proceedings in exchange for him surrendering his license. “Basically, this woman went in to see him with chest pains and over and over again, he didn’t hospitalize her, he didn’t read the EKG correctly--and if he couldn’t read it, he should have sent it to someone who could.”

Licenses Lifted

These are the reasons California doctors lose their licenses.

Type of violation 1987-88 1988-89 1989-90 Gross negligence/incompetence 12 17 27 Voluntary surrender -- 10 9 Inappropriate prescribing/treatment 5 9 12 Violation of drug laws 6 3 9 Self abuse of drugs or alcohol 5 3 14 Dishonesty/fraud 7 5 0 Mental illness 5 4 5 Aiding unlicensed practice 1 1 1 General unprofessional conduct 4 8 2 Probation violation 2 6 6 Sexual misconduct 8 2 12 Conviction of a crime 11 9 20 Discipline by another state board 17 15 23 Other 13 7 0 TOTAL DECISIONS RENDERED 96 99 140

Source: Medical Board of California