COLUMN ONE : At War Over Her Call to Heal : A doctor cited ethics in refusing reservist duty in the Persian Gulf--and paid the price of 8 months in Leavenworth. Kansas medical officials now want her license revoked as well.

When Dr. Yolanda Huet-Vaughn emerged from the United States Disciplinary Barracks at Ft. Leavenworth April 6, free after eight months in a military prison, it looked to be the final chapter of an undeniably fractious story.

Irksome memories still poked at people, of course. Few in this region will soon forget how the 40-year-old medical doctor and Army Reserve captain so publicly refused to serve when called to active duty during the Persian Gulf War. Even those who didn’t read a newspaper saw her on the television talk shows or before a United Nations committee or at the National Press Club, insisting that the Gulf War was a “public health catastrophe” in conflict with her “medical ethics.” Some responded by praising Huet-Vaughn, many others by condemning her. The Army, for its part, court-martialed and sentenced the mother of three young children to 30 months detention.

But last spring, with Gulf War fervor waning, Huet-Vaughn’s sentence was cut in half by a base commander, then commuted by the secretary of the Army. So, rushing to hug her family on the day of her release, the doctor thought mainly of returning to her home and to her practice at a storefront operation here in an impoverished section of downtown Kansas City.

Her story, however, was not nearly as close to its end as she had hoped.

Just one day after Huet-Vaughn’s release, the disciplinary counsel for the Kansas Board of Healing Arts filed a petition to “revoke, suspend or limit” her medical license. There are “reasonable grounds,” the petition explained, to believe the doctor “committed an act or acts in violation of the Kansas Healing Arts Act.”

In other words, the board believes Huet-Vaughn might no longer be qualified to practice medicine.

Did Huet-Vaughn’s refusal to serve constitute a threat to the public’s health, safety and welfare? Should she be denounced for refusing to treat injured soldiers and civilians in the Persian Gulf, or celebrated for putting what she views as the dictates of her profession over the needs of the military? Was hers an act of moral conscience that exemplifies how doctors should behave, or an “act of dishonorable conduct” as described in the state’s Healing Arts Act?

Most to the immediate point, does the Board of Healing Arts have any business getting involved with this doctor?

These are the questions now driving a passionate debate over Huet-Vaughn’s fate. In editorials and political cartoons, rallies and petitions, columns and letters, voices rise with obvious emotion. Everyone seems to have an opinion, and most are emphatically unambiguous.

“When a doctor refuses to render medical aid, she should have her license revoked. Period. End of story,” wrote Wes Jones of Kansas City, Mo.

“I am absolutely amazed at the vindictiveness. . . . Whatever one may think of Dr. Huet-Vaughn’s decision, she already has paid her price for defying a military order. . . . The threat to take away the license from a competent, conscientious physician appears lacking in common sense as well as common decency,” wrote Franz Samelson.

Staring at a three-foot-high pile of such letters one day recently, Larry Buening, executive director of the Kansas Board of Healing Arts, appeared overwhelmed by their ferocity and volume.

“Nobody doesn’t have an opinion,” he said. “We have equal piles of letters on both sides, hundreds of them. About seven are mixed; the rest are very strong one way or the other. This case has raised a fever pitch on both sides. . . . This is an extraordinarily difficult case. The board will have to make a gut-wrenching decision.”

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There is no point trying to mythologize Yolanda Huet-Vaughn. Even friends and relatives find it hard to explain just why such a committed political activist enlisted in the Tennessee National Guard in 1977, and later transferred to the 325th Army Reserve General Hospital Unit in Kansas. There are not many other soldiers, after all, who can claim membership in Amnesty International, the Tennessee Coalition Against Apartheid, the United Farmworkers Support Committee, the United Farmworkers Boycott Committee, the Coalition to Stop Funding the War and the Nashville Peace Coalition.

Huet-Vaughn allows that money played some role in her initial decision. The military did not pay her medical school tuition, as some have suggested, but it did provide Huet-Vaughn one of her several part-time paychecks while she attended medical school. Money surely was a stronger incentive in the early years, however, than later in Kansas City, where Huet-Vaughn re-enlisted in 1990 after she already was a practicing doctor.

“I got paid for the weekend drills, yes,” Huet-Vaughn said. “I didn’t do it for nothing. It was $200 or $250 a weekend. But I could get paid $50 an hour in acute care clinics around town.”

She prefers to emphasize more varied and amorphous reasons.

She was not always a pacifist. She was idealistic, thinking after Vietnam that there would be no more “unjust wars.” She thought the reserves would be called on mainly to help out in “natural emergencies” such as tornadoes. She felt a commitment to this country, having just become a naturalized citizen after moving here from Mexico with her family when she was 5. She wanted to be in a setting where she could raise issues to people who wouldn’t normally hear them.

However one regards these various motives--all offered with a serene if sometimes murky sincerity--it seems apparent that Huet-Vaughn should never have joined the Army reserves.

It also seems apparent that Huet-Vaughn chose a decidedly poor moment to re-enlist. Six days later, on Aug. 2, 1990, Saddam Hussein invaded Kuwait.

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When activated, Huet-Vaughn figured President Bush was bluffing. Then came what seemed to her a disturbing stream of news: They were sending 40,000 body bags to the Gulf; they were mobilizing the blood supply; they were going to bomb civilian targets; they were deploying nuclear arms; worst of all, they were going to use “investigational” drugs on the troops without informed consent.

By the time President Bush warned that Saddam Hussein was “going to get his ass kicked,” it had occurred to Huet-Vaughn that this man’s agenda was war, not conflict resolution. There was, she decided, a “public health catastrophe in the making.”

There was also, she concluded, a fundamental dilemma for military physicians. Doctors are supposed to be advocates for their patients, but doctors serving in the Gulf would be obliged also to serve the needs of the military operation. Conflicts seemed unavoidable.

Military policy encouraged the doctor to patch up the soldier and return him to the front if possible. Military policy required doctors to treat their own troops first, even if others nearby had more life-threatening injuries. Most important, military policy called on doctors in the Gulf to give soldiers two “investigational” vaccines--an anthrax toxin and a botulin toxin--without the soldiers’ informed consent; in December of 1990, aiming to protect against Iraq’s suspected biological weapons, the Defense Department obtained a waiver from the Federal Drug Administration for their use.

“The Department of Defense was interfering with the doctor-patient relationship,” said Huet-Vaughn. “It was amazing. I didn’t think it could happen. This violated the Nuremberg Codes.”

Here Huet-Vaughn was facing an issue of some complexity.

An impressive lineup of medical ethicists and international law experts share her concerns about administering investigational drugs without informed consent. But others argue that the ethical context shifts in combat, that both soldier and doctor implicitly agree to subordinate their own interests and autonomy when they join the military.

Likewise, although a good number of prominent ethicists and law professors think the Nuremberg Code gives Huet-Vaughn a valid basis to defy orders, others ask how a doctor concerned over medical ethics could, under any circumstances, refuse to treat patients. She had not been asked to pull a trigger, after all--she’d been asked to join the 410th Evacuation Hospital unit at a hospital near the Iraqi border.

“The routine duties performed by the 410th included caring for sick and wounded soldiers of all countries,” observed the prosecutor at Huet-Vaughn’s court-martial. “For three months, the 410th was deployed and treated almost 6,000 patients. For three months, the accused deprived every sick and wounded patient that walked in that door the benefit of her compassion and medical skills.”

Faced with these conflicting arguments, Huet-Vaughn in late December of 1990 made a choice.

The war had not started yet. There was still a chance to educate and prevent. Yes, she could be court-martialed, yes she could lose her license. But there was to her a greater risk in not attempting to stop a catastrophe.

“I was not willing to enable the military,” she said. “The war offensive depended on the medical corps. So it’s not just taking care of patients. It’s enabling the war conflict to proceed.”

On Dec. 30, Huet-Vaughn left her unit at Ft. Riley and traveled to New York, where she began a monthlong tour of television talk shows and other public forums. “I wanted more than to get out of the military,” she said. “I wanted to work for a change in policy.”

The climax of the media blitz came on Feb. 2, 1991, at a Kansas City church rally, after which Huet-Vaughn surrendered to military police at the federal courthouse. They transported her to Ft. Leonard Wood in Missouri, where the Army eventually denied her application for conscientious-objector status and charged her with deserting her unit “with the intent to avoid hazardous duty and shirk important service.”

After a three-day court-martial--during which Huet-Vaughn was barred from introducing evidence about her reasons for leaving her unit--a jury of seven Army officers on Aug. 9 deliberated one hour before finding her guilty.

That same week, during a meeting of the Kansas Board of Healing Arts in Topeka, a staff attorney thought to toss a pile of newspaper clippings on the table. We have all seen these reports about this doctor who was just court-martialed, he pointed out. Do we want to look into this?

Members of the Kansas Board of Healing Arts did not really need their newspaper clipping service to keep abreast of Yolanda Huet-Vaughn’s activities. After all, as they walked the streets of their home towns in the spring and fall of 1991, they heard plenty about the rebellious woman doctor from strangers and neighbors alike.

Huet-Vaughn’s crime would not have been fashionable anywhere, for the Gulf War was too popular and too much a source of pride. But Kansas is a particularly inhospitable state for anyone to refuse to go to war, since the state is home to three military bases--Ft. Riley, Ft. Leavenworth and McConnell Air Force Base. In towns across Kansas, citizens with family members in the Gulf hung yellow flags, paraded in support of Operation Desert Storm, mourned relatives they’d lost on the battlefield--and spoke out about Huet-Vaughn.

It is possible that the board also heard about Huet-Vaughn from one of its own members. In 1989, well before the Gulf War controversy, Huet-Vaughn gave a deposition on behalf of the plaintiff in a malpractice suit filed against a doctor in board member Don Bletz’s Kansas City medical clinic. When Bletz learned of this, according to Huet-Vaughn and court documents, he called Huet-Vaughn’s supervisor at the HMO where she then worked.

How come you don’t control your employee better? Bletz is said to have inquired, according to court documents. Why is she giving a deposition against us? Doctors shouldn’t testify against doctors. Did you know she’s a member of a Commie, pinko organization called Physicians for Social Responsibility?

“Unless Bletz is a totally forgiving person,” Huet-Vaughn observed recently, “I would say this event has colored his actions.”

Whatever the mix of reasons, the board in the summer of 1991 began to study the wording of Kansas’ recently expanded Healing Arts Act. A felony or class A misdemeanor “whether or not related to the practice of medicine” was now on the list of causes for revoking a doctor’s license. So was “an act of dishonorable conduct.”

Huet-Vaughn’s court-martial looked to board members as if it just might meet both of these criteria. Yes, they decided on Aug. 17, we do want to look into this.

“My personal belief is she should have a revoked license, and when she paid her penalty, then she can come back and ask for the license to be reinstated,” the board’s vice chairman, Rex Wright, told a reporter two days later.

If this comment appeared to constitute an unusually rapid rush to judgment, it nonetheless was widely shared.

Huet-Vaughn wasn’t against the military in peacetime, people pointed out in a furious flood of letters to newspapers and the board. She wasn’t a CO until called to active duty. She had no problem accepting the taxpayers’ money until it was time to fulfill her obligation. She had a duty to treat the wounded regardless of her political feelings. Hers is the vile smell of selfishness. All she cares about is money. Boycott her hypocritical practice.

“She deserves everything she gets and more . . . I went and it cost me my marriage . . . I didn’t refuse,” one GI told a reporter as he lugged a 40-pound pack during an exercise at Ft. Leonard Wood.

Others, however, rose in passionate support of Huet-Vaughn. Lawyers offered their legal services, patients their prayers, medical ethicists and philosophers their validation. Amnesty International named her one of its “prisoners of conscience.” A local minister helped launch the Greater Kansas City Campaign to Free Dr. Yolanda Huet-Vaughn.

“Her act may well reflect a willingness to make difficult ethical choices in the face of the greatest adversity and penalties,” wrote William G. Bartholome, a medical doctor and director of a health care ethics program at the University of Kansas Medical Center. “Such an act provides no cause to question her fitness to practice medicine . . . I can only hope that the students I am teaching today may act with such moral courage.”

In time, it became clear that something beyond the particulars of a single doctor’s story was triggering so varied and ferocious a response. Here was an occasion for all sorts of people to spell out their own moral codes, to say what mattered most to them, to declare who is worthy and virtuous and who is not.

So some have found it important to compare soldiers on the battlefield to a doctor who refused to serve. Others have found it important to compare a doctor who selflessly treats the poor and needy with board members known to pressure patients over unpaid bills.

This clash of fundamental values is finally what drives the fiery debate over the most consequential question of all: By her actions--whatever one thinks of them--is Huet-Vaughn a threat to the health, safety and welfare of the Kansas populace? Does the board, in other words, have any reason to concern itself with this doctor?

It is an intriguing question indeed. It is apparently not, however, one that much engages the Kansas Board of Healing Arts. In fact, when next the board members convened, in the early fall of 1991, they hardly examined the topic at all.

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“There was a lack of discussion,” recalled former board member Richard Uhlig of that Oct. 19 meeting. “I didn’t hear a word about Huet-Vaughn.”

This troubled Uhlig, an osteopath from the small farm town of Herington.

“Does the board really have authority in this area?” he asked his colleagues. “It seems to me that this doctor’s problem was with the military, not the board. There’s no evidence regarding her medical practice, no complaints.”

The response, as Uhlig would later describe it, was “kinda blank faces.”

In the end, the motion to file a petition to initiate formal proceedings against Huet-Vaughn was made by her old nemesis, Don Bletz; only Uhlig voted against it. Since Huet-Vaughn just then was confined at Ft. Leavenworth, with limited access to a lawyer and even less ability to attend hearings, the board members waited until the day after the doctor’s release before officially filing their petition against her on April 7, 1992.

That same month, Richard Uhlig resigned from the board.

“My feeling was, I believed they were going to take her license and I didn’t want to be part of it,” he explained.

The board’s decision will come after it receives the findings from a public hearing due to be held later this month. Awaiting the outcome, Huet-Vaughn continues to see patients in the second-story walk-up office she and one other doctor currently occupy in downtown Kansas City.

Their practice, Family Health Services, is a not-for-profit, community-based corporation where patients serve on the board and doctors draw salaries as employees. An office visit officially costs $20, but there is a sliding scale based on financial capability and installment payments are allowed. AIDS patients are welcome, as well as pregnant women without insurance and those dependent on Medicare and Medicaid. Providing health care in this fashion is not lucrative; Huet-Vaughn’s colleague here--on call 365 days--made $30,000 last year after paying out $18,000 for malpractice insurance.

It is, however, much appreciated. Huet-Vaughn’s waiting room is usually full well into the evening, often with people who have traveled considerable distances to get there. Patients stop her on the street and in the nearby barbecue restaurants with warm hugs and medical updates and reports on children she has delivered.

Whatever else the Kansas Board of Healing Arts will be doing if it revokes Huet-Vaughn’s license, it will be putting a stop to all this. Huet-Vaughn could still practice in Tennessee or Missouri, where she also holds licenses, but those states may exercise reciprocal revocations. So Huet-Vaughn is thinking about teaching as a new career.

Looking back at all that’s happened, she allows that she wouldn’t have re-enlisted if she’d known what was to happen. But Huet-Vaughn insists that once she did re-enlist, she had no choice but to resist.

“I don’t regret what I did,” she said one recent morning. “I would do it again.”