March 3, 2002 Sunday
LENGTH: 2261 words
HEADLINE: A sad fact of life; Dr. Robert Weitzel, who was sent to prison for treating old patients who died under his care
ANCHORS: ED BRADLEY
A SAD FACT OF LIFE
ED BRADLEY, co-host:
It's a sad fact of life--or perhaps death--that nearly half of all Americans spend their last days in severe pain. Eighty percent die in institutions such as hospitals or nursing homes and yet very few doctors in this country have more than a cursory knowledge of how to treat a dying patient. What's worse, some doctors say they don't want to treat them for fear they will be blamed for their deaths. And if you asked Dr. Robert Weitzel, a psychiatrist in Utah, he'd say those fears are justified. Dr. Weitzel was charged with the murders of five of his elderly patients. He says he was just giving them proper end-of-life care. His case has drawn the attention of physicians around the country, and Dr. Weitzel says it's cost him his career, his license and all of his savings.
(Footage of Weitzel)
BRADLEY: (Voiceover) Dr. Robert Weitzel used to have a busy medical practice, but when we talked to him a few weeks ago, he was working as a waiter at a downtown Salt Lake City restaurant and he wasn't expecting to see patients again any time soon.
Dr. ROBERT WEITZEL: At least in Utah--and it seems like probably everywhere now, you know, a--a doctor who's just trying to take care of people is walking a real thin line between going to prison and--and--and j--and going home at night.
BRADLEY: Look, Doctor, here's--I--I don't know you, but here's a picture that's painted of you. You're a murderer. You put five people down. You killed them. That's what the state says about you.
Dr. WEITZEL: That's what the state says, and they're absolutely wrong.
(Footage of Davis Hospital and Medical Center; photos of patients; documents)
BRADLEY: (Voiceover) Dr. Weitzel's problems began at Davis Hospital in Layton, Utah, where he was running a psychiatric ward for elderly patients. In the winter of 1995, the ward admitted five new patients, all with advanced dementia--patients who couldn't be cared for in their nursing homes. Dr. Weitzel continued their normal medications and also began treating them with common psychiatric drugs for their dementia. Then, he says, he realized they were all dying from a number of physical problems such as pneumonia, multiple strokes, severe weight loss and congestive heart failure.
Dr. WEITZEL: These were like medical emergencies here. These patients came in--they were at the end of the road. They've been basically kicked out of their nursing homes. And I've got to do something and do something pretty quick.
BRADLEY: Why not send them to some place that deals with end-of-life care? That's not what the psychiatric ward is about.
Dr. WEITZEL: Well, I'm a physician, and they get sick on my ward, I'm supposed to take care of them.
(Photos of patients; footage of Weitzel)
BRADLEY: (Voiceover) Dr. Weitzel says that because they all had legal documents saying they wanted no extraordinary measures to keep them alive--and because he believed they were dying--it was his duty as a physician to withdraw all their regular medications, and with their families' permission, let them die naturally. Then he prescribed morphine for them so they wouldn't die in pain. In just over two weeks, all five patients died, and Dr. Weitzel went on with his normal practice. But what he didn't know was that some of his nurses were talking to state investigators about the five deaths on his ward. Earline Cozzens was one of those nurses.
Ms. EARLINE COZZENS (Nurse): You don't have that many people dying on a medical floor. You don't have that many people dying in ICU. And here this--this is your psychiatric unit and you have these people dying. There's something radically wrong here.
(Footage of Cozzens; Layton City Police Department; Davis County Sheriff's Office Booking Information document; Elizabeth Bowman and Bradley)
BRADLEY: (Voiceover) After talking to Weitzel's nurses, state and local officials also came to the conclusion that something was radically wrong on his ward and immediately opened a murder investigation. In 1999, four years after his patients had died, Dr. Weitzel was charged with five counts of homicide. Elizabeth Bowman, at one time a working registered nurse and now a lawyer, was part of the team that prosecuted Dr. Weitzel for the attorney general's office. She says his patients could have lived years longer if not for the medication they got on his ward.
BRADLEY: How would you describe what the state thinks that Dr. Weitzel did?
Ms. ELIZABETH BOWMAN (Attorney): Well, the theory was that the drugs that he loaded these people up with put them in such a debilitated state that they were on death's door from the drugs and then comes the morphine on top of that which they had no chance of overcoming.
BRADLEY: Did he ever himself give the patients the medication? Did he ever inject them?
Ms. BOWMAN: Not that I'm aware of.
BRADLEY: So who gave them the medication?
Ms. BOWMAN: As in hospital settings normally it's the nurses.
(Footage of records; hospital; Dr. Ira Byock, Dr. Linda Finke and Bradley)
BRADLEY: (Voiceover) Records show 16 nurses administered Dr. Weitzel's medication orders, orders that were also reviewed by pharmacists and other doctors. Then hospital administrators conducted a formal investigation and found no wrongdoing by Dr. Weitzel, neither did Dr. Ira Byock and Dr. Linda Finke, when we asked them to look at the records. Dr. Byock directs a program studying end-of-life care in this country, and Dr. Finke is president of the International Society of Psychiatric-Mental Health Nurses.
Here's what the prosecutors say--say about those patients, that they just needed Dr. Weitzel to adjust their medications, help them out with their mental problems, but that physically, they were strong.
Dr. IRA BYOCK: That's preposterous.
Dr. LINDA FINKE (President, International Society of Psychiatric-Mental Health Nurses): Yeah.
Dr. BYOCK: If you look at these charts, several of them had lost large amounts of weight. One of them I think clearly had a pneumonia on admission and was clearly dying. These are somewhat common conditions that people die of.
Dr. FINKE: These people were clearly in agony. The nurses have recorded how, over and over again, they were moaning, they were groaning. Some of them were even saying they were in pain.
Dr. BYOCK: I think that's the key point in this case is th--is this case illuminates a--a problem that is much, much bigger than Dr. Weitzel and the deaths of these five patients. We have a public health crisis that is confronting us in America today. Too many Americans die poorly, die with unnecessary suffering.
BRADLEY: In fact, a number of recent national studies have found that, on average, 43 percent of nursing home residents across the country say they are often in pain. Utah's record is the worst in the nation. According to a study published in the Journal of the American Medical Association, half of all nursing home residents there say they suffer severe pain all the time. And records for Dr. Weitzel's patients suggest they might have been suffering before they even got to his ward.
(Footage of medical charts)
BRADLEY: (Voiceover) Their medical charts show they had a number of painful conditions, including bone fractures, spinal disk degeneration and severe infections. One patient when asked what she would like to change about herself answered simply, 'My pain.' But Elizabeth Bowman says...
Ms. BOWMAN: There were no indicators found that any of these patients had something that we would know to be painful, physically painful. They may have had emotional pain. They probably did.
BRADLEY: This is what one of the nurses on this unit wrote about Ellen Anderson. 'Patient becomes rigid and screams when touched. Severe pain related to profound osteoporosis.' If that wasn't true, why--why would a nurse write it?
Ms. BOWMAN: She may not have wanted to be touched and that may have been here way of communicating that.
Ms. LAURIE STEPHENSON (Nurse): I was the one sitting there. I saw the tears. I saw the screaming.
(Footage of Stephenson and Bradley)
BRADLEY: (Voiceover) Laurie Stephenson was one of the nurses who treated that patient, Ellen Anderson, the night before she died.
Why did he order morphine for her?
Ms. STEPHENSON: Probably because of the level of pain that I was describing. I mean, this was a person who would be impossible even to put her into the bed. I couldn't even put my hands on her. She'd had compression fractures in her spine in several places.
(Footage of Bowman and Bradley)
BRADLEY: (Voiceover) But when we asked Elizabeth Bowman about Ellen Anderson's compression fractures, she told us some old people just don't feel pain.
Ms. BOWMAN: If you or I have a broken bone, we're--we're very likely to be in a great deal of pain. And an elderly person can have a fracture and not be aware of it. Since this case, I have actually approached women who have backs that are quite curved and looked to me to be painful. And you ask them, 'Is this painful?' and they say, 'What are you talking about? No, I'm fine.'
Dr. WEITZEL: We look at them and they look like they're suffering and--and these people--these--these lawyers and so-called experts just brush that off and say, 'Oh, that's just anxiety,' or, 'Well, no, that--they weren't in pain. You--you--or th--it could have been something else.' If they look like they're in pain, you ought to treat the pain. It's heartless and it's wrong to refuse to take care of people at the end of their life.
BRADLEY: Since Dr. Weitzel's arrest, medical groups have warned that his case could cause some doctors to stop treating pain in their own dying patients. Physicians around the country have donated more than $100,000 to his defense, and the Utah Medical Association has put out a statement saying they are distressed that some doctors in Utah are already worried about prescribing pain medication because of this case.
(Footage of Weitzel and others)
BRADLEY: (Voiceover) When Dr. Weitzel's trial began in June of 2000, he says he was confident he would win.
Dr. WEITZEL: (Voiceover) I went up there thinking I'd be acquitted.
I--I just locked up the house, and there--you know, left my--my two cats, thinking, 'Well, I'll be home to feed them the next morning,' and I never saw my house again.
(Photo of Weitzel in custody; footage of Dr. Perry Fine; University of Utah Clinics - Pain Management Center; Fine and Bradley)
BRADLEY: (Voiceover) Dr. Weitzel was found guilty of manslaughter and negligent homicide, not murder, and sentenced to one to 15 years in prison. And that would have been the end of the story but for one witness prosecutors never called to testify. Dr. Perry Fine is a specialist in end-of-life care at the University of Utah. Before Weitzel's trial, prosecutors went to him for his expert opinion on the case. He says he told them that while he had a lot to criticize about the care Dr. Weitzel gave his patients, he thought Dr. Weitzel had given them standard end-of-life treatment.
After you went over all of the charts for these patients, how would you summarize what you told the prosecutor about your findings?
Dr. PERRY FINE: After reviewing all these cases, I don't find evidence of criminal action. I don't--I don't think the theory of your case is--is accurate. These were terminally ill patients, and he treated them reasonably.
BRADLEY: Clearly not a doctor who killed his patients.
Dr. FINE: Clearly not a physician who wittingly or, I think, unwittingly killed his patients.
(Footage of Bowman and Bradley)
BRADLEY: (Voiceover) But prosecutors never told the defense about Dr. Fine's opinion. Elizabeth Bowman says it wasn't worth mentioning.
Ms. BOWMAN: He didn't seem to have anything that could add to the case.
BRADLEY: So there's nothing that Dr. Fine said that you buried?
Ms. BOWMAN: No.
BRADLEY: You clearly said to her, 'This is not a criminal case.'
Dr. FINE: Very clearly.
BRADLEY: And--and what happened to your opinion? What did they do with it?
Dr. FINE: They said that I was under no obligation to notify the defense about my opinion because they were, in fact, obligated to notify the defense about my opinion.
BRADLEY: And did they turn that information over to the defense?
Dr. FINE: Apparently not, and I only found that out later on.
(Footage of Fine; documents; Weitzel being released; Weitzel)
BRADLEY: (Voiceover) When Dr. Fine did find that out, the trial was over. So he went public both with his expert opinion and with the fact that prosecutors hadn't told the defense about it. That prompted a judge to rule that prosecutors had failed to disclose evidence that was powerful and credible. A year ago, Robert Weitzel's conviction was overturned because of Dr. Fine's testimony. He was released from prison and granted a new trial. And although prosecutors have offered to reduce charges against him to five misdemeanor counts of negligent homicide, Dr. Weitzel has refused that offer, saying he'd rather meet them in court.
Tell me in--in your opinion what's the importance of this case?
Dr. FINE: An individual has been charged with murder who in his best estimation was practicing a legitimate form of medicine. And if that can happen to him, then it can happen to any physician. This is absolutely the wrong message to give physicians. They will pull back. And who will suffer is you, me and anybody we care about.
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