Respectful Insolence

Longtime readers of this blog probably remember the tragic case of Abubakar Tariq Nadama, the five-year-old autistic boy who died as a result of being treated with chelation therapy three years ago by Dr. Roy Kerry, an otolaryngologist who had apparently had given up doing head and neck surgery in favor of the more lucrative pastures of woo. This case was about as clear as a case could get. A known potential complication of chelation therapy is a lowering of calcium levels in the blood, to the point that cardiac arrhythmias and cardiac arrest can occur. Moreover, children are more sensitive than adults to this potential complication, and the autopsy clearly concluded that Tariq had . But did that stop Dr. Kerry? Sadly, no, it did not. But not only did he give a drug for an invalid indication (disodium EDTA for autism), but he incompetently gave it IV push instead of over time, leading to a rapid drop in blood serum calcium levels and cardiac arrest. Negligent incompetence just doesn’t get any more obvious than this in medicine.

Indeed, so egregious was this case that last summer the Butler county prosecutor did something that’s very, very rare in cases of a patient death due to physician incompetence. He actually decided to file criminal charges against Dr. Kerry for involuntary manslaughter. Before going on, I would ask you to read the charges against Dr. Kerry filed by the Pennsylvania State Board of Medicine. The description of Tariq’s last moments is chilling, as is the callousness with which he was treated, being stuck multiple times for an IV treatment that has no hope of alleviating his autistic symptoms.

Unfortunately, the prosecutor has decided to drop all criminal charges:

PITTSBURGH (AP) – Criminal charges were dropped Tuesday against a doctor accused of causing the death of a 5-year-old autistic boy by incorrectly administering the wrong drug for him.

I’m sorry to butt in here, but this is just plain wrong, and it’s probably unintentionally describing at least one reason why criminal charges were dropped. The quacks have successfully argued that giving chelation therapy for autism was not the “wrong” treatment but that Dr. Kerry inadvertently used the wrong drug, namely disodium EDTA (generic name Endrate) instead of disodium dicalcium EDTA (generic name Versinate) because they were “sound-alike” drugs. Never mind that this is a pretty lame defense, given that the names of the two drugs don’t sound or even much look alike other than the “-ate” in the final syllable. Never mind that there is no scientifically supported medical indication for either drug to treat autism. The argument apparently sucked in even Dr. Mary Jean Brown, Chief of the Lead Poisoning Prevention Branch of the Atlanta-based Centers for Disease Control and Prevention, who said:

It’s a case of look-alike/sound-alike medications,” she said yesterday. “The child was given Disodium EDTA instead of Calcium Disodium EDTA. The generic names are Versinate and Endrate. They sound alike. They’re clear and colorless and odorless. They were mixed up.”

[...]

Dr. Brown said the same mix-up happened in two other recent cases: a 2-year-old girl in Texas who died in May during chelation for lead poisoning and a woman from Oregon who died three years ago while receiving chelation for clogged arteries.

Dr. Brown said that in each case, the blood calcium level was below 5 milligrams. Normal is between 7 and 9.

The correct chelation agent — Calcium Disodium EDTA — would not have pulled the calcium from the bloodstream, she said.

Of course, chelation for lead poisoning is a medically appropriate treatment; on the other hand, chelation therapy for cardiovascular disease is not. Personally, I think that causing a death by mistakenly using the wrong drug is a much worse offense when the drug is being given for a condition for which it is not even indicated in the first place. The reason is that the patient didn’t even the drug, which had almost zero chance of helping him, and this compounds the error in execution of therapy with incompetence in medical judgment in choosing the therapy. Also, remember that criminal charges require evidence “beyond a reasonable doubt.” It’s a very high standard for a prosecutor to meet. It wouldn’t in the least bit surprise me if this statement by Dr. Brown was reasonable doubt served up to Dr. Kerry and his defense team on a silver platter. Indeed, it’s my considered opinion that Dr. Brown, in her seeming ignorance about autism quackery, unwittingly gave Dr. Kerry exactly what he needed to escape serious punishment for his misdeed. At the time, I characterized her statements as the CDC’s having “flubbed it.” Little did I know just how badly the CDC did indeed flub it. Now that I look back on this case, I’m not even sure whether Kerry’s lawyers would have thought of this particular defense were it not for Dr. Brown spouting off this nonsense less than five months after Tariq’s death, and it wouldn’t in the least bit surprise me if Kerry’s lawyers had planned on calling Dr. Brown to testify or provide and affadavit stating this for the defense. Certainly that’s what I would have done if I were a lawyer defending Dr. Kerry.

Fortunately, I’m not, and I don’t have to deal with him, other than commenting on this case in my blog. So let’s see if there’s any more information:

The boy went into cardiac arrest in Kerry’s office on Aug. 23, 2005, immediately after receiving chelation therapy.

The CDC, which investigated the boy’s death, has said the boy was given a synthetic amino acid called Disodium EDTA instead of Calcium Disodium EDTA. Both are odorless, colorless liquids and may have been confused, the CDC found.

It certainly sounds as though I could be right in blaming the CDC and Dr. Brown for unwittingly contributing to the collapse of the criminal case against Dr. Kerry, but here’s the kicker, a revelation that should make anyone who needs to see a doctor in the State of Pennsylvania shudder:

Kerry had surrendered his license pending the outcome of the case, but his license will be reinstated based on the withdrawal of the criminal charges, a Department of State spokeswoman said.

That’s right, Dr. Kerry could well be chelating autistic kids again by the end of the week, his medical license restored. Of course, it may not be that easy. The people of Pennsylvania can only hope that there’s no insurance company in the world that will touch Kerry with a thirty-nine-and-a-half foot pole. Unfortunately, a mere lack of malpractice insurance all too often fails to stop dubious practitioners like Dr. Kerry; so that’s no guarantee. There’s also the much-deserved civil suit against him, but that is likely to take years to grind its way through the courts, and Dr. Kerry is old enough that even without this cloud hanging over him it would be unlikely that he will continue to practice for much longer. (For that, at least, we can be thankful.) Finally, there is the state medical board’s disciplinary action, which, sadly, has already taken more than two and a half years and shows no signs of stripping Dr. Kerry of his medical license. Like Dr. Rashid Buttar, Dr. Kerry is Exhibit A in the case demonstrating the flaws in our system that prevents it from protecting patients from bad medicine by stripping dangerous doctors of their licenses in a more timely fashion than several years.

It may all be a moot point anyway. Dr. Kerry, as it has been pointed out, is 70 years old. He may well just retire, in which case taking away his medical license will not inconvenience him. The only inconvenience he might suffer is if the Board decides to fine him, as he could be fined $10,000 for each violation, a maximum of $20,000 (he is charged with “breaching the standard of care” and “engaging in unprofessional conduct”). I suppose one could argue that all this legal trouble forced him to retire and that that will protect future patients from him, but remember that all this legal trouble fell upon him because his incompetence killed a child. All that’s left is the civil lawsuit, any settlement of loss of which is likely to be paid by his malpractice insurance. The bottom line in this case is that Dr. Kerry is looking increasingly likely to get off scot-free and that there will be no real justice for Abubakar Tariq Nadama.

ADDENDUM: If you want to see video of the negligent killer, go here; that is, if you can stomach it.

Comments

  1. #1 TheProbe
    May 7, 2008

    Even if Kerry gets his license back, the state board may suspend it. His license is due to expire on 12/31/08 and he just may allow it to do so.

    In any event, Tariq did not receive justice. Where is the Rev. Al Sharpton when you need him?

  2. #2 isles
    May 7, 2008

    Thanks a lot, CDC. This was absolutely NOT a sound-alike error, and if it’s true that Dr. Brown was prepared to testify that it was, well, that’s a travesty. There should have been a corrective statement issued when it came to light that Nadama got exactly what Roy Kerry intended for him to get, and that there was no reason in the world for him to be subjected to this treatment.

    Now this quack is free to do the same to other kids. Way to go, Atlanta.

  3. #3 sophia8
    May 7, 2008

    The description of Tariq’s last moments is chilling, as is the callousness with which he was treated, being stuck multiple times for an IV treatment that has no hope of alleviating his autistic symptoms.
    Indeed. Autistic children are often highly sensitive to touch and other sensations. Just being handled unnesesarily, let alone being held down by up to four adults and having needles stuck in him, would have been torture for the poor little boy.
    This so-called “doctor” shouldn’t be allowed anywhere near children.

  4. #4 mike stanton
    May 7, 2008

    I think your analysis is spot on. There is another detail from the defence. I recall reading a suggestion that the dose that killed Tariq was “the wrong drug” and was given in error by one of Kerry’s juniors while he was not in attendance. The implication being that the previous two doses with Kerry in attendance where “the right drug” and so he could not be blamed. Of course all three doses were of the same drug, Endrate, administered by IV push and all three doses were prescribed by Kerry. Would his absence from the treatment room at the time of the final dose make him less culpable or more culpable in the eyes of the law?

  5. #5 Prometheus
    May 7, 2008

    Orac,

    Just a small nit to pick:

    EDTA (even the calcium-disodium version) is not the first-line treatment for lead (or mercury) poisoning. The current (as of the early 1990′s) first-line treatment for lead and mercury poisoning is DMSA (2,3-dimercaptosuccinic acid).

    Versinate (calcium disodium EDTA) remains as a second-line treatment for lead (but not mercury) poisoning, to be used only when the patient cannot take oral medication (since DMSA is only available as an oral medication) or has had adverse reactions to DMSA.

    I suspect the reason Dr. Kerry used EDTA was because it is the “traditional” drug for chelation in “alternative” medicine. As usual, “alternative” medicine is still using a drug that “mainstream” medicine pretty much abandoned in favor of a drug that is much less dangerous, much easier to administer (oral EDTA is ineffective – it doesn’t get absorbed) and much more effective (EDTA is a fair chelator of lead and a poor chelator of mercury).

    Prometheus

  6. #6 AndyD
    May 7, 2008

    Was there any investigation of his practise? Was this unusual? Did he normally use the “right” drug?

  7. #7 BB
    May 7, 2008

    Is there a “right” drug for autism?

    Thought not.

  8. #8 Patrick
    May 7, 2008

    Disgusting.

    Are we not supposed to trust that our professionals would not fall into the look or sound alike pit? After all, aren’t we paying them to be aware of these differences by keeping up with the current standard of care in their respective fields?

    I think an investigation into why the prosecutor has dropped the charges is in order. Who would try to let a party guilty of this level of incompetence get off the hook for Killing someone in the name of curing them without some extremely mitigating circumstances?

  9. #9 notmercury
    May 7, 2008
  10. #10 Joe
    May 7, 2008

    F*** me dead!

    I try to be well-spoken and analytical. In this case, I cannot even come close …

  11. #11 Ms. Clark
    May 7, 2008

    Oh yeah. I agree with Dr. Kerry, it was a medical “event” all right. And let’s make sure to thank DDS laboratories, Dr. Garry Gordon and Dr. Anju Usman for helping make this “event” possible. And let’s that “Defeat Autism Now” (DAN!) for adding Dr. Kerry to their list of DAN! dox after he killed Abubakar in a horrifying manner.

    (I meant to put this comment on this blog entry, but put it on the one about Butler county by mistake)

  12. #12 Ms. Clark
    May 7, 2008

    I don’t know why I can’t type “thank”. I meant, “And let’s thank “Defeat Autism Now” (DAN!) for adding Dr. Kerry to their list of DAN! dox after he had killed…” Oh wait, Abubakar wasn’t slaughtered, he merely suffered a “medical event.”

  13. #13 Ms. Clark
    May 7, 2008

    This little boy was black, probably Muslim, had a funny name compared to “Billy” or “Sammy”, was from another country (England) and according to some autism organizations didn’t have a life worth living anyway unless he was cured. I can’t help but wonder if all that made the judge less sympathetic toward his death.

  14. #14 DLC
    May 7, 2008

    Okay, so this guy deserves to have his license yanked.
    If I did this, not having a medical license, I would be jailed. This fellow is supposed to be knowledgeable in his profession, and to stay in practice. Supposed to be.
    I don’t suppose there is any chance for a civil suit against this crumb ?

  15. #15 Ms. Clark
    May 7, 2008

    There’s a civil suit against him and his partner in his practice and against the outfit that made the disodium EDTA, if I recall correctly it’s a little-pharma business. Garry Gordon was the distributor and Garry is like the kind of the EDTA chelationists. Google, “Garry Gordon” and “EDTA” and “push”. I just got 700 results. I gather that he sometimes recommends that Versenate be used, or that they mix calcium or magnesium with Endrate.

    There’s a whole lot of info about chelation quackery, not just for autism, here
    http://www.autismstreet.org/weblog/?p=84

  16. #16 Ms. Clark
    May 7, 2008

    Garry Gordon is not named in the civil suit, I should have made that clearer. They are going after the maker of the EDTA and skipping over the dealer who sold it to Kerry. Gordon has this odd thing where he sells chelation kits, IV bags, tubing, needles, drugs, etc. He sells them in tens or dozens or something. It looks really weird, to me.

  17. #17 Ms. Clark
    May 7, 2008

    Apothecure is the Compounding Pharma that is being sued, they work with Garry Gordon, somehow. Apothecure has killed people with some of their drugs that were infected or mixed wrong. http://autismdiva.blogspot.com/2007/03/compounding-problems.html

    This is from Apothecure’s site:
    “Heavy Metal Detox

    ApothéCure, in association with the Texas Institute of Functional Medicines (TIFM), has formulated some of the most innovative and effective Heavy Metal Detoxification products and protocols in today�s market. As members of many alternative medical organizations, ApothéCure has become familiar with the needs of physicians and patients to be aware and educated in this fast-developing practice.

    ApothéCure is one of the exclusive compounders of Calcium EDTA. Along with Garry Gordon, ApothéCure helped develop many products and protocols. Our affiliation with the Gordon Research Institute allows us to be your complete Heavy Metal Detox partner.

    Aside from Calcium EDTA, we also offer many other products to aid in the detoxification process. EDTA, DMPS, DMSA, and a host of other products are readily available to be compounded in many different forms.”

  18. #18 sophia8
    May 8, 2008

    This little boy was black, probably Muslim, had a funny name compared to “Billy” or “Sammy”, was from another country (England) and according to some autism organizations didn’t have a life worth living anyway unless he was cured.
    His parents were from Nigeria. In general, Nigeria has a long tradition of folk medicine, witchdoctors, shamanism and so on, and here in the UK there have been several cases in the courts of Nigerian ‘witchdoctors’ defrauding fellow Nigerian immigrants.
    So it’s quite possible that the parents were easy prey for anybody who offered a miracle cure for their child. If so, it’s a pity that they weren’t scammed by a real witchdoctor instead – they’d have only lost their money.

  19. #19 Sastra
    May 8, 2008

    A friend of mine (who is into alternative medicine) told me not long ago that she’s found out a former classmate of hers had cancer, and the prognosis was not good. She said she’d written him to recommend that he see some doctor she’d heard good things about: he was practicing somewhere in Mexico, curing ‘incurable’ cancers at his clinic at an amazingly successful rate.

    As an aside, she mentioned that the doctor was in Mexico because he had been stripped of his medical license and thrown into jail in the US, just for trying to heal people. She then laughed and said “Oh, I suppose that will probably turn you off.”

    Well, yes. I admit it. That additional twist of information was especially helpful in turning me off even further than I was already turned. Yet I got the impression that she thought that my being “turned off” by someone administering medical treatments which were evidently so dangerous they merited criminal charges was some personal quirk of mine. Oh, you know those atheists — they just don’t want to believe in anything. And they’re so trusting of the Establishment.

    It is hard to realize that, for some people, legal ramifications being enforced against a quack are apparently a feature, not a bug.

  20. #20 wfjag
    May 8, 2008

    “A friend of mine (who is into alternative medicine) told me not long ago that she’s found out a former classmate of hers had cancer, and the prognosis was not good. She said she’d written him to recommend that he see some doctor she’d heard good things about: he was practicing somewhere in Mexico, curing ‘incurable’ cancers at his clinic at an amazingly successful rate.”

    I take it, Sastra, that your friend has never heard of Andy Kaufmann or seen the movie “Man in the Moon”?

  21. #21 John Best
    May 8, 2008

    While this condemnation of medical malpractice is justified, I’d call the negligent incompetence of continuing to poison millions of babies with mercury much more egregious.

    Geez, how many times can you slugs dance on this poor kid’s grave.

  22. #22 Soy = devastation
    May 9, 2008

    John Best,
    What about all that $oy that JB Handley is padding his wallet with? His website states that soy isn’t a good food for children, but he is on the board of Genisoy. One of his Genisoy bars was found to contain .5 mcg of mercury. No telling how many lost their hopes via the toxic synergism of bioidentical estrogen, fluoride, aluminum, cadmium and mercury that is found in soy foods.

    More than a decade ago, Dabecka and McKenzie from Health Canada did some surveys on fluoride, lead, cadmium, and aluminum content in soy formula.5,6 In canned, ready-to-use formulas, lead, cadmium and fluoride levels averaged 37.3, 1.50, and 840 ng/g, respectively. In concentrated liquid formulas, the respective levels were 21, 3.54, and 600 ng/g. In powder formula concentrates, respective levels were 73.7, 6.78, and 1130 ng/g.

    They reported that aluminum content in soy formula for 1-3 month old infants could result in an intake of 363 micrograms/kg/day (2088 micrograms/day) alone, not including potential contribution from other foods or water.5 They also reported that soy based or milk-free formulas contained about 8-15 times more cadmium than milk-based formulas,6 as well as high amounts of fluoride, which, of course, has been known for a long time now. (By the way, cadmium will also cause exactly the same enamel condition as “dental fluorosis.”)

    Ekland in 1999 reported that cadmium was 6 times higher in soy formulas than cow’s milk formulas.7

    Hawkins and colleagues found mean aluminum concentrations of 534 micrograms/L in soy formula, as compared to 9.2 micrograms/L in breast milk.8 These authors concluded that infants may be at risk from aluminium toxicity when consuming formula containing more than 300 micrograms/L.

    In 1986 a research team headed by McGraw reported in The Lancet that, compared with carefully collected human breast milk containing 5 to 20 micrograms per liter, aluminum concentrations were 10 to 20 fold greater in most cow’s milk-based formulas and 100-fold greater in soy-based formulas.9

  23. #23 John Best
    May 9, 2008

    I don’t think most babies eat Genisoy bars. Aside from a few hippies, who eats soy? Isn’t it used mostly to slop hogs?

    But, if you want to blame soy for containing mercury and aluminum and causing autism, at least you’re admitting that these metals do cause autism. So, then you would agree with Orac that chelation is indicated to cure the mercury poisoning.