Monte Sereno doctor accused of faking patients' need for surgery

Motive? More notches under his belt? Some look to specialists who have
more experience.
Poor excuse - preventative.
It's elder abuse and abuse of power and greed, if I'm right about the
motive.
J

Monte Sereno doctor accused of faking patients' need for surgery
http://www.mercurynews.com/ci_6549186?nclick_check=1
By Barbara Feder Ostrov
Mercury News
Article Launched: 08/05/2007 01:37:41 AM PDT

On the day of his cancer treatment, 87-year-old Dung Le lay on a table,
his frail body sedated as needles loaded with radioactive seeds were
inserted into his prostate to destroy the malignant tissue his doctor told
him was there.

Afterward, the San Jose man was bruised, fatigued and hungry, having been
forbidden to eat solid food for 24 hours.

But Dung Le never had cancer, and his doctor knew it.

Now that doctor, Ali Moayed of Monte Sereno, faces felony charges of
battery, elder abuse and fraud for his treatment of Le, in a bizarre case
that has deeply unsettled local physicians. Two other men in their 70s,
their medical files falsified by Moayed, narrowly escaped the same
unnecessary procedure, according to a state medical board investigator's
report.

Santa Clara County prosecutors are also investigating whether Moayed - who
has pleaded not guilty to the charges - may have harmed 13 other men in a
similar scheme.

"He doctored the pathology reports to induce a patient to undergo a
procedure that carried a significant risk," said Santa Clara County
prosecutor Bill Butler. "The conduct was so egregious, it goes beyond
simply medical malpractice."

Sparked by a colleague's discovery of altered lab reports, the unraveling
of Moayed's alleged deceptions spanned two years of investigation by
several agencies, leading to his arrest in late June.

But the question remains: Why would a prosperous doctor risk his
career this way? Was it greed? A misguided sense that he was doing the
right thing for his patients?

Free on $500,000 bail but currently barred from practicing medicine, the
41-year-old urologist faces more than seven years in prison and potential
civil lawsuits that could bankrupt him.

Moayed did not return phone calls or e-mails from the Mercury News and his
attorney declined to comment. Yet hints about Moayed's motivation are
found in the normally confidential medical board investigator's report
placed in his court file.

Missing report in '05

A missing pathology report proved to be Moayed's undoing.

In May 2005, Dr. Abhinand Peddada, a Los Gatos radiation oncologist, was
reviewing the medical files of one of Moayed's patients, identified only
as "S.B.," 75, who was scheduled for a prostate cancer treatment known as
brachytherapy.

The procedure isn't pleasant: It involves sedating the patient, then
inserting radioactive seeds the size of rice grains into the prostate to
shrink tumors.

As Peddada scrutinized the file to confirm the patient's post-surgery
treatment plan, he noticed that a crucial lab report confirming the cancer
diagnosis was missing.

He called Moayed's medical office in Los Gatos first, then the lab that
had examined a sample of tissue taken from the patient's prostate. Two
pathology reports came in. The first one, from the lab, said the patient
was cancer-free. The second - from Moayed's office - said the opposite.

Peddada suspected that the report from Moayed's office had been altered.
S.B.'s procedure was immediately canceled.

Good Samaritan Hospital in San Jose, where both Peddada and Moayed were on
staff, began to investigate. When Peddada, hospital administrators and
other physicians reviewed the files of Moayed's other patients, they found
that pathology reports for Dung Le and another patient, referred to in
medical board documents as "B.T.," 75, were falsified. They were able to
cancel B.T.'s upcoming brachytherapy.

But for Dung Le, it was too late.

Hospital findings

Good Samaritan officials quickly reported their findings to the state
medical board, law enforcement and Los Gatos Community Hospital, where
Moayed also was on staff. The medical board and the Santa Clara County
District Attorney's Office opened investigations.

By August 2005, Moayed, on the advice of his lawyer, had resigned from the
medical staffs at both hospitals.

He relinquished his medical license the next month, and his practice was
taken over by Dr. Farshad Nowzari, according to the investigator's report.
Until this incident, Moayed had never been investigated or disciplined by
the state medical board.

Once Moayed stopped practicing medicine, investigators could take their
time to build a case.

As Peddada dug deeper into Moayed's patients' files, his concerns grew.
There were other aspects of Moayed's treatment of cancer patients that
were difficult to fathom.

Moayed gave some of his patients hormone injections to prevent their
prostate cancer from progressing, but according to their medical files,
they didn't appear to show effects of the treatment - almost as if they
had been given a placebo, Peddada told investigators.

He called Moayed to ask if he had received "a bad batch" of hormones, the
report says. After Moayed got that call, Peddada told investigators, the
patients began to show the response to the treatment that should have
occurred all along. Peddada declined to speak with the Mercury News.

Much to lose

Moayed had a great deal to lose from his apparent deceptions.

A 1991 graduate from the University of Cincinnati Medical School, Moayed
owns a medical building and lives in a Monte Sereno mansion with an
estimated value of more than $3 million.

He admitted to the medical board investigator that he had falsified the
reports for three cancer-free patients, inserting lab results from
patients who did have cancer.

He said he didn't do it for the money. Each brachytherapy procedure would
have netted him only $600 because they are performed alongside a radiation
oncologist, he told investigators.

Why, then, would he lie to his patients? The investigative report isn't
clear, but Moayed appears to claim that the brachytherapies would help
them by preventing future cancers. At least one of his patients had
displayed early warning signs, including an elevated PSA (prostate
specific antigen) level.

Moayed "felt the patients were on the brink of getting cancer and that he
wanted to give them a definitive answer," the report says.

"He knows he messed up and that he will no longer be practicing medicine,"
the investigator wrote in the report. "He stated that there was no
justification for what he did."

Moayed said "he was under a lot of stress," logging many after-work hours
on his computer instead of spending time with his children, the
investigator reported.

Treatment debated

In medical circles, the best way to treat prostate cancer is fiercely
debated.

The disease afflicts more than 218,000 American men each year, many of
them elderly. An estimated 20 percent of American men will be diagnosed
with the disease between the ages of 70 and 75, according to the National
Cancer Institute.

Once cancer is detected, treatment options range from "watchful waiting"
(in which patients are closely monitored but not treated) to hormone or
radiation therapy, to surgery.

But an independent doctor who reviewed evidence in the case told medical
board investigators that Moayed's apparent conviction that his patients
ultimately would develop cancer, based on the early warning signs, simply
wasn't valid. Nor should a doctor pursue cancer treatments for a patient
whose cancer has not been confirmed, the independent doctor said.

Many doctors believe that elderly patients are more likely to die of other
causes, such as heart disease, before they die of prostate cancer.

Moayed told the investigator he had "messed up" with only three patients,
but local prosecutors and the medical board investigator are examining his
treatment of more than a dozen other patients from Los Gatos Community
Hospital.

Dr. Domenico Manzone, a Los Gatos urologist, told the medical board
investigator that Moayed had performed 13 other brachytherapy procedures
at the Silicon Valley Urology Center at Los Gatos Community Hospital.

But when Manzone reviewed the patients' charts, he found no reports
documenting their cancer - only a statement from Moayed that they had the
disease, the investigator's report says.

Manzone declined to speak about Moayed. But in an e-mail, he said, "The
dedicated and hardworking physicians" of the Silicon Valley Urology Center
"deplore the apparent breaches by Ali Moayed of some of the most
fundamental principles of our profession."

Hearing not set

A date for Moayed's preliminary hearing hasn't been set yet, but the
criminal charges against him are the only the start of his legal woes.

He could face malpractice lawsuits that wouldn't be subject to
California's $250,000 damages cap because of the age of the victims, said
prominent San Jose attorney *** Alexander. If a jury finds him guilty of
willful misconduct, the doctor's malpractice insurance would not cover
him.

It's unusual, but not unheard of, for prosecutors to file criminal charges
against doctors over medical treatment, said David Magnus, a Stanford
University medical ethicist. Such cases are typically handled by state
medical boards, which can revoke a doctor's license, and in civil courts
through malpractice lawsuits.

If the facts of Moayed's case are true, Magnus said, they represent a
doctor out of control.

"That kind of blatant paternalism might have been common in this country
in the 1940s and 1950s, but it's inappropriate and something that won't be
countenanced today," Magnus said. "You can't knowingly, intentionally lie
to patients to get them to do what you want."



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