by Craig Klugman, Ph.D.
When I was graduating from college, I had a friend who was diagnosed with cancer. At least, that’s what she told her friends. She would ask to crash on a living room couch because she was scared to be alone, or ask for a ride home from work because she felt too weak to complete her full shift. Some things, however, did not add up. We were not allowed to tell her parents. She said she was getting chemo but had no side effects at all. Some people became suspicious about whether she was sick and drifted away from caring. After two years, she finally admitted to having made the whole thing up—she had wanted attention and to feel important.
I felt betrayed. The idea that someone would lie about having cancer was appalling and beyond the bounds of acceptable behavior. I had reasoned away all of the indications that she was not sick and ignored my doubts because I believed no one would lie about having cancer.
Imagine it was not a friend who lied about having cancer, but your physician telling you that you have cancer when you do not. Dr. Farid Fata was a Detroit-area oncologist who was the subject of a joint FBI, IRS, and DHHS investigation. That probe discovered that for 6 years, Dr. Fata prescribed unnecessary treatments and sent healthy patients for cancer treatment.
Prosecutors allege that 553 people received these unnecessary treatments. Fata is in the middle of a criminal trial facing 175 years imprisonment.
Why was Fata willing to throw away his medical license (revoked in January 2014) and his professionalism to cause harm to patients? Money. He was able to bill insurance and Medicare tens of millions of dollars for procedures and treatments. He also received kickbacks for referring “patients” to home health care and hospice.
Fata got away with it for many years. When patients questioned, he prescribed anti-anxiety medications. He owned the medical diagnostics company and scanning equipment. Thus, he was able to control the full experience from diagnosis to treatment to hospice with no one questioning or overseeing him.
This case is horrifying for many of the reasons that my friend’s lie was horrible: It is a betrayal of a trust. Physicians are entrusted by society to care for the vulnerable and the sick. This is a fiduciary relationship because the patient is powerless and the physician has all of the knowledge and is the gatekeeper to treatment. We trust physicians to be honest and to put the patient’s interest first. Fata put his own first. He violated core values of honesty, transparency, and nonmaleficence. One could argue that patients could have walked away or sought second opinions. The Milgram experiment shows though, that when faced with a white coat and air of authority, most people will do as they are told.
His patients were put unnecessarily in harm’s way. Healthy patients were told they were sick and then received treatment. Sick patients received therapy that could not have benefited them and that caused significant pain and suffering.
From a public health perspective, he wasted many scarce resources: staff time, diagnostic machines, treatments, and money. How many people did not receive prompt treatment or rationed chemo drugs because one of his “patients” was prescribed these resources.
This case points to the problem of medicine being a business: When people are driven by money and profit, the patient suffers. Fata was not only a physician, he was also a business owner. Serving a patient and being the principle of a business is a recipe for a conflict of interest. The more his patients were treated, the more wealth he accumulated. All physicians have similar conflicts, even if they do not own medical businesses. Thus, we rely on physicians to use sound clinical judgment to put the patient first, ahead of their profit interests. This is not to say that physicians should go broke or not make a living. But, there is a line that is crossed when your interest in accumulating money causes you to lie to patients, prescribe unnecessary tests and treatments, and harm your patients. This is not a case of ordering one more test to make sure that a diagnosis is certain or to guard against a potential future lawsuit. This is about making decisions based purely on greed. The result is harmed patients and ruined lives.
As a profession, the control of medicine is mainly in the hands of other doctors. This case is an instance when a physician’s behavior crosses over form unprofessional to violating the rules of civilized society. The state board, a body composed of physician peers, revoked his license. It is now up to the court, composed of a body of his fellow citizen peers, to decide if his behavior was criminal.