Tray Whitening: What the Evidence Shows CE 3 In recent years, many dental professionals have changed their philos- Bruce A. Matis, DDS, MSD ophy regarding the use of trays with at-home bleaching regimens. However, facts do not change—and successful vital tooth bleaching still occurs only when tooth surfaces are in direct contact with the appropriate concentration
Foundersacademy.orgAbout the series
Four Times reporters and a photographer spent a year systematically examining long-troubled Martin Luther King Jr./Drew Medical Center, founded with high aspirations after the Watts riots.
This series, in five parts, covers the severity of the hospital’s recurring medical lapses, its managerial shortcomings and the political conditions that have thwarted effective reform.
Deep trouble: A hospital inspired by the civil rights movement Timidity at the top: The county Board of Supervisors shies fails - sometimes kills - those it was meant to serve.
away from reform, paralyzed by community protest and racial politics.
PART TWOThe myth of poverty: King/Drew isn’t underfunded. It’s Overhaul urged: County board must give up its control of King/Drew, experts say. Some also suggest closing for a time to Unheeded warnings: How one pathologist got hired and remained on staff despite misdiagnoses and legal woes.
The series was reported and written by Times staff writers Tracy Weber, Charles Ornstein, Mitchell Landsberg and Steve Hymon. Staff photographer Robert Gauthier took the pictures.
Broad failure: Beyond individual workers’ shortcomings, whole departments are in disarray.
Part 3 adoring 117th Street neighbors. In early July, Hooper had said
Soon afterward, Mohamed recalled, the pathologists met with reality that their lives are ending.
she was cancer-free - having failed to spot the malignant cells the hospital’s medical leaders, who said they would investigate One doctor’s long trail of dangerous mistakes Alarmed the complaints and keep an eye on Hooper.
Six months after the pathologists sent their letter, Johnnie Mae colleagues reported pathologist Dennis Hooper to King/Drew Williams, then 40, went to the public hospital in Willowbrook, officials, but he stayed on the job. Records detail sloppy work Six weeks later, another pathologist, Dr. Theresa Loya, found Further entreaties brought no response. Tension gave way to south of Watts, for a seemingly minor gynecological exam. and faulty diagnoses even before he was hired.
invasive bladder cancer in a subsequent biopsy. The cancer bitterness as the colleagues realized that this was the hospital’s Hooper determined that she had cancer of the uterine lining, would eventually kill Jackson, a mother of 16 and grandmother and surgeons quickly gave her a radical hysterectomy, taking By Tracy Weber and Charles Ornstein, Times Staff Writers “Here you had five pathologists signing a letter listing cases About the same time, Dr. Hezla Mohamed was asked to and telling administration in no uncertain terms that this recheck another of Hooper’s cases. Hooper had seen “no area pathologist has competency problems, and there was no Five pathologists slipped into the microscope lab at Martin of malignancy” in the swollen neck tissue of a 59-year-old man, response,” said Dr. Timothy Dutra, who signed the letter.
He had seen cancer - but it wasn’t hers. His findings, it was later Luther King Jr./Drew Medical Center, steeling themselves to act medical records show. Mohamed suspected that it was thyroid determined, were based on a slide from another patient, who after months of deepening suspicion.
cancer - a finding that an outside lab would later confirm.
Worse than that, he said, the hospital’s medical leaders later had brain cancer. In his report, Hooper raised the possibility that denied ever receiving the letter, “even though I know it was the slide had somehow been mislabeled, but medical records They’d seen enough. They were convinced that their newest At a certain point, “you start to wonder if the person knows given to them on three separate occasions.” show no evidence that he investigated where the slide came colleague, Dr. Dennis G. Hooper, was making dangerous what he’s doing,” said Mohamed, now pathology chairwoman mistakes. And on this August afternoon in 2000, they were at the Los Angeles County-owned hospital.
Hooper continued working, whipping slides through his microscope with a speed some colleagues considered When Mohamed examined Williams’ excised organs 2 1/2 In the microscope lab that August day, Hooper’s colleagues irresponsible. The tall, paunchy pathologist, once eager for their weeks after her surgery, she found no evidence of cancer, Dr. Brian Yee had caught the first hint of trouble in April. worked out the details of a warning letter to the hospital’s chief friendship, kept more to himself now, listening to the music of according to Williams’ medical records.
Rechecking a 27-year-old man’s blood work, he noticed that Yanni on his headphones and saving his charm for their boss, Hooper, a pathologist with 16 years’ experience, had missed A uterine-cancer expert said that what Hooper saw on The letter said Hooper, in his first six months on the job, had the slides should have made him wary. The cancer that he lost specimens and at times cut tissue so sloppily that he could Even when confronted with mistakes, some co-workers recall, diagnosed is uncommon in a woman of Williams’ age, and Over the summer of 2000, the pathologists believed, Hooper not make an accurate diagnosis. It meticulously charted his Hooper seemed indifferent to the life-or-death importance one cell type necessary for Hooper’s finding was absent, said had misdiagnosed at least four other patients.
alleged failings, listing each by case number, and cautioned that of his job. Though pathologists rarely see patients in person, Dr. Lora Hedrick Ellenson, a professor of pathology at Cornell his work “puts all of us and the institution at risk for medical they issue crucial verdicts based on blood or tissue samples. University’s medical school, who reviewed Williams’ medical One was Virginia Jackson, 75, known as “Mama Jackson” to her Depending on a pathologist’s report, patients can return home to a normal life, require surgery and other treatment, or face the “Everything about this case should have raised all kinds of red Nesbit’s attorney, who dismissed Hooper’s defense as specious, After a second physician expressed worries, Hooper was found As much as they scrutinized Hooper’s performance at King/ negotiated a $450,000 settlement with the doctor in 1998.
to have made at least two more serious errors, VA documents Drew, his fellow pathologists knew little about his past. The Mohamed informed at least five other doctors at King/Drew, same was true, apparently, of hospital officials.
Less than a year later, Nesbit was dead at 57.
including several involved in Williams’ care, that she did not Ultimately, hospital administrators opened an investigation Had they looked into it more closely, they might not have hired “We’re not talking about some trivial error here,” said Nesbit’s and sent slides from 346 of Hooper’s cases to the nationally lawyer, Richard Binder. “We’re talking about something that cost renowned Armed Forces Institute of Pathology for a She did not learn of the misdiagnosis until more than two years Hooper moved on. By late 1997, he was filling in at a Reno Of these cases, nearly a third contained mistakes. The institute later, when a Times reporter - unaware that she didn’t know When Roberta Nesbit got the results of her biopsy back from a medical center operated by the U.S. Department of Veterans found that Hooper had made major errors in 10 cases and San Diego lab in 1995, she had reason to celebrate.
Affairs and tending to private medical laboratories he had minor errors in 104 more. Major errors typically require opened in California, Nevada and Wyoming. (He eventually remedies such as chemotherapy or surgery.
After the operation, “I felt like I wasn’t even going to be a full The mole on her groin was benign, according to Hooper, who operated at least six, at various times.) woman anymore,” she said, her hands shaking.
was filling in for another pathologist at the lab. She was cancer According to a published study and two experts, the standard At the VA medical center, former co-workers remember him error rate for major mistakes by a general pathologist such as The mother of three had wanted to have more children. But in rumpled khakis, singing along with Elvis recordings during Hooper is less than 1% when all cases are reviewed.
she’d taken solace in being a cancer survivor, and she’d been Actually she wasn’t. Over the next 15 months, the melanoma autopsies or lamenting the ban on the diet drug combination grateful to King/Drew. “Everyone kept calling it ‘Killer King,’ “ she would grow underneath her skin, becoming a massive tumor. fen-phen. He’d hurry through dissections and slides, then make Hooper’s rate was nearly three times that.
said. “I used to say, ‘No, that hospital saved my life.’ “ She had a second biopsy, which revealed not only that she did phone calls related to his outside businesses, they say.
have cancer, but also that it had spread to her lymph nodes.
His contract as a fill-in at the hospital was not renewed, VA Hooper, 55, has repeatedly declined to discuss the case and As at King/Drew, it wasn’t long before the quality of his work Nesbit sued Hooper and the lab for malpractice.
“I would not hire him ever” again, said Dr. Paul Jensen, former His attorney, James Andrew Hinds Jr., wrote in a Nov. 5 letter In court papers, the pathologist’s own attorneys conceded In May 1998, a surgeon discovered that Hooper had failed to chief of pathology and laboratory medicine at the Reno facility. to The Times that the criticisms of Hooper amounted to that even a second-year medical trainee would have spotted notice one of two tumors in a section of colon she had taken “innuendo” and were “without factual substantiation.” In fact, the cancer in the mole. But Hooper, they said, was not at fault: out, according to VA documents that The Times obtained he said, Hooper cleaned up “an administrative mess at the He must have looked at a slide from another, healthy patient, through the federal Freedom of Information Act. Another But the VA kept Hooper’s litany of mistakes to itself - never hospital.” Hinds also indicated that the doctor was precluded mislabeled by a technician as Nesbit’s.
pathologist determined the growth to be cancerous.
alerting the Nevada Board of Medical Examiners.
from commenting because of patient confidentiality rules.
Dr. Thomas Barcia, the hospital chief of staff, said VA lawyers patient got a positive pregnancy test from the lab Hooper ran advised him that Hooper’s errors fell within acceptable industry Hooper rebounded quickly. He captivated friends and Before long, however, his enterprises crumbled. The promised colleagues in the mid-1990s with ideas for lucrative diagnostic profits never materialized. And Hooper, once so solicitous, stopped returning investors’ calls.
To this day, if another hospital called to inquire about Hooper, the VA would give him a clean reference, Barcia said, adding From an early age, Hooper sought to make his mark in the They recall his saying that he was on the hunt for an HIV Hal Forseth, a Montana obstetrician who interned with that “the data I have does not show he was a substandard vaccine and that he had a patent on his research. He planned to Hooper in the Navy, recalled the pathologist’s sending a brisk sell the idea to a pharmaceutical giant.
form letter saying Forseth’s investment had been lost: “Just, it After high school, he left tiny Ely, the dusty east Nevada mining tanked. Adios, amigo. That was hurtful. He was a friend.” In 1999, the year after the VA’s investigation of Hooper, another town where his father was postmaster. While pursuing a PhD But first he needed money. Many friends - and their families arm of the federal government sanctioned him for lapses in his in microbiology, Hooper attended medical school at the and their friends - invested with Hooper, some handing over Hooper filed for personal bankruptcy in 1999 - a year before King/Drew hired him - listing 28 pages of creditors. Two groups of investors sued, accusing him of swindling them out of nearly The Health Care Financing Administration determined that He told admiring classmates that he’d been asked by medical Hooper, who had been active in his Lutheran church, came $1 million in all. In court papers, he denied the allegations.
Hooper had falsely claimed the lab was accredited by the school officials to teach microbiology, but felt it would be across “as a person who is really dedicated to medicine and College of American Pathologists. In fact, he had never applied especially to HIV,” said Father Frank Hoffmann, a Catholic In one suit, investors alleged that Hooper had coaxed them into for such accreditation, government records say.
hospital chaplain in San Diego who invested $8,000 of his funding labs and research destined to fail. They contended that “He was on the fast track,” Champa recalled. “I was awed.” retirement money. “He looked honest, sincere. With me he he knew his HIV vaccine didn’t work and that, contrary to his The regulators also found that Hooper closed the lab to avoid would always bring up the religious part.” an inspection. The government banned him from owning or Hooper trained as a pathologist in the Navy and leaped over operating a pathology lab anywhere in the United States for colleagues to become chairman of the laboratory department Colleagues and other investors say Hooper appeared to be the “You’re looking at him and you’re thinking, ‘This is the nice guy at the Naval Medical Center in San Diego.
high-rolling businessman, entertaining them in casino suites next door who will help my mom across the street,’ “ said Dr. Thomas O’Gara, a Reno family physician and medical school Even before these sanctions, some associates had serious Then, in 1994, his nearly 15-year naval career came to an abrupt, doubts about the quality of work at Hooper’s labs.
He would disarm them, they say, with funny asides punctuated with high-pitched giggles.
O’Gara’s family won $70,000 in a court judgment last year, One of them was James Champa, a Wyoming orthopedic Hooper resigned after he was investigated for allegedly using but he said they had yet to collect anything. With interest, surgeon and former medical school friend.
government resources improperly, according to his own He seemed to handle the pressures of business well, his the award had grown to at least $95,000 as of October 2003, testimony in a 2002 court hearing. The Navy would not discuss associates said, though they noticed that he chain-chewed “I realized something was wrong,” he recalled, “when my male Pepcid AC and Tums, bought in bulk at Costco.
“He didn’t just take me,” O’Gara said. “He took my mother, my malpractice record on a national registry. County spokesman him later and, in obscene terms, told him to “shut the . up,” John Wallace said he could not discuss the registry results In the pathology lab at King/Drew, Dr. Dutra knew only what because they are confidential. Hooper had no criminal history, he saw: a colleague who shrugged off his mistakes - when he The second suit, filed by eight other investors - including Father County auditors, spurred in part by Dutra’s effort, began asking questions about Hooper in November 2000. Stymied by what It is unclear whether King/Drew knew of Hooper’s federal “He would make these casual diagnoses that were wrong, and they saw as hospital officials’ slow responses, they didn’t Robert Mallon, a Yuma, Ariz., pathologist and former Navy lab sanctions or the investor lawsuits, Wallace said. Physician they didn’t seem to bother him,” Dutra recalled.
complete their report until September 2001.
colleague of Hooper, said he hoped to recover at least some of applicants at the hospital are not required to disclose bankruptcy filings or lawsuits unrelated to malpractice.
While the other pathologists sank into bitter disappointment Their conclusion: Dutra and his colleagues had been right all at management’s seeming indifference to their concerns, Dutra along. Hospital leaders had known of Hooper’s failings and “If we get a judgment against him, I’ll follow him to his grave,” But a hiring expert said a responsible hospital should make embarked on an impassioned campaign. He made angry phone done nothing.
every effort to learn if there had been any.
calls and wrote pleas to county Supervisor Yvonne Brathwaite Burke’s office, county auditors and health department leaders The 16-page report faulted Dr. Edward Savage, the former Any business should be wary of a bankrupt applicant who and the Medical Board of California. He listed new diagnoses medical director to whom the pathologists had addressed their is being sued by his partners, because he might be more by Hooper that he considered questionable, including case letter, and Gleason-Jordan, the department’s chairwoman, for The investor suits are among several items in public records concerned with his legal woes than the job at hand, said that document Hooper’s legal and professional troubles in the William Greenblatt, chief executive of Sterling Testing Systems, years before King/Drew put him on staff.
which performs background checks on hospital job applicants He sometimes began his letters with sheepish apologies for his The audit urged disciplinary action against Hooper. But by this time, he was on disability leave, claiming harassment and Evidence could also have been found at the Nevada medical stress, the audit said. He formally left county service in July board, to which - as a doctor licensed in that state - he was “You would have to know that he had lawsuits,” said Dr. David “The truth of the matter is that we’re only seeing the tip of 2002. Hooper was never disciplined, county officials recently required to report the Nesbit settlement. Other information Shenton, who added that he lost $15,000 in one of Hooper’s the iceberg,” Dutra wrote in May 2001 to Dr. Gail Anderson Jr., was in the U.S. government’s Laboratory Registry and in federal the health department’s acting medical director who oversaw King/Drew. “Who knows how many other time bombs Dr. Others faulted in the audit still contest its findings.
“You’d see some red flags, and then you’d call references,” said Hooper has out there, waiting to show up sometime in the And these are just the public documents. More could have Shenton, who helps screen physician applicants at his Billings, “They don’t know what they’re talking about,” said Savage, who been gleaned from private reference checks.
Mont., hospital. “It just seems sort of odd that [King/Drew] retired under pressure but now works at the hospital part time. Dutra’s frustration clouded his professionalism at times, he “We did everything according to the rules.” Los Angeles County health officials said King/Drew did a freely acknowledges. One day he ranted against Hooper so criminal background check on Hooper and searched his loudly in the pathology department hallway that Hooper called Gleason-Jordan was replaced as chairwoman the month after the audit was released, and she later retired.
Dutra distinctly remembers one administrator’s response.
their letter - when the state medical board accused him of mishandling the care of six King/Drew patients, including In an interview, she defended Hooper’s performance and Anderson, the health department’s acting medical director, Williams, whose reproductive organs were removed chastised Dutra in a letter for “releasing confidential, patient- unnecessarily. He is contesting the board’s accusation.
specific information” to the medical board and Burke’s office.
Dr. Thomas Garthwaite, who became director of the county Dutra took no solace in his group’s ultimate vindication by Department of Health Services in early 2002, said the Hooper In the final paragraph, however, Anderson briefly commended county auditors. He left King/Drew in July 2003, disgusted, he case was his first signal that King/Drew suffered from grave Dutra’s concern for patient safety.
said, with its leadership. “Even when you win, you don’t win “I was just struck by the nature of the errors and by the By the time the medical board filed its case, Hooper had left the relatively casual way it was handled,” he said recently. “It was Administrators finally did something about Hooper - after he very clear to me we needed new leadership.” Today, he is a staff pathologist at a large private hospital in San Garthwaite could not explain, however, why he did not act They paid Mohamed and another pathologist thousands of dollars to comb through all his nearly 2,000 diagnoses.
“Dr. Hooper is a member in good standing of our medical staff An independent expert who reviewed the audit, the Mohamed said she had not kept a precise tally of misread tests, here at Baptist Health System,” spokeswoman Karen May said. pathologists’ letter of warning and other records for The Times but had referred cases as she found them to the hospital’s risk “And that’s the information we’re prepared to release.” said Hooper’s ongoing mistakes pointed to broad failures in management department. She said recently that she could remember just one significant case beyond those the hospital Times researcher Scott Wilson contributed to this report.
“Certainly his bosses were not doing a good job in preventing these errors,” said Dr. Hector Battifora, former chairman of According to court files, Maria Aparicio, now 66, learned after pathology at City of Hope National Medical Center in Duarte. the review that Hooper had missed her breast cancer two years “When errors like this happen and they are reported and earlier. Aparicio, who required surgery and follow-up treatment, nothing is done . that is absurd. And the administration should sued and collected a $25,000 settlement from the hospital.
have been aware of it, and they should have done something about it.” California authorities did not try to discipline Hooper until October 2003 - three years after the pathologists wrote
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