Chapter 39: Ohio State Medical Licensing Board

August 23, 1989, Columbus, Ohio

After lunch on Wednesday, I took Rachel to stay with her aunt, then drove to Columbus to meet Tom Kirkland in advance of the hearing later in the afternoon. I met him at a coffee shop down the street from the Medical Licensing Board offices on East Broad Street.

"I think they're going to come at you hard," Mr. Kirkland said. "From their perspective, you're the most dangerous witness, so they're going to do everything they can to put your future at risk."

"Why me, rather than Doctor Mercer?"

"They can't hurt her; they can hurt you. You'll come before the Board for your license, and they're going to try to poison the well."

"I'm not going to run away."

"I was positive that was true, or I wouldn't have listed you as a witness. For you to withdraw would strengthen their position. The key to surviving this is not falling for any of their traps. No matter what they ask or how they ask it, you're testifying as Angie's friend, not as a doctor. I'll emphasize that all of this occurred before you graduated from medical school."

"So, how do you want me to answer."

"All you need to do is corroborate what Doctor Mercer and Mrs. Stephens have said in their depositions and will say, and what Doctor Hoffman stated in her affidavit. Don't let Doctor Greenberg's attorney lead you off that path. No matter how you think the hearing is going, it will go worse if you deviate. Our argument is simple — Angie had a clear picture of the future, had put together a long-term plan, and was implementing it. When Doctor Greenberg became aware of that plan, he acted contrary to best practices. But remember, YOU can't say that last part."

"Understood."

"Then let's go."

We left the coffee shop and walked down the sidewalk to the building, which housed the medical licensing board. Mr. Kirkland gave our names, and we were directed to the hearing room, where Lara and Clarissa were waiting. I also saw Doctor Mercer and, to my surprise, Doctor Lawson.

"That's the Psych Chief from my hospital," I said quietly to Mr. Kirkland. "We need to talk."

"We have a few minutes; let's step out into the hallway."

We did and moved a short distance from the door to the hearing room.

"He's not on the witness list," Mr. Kirkland said. "But the Board will probably allow it. What's he going to say?"

"He'll likely describe an incident with a mentally ill patient who I treated. I felt the best approach was to humor the patient, and I was having success. The Psych Resident rejected my plan, and that resulted in an agitated patient who had to be medicated. He'll say I'm a cowboy or something similar. On the flip side, he threatened my career if I testified today."

"Will you say that on the stand?"

"If he tries to assassinate my character, yes."

"I'll make a judgment on whether we need to raise the issue or not. You answer my questions, and you don't go beyond where I lead you."

"OK."

We returned to the hearing room, and I sat down next to Clarissa, noting that Mr. and Mrs. Stephens had arrived, as had Doctor Underwood, who had first treated Angie when we were at Taft.

"You OK?" Clarissa asked quietly.

"I'm not going to be intimidated."

"Good."

"Uh-oh," I said as Doctor Paul Forth walked into the room.

I got up and moved to where Mr. Kirkland was sitting.

"That's Doctor Paul Forth," I said. "He and I had in-depth conversations about Angie."

"What can he say that will hurt us?"

"That, at the time, I agreed Doctor Greenberg made a clinical decision based on the usual standard of care. My response was more nuanced, but that's how he'll spin it."

"He's also not on the witness list," Mr. Kirkland said. "When was that conversation?"

"During my Third Year, sometime in March last year."

"That might actually work in our favor. One late addition would probably be allowed, as I said. But given the conversations weren't in the last few weeks, these are not 'unavoidable circumstances'. Thanks for letting me know. I believe I'm going to change my plans and call you first."

"OK."

I returned to my seat just as the members of the Review Board entered the room. They all took seats at a long table in front of the room, and the Chairman banged his gavel to call the meeting to order.

"In the matter of Doctor Jules Greenberg," the Chairman, Doctor Brewer, announced.

The five-member panel was introduced, all of whom were active, practicing physicians, none of whom were psychiatrists. I wasn't sure if that was a good thing or a bad thing.

"Is counsel for the complainant here?"

"Tom Kirkwood on behalf of Mrs. Marjorie Stephens, natural guardian of Angela Marie Stephens, and Laura Bragg, next friend of Angela Marie Stephens."

"And counsel for Doctor Greenberg?"

"Arthur Braun, of Volstead and Braun, representing Doctor Jules Greenberg. With me is my colleague, Evan Miller."

"We've all read the complaint. Mr. Kirkwood, you may begin."

"Doctor Brewer and members of the Committee. The matter before you is straightforward. I will present witness and expert testimony that Doctor Jules Greenberg callously disregarded clear contraindications to his treatment of Miss Stephens. May I call my first witness?"

"You may."

"I call Doctor Michael Peter Loucks."

I got up and moved to a chair that Mr. Kirkwood indicated.

"Doctor, would you raise your right hand, please?" Doctor Brewer asked.

"Doctor, I request my right to affirm rather than swear."

"Do you affirm that the testimony you give before this committee will, to the best of your knowledge, be true and accurate?"

"I do."

"Mr. Kirkwood?"

He had me state my name, address, and current employment.

"Mr. Chairman, despite his recent graduation from medical school, Mr. Loucks is not testifying as a physician but as a close friend to Miss Stephens to events that occurred before he completed medical school. As such, he is not providing medical judgment, and I ask that he be treated as a layman for the purposes of this hearing."

"Mr. Braun?"

"Doctor Loucks is a physician and is subject to the rules of this Committee, including discipline for any statements he might make. I ask the Committee to take official notice that he is a practicing physician."

"Mr. Kirkwood?"

"None of the events which occurred, nor any statements made about Miss Stephens to anyone, occurred or were made as an MD. In fact, many of them were made before Doctor Loucks even entered medical school and the majority of them before he entered his clinical rotations. There is no witness that Mr. Braun can call and no evidence that he can present which shows any statements about Miss Stephens made as a physician. No testimony given today will cover any events which occurred after May 25th, 1989, the date of the McKinley Medical School graduation."

The Chairman turned off the microphones and consulted with the doctors on either side of him, who each asked the doctors at the end of the table, with the answers communicated in voices too low for any of us to hear.

"The Committee will consider any statements made by Doctor Loucks about events before May 25th to be those of a layman. Doctor Loucks, I caution you to keep your answers factual and not diagnostic, or this decision may be reconsidered."

"Yes, Mr. Chairman," I acknowledged.

"Is it OK to call you Mike?" Mr. Kirkwood asked.

"Yes."

"Mike, would you describe your relationship with Miss Stephens, beginning with when you first met her?"

I spent fifteen minutes describing how I'd met Angie, how our relationship had progressed, and the series of incidents which had led to her being diagnosed with schizophrenia.

"What happened after that?"

I described marrying Elizaveta, our friendship with Angie, then Elizaveta's death, and how Angie had changed.

"You observed Miss Stephens making long-term plans with specific goals and then executing those plans?"

"I did."

"Did you have an occasion to discuss her actions with her?"

"Yes."

"What were those interactions?" Mr. Kirkwood asked.

"When she first put her plan into action, she stopped taking her medication. She confided in me that she had done so, and I insisted that she adhere to the treatment plan established by Doctor Greenberg and Doctor Mercer, a clinical psychologist and that she discuss the situation with Doctor Mercer."

"Did she comply with your suggestions?"

"To the best of my knowledge, yes."

"What happened next?" Mr. Kirkwood asked.

"She confided to her priest, outside of confession, that her goal was not just her driving license but marriage to me. Because of direction from our bishop, her priest notified Doctor Mercer about Angie's statements. Doctor Mercer communicated those to Doctor Greenberg. The next thing I knew, Angie was in the hospital under sedation."

"Then what?"

"Her care was moved from Doctor Greenberg to Doctor Hoffman. Doctor Greenberg challenged that move but was unsuccessful."

"As Miss Stephens's closest friend, what can you say about her behavior just prior to her final meeting with Doctor Greenberg?"

"That she was very much like the Angie I met at Taft in late 1981 — a normal but quirky eighteen-year-old. I and my closest friends were all quirky, so she fit right in. In other words, Angie was, in layman's terms, back to normal. She was working, taking classes, practicing Aikidō, and going to church. She knew what she wanted, and she was, within the restrictions placed on her by the State of Ohio, taking steps to accomplish her goals."

"When did things change?" Mr. Kirkland asked.

"December 1987, after the communication from Angie's priest."

"And how is Angie now?"

"Similar to how she was after her diagnosis."

I wanted to add 'due to medication', but I had to be VERY careful about that.

"Which means?"

"Barely able to care for herself and unable to work."

"And that changed in December 1987, after her intentions were communicated to her doctors?"

"Yes."

"Thank you. I have no further questions of this witness, Mr. Chairman."

"Mr. Braun?"

"Good morning, Doctor Loucks. It's good to see you again."

I'd expected that, so I was ready to tell a 'little white lie' of social convention despite being under oath.

"And you as well," I replied.

I made sure to keep my tone light, but all I could think of was that I now fully understood what the Holy Apostle Paul meant by a 'thorn in his side', and it did not appear that God would remove this particular thorn any time soon.

"Doctor," he said, emphasizing the word, "did you have occasion to speak to Doctor Paul Forth and Doctor William Lawson about Miss Stephens?"

"Objection, Mr. Chairman," Mr. Kirkland said.

"On what grounds?" Doctor Brewer inquired.

"Both doctors are employed at Moore Memorial, a teaching hospital, and any conversations were of a didactic nature. Medical students are not only expected but expressly instructed to ask wide-ranging questions and explore non-traditional responses with the aim of education. To attempt, years later, to hold a medical student accountable for questions he or she asked would do a grave disservice to medical training.

"I will also point out that neither Doctor Forth nor Doctor Lawson appear on the witness list submitted by Mr. Braun. The fact that he led with that question indicates an attempt to sway the committee to allow him to sandbag Doctor Loucks and Miss Stephens' guardian and next friend by relying on what amounts to trickery to bring in their testimony without depositions or interviews."

"Mr. Braun?"

"It's a legitimate question that will show that Doctor Loucks admitted that the actions of Doctor Greenberg were warranted and justified by the standard of care."

And he'd managed to get the testimony in, even if his witnesses were disallowed, which I had to tip my hat to despite feeling the thorn dig deeper into my side.

"The questions and speculations of a medical student during clinical rotations," Mr. Kirkland countered, "are not only privileged but also, as I said, an expected, even required, part of medical training. I'm going to raise my objections now to Mr. Braun calling those two physicians who do not appear on any witness list, nor are their names listed in any responses by Mr. Braun on behalf of Doctor Greenberg."

"Doctor Loucks," Doctor Brewer said, "these conversations, were they didactic in nature?"

"Yes, Doctor," I replied.

"Then I'm not going to allow this line of questioning. Mr. Braun, you may continue."

"But, Mr. Chairman..."

Doctor Brewer held up his hand, "Mr. Braun, would you like to be called before the Bar and have every word uttered in law school examined to see if you might have said something which was legally in error and have that used to disbar you for unlicensed practice of law?"

"No, but..."

"I'd say that answers my question. Do you have further questions?"

He frowned, but I knew that wasn't the end of it.

"Doctor Loucks," he said.

"Excuse me," I interrupted, "but we all know I'm a doctor as of May 25th. You can say the word without emphasizing it every time."

I was hoping he'd say something to the Chairman about me being uncoöperative or whatever, but to his credit, he didn't and continued.

"You testified that you advised Miss Stephens about the proper use of her medication, did you not?"

"Not," I replied. "I advised her to follow the directions of her physician, which I was required to do by my oath as a medical student."

"Did you or did you not instruct her to take medication?"

"I instructed her to follow the prescription she had been provided by her treating physician. I also instructed her to report her non-compliance to Doctor Mercer, again, as I was required to do by my oath as a medical student to not practice medicine in any way."

"Did you communicate with Doctor Fran Mercer about Miss Stephens' treatment?"

And this line of questioning didn't fall under medical training, so there was no way I'd be able to avoid answering.

"I did, at her invitation."

"And in the course of those conversations, did you object to Miss Stephens' treatment program?"

"I did, and sometimes quite insistently, to a clinical psychologist, who is not an MD, who asked my views."

"When did those conversations take place?"

"After Angie was hospitalized."

"Never before?"

"Before that, Doctor Mercer provided advice on how my deceased wife and I could best support Angie and her parents. I also saw Doctor Mercer for pre-marital counseling."

And for Liz's situation, but I wasn't going to bring that up.

"What specifically did you say?"

"What I've said here — Angie had shown self-awareness, was making detailed, long-term plans, and was taking the steps to achieve them."

"Did you claim Doctor Greenberg had committed malpractice?"

"Yes, and that was borne out by the settlement reached by his insurance company."

"No liability was admitted," Mr. Braun said quickly. "And that is not relevant because it was settled."

"You brought up malpractice," I said with a grin. "I simply noted what occurred."

"Did you, at any point, propose a treatment plan for Miss Stephens?"

"No. I pointed out the negative outcome and expressed my belief that Angie's behavior was not properly taken into account."

"So you made a diagnosis?"

"No, I reported observed behavior to Doctor Mercer and pointed out to her that it had, in my opinion, not been taken properly into account."

"You obviously felt Doctor Greenberg was wrong. What would you have done differently?"

"It wasn't my place to make that decision," I said.

"I'm asking what you would have done had it been up to you?"

"And that's a question I cannot answer. I wasn't aware of Doctor Greenberg's actions until after the fact. All I can say is that inside of twenty-four hours after her statement to her priest, she went from working, caring for herself, practicing Aikidō, and being able to carry on normal conversations to being medicated in the hospital. At that point, there was nothing to do, except hope for recovery."

"You're saying you never proposed a course of treatment nor gave an opinion on how to proceed?"

"Never. All my comments to Doctor Mercer and to the doctors who helped train me were all after the fact, and thus, purely hypothetical, similar to case studies."

"Did you have an affair with Miss Stephens?"

"Angie and I spent a lot of time together, but we were never a couple, and beyond a single kiss during Freshman year at Taft, there was no intimate behavior."

"Isn't it true that the other residents of your dorm called her 'Mrs. Loucks'?"

"Yes, that's true."

"And you would have us believe that there was no intimate behavior when the average person would assume a married couple was engaging in intimate behavior?"

"They called her that because, as my sister put it, Angie and I went to church together, prayed together, ran together, practiced karate together, and acted as if we were married, minus sex. My friend and colleague, Clarissa Saunders, made the same observation. I offered, at one point, to get engaged to Angie, reserving sexual intimacy for after our marriage, and Angie couldn't even take that step."

"But you wanted to have sex with her?"

"As a college Freshman with strong feelings for a pretty red-haired girl with green eyes? With all due respect to her and her parents, absolutely. But her reaction to that solitary kiss changed everything, and as I said, I set that desire aside because of her reaction."

"And after you lost your wife?"

"Angie was a ward of the State and was declared incompetent, and as such, could not consent. One of her goals, before she was hospitalized, was to get her driving license, which she saw as her first step to having herself found competent, and then to marry and have children. She clearly expressed that to me before she said it to her priest. I made it clear that she had to take one step at a time and that no promises could be made."

"So you gave her advice on how to overcome the State's determination of incompetency?"

"I did, in the sense that I referred her to an attorney who specializes in such things and advised her to follow his instructions. I defer to professionals, Mr. Braun. I never once took matters into my own hands."

"Does that include treating patients in ways that go counter to the instructions of Attending physicians?"

"Objection," Mr. Kirkland said. "First, Doctor Loucks cannot discuss any patients without their consent or an order from the Medical Licensing Board for a review of records. Second, any such incident, if it occurred, would have occurred after May 25th and is not relevant to this inquiry."

"I think I'd like to hear it," Doctor Brewer said. "Doctor Loucks?"

"If Mr. Braun will specify the case to which he is referring, I'll answer in a way that protects patient privacy."

"Mr. Braun?" Doctor Brewer inquired.

"Specifically, a patient with delusions who you chose to treat outside protocols."

"Well," I said, "as an Intern in trauma surgery, I'm subject to the policies of the Emergency Department, which I didn't violate. I did make a suggestion to the Psych Resident about a preferred way forward, but they rejected that suggestion."

"Doctor Loucks, would you be more specific, please?" Doctor Nelson, one of the other Board members, requested.

"I can, though it touches on diagnostic actions."

"Nothing you say about this incident will open you to any discipline, nor will it allow Doctor Greenburg's attorney to claim you testified as a physician. Please proceed."

"A patient came into the ED complaining his body had been infested by aliens. Upon exam, he stated that aliens had inserted tracking probes into his brain via his nasal passages. He had wrapped aluminum foil around his head to block the signals. In order to be able to perform a primary exam, I explained that I'd leave the foil in place, and once I'd completed my exams and run appropriate tests, I'd call the hospital's alien expert."