No justice for Abubakar Tariq Nadama after all?

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.