The date was September 27, 1991, and Dr. Stephen Gould, a La Jolla psychiatrist in private practice, wrote a memo regarding an unpaid assignment he had been given by the University of California San Diego Medical Center. Gould had been asked by Dr. Sidney Zisook, another psychiatrist then employed by UCSD's Gifford Clinic, to keep track of a second-year psychiatric resident by the name of Dr. Robert Allan Weitzel.
"I have been supervising Doctor Weitzel now on a regular basis. I was specifically asked to see him by Dr. Sidney Zisook because of Doctor Weitzel's self-reported confusion about patients having sexual feelings for him and how to handle that in a therapeutic manner. Doctor Weitzel has been prompt and timely in appearing for supervision. He has been involved. He has been sincerely interested in understanding, within the supervisory context, his own feelings and behavior that have resulted in patients having sexual feelings for him. He has been very open about trying to introspect about his own feelings and behavior.
"We have discussed that part of his difficulties were conceptual in that he had the feeling from his reading and previous work that sexualized transferences were part of the 'gold' of psychotherapy...that one would dig for. As he began to understand that in fact these feelings were, in part, resistances to the therapeutic process or that they were not universally ubiquitous or that they were more obvious in patients that had in fact a history of sexual problems as opposed to others, he was able to modify his own expectation of what good therapy was and was not about."
Concluded Gould: "Doctor Weitzel very much values being a good psychotherapist and is attempting to become one. I think he is finding that it is more complicated than he had first realized."
Was that a deadly prophecy?
Today, Weitzel, 44, is on trial for the murder of five elderly patients in a Utah geriatric-psychiatric clinic, and a San Diego attorney is charging that UCSD contributed to the tragedy. Nancy Sussman, an ex-nurse who practices medical malpractice law from an office just north of downtown, says the University of California "did everything in its considerable power" to protect Weitzel after she filed a sexual-abuse suit against him and UCSD on behalf of a female patient in late 1994.
In addition to having conducted a sexual affair with the patient, the complaint alleged, Weitzel was shooting up drugs such as Demerol, which he obtained by writing illegal prescriptions on UCSD prescription pads. "The university is extremely powerful and has tremendous financial resources to fight these types of cases. They refused to blow the whistle on this guy."
The result of UCSD's failure to warn the public about its wayward doctor, Sussman says, is that Weitzel was able to retain his license to practice medicine in both Texas and Utah even after the State of California's Board of Medical Quality Assurance had yanked his California medical license. That happened in May 1997, more than two years after Sussman's malpractice case against Weitzel and UCSD was settled out of court for a sizable amount of cash, with no public admission of guilt by either the doctor or the university.
"I think University of California did everything to keep the information about this case from everyone involved. They didn't do anything to cooperate with the medical board and its investigation. They refused to do anything that might have resulted in forewarnings to the other enforcement agencies or other states. They told absolutely no one. They took the position that we're going to sweep it all under the carpet and protect ourselves from further liability."
Weitzel voluntarily gave up his California license rather than challenge the medical board's allegations that he had "methodically manipulated a patient and her treatment in order to use her as an object to gratify his own emotional and sexual needs." But he didn't lose his Utah license until 1999, when he refused an order to undergo a mental examination to determine if he had a "malignant personality disorder."
By then, the psychiatrist was in Texas, running another geriatric clinic at the Matagorda County Hospital in Bay City, where he had gone to work in February 1998. Though the U.S. Drug Enforcement Administration had pulled his permit to prescribe controlled substances, the hospital allowed Weitzel to write prescriptions using its own federal control number. Weitzel's Texas medical career finally came to an end after he was arrested on September 20, 1999, on a warrant charging him with the deaths in Utah. Texas authorities are now investigating the suspicious death of an elderly patient that occurred at Matagorda County while Weitzel was there.
Weitzel began work at the Davis Hospital and Medical Center in Layton, Utah, near Salt Lake City, in August 1995, about a year after arriving from San Diego, and left the clinic in September1996. During 16 days between December 1995 and January 1996, prosecutors charge, the psychiatrist administered a combination of psychotropic drugs and lethal doses of morphine to five elderly patients in the clinic under his command. The victims are alleged to be Ennis Alldredge, 85; Ellen B. Anderson, 91; Mary R. Crane, 72; Judith Larsen; and Lydia M. Smith, 90. The state has charged Weitzel with five counts of first-degree felony murder, which could put him in jail for life.
Weitzel's defense attorney Peter Stirba has countered that the murder charges against his client are a bum rap, and that, if anything, the allegations of negligence, poor patient care, and improper diagnoses belong in civil, not criminal, court. In addition, Stirba has argued that much of the evidence against his client is circumstantial and based on the flawed, five-year-old recollections of nurses who administered the drugs on Weitzel's orders. The defense attorney has also convinced the Utah trial judge to bar admission of any evidence or testimony regarding Weitzel's past history, including the San Diego malpractice case against him.
The description of life in the geriatric ward is not for the faint of heart. As told during trial testimony, the Davis clinic serves as a way station for violent, mentally unstable elderly patients who become hard to manage in convalescent hospitals. In some cases they have fought with nurses and injured staff and other patients by throwing wheel chairs and cutlery. At Davis, they are treated with psychiatric drugs and sedated with morphine to change their behavior, then sent back to their rest homes within a few weeks. Many suffer chronic heart and kidney conditions and senile dementia; they do not have long life expectancies.
Two weeks ago, a nurse testified at Weitzel's trial that she had confronted the doctor about the morphine injections. "I had concerns that the morphine would interact with the high doses of psychotropic medications," she said. On cross-examination, Stirba heatedly questioned the nurse's recollection of the incident.
Weitzel's defense team has maintained that the sedative and pain medications, including morphine, he prescribed for the terminally ill patients were based on the compassionate use of "comfort care" for those without long to live. Prosecution experts have testified that the amounts of morphine, Haldol, Trazodone, Risperdal, Ativan, and Fentanyl that Weitzel prescribed for the patients were excessive and used in dangerous combinations, demonstrating Weitzel's gross negligence and intent to kill. None of the dead patients were terminally ill when they entered the clinic, say prosecution witnesses. A week ago Monday, the prosecution rested its case and Stribal began what is expected to be a three-week presentation for the defense.
Last Thursday, Dr. Laurel Herbst, the vice president of San Diego Hospice, took the stand to testify in Weitzel's defense that, based on her review of medical records, the morphine levels Weitzel had prescribed for the five patients who died was not out of line. All five were terminally ill, she said.
[Herbst interview and trial update to come Mon AM, hopefully. She's in Atlanta, per San Diego Hospice. Hopefully can contact on Monday. She probably got paid for this testimony and might not want to talk. We'll see--mp]
Meanwhile, Weitzel has been charged in federal court with 22 counts of fraudulently obtaining Demerol and morphine, controlled substances, for his personal use. Those allegations are still pending. And the Utah Division of Occupational and Professional Licensing (DOPL) filed still more charges against Weitzel in August 1999, alleging that he provided substandard care by prescribing injectable morphine and Demerol to nine patients who had come to him with complaints of headaches, then taking the drug himself.
All of which comes as no surprise to Nancy Sussman, the attorney who handled a malpractice case against Weitzel and UCSD back in 1995. "That's what he did here. He stole from the university." The plaintiff, whom Sussman requests be identified for publication as Patient X to protect her privacy, alleged that Weitzel had initiated a sexual relationship with her after she had entered the university's Gifford Clinic seeking psychiatric treatment following an emotionally crushing divorce in January 1990.
Two years later, after her divorce from her husband became final in June 1992, Weitzel told his patient that he was terminating his therapy sessions with her. The next day, according to the lawsuit, Weitzel and Patient X began a sexual relationship that lasted until 1994, during which time she became pregnant and had an abortion, according to court records. In December 1995, Patient X filed suit against Weitzel and UCSD.
In a letter dated June 23, 1992, which later was made part of the court case, Weitzel wrote to Patient X:
- I love your wisdom,
- I love your laughter,
- I love your strength,
- I love your body,
- I love your child,
- I love your soul,
- I love you,
That same year, Weitzel wrote another letter to Patient X on Utah hotel stationery:
"I've been thinking a lot on the drive here...good thoughts. There's a lot to say; I just want to say it in person instead of by letter or with flowers. I hope your move went well , mine did. (It seemed like earthquakes followed all the way here...)
"It's 3 hours later, and we just spoke on the phone, so you'll call me back in a while and I'm very happy! I'm not much for letters, but you've got me totally wired/inspired/fired -- I'm crazy about you...
"Meditating on the way here, it feels like being born again, opened up, I look forward to the deliciousness of more life with you.
"It'll be fun.
"I'm gonna make it so much fun for both of us. We're both gonna make it fun for each other.
"I haven't written a love letter since grade school."
During the lawsuit, Sussman ferreted out testimony and evidence that she says clearly demonstrates that UCSD was aware of, but repeatedly ignored, signs of trouble with Weitzel.
In a deposition conducted on April 5, 1995, Dr. Stephen Gould was asked by Sussman why he had been requested by UCSD's Dr. Sydney Zisook to monitor Weitzel's behavior. Zisook, Gould testified, had said that "they had a second-year transfer resident...that they had some concerns with and that he was not psychologically minded, very reactive and that it interferes with his professionalism, and that he shows irritation, that he's uncomfortable -- I think this last thing means that he's real uncomfortable with provocative and seductive patients."
Gould also recalled that "others have felt that [Weitzel] himself could be seductive and intrusive and so for these reasons -- and [Zisook] also mentioned on the phone that I remember that [Weitzel] was seen, for example, having a therapy session outside of the office under a tree rather than in the office, and [Zisook] wanted me to help [Weitzel] to understand that it was important to keep therapy in the office"
When contacted late last week and asked for comment about the Weitzel case and his role in it, Zisook hung up the telephone.
Sussman's complaint charged that UCSD had failed to adequately monitor Weitzel's behavior and alleged drug abuse. "Defendant Weitzel made sexual advances to plaintiff, many of which occurred in 'therapy sessions,' which were also held in his apartment, with the presumed knowledge and consent of defendant [UCSD]. Defendant Weitzel also encouraged plaintiff to accompany him to social engagements, offered to give back rubs, made sexual advances, invited plaintiff on dates, took plaintiff to a bar, and offered to marry plaintiff.
"Defendant Weitzel's therapy was ineffective and below the standard of care. Defendant Weitzel encouraged plaintiff to have a sexual relationship with defendant Weitzel and offered the termination of therapy as incentive for sanctioning of their new relationship.
"During the course of the psychiatrist/patient alleged therapeutic relationship between defendant Weitzel and plaintiff, defendant Weitzel is believed to have used illegal and patient drugs, and converted drugs from plaintiff and other patients which he had ostensibly prescribed for them. This was done with the implied knowledge and consent of defendant UCSD Medical Center and defendant Regents.
"The sexual relationship between defendant Weitzel and plaintiff lasted until or about April 1994. Defendant Weitzel informed plaintiff throughout her therapy and after June ??10 22, 1992, that sexual contact between psychiatrist and patient was permissible and beneficial."
In a sworn statement, dated May 5, 1995, Patient X claimed that she had personally seen evidence of Weitzel's alleged drug abuse. "During therapy with Defendant Robert Weitzel, M.D., I returned to him prescription bottles of tranquilizers that he prescribed for me (Buspar) for his supposed disposal at his request. I was unable to tolerate the medication.
"During our affair, I found my prescription bottle of Buspar plus several (about 12) prescription bottles of other patients of Defendant UCSD in Defendant Weitzel's possession. Defendant Weitzel admitted to me he was taking the medication he prescribed to other patients himself as well as my Buspar.
"Further, Defendant Weitzel admitted to me he was self-prescribing himself."
When attorneys for Weitzel and UCSD blocked Sussman's attempted subpoena of Weitzel's prescribing records, she fired off another brief.
"Plaintiff...has good cause for ascertaining if Defendant Weitzel's abhorrent behavior was in part precipitated by his abuse of controlled substances on Defendant UCSD's prescription pads. Plaintiff has knowledge that Defendant Weitzel was taking her drugs and had a lot of other UCSD patients' drugs in his possession. Defendant Weitzel admitted to Plaintiff that he was self-prescribing narcotics to himself on Defendant UCSD's prescription pads indicated for office use.
"He was 'shooting up' with the narcotics. The fact that Defendant Weitzel was frequently under the influence of controlled substances would partly explain his misconduct, as well as be relevant to the issue of whether Defendants Regents and [UCSD Medical] Center were on notice of Defendant Weitzel's incompetent and dangerous behavior toward female patients such as Plaintiff."
Within weeks after a judge took Sussman's request to subpoena Weitzel's prescribing records under consideration, she says, the university settled the case.
"The university and Dr. Weitzel's attorney did everything they could to prevent us from getting those records. They didn't even want to have a hearing on the issue. That's what finally caused the resolution of the case, not the doctor's conduct. They were afraid of turning the prescribing records over to us," says Sussman. "That would have looked terrible for UCSD had we got his prescription forms and found out the amounts of [controlled substances] involved. It would have looked very bad."
Today, Sussman questions UCSD's decision to graduate Weitzel from its psychiatric residency program. "They shouldn't have graduated someone like this. He was really showing signs of someone who did not know his boundaries. They had a duty to the public not to graduate this doctor out. Instead, they circle the wagons and protect their own."