The Medical Board of California attorney, Mr. Arnold, proceeded to read the discussion I had with the undercover agent regarding the source of the human growth hormone, including the part where she specifically asked whether the drug was from China, and I replied, “No.” When he finished reading, Mr. Arnold spun away from Dr. Morgan, the board’s medical expert, raised the transcripts above his head and stared at me for a few moments before resuming his questioning.
“Dr. Morgan, is the conduct displayed by Dr. Kepler in this exchange consistent with the responsibilities of a physician?”
“No. This conduct is an outrageous break of the trust relationship between a patient and doctor. Dr. Kepler was dishonest with patients. Dr. Kepler was asked a direct question and lied. By doing so, he misled the patient.”
By this time, I had slipped back into my familiar place of self-loathing. Maybe they were right; I wasn’t worthy of being a doctor. My very existence demeaned the whole medical profession. I sank into a progressively deeper and darker place as these feelings washed over me. I was nothing more than a common criminal. It didn’t matter that the medical board attorney and his expert witness were telling everyone I was a bad doctor, because I already knew that.
I remembered a Christmas party in San Francisco, attended almost entirely by doctors, where I had felt completely out of place after my arrest. As I looked around that night, I became convinced I didn’t belong with those respectable members of society. If they had known my history, surely they would have cast me out.
“Dr. Kepler violated multiple ethical and professional principals, including beneficence, do no harm, patient-doctor relationship, good faith examination, accurate assessment of benefits and risks of a treatment, adequate follow-up and the use of a medication for non-approved purposes.”
“Thank you, Dr. Morgan. I have no further questions, your Honor.”
The judge stared down my attorney and asked, “Mr. Fanning, do you have any questions of Dr. Morgan?”
My attorney grabbed the legal pad and quickly scanned the few notes he had there. He leaned back and slid his thumbs up and down his suspenders for a few moments. Then he shook his head.
“No questions, your Honor,” he said, the obliteration of my reputation now complete.
This hearing took place exactly ten years ago in the California Office of Administrative Hearings in Oakland, California. One year earlier, I had been convicted of a misdemeanor for the illegal importation of human growth hormone from China, although that was not my only unethical behavior in the proceeding two years. And for that misbehavior, I had spent three months in a San Francisco halfway house and then three months under house arrest.
As much as the criminal process was difficult, it did not compare with my experience with the Medical Board of California. For me, being formally branded as a criminal was easier than being called an unethical doctor and facing the prospect of losing my medical license.
We had all learned in medical school the absolute central importance of the doctor-patient relationship, but my conduct had sullied the inviolate. In doing so, I had sacrificed the awesome responsibility conferred by a medical degree. And without that essential trust, how can one truly be a physician? And once that violation occurs, is it ever pardonable, whatever punishment is served? How can the public entrust their lives with a profession that has members who have contaminated the integrity of the relationship? Should I have been given a second chance?
I can say, without hyperbole, that not a single day passes when I don’t consider one or a combination of the above questions. Perhaps they don’t always come with the same emotional intensity as those first few years, but they still come, and they can transport to a dark place. I wish they would just go away. Or maybe I don’t. Maybe it’s part of my self-imposed retribution.
One thing I do know, however, is that not one day passes when I don’t have supreme gratitude for each and every patient that welcomes me into his or her life. And I guess that’s one good thing that came out of this.
Max Kepler is the author of Confessions of an American Doctor: A true story of greed, ego and loss of ethics.
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