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TRICK OR TREATMENT

part 2 of 2
Most physicians who are honest with themselves will acknowledge that cancer can be a capricious disease and that claiming success for cures or remissions is an inexact science. Add to this the fact that many terminal patients go to oncologists with the expectation only that they will die, and there is ample opportunity for people to believe exactly what they want to believe.

"I love him," responds Robin Flood, a Chicago woman with an autoimmune disease who moved to Hilton Head to be closer to Medenica's clinic, and who named her daughter Demetria after the doctor's middle name. "He's changed our lives. There are many sides to Dr. Medenica, and they're all good. He is what doctors should be."

"His treatments have never been proven," says a local doctor familiar with Medenica's work. "His anecdotal success stories are of no scientific value whatsoever; we all have those. He tends to mix some conventional treatment with the bullshit, so you never know what's actually working."

For years such contradictory anecdotes of Medenica's work were just that--until 1986. That's when a young oncologist named Jane Gehlsen arrived on Hilton Head Island. A graduate of Memorial Sloan-Kettering Cancer Center, she noticed that Medenica's resume showed he was there at the same time. She also observed that he had claimed to study or do research at a number of first-rate centers when several of her friends had been at the same institutions, yet neither she nor her friends had ever heard of Medenica.

Gehlsen began checking the oncologist's credentials. In short order she received letters from administrators at Sloan-Kettering, Dana-Farber Cancer Institute, M.D. Anderson Tumor Institute and the Mayo Clinic indicating that Medenica had exaggerated his affiliation with them.

Meanwhile, another island physician, Daniel Howley, a neurologist, also began investigating Medenica. He began reviewing the oncologist's charts, and according to court documents filed in South Carolina, eventually went so far as to contact several of Medenica's patients under a false name in an effort to obtain information on how he had treated his patients.

The suspicions snowballed. In 1991 Gehlsen and another doctor filed complaints with the hospital against Medenica, in which they alleged malpractice in specific cases. By then, says one source, "the hospital had two complaints from hospital staff saying this guy was full of shit."

By 1992 the hospital was concerned enough that it ordered a peer review of Medenica done by an outside specialist. It selected an oncologist from North Carolina. Although the review has not been released, it reportedly was not favorable to Medenica's work.

Medenica's medical reputation continued to take a beating as the new year began. In early 1993 a more comprehensive review of his work was conducted by specialists in several fields, including a neurologist and an immunologist, as well as two oncologists. It, too, was devastating.

A hospital committee's summary of that evaluation, now a court record, concluded that "Dr. Medenica's practice at Hilton Head Hospital represents an unregulated, scientifically undisciplined application of medical technology mixed with charisma, unrealistic optimism, pseudo-scientific protocol, and excellent basic nursing care."

Although the text of the special outside peer review team's work was confidential, a portion of the report, dated April 1, 1993, was obtained by The Cancer Letter, a public-policy newsletter published in Washington, D.C. According to the evaluation, Medenica's medicine was poor. It concluded that Medenica seemed to "cloak last-effort therapy with pseudoscientific procedure, thus providing false hope for patients."

In other words, summarizes one source (who, like many others, wants anonymity because of a fear of being sued by Medenica's supporters): "Medenica's patients are all cured--right up until they die."

The evaluation further observed that Medenica performed "excessive and useless laboratory testing costing hundreds of thousands of dollars." At one point the reviewer, Dr. Howard Ozer, then chief of oncology at the University of North Carolina Lineberger Comprehensive Cancer Center, described the number of tests as "beyond bizarre." He concluded, "It is clear at this point that Dr. Medenica does not realize what he's dealing with."

Last May, Alfred Higgins, a neurosurgeon and chairman of Hilton Head Hospital's medical executive committee, sent a series of letters to the American Cancer Society and the South Carolina Board of Medical Examiners, among others. In them, Higgins asked for assistance in evaluating Medenica's treatments, which, he wrote, "suggested a number of questionable practices in terms of both medical and ethical issues."

Perhaps realizing that they had a potential legal bombshell on their hands, administrators at Hilton Head Hospital quietly began attempting to get rid of Medenica. In a taped telephone conversation that is part of a lawsuit in South Carolina, for instance, Hilton Head's CEO, Steven Caywood, assured Gehlsen that Medenica was on his way out. His application for renewed privileges at Hilton Head, Caywood said, was "just not going to happen."  

Ten months ago, Stevinson--along with Ali, Anne Coors and ten other Medenica patients--filed their lawsuit against Gehlsen, Howley and Higgins. In it, they charged that the three doctors had conspired to oust Medenica from Hilton Head. As a result, they concluded, the doctors were interfering with their physician/patient relationship and denying them potentially life-sustaining treatment.

Despite the hovering legal threat, the final blow against Medenica fell several months later. Last November the South Carolina hospital drastically restricted the type of medicine he could practice to traditional oncology--no more immunology, hematology or neurology.

It is a move that has enraged Stevinson, who argues that in a country busy debating terminal patients' right to die, it doesn't make much sense to curb the rights of dying patients who want to live. "They say, `This is not the right protocol, that is not the right protocol,'" he fumes. "Well, we don't care about that. All we care about is that this is our last chance, and they don't have a right to condemn us to death."

When asked how Medenica's treatments are different from a traditional oncologist's, inevitably his patients will get around to saying that he treats the person and not the disease. Medenica says this means that he tailors his response to each patient:

"How can you treat a disease? I treat human beings whatever is wrong with them. Each patient has a tumor unlike any other human being, and none are treated identically. Each patient may start out with the same program of treatment, but then it is customized and individualized."

Practically, he does this by culturing a patient's cancerous cells inside a test tube and then experimenting with different therapies--usually a combination of traditional chemotherapies and interferons--until he achieves the most effective mix. Because the experimentation can be extensive, he says that dozens and dozens of tests must be performed--hence the unusual number of laboratory procedures his critics have blasted.

Although such tactics are not necessarily uncommon, Medenica has tweaked the medical community by applying his methods to neurological and other disorders outside the normal purview of most cancer doctors (he says he treats multiple sclerosis successfully). It is telling that he refers to himself more frequently as an immunologist rather than an oncologist.

It is also noteworthy that his disdain for oncology and oncologists is not well hidden. Their methods, he says, are "cookbook." To force him to cut back on his extensive testing would "make me complacent like they are--usually that's why the patient left their care." He says that most oncologists are concerned only with making their patients feel good until they die:

"Palliative care is not enough. Why not try...to cure a patient if it is possible? I just don't give up until the patient is ready to quit.

"Eighteen months ago I had a 62-year-old lady from Hilton Head Island come to me seeking help with generalized breast cancer. She had been unsuccessfully treated by another oncologist [who had] given her only six weeks to live and put her on morphine for pain. Not only did my therapy improve the patient's condition, but her quality of life considerably improved, and I have extended her life. This patient is real and alive today--thanks only to my treatments."

Indeed, some respected professionals say that, whatever his track record with treating terminally ill patients, Medenica is on the frontier of cancer treatments.

Francis Gasparro, for instance, holds a Ph.D. in physical chemistry and conducts his research at Yale University's medical school. He also works with Medenica on a relatively new treatment process called photopheresis, in which some of a person's blood is removed and exposed to ultraviolet light. Medenica, says Gasparro, "is on the cutting edge. The rationale for his work is on a solid scientific foundation."

Medenica also insists that his resume is accurate--that he has published more than 300 papers explaining his work (although he says most of them appeared in other languages) and that his decision to pack his resume with fleeting affiliations at leading cancer institutes here is common practice in Europe.

Finally, he says that, contrary to the findings of the peer review, he does keep his patients fully informed about what he is doing. "If any patient is kept uninformed," he contends, "it is because they don't ask or their family does not want them to know something, or possibly because they don't want to ask and would rather just take it one day at a time. This is their choice, not mine."

Depending on who is talking, the whirlwind of activity surrounding Medenica's last two years on Hilton Head is either the slow awakening of a corrupted medical community come to its senses or a heavy-handed attempt by a small group of professionally and financially jealous colleagues to push him out of the way.  

According to local news reports, court documents and conversations with Hilton Head people who asked not to be identified because of the tangle of pending litigation, Medenica arrived at Hilton Head during a time when the hospital was losing money. But thanks partly to his high fees, prodigious testing and busy practice, the hospital there is now profitable. (The local Island Packet obtained documents showing that in an eight-month period last year, Medenica generated $4.5 million for the hospital by himself--15 percent of the facility's total revenues.)

The hospital wasn't the only beneficiary of Medenica's work. Other physicians got part of the cut as well. For example, "pathologists were raking in a lot of money from the labs," says one person familiar with the situation.

According to Medenica's critics, the local hospital acknowledged the oncologist's substantial contribution in several ways. His patients--who, after all, were the source of the money--were "given the red-carpet" treatment, says one source, recalling that instead of filling out the voluminous registration paperwork when they arrived, Medenica's patients were all preregistered.

In fact, this source adds, when the hospital staff was contemplating shuffling Medenica off the island last spring, administrators convened a special meeting "to determine if they could afford to get rid of him."

Perhaps the most notable evidence of Medenica's own VIP treatment, however, showed up during the process of peer review. That's the normal, ongoing self-evaluation hospitals regularly do of their doctors. Except in the case of Rajko Medenica.

According to sources, other physicians at the hospital conspicuously avoided overseeing Medenica's work because of his stature with the hospital's board. As a result, analysis of his medical treatments was, until very recently, virtually nonexistent. "He wasn't reviewed for several years," a source says. "His cases would come up at the medicine department, and no one would pick them up. They would just pass them around and do nothing."

In a 1991 letter now filed in court, Gehlsen (who, when contacted in Birmingham, Alabama, where she has since moved, declined to comment) added: "I believe there is an active conspiracy of silence to protect Dr. Medenica simply because of the amount of money being generated by him locally."

Although he declines to discuss the specific reviews of his work, it is clear that Medenica, too, thinks there was soul-selling on Hilton Island, but that it is not his own that was on the block. Rather, he says that the flareup over his work shows how quickly and easily physicians can act out of self-interest.

"What surprised me," he says, "was the intensity of professional jealousy from fellow physicians who were not receiving the patients, the income, the growth, the recognition that I was receiving in my specialty."

Medenica's patients and supporters easily brush off criticism of their doctor and mentor as the nervous reaction of a hidebound medical establishment confronted by genius. The outside examiners' devastating review of Medenica's work, for example, shows only that "the water was over their head," says oncologist Richard Hankensen.

Yet as evidence of the alleged plot to jettison Medenica from Hilton Head, Stevinson and his attorneys have gathered documents that they say show that Howley (who declined to comment), Higgins (who did not return phone calls) and Gehlsen were not conducting an authorized peer review of Medenica at all. Rather, they say, the three doctors were orchestrating a smear campaign against their controversial colleague.

And a review of available records suggests that the three at times seemed intensely interested in Medenica, to put it mildly. In one letter to a Swiss physician, now a court record, Gehlsen predicted "a holocaust" if Medenica were allowed to open a bone-marrow transplant program. And in a response to another one of Gehlsen's letters digging into Medenica's past, Gerald Murphy, chief medical officer of the American Cancer Society, pleaded, "Why do you people persist in this?"

Moreover, Howley's evaluation of his colleague was unorthodox, at best. Medenica's supporters make much hay over the fact that Howley contacted a number of the oncologist's patients using a fake name. (Howley subsequently received a disciplinary letter from the medical staff's president, and later sent a letter of apology to Medenica.)

Finally, Medenica's lawyers have uncovered letters sent by Caywood, the hospital's CEO, to each of the institutions that Higgins had written to last year asking for help in evaluating Medenica's work. In them, Caywood tried to distance the hospital from the queries. "The letter and materials which you received from Dr. Alfred Higgins ...were not sent by him with any official authorization by the Hilton Head Hospital, its Board of Trustees, or its Medical Staff," Caywood wrote.  

According to local and South Carolina sources, and allegations contained in the taped conversation between Gehlsen and Caywood, Hilton Head Hospital responded to the legal maelstrom that was building around its most notorious physician in an unusual way. In exchange for Medenica agreeing to relocate his practice to Denver, administrators hired an expert lawyer to find a loophole in the laws requiring hospitals to report disciplinary actions to an organization called the National Practitioner Data Bank. The data bank is used by hospitals and government agencies to keep tabs on physicians' careers.

Court documents suggest a loophole was found. According to a plan proposed by the hospital's lawyer, Medenica would voluntarily restrict his Hilton Head practice to only oncology. That would make it unnecessary for the hospital itself to take any action; thus reporting to the NPDB would not be required. And since the information would not be on the data bank, there would be no way for St. Anthony's Hospital in Denver to know of the South Carolina hospital's concerns about Medenica's brand of medicine. "The key issues here are how to handle this in a way that basically would allow Medenica to relocate in a way that we don't end up facing F. Lee Bailey and hung up in a long, drawn-out procedure," Hilton Head CEO Caywood said in a taped telephone conversation that is now part of the court record. "We want to make sure that [Medenica] gets secured in Denver at the hospital where he is going. They want him. They know what they are getting."

Unfortunately for Hilton Head Hospital, the deal fell through last summer. And when St. Anthony's administrators later learned of the plan, they were less than thrilled.

Medenica's Denver clinic sits at the far northeast corner of Denver West, the highly successful office park off I-70 between Denver and Golden that earned the Stevinson family a good chunk of its fortune. It is four stories high and built in the brown sameness as the rest of the park. In the fifteen minutes he has before a meeting, Chuck Stevinson has agreed to a tour.

Although he repeatedly refers to himself as "scarred," the 66-year-old Stevinson still looks remarkably good these days. The skin on his face is discolored in several spots, and he walks with a marked limp. Yet he drives himself to work every day and doesn't leave until evening.

The clinic is still largely undeveloped, and the doctor's offices are empty. But it is clear that Stevinson has big plans. The first floor is filled with large and very expensive diagnostic machines; it is also the outpatient surgery center. On the third floor, he has persuaded Bonfils, the blood company, to set up a branch so Medenica's lab work won't have far to travel. Down the hall is another modern lab to run other tests for the doctor.

Whether or not it will ever be filled full-time remains to be seen. Stevinson himself seems confident. Last month, however, St. Anthony's Hospital downgraded Medenica's privileges from permanent to temporary, in effect putting on hold any plans it may have had of accepting the Yugoslav as part of its staff. In an even greater show of nonconfidence, the hospital also restricted Medenica's practice to only current patients.

A spokeswoman for St. Anthony's insists that downgrading a physician's privileges is not unusual; beyond that, she declines comment. But sources familiar with the hospital say the actions were taken because Medenica did not inform St. Anthony's in a timely matter of the restrictions put on his Hilton Head practice.

That, along with Medenica's stormy past on Hilton Head, has made him a legal headache. If St. Anthony's accepts him, the Denver hospital--because of the devastating peer review Medenica absorbed in South Carolina--could be a sitting target for any of his patients who decide to sue. Yet if they deny him employment at the hospital, St. Anthony's administrators may face the litigious wrath of Stevinson, who has shown that he is not averse to protecting his physician through the courts.

Still, one person intimately familiar with the negotiations between St. Anthony's and Medenica predicts that the hospital will choose to fight Medenica rather than risk any future disgruntled patients. "He'll never get privileges," says the source.

That possibility does not disturb Chuck Stevinson. "I guarantee you that we're not going to let a small group of doctors let us die," he says. If Medenica doesn't get privileges at St. Anthony's, he adds, "we'll just build a new hospital."

end of part 2


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