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In 1995 Neal’s relentlessness backfired on him and his client Stacey Mullen. The defense lawyers renewed efforts to disqualify him from the case. First, they asserted, Neal had tried, through trickery, to get confidential Nezhat personnel files from hospitals where the brothers had worked. Second, the defense lawyers contended, Neal wouldn’t stop trying to find evidence that the Nezhats had sexually assaulted patients, even after the lawyer from whom he’d gotten the tip had told him it wasn’t true. Neal and his co-counsel, Mixson, said that Neal’s letters to other hospitals were just routine inquiries; and that it was Mixson — not Neal — who’d sent out the document production request on the alleged sexual assaults. None of their requests, they argued, were deceptive, improper, or even unusual. Magistrate Barnes, however, had had enough. “The unrelenting fashion in which [Neal] has attempted to acquire this information is harassing and malicious,” he wrote. His conduct was “unethical” and “deceitful.” On August 16, 1995, Barnes disqualified Neal, leaving only Mixson to represent Mullen. Barnes had also had enough of Neal and Mixson’s far-flung allegations about the doctors. On the same day he tossed Neal, he strictly curtailed Mullen’s suit, throwing out the state claim under the Racketeer Influenced and Corrupt Organizations (RICO) act. In a ruling that has been cited in at least two other Nezhat suits, Barnes found (without a summary judgment motion from the defense) that because Mullen had signed a consent form in which she waived the right to be informed about her surgery, she had not been defrauded and no battery had been committed. Mullen’s suit was reduced to a medical negligence case. Barnes’ disqualification order reverberated in a companion suit to Mullen’s state court action, a federal court case against the board of directors of Atlanta’s Northside Hospital. In September 1995 Neal won what he considered a breakthrough in that litigation when U.S. district court judge Clarence Cooper ordered the hospital to produce the records of the 16 patients who had been the subjects of the Nezhats’ journal publication about rectal eversion. The defense was claiming that Mullen wasn’t one of the 16, that data on her surgery had been excluded from the article because her rectal endometriosis wasn’t as severe as that of other patients. Neal, however, believed the records would show that the Nezhats had falsified their data, the first step toward proving that they were promoting a dangerous operation to attract surgeons to their workshops and to expand the market for surgical staplers made by the company that paid them as consultants. “Mike [Mixson] and I celebrated over the phone,” Neal says. “We thought, ‘We’ve finally got them.’ “ At a hearing on Oct. 25, however, a new lawyer hired by the Nezhats, David Walbert, then of Atlanta’s Walbert & Mathis, told the judge about Barnes’ disqualification ruling in the state court case. Though Neal resigned as counsel in the federal suit two days later, Judge Cooper reversed his previous order on the 16 patient records. Eight months later, when Neal’s co-counsel, Mixson, was seeking an order to keep the defense away from his witnesses, Cooper found, after briefing and a hearing, “no evidence of threats to witnesses by any person directly or indirectly involved in this case.” And six months after that ruling, in January 1997, Cooper granted the hospital’s summary judgment motion and dismissed Mullen’s federal suit. Neal’s friendship with Mixson was by then a casualty of the Nezhat litigation. Mixson was as sure as his old Navy friend that the Nezhats were corrupt, and he was as sure that Barnes had treated Neal unfairly. At first he agreed when Neal insisted that he appeal the disqualification ruling. But then, without telling Neal, he withdrew the appeal. (Mixson says only that he and Neal “had disagreements over strategy and approach.”) Neal says he was so enraged when he learned what Mixson had done that he drove from Ohio to Georgia and dumped a box of documents at Mixson’s house, along with a note saying he never wanted to speak to Mixson again. Neal, who was convinced the experts he’d found would back out if he wasn’t in the litigation, flew to California to talk to Mullen about his fight with Mixson. Mullen chose Neal. Mixson, with regret for his lost friendship, withdrew from Mullen’s case. He also stepped out of a second federal court case against the Nezhats, this one on behalf of another former Nezhat patient that Neal had turned up. Debra Manov claimed that the laparoscopic appendectomy the Nezhats performed on her had been unnecessary, since her appendix actually showed no signs of endometriosis; and that after the operation the Nezhats allowed her to become dangerously sick with a surgery-related infection. Manov’s injuries, Neal concedes, were nowhere near as severe as Stacey Mullen’s, but he figured the discovery rules in federal court would let him use her case as a vehicle to establish the pattern of fraud he was sure the Nezhats had engaged in. Tactically, Neal couldn’t be lead counsel because of the 1995 disqualification. In the course of his Nezhat investigation, though, he’d stumbled across a Georgia lawyer, Michael Byrne, who had once represented a former Nezhat office manager in an assault suit against a fourth Nezhat brother. Byrne had collected his own store of unsavory tales about the Nezhats. He added his stockpile of allegations to Neal’s — he contributed the kidnapped-old-girlfriend accusation, for instance — and in early 1996 signed a huge, sprawling omnibus of a complaint, in which he and Neal detailed almost every bit of alleged Nezhat wrongdoing they’d gotten wind of, from systematic overbilling to research fraud. The federal judge overseeing the Manov case, G. Ernest Tidwell of Atlanta, wanted to hear none of it. Right after the complaint was filed, the defense lawyers wrote a letter asking for Rule 11 sanctions discovery. Tidwell granted it, before any discovery in the underlying case had taken place. Byrne fought the Rule 11 discovery for almost two years, but Tidwell’s July 1998 ruling on sanctions was devastating. “Due to the grossly intemperate nature of Neal’s allegations,” the judge wrote, “there is a strong suspicion that Neal’s assumptions and suspicions are not reasonable or factually supportable.” Tidwell found virtually none of the claims in the complaint to be credible, concluded Byrne had done almost no prefiling investigation of his own, and decided that Manov had lied in her deposition. In a later ruling he assessed almost $400,000 in damages against Byrne and Manov. (He didn’t sanction Neal because Neal wasn’t Manov’s counsel of record and hadn’t been deposed.) A California state court case against the Nezhats was floundering at the same time. Neal represented a California woman named Katherine Avakian, who claimed that she’d suffered nerve damage as a result of surgery that Camran Nezhat had performed. In her complaint Neal recycled allegations from the Mullen and Manov cases: Camran’s medical license was fraudulently obtained; he was performing experimental surgeries without permission; he fabricated examination and surgical reports; he repeatedly abused women. In early 1998 the Nezhats’ California defense lawyers retaliated with 562 special interrogatories asking for the factual basis for each of Neal’s allegations. With his cases crumbling around him Neal had what he calls a “mini-breakdown” in 1998. “I came to the crushing realization that I couldn’t be effective in this litigation,” he says, blaming his disqualification and the subsequent adverse rulings in Atlanta. His father was dying of cancer, and he was overcome with guilt and regret. “I was so angry at not having spent time with my dad,” Neal says. “I was spending all my time on the Nezhats.” With the California judge threatening to dismiss Avakian’s suit, Neal withdrew from the case (it was eventually dismissed anyway) and retreated home. Back in Ohio, Neal sank into depression, smoking two packs of cigarettes a day. He started seeing a psychologist. **** It is 1982 in Elyria, Ohio. Jim Neal’s dream is coming true. He is taking his first deposition in a civil suit, and it is of the pediatrician who treated his nephew Michael. His sister Donna is sitting next to him as he asks the doctor, who hasn’t seen Neal in more than 10 years, about Michael’s treatment. Why had the doctor given Michael the vaccine when the baby had a fever? Why hadn’t he listened to Donna after the first seizure? Why hadn’t he listened to Donna’s mother? Why did he give the baby a sedative instead of antiseizure medication? The deposition lasts three or four hours. The doctor’s explanations hardly matter to Neal. He knows the man made mistakes, and now, he thinks, the man knows, too. Michael and Donna’s suit has problems. Neal and his co-counsel can’t prove which company made the vaccine Michael received. There are statute of limitations issues, and even the treatment case isn’t clear-cut. It’s hard to prove that Michael would have ended up better off if the pediatrician had done things differently. But the deposition is a triumph for Neal. The doctor has been confronted. Neal has shown him his mistakes. He has held the doctor accountable. By the end of 1998 friends and family were begging Neal to walk away from the Nezhats. Not that there was much to walk away from: For all his years of investigating and litigating, the only active Nezhat case was Stacey Mullen’s Georgia state malpractice claim, and Neal had been thrown out of that. Neal refused to let up. Everything would fall apart without him, he says; the doctors he’d persuaded to testify against the Nezhats were relying on him. And by now, he says, he was hoping, somehow, to recoup some money from all he’d found out. “I thought if I kept digging, I’d find something that would turn into a big case,” he says. “I’d bankrupted my family.” Neal redoubled his efforts to win vindication. His problems, he argues, all began with magistrate Barnes, the judge who disqualified Neal from the Mullen case in 1995. Barnes was then a temporary magistrate with a branch office, Neal is fond of noting, in a strip mall that also contained a tattoo parlor. Barnes first showed his partiality to the defense by refusing to rule on the plaintiff’s discovery motions, Mixson and Neal have argued. Then he violated Georgia judicial canons by signing disqualification and summary judgment orders that, Neal and Mixson were convinced, had been drafted by Nezhat defense counsel and handed ex parte to the judge. Neal regards as suspicious Barnes’ recusal from the Nezhat litigation only days after Mixson told him the FBI was investigating the Nezhats. (Barnes said an old client had surfaced and reminded him that he’d long ago represented her in a case against the Nezhats. He did not respond to requests for comment.) Judge Cooper in the Mullen federal suit, Neal asserts, was a friend of Nezhat counsel Charles Mathis Jr., and overturned his own order on the 16 patient records because of that friendship. Like Barnes, Mixson asserted in a letter to the Justice Department in 1998, Cooper signed an ex parte order written by the defense, this one quashing 19 plaintiff subpoenas to medical organizations. (Judge Cooper says not only that Mathis isn’t a personal friend, but that the 11th Circuit was so unimpressed with the allegations of wrongdoing against him that the appeals court upheld his ruling on the patient records without even asking him to respond to them.) Neal’s litany continues: Judge Tidwell, the federal judge who dismissed Debra Manov’s RICO claims and ordered Rule 11 sanctions, had a law clerk who had been a Nezhat lawyer in the Mullen suit — and a second clerk who interviewed for a job at Nezhat defense lawyer Henry Green’s old firm while working on the Manov case — yet refused to recuse himself. “Like many other occurrences in the Nezhat case, this would not be of concern if viewed in a vacuum,” Mike Mixson wrote to the Justice Department, “but it is another in a series of occurrences, viewed in conjunction, which I find disturbing, to say the least.” (Mixson returned to the Manov case to help on appeals.) Tidwell’s grant of unilateral Rule 11 discovery was unprecedented, Neal and Mixson contend, and the judge’s refusal to consider the affidavit evidence of the plaintiffs utterly distorted the record. “It is difficult for me to believe, as with Magistrate Barnes’ inexplicable failure to rule on our discovery motions, that this … was accidental,” Mixson wrote. “For a long period of time I rationalized the unusual events and judicial actions and just viewed them as ‘bad breaks’ that could be overcome with more effort. I can no longer rationalize the repetitive, unique, and irrational rulings and events that have occurred in litigation involving the Nezhats.” Neal’s allegations of judicial wrongdoing have gone nowhere. Neal says Justice Department lawyers asked if he had audio or videotape evidence, which he doesn’t. Nor has any appeals court in the Nezhat cases overturned the trial courts. But in early 2000 Neal finally got one thing he’d wanted since 1993: The judge now presiding over Stacey Mullen’s suit ordered the Nezhats, the colorectal surgeon, and Northside Hospital to produce the records of the patients who’d undergone the rectal eversion procedure documented in the Nezhats’ published article. The law firm that took over Mullen’s case from Neal and Mixson, Atlanta’s Garland, Samuel & Loeb, was now controlling the litigation — Mullen, without an explanation to Neal, stopped calling him last August — but still forwarded the records to experts Neal had found. “My expectation was I was going to find three or four charts that weren’t what I expected,” says Spirtos, the Palo Alto, Calif., gynecological oncologist. “I anticipated writing a letter to the editor saying their work was sloppy, asking for a strong reprimand. What I saw on the charts was so much worse than that … . Once I was looking at the charts. I said, ‘Oh, my God! There isn’t one match with what they published. They don’t even have the ages right!’ “ Spirtos’ misgivings about the Nezhats are well known enough among the doctors who follow the litigation that his assertions alone can’t be considered conclusive. (Camran replaced Spirtos as deputy chief of Stanford’s gynecology department; and Spirtos recently sued the university for defamation stemming from the Nezhat litigation.) Two other experts, however, had none of the credibility problems Spirtos did: They both testified that they’d been approached by the Nezhats about becoming experts before they signed on with Mullen. Their joint affidavit was damning for the Nezhats, essentially accusing them of manipulating their research in medically dangerous ways. Aside from discrepancies between the records and the published article in surgical dates and patient ages, these experts, physician Warren Grundfest and bioethicist Andrea Scott, found that only nine of the 16 patients actually had the precise procedure described in the article. Of the other seven, two didn’t have a colorectal resection at all. The blood loss numbers in the article, Grundfest and Scott wrote, “are a complete fiction.” The Nezhats asserted that the published figures referred only to blood loss during the rectal eversion procedure, but the raw data that experts reviewed indicated that records were kept only for total blood loss for each patient, not blood loss during each part of the surgery. The same was true of operating time, Grundfest and Scott found. Moreover, they wrote, the Nezhats hadn’t reported postoperative complications that included rectal strictures, bleeding, incontinence, constipation, bladder spasms, cramping, and abdominal pain. Nor did they report their use of large doses of vasopressin, which Grundfest and Scott speculated they’d administered to control bleeding for the videotapes of the surgeries. “Failure to make any mention of defendant surgeons’ use of vasopressin,” they wrote, “is a significant and ethically suspect omission from the publication.” The experts’ conclusion was crushing: “When information was missing or did not fit [the Nezhats'] desired picture, it was invented or altered to provide readers with the impression that this experimental procedure could be performed safely and with minimal risk of complication.” The Nezhats have gone to great lengths to defend themselves. Middle brother Farr, the article’s principal author, conceded in an affidavit that there were some discrepancies between the records and the published data, though he said they were just mistakes, not an attempt to mislead. (Camran Nezhat blames errors in data collection on students the Nezhats employed to help with their research.) Farr explained the blood loss and operative time figures were intended to refer only to the bowel resection parts of the patients’ surgeries, and says that complications such as diarrhea or mild incontinence are typical of bowel surgery. The article, he said in his affidavit, “was accurate in stating that no ‘unusual’ ill effects were evident.” A Stanford colleague of the Nezhats, surgeon Mark Vierra, submitted an affidavit seconding most of Farr’s explanations. Camran also points out that several years ago, when he learned some of the patients in the article had experienced postoperative complications that hadn’t been reported, he contacted the then-editor of the journal and volunteered to retract the article. The now-retired editor, Dr. Karl Zucker, says he talked about Nezhat’s offer with one of the doctors who had reviewed the initial article, and asked instead that Nezhat simply update the clinical data in a subsequent publication, which Camran did. After the journal’s new editors finally retracted the Nezhat articles in February 2001, Zucker was among the Nezhat defenders who wrote to question whether the Nezhats had been treated fairly. “Some of the medical and legal accusations against them,” wrote Paul Wetter, chairman of the Society of Laparoendoscopic Surgeons, “have overtones of an overzealous medical malpractice attorney.” From the start of the litigation, the Nezhats always followed the advice of their lawyers and insurers and avoided comment on Neal’s accusations. The retraction made them realize they had to be more outspoken. Camran says he gets angriest when he hears that Neal has accused him and his brothers of devising and promoting operations like the rectal eversion to help sell surgical instruments because of contracts with device manufacturers. “I absolutely deny that! That is absolutely wrong!” he says, pounding his fist on his desk. “All of the techniques we have done, all of them are old, time-proven. We just tried to do them through the laparoscope.” Neal’s assertions that the Nezhats received millions from device makers, Camran says, are drastically exaggerated; he and his brothers, Camran asserts, were paid $15,000 or $20,000 in consulting fees by one such company in the early 1980s, and were paid travel expenses in subsequent years to teach at conferences the company sponsored. The Nezhats, he adds, collected only a tiny piece of the $40 million sale of the device company they partly owned. “I am proud of this: I will not submit,” Camran says. “I will not submit to force. This lawyer! What I did to deserve this I do not know. Only God knows.” The lawyer in question is as busy as ever, drafting letters and assembling his packets of anti-Nezhat information for distribution to doctors, reporters, medical officials, government regulators, journal editors. He’s encouraged, he says, that the FDA has finally asked for his help in investigating the trocar. He’s studying some other Nezhat articles he’s convinced are faked. He’s also pressuring Stanford, which has never responded to his Nezhat allegations as he would like. “You ignored surgeons’ concerns and information provided to Stanford University for seven years,” Neal wrote to Stanford acting general counsel Debra Zumwalt on February 27. “Now you absurdly act as though the burden remains on me to show you exactly where all Nezhat research frauds are … . I would not be surprised to learn you ask waiters to cut your food into pieces, Ms. Zumwalt, then ask for help with your fork. Do your job. Audit each study.” Neal says he may never practice law again after this case. He’s thinking of starting a company, assembling a pool of physicians to establish their own medical malpractice insurance business. Of course, this Nezhat thing won’t be over, Neal says, until other doctors know how much of the Nezhats’ research is unreliable — and until Mullen and Nezhat victims are compensated. In March Neal wrote a pair of letters to the Nezhats’ latest lawyer, Joseph Cotchett of San Francisco’s Cotchett, Pitre & Simon. They’re typical Neal letters — accusing Nezhat lawyer David Walbert of “fraudulent and offensive” strategies and mentioning Barnes’ allegedly ex parte disqualification order. But one letter contains surprising language. “Individuals I represent have an interest in ensuring that the Doctors Nezhat remain financially responsible … . This letter is to inform you that I have always been and continue to be amenable to negotiation on behalf of my clients.” “I want dialogue of any kind, even yelling,” Neal says. “I would negotiate now after seven years for one [more] retraction.” **** It is late April 2001 in Hudson, Ohio. Jim Neal is on the phone talking about his nephew Michael. He is crying. “This is the only thing I cry about,” he says. Michael’s lawsuit settled in the mid-1980s. It wasn’t for as much as Neal had hoped, but it helped. Donna died of breast cancer in 1989, not long after Neal moved back to Ohio. Michael went to live in a state-run group home after Donna died. He seems okay there, Neal says, though the violence is still a problem. Neal wonders where he’ll end up if the group home asks that he leave. Neal goes to visit Michael sometimes. It’s very painful. Sometimes even accountability isn’t enough. Back to “Obsession”

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