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It is 1966 in Elyria, Ohio. James Neal is a 16-year-old high school junior, a three-sport athlete who spends most school nights at his sister Donna’s apartment in town. It’s more convenient than going all the way home to the farm near Oberlin, and besides, it gives him time to play with his baby nephew, Michael. Donna’s pregnancy had been a scandal in small-town Elyria — she was 17, Catholic, and unmarried — but the Neals had rallied around her. Jim, who has always doted on his big sister, is enchanted with Michael, his godson and the first baby he’s ever really known. On the day Donna brings Michael to the pediatrician for his DPT vaccination, he has a cold. A couple days later, Michael suffers a seizure. Jim misses that first one, but over the next few days he watches in shock as two, three, four times a day the baby’s face goes blank and his arms fly back, as though someone had grabbed them and pulled them behind him. Jim is scared. Even when Michael’s not in the middle of a seizure, he seems different. He doesn’t smile anymore. Donna is making daily trips to the pediatrician, who tells her not to worry. The Neals, Jim especially, want to believe him, but the seizures continue. Jim’s mother goes to the doctor’s office. She tells him something is terribly wrong with her grandson Michael. He asks her if she went to medical school. Finally Donna and her mother bring the baby to the doctor’s office and sit there with him until he has a seizure. Michael is admitted to the hospital. The pediatrician prescribes Valium. After several days in the hospital with no improvement, Michael goes home. Donna takes him to a pediatric neurologist in Cleveland. Jim insists on talking to the doctor himself. He cries when the doctor says Michael has severe and irreversible brain damage. **** It is 2001 in Hudson, Ohio. James Neal is a 51-year-old medical malpractice lawyer, working alone from the sun porch of his house outside Cleveland. The setting — rattan furniture and flowered cushions, a view of the neighbor’s jungle gym — is weirdly at odds with the story of evil that Neal is telling. James Neal is filled with fury. He is holding a trocar, a sharp-tipped device used to puncture holes in a patient’s body for laparoscopy, Band-Aid surgery, as it’s called, in which doctors operate using a tiny viewing instrument inserted into a patient’s abdomen. Neal demonstrates how the trocar, which is supposed to limit the depth of the puncture wound, can cause the accidental severing of major blood vessels. “It’s a piece of junk!” he says, slamming the device against his palm. “People are dying because of this piece of junk. And I hold the Nezhats responsible.” Neal holds the Nezhats — three brothers who are among the most famous laparoscopic surgeons in the country — responsible for a truly breathtaking panorama of wrongdoing. For the last seven years, Neal’s life has been consumed by the Nezhats. Beginning with a medical malpractice claim filed in December 1993, he has done virtually nothing but investigate the brothers. He has had almost no income during those seven years. He has run through his family’s savings, all the money he earned in other cases. His wife, Nancy, a pastry chef, is now working three jobs while Neal conducts his campaign from the sun porch, trying to convince the world that patients are dying every day because of the Nezhat brothers’ faked research. Neal has interviewed more than 500 people about the Nezhats. He has read almost all of the brothers’ dozens of publications. He has examined every aspect of their lives, from their education in Iran to the $40 million sale of a device company in which they had an ownership stake. In court filings and widely distributed mailings, Neal has accused the Nezhat brothers — all three of whom are on the faculty at Stanford University School of Medicine — of, among other things: lying about their credentials; systematically overbilling their patients; threatening witnesses; conducting unauthorized experimental surgeries; sexually assaulting patients; kidnapping at gunpoint; and faking their research in order to promote devices such as the trocar in exchange for consulting fees and royalties from manufacturers. The high point of Neal’s campaign came in February 2001, when a medical journal called Surgical Laparoscopy, Endoscopy & Percutaneous Techniquesretracted two Nezhat articles it had published in the early 1990s. Expert witness reports from Neal’s 1993 suit against the brothers led the journal’s editors to conclude that one of the articles “inaccurately represents the data on which it is based.” A journal’s retraction of a published paper is quite rare in medicine, and though defenders of the Nezhats have questioned the judgment of the journal editors, Neal and his allies regard the retraction as an affirmation of what they’ve been saying about the Nezhats. It is, however, the only substantive official affirmation Neal has received in the last seven years. Medical boards in Georgia and New York, where the brothers also practice, have declined to take action against the Nezhats. Stanford University, where the eldest brother, Camran Nezhat, is deputy chief of obstetrics and gynecology, has stood staunchly by the brothers. The U.S. Department of Justice looked into Neal’s allegations of federal billing fraud and didn’t proceed; nor have any of the local prosecutors Neal has approached. Even with all the bad publicity the Nezhats received after the journal retraction, the American College of Obstetrics and Gynecology has asked Camran to perform a live surgical demonstration at its meeting in October; and the Society of Laparoendoscopic Surgeons has elected the middle brother, Farr Nezhat, to serve as its president beginning in January. The Nezhat litigation, suits filed in Georgia and California, has gone particularly badly for Neal. He has been involved in three suits against the Nezhats and one against the board of the Atlanta hospital where the brothers worked in the 1980s. All of the cases have had bizarre twists and turns; in one, a Georgia federal judge ordered almost $400,000 in Rule 11 discovery sanctions against Neal’s cocounsel and client. Though adverse rulings in the other cases are on appeal, only one of Neal’s suits, the original 1993 case, remains viable — and even that only as a simple malpractice claim, not the grandiose civil racketeering suit Neal once envisioned. Neal himself was thrown out of that case in 1995. His relentless pursuit of the Nezhats has been a focus of the litigation in all of the cases, to the great benefit of the defendants. Neal believes the Nezhats and their lawyers “perverted the process” in at least two of the suits, though his account of judicial corruption consists largely of inference, of drawing lines between dots to create the picture he wants. Camran Nezhat, at 54 the oldest of the brothers, says that Neal has ruined the Nezhat family’s life for the last seven years. He, his brothers, and his mother, he says, left Iran in the 1970s to escape just the kind of ceaseless scrutiny Neal has visited upon them. “We were the most respected surgeons in the world,” Camran says. “People were coming to us that no one else could help … . Then, when they heard about all this, gradually they doubted us.” Camran, a slight, neat man with graying hair, says he prays to God for help with Neal. “I don’t wish bad for him,” Camran says in his slightly awkward English. “I wish him guidance. I hope God directs him in the right way.” As nightmarish as these seven years have been for the Nezhats, they’ve been horrible for Neal, too. His reputation as a lawyer, he says, has been unfairly destroyed. He has lost friends. His original client, the only plaintiff whose case seems to have a realistic chance of succeeding in the forseeable future, no longer speaks to him, and he has been excluded from strategic decisions by the lawyers who now represent her. Neal, who says he retains a financial interest in her case by dint of his contract with her, has been reduced to threats of filing a motion to intervene in the litigation. Nevertheless, Neal says, he could never have cut short his mission. “They had to be stopped,” he says. “It was just too important. You know, I feel like Jesus did when they gave him the cup. ‘Give it to someone else,’ he said, but no one else would take it. I’ve tried to give it to someone else. No one else will take it.” **** It is 1971 in Athens, Ohio. Jim Neal is a senior at Ohio University. He reads a newspaper story about babies having seizures after DPT vaccines. Neal is curious. He drives to Columbus and begins reading articles at Ohio State’s medical school library. He moves from stack to stack, pulling articles that might explain what had happened to his nephew. Michael is still living at home, still having seizures. As he’s gotten older, his seizures have become more violent. Neal is worried that someday Donna won’t be able to take care of him. He doesn’t want Michael to end up in a state-run institution. Neal’s research infuriates him. Before Michael was vaccinated, drug companies had had warnings that it was dangerous to give the vaccine to sick babies, but the manufacturers didn’t tell doctors and patients. And Michael’s pediatrician, he concludes, had made mistakes as well: The doctor, Neal comes to believe, hadn’t given the baby drugs that might have limited the brain damage. Sitting in the library, Neal decides that he wants money for Michael and Donna. Even more than that, he wants someone to be held accountable for what happened. Neal has been thinking about becoming an engineer or maybe going into business. He changes his mind. He decides to become a lawyer — a lawyer who will represent patients wronged by their doctors. Neal had been in private practice for about eight years when his friend Michael Mixson, a lawyer in Georgia, called him in 1993 with the horrifying story of Stacey Mullen’s bowel. Neal had taken a back road to the place he had imagined at the Ohio State medical school library in 1971. He’d joined the U.S. Navy in 1972, gone to University of California, Hastings College of the Law through the Navy’s law education program, and angled his way into a posting as hospital counsel at the Naval Regional Medical Center in Philadelphia. Neal had spent every spare minute in the hospital library, teaching himself medicine. The reports of his superior officers depict him as an exemplary officer with a seemingly limitless future in the Navy, but his hospital experience, Neal says, confirmed his suspicion that doctors weren’t policing themselves. When he left for private practice in 1988, he resolved to search out doctors and hospitals that were mistreating patients. “I’m hooked on the concept of accountability,” he says. “Almost pathologically.” Mike Mixson had served with Neal as a Navy lawyer, and knew of his hospital expertise — which, Mixson told Neal in that 1993 phone call, he needed if he was going to help Stacey Mullen. Mullen was a California woman, then in her early 30s, who suffered from endometriosis, a disease in which cells from the uterine lining migrate to other parts of the body, sometimes leading to such symptoms as infertility and pelvic pain. Mullen’s doctor in California had referred her to Camran Nezhat, whose Atlanta-based practice was then the country’s best known for treating endometriosis with laparoscopic surgery. Mullen traveled to Atlanta’s Northside Hospital for the operation. On Dec. 18, 1991, records indicate, Camran and Farr Nezhat, along with a colorectal surgeon named Earl Pennington, operated on her. One of the procedures they performed was called a rectal eversion, in which Mullen’s rectum was severed from its nerve and blood supply and pulled, inside out, from her body. The surgeons removed a piece of tissue from Mullen’s rectum, resected it, and returned her rectum to the inside of her body. Several hours after the surgery, Mixson told Neal, Mullen went to the bathroom, and a foot of her colon fell into the toilet. (Mullen eventually suffered through years of additional complications and surgeries before finally getting an internal pouch.) Neal was skeptical, but he called Mullen in California. She, and the medical records she sent him, convinced him the story was true. Neal called an old friend, Richard Goldstein, a Pennsylvania colorectal surgeon who’d been chief of surgery at the naval hospital when Neal worked there. Goldstein, who has since served as an expert witness in the Nezhat saga, told him the operation sounded crazy. “I said, ‘They did what?’ ” Goldstein recalls. “ They’re supposed to be gynecologists!” Indeed, the Nezhats were famous gynecologists. Camran, who as much as any surgeon anywhere is responsible for the now-widespread use of video laparoscopy, innovated the treatment of endometriosis with a laserscope. In medical journal articles in the 1980s he reported that an amazing percentage of the endometriosis patients he treated for infertility were able to become pregnant. He has scrapbooks filled with glowing letters from patients, some of whom named babies after him in gratitude. The Nezhats published widely, wrote laparoscopy textbooks, demonstrated their techniques in seminars, and managed to attract the admiring attention of Time, Newsweek, and several women’s magazines. When Johnson & Johnson founded a surgical instrument company called Ethicon Endo-Surgery, Inc., in 1992, the Nezhats were asked to serve as consultants. Neal learned all of this as he began researching the Nezhat brothers. He is an indefatigable researcher. Neal says he has read over 2,000 medical journals and textbooks; his success in the malpractice cases he had won since going into private practice — at least two settled for more than $1 million — usually had been due to his determination to understand what happened to his clients as well as their doctors did. He would take only one or two cases at a time and work them up exhaustively, preparing himself for long physician depositions. “He might be the most tenacious person I ever met,” says Robert Greenberg, who was Neal’s co-counsel in a 1980s case that ended in a multimillion-dollar settlement. “In depositions other lawyers would pull me aside and say, ‘Come on. What medical school did he go to?’ “ Of course, Neal’s zeal didn’t wear as well on opposing counsel. “He’s more focused on minutiae than any lawyer I’ve encountered,” says one. “The intensity of it got under my skin so much that when he called, I’d give the call to someone else.” Neal soon found two articles that Stacey Mullen’s surgeons had published about the rectal eversion procedure, the same operation they’d performed on her. In one paper they described 16 patients who’d had the surgery — and claimed that none of them had experienced serious complications. Yet Mullen’s surgery was performed during the period described in the articles, and the Nezhats knew by the time the 16-patient study was published in 1992 that she’d had horrible complications. The discovery of that 16-patient study in January 1994 changed Neal’s life, setting him on his ever-expanding quest to bring down the Nezhats. Bad doctors were one thing. Deceptive research was another — particularly when, as he hypothesized, the research was used to expand the market for surgical devices, in this instance, an Ethicon surgical stapler used in bowel resections. Stacey Mullen’s case, Neal and Mixson decided, wasn’t a simple medical malpractice action at all. “There might be 100,000 women they could do this to,” Neal says. “I was filled with this undefined fear that they were going to do this to more women.” Neal and Mixson amended their complaint to include allegations that the Nezhats had defrauded Mullen by performing experimental surgery on her, and that they’d committed battery by doing it without her permission. Mullen had, in fact, signed an unusual waiver of informed consent to the surgery — meaning she agreed to let her doctors operate on her without explaining the surgery — but Neal and Mixson said the waiver was improper and that Mullen never would have agreed to the surgery if Camran Nezhat had told her it was experimental. Then Neal unleashed a series of threatening letters that he, even at the time, called “abrupt and ill-mannered.” To the lawyer representing the Nezhats’ co-surgeon he wrote: “I do not think of these three men as physicians. Your client was chief of surgery, but still boarded the Nezhats’ experimental gravy train … . Perjury charges from civil cases are rare but with aggravated facts like these just maybe I’ll be able to interest the D.A. I know I’ll try.” To the Nezhats’ lawyer, Henry Green Jr., he wrote: “It is only a matter of time before some reporter discovers this case. Once this case is in the newspapers the U.S. attorney will be knocking at the door … . If you make the mistake of handling this case like any other, then all hell may break loose.” After Green wrote back to Neal noting that he couldn’t find him listed in Martindale-Hubbell, Neal responded: “Please take your asides, your computer searches, your Martindale-Hubbell and put them in the same box that may well be departing for Iran within the next year.” The barrage of threats and insults continued until the defendants filed a motion to block Neal from getting pro hac vice admission to the Georgia bar. Neal and Mixson argued (and have since argued time and again) that the letters were not an attempt to extort money, but rather a strategy to shock the defense lawyers into checking patient records and pressing the Nezhats to correct the data they’d published. The risk of other women suffering Stacey Mullen’s fate, Neal says, justified his extremism. Unfortunately for Neal, Georgia magistrate Rowland Barnes, who was then overseeing the Mullen case, was unpersuaded. “The court believes that Mr. Neal wrote his letters and other communication in a cavalier and ‘half-cocked’ manner in an effort to bully the defendants into a quick and favorable settlement,” he wrote in July 1994. Barnes called Neal’s letters “unprofessional, scurrilous, and distasteful.” The lawyer’s remarks about the doctors’ foreign roots particularly irked the judge. “The court finds it unbelievable that, in this day and age, [Neal] would improperly inject the topic of national origin into a case focusing on other issues,” Barnes wrote. He decided to let Neal stay in the case (after ordering him to read the Declaration of Independence and the U.S. Constitution) but warned that he’d tolerate no more peculiar behavior from Neal. **** It is the early 1980s in Philadelphia, Pa. Jim Neal is counsel at the Navy medical center, a job that has made him so suspicious of his own hospital that he won’t let his wife deliver their children there. Neal has continued gathering information about DPT vaccinations. He decides it is time to hire a lawyer for Donna and Michael. As Michael has become a teenager, he has become more violent. He sometimes lashes out and hurts people. Neal asks around and hears about a Chicago lawyer who has handled more than 500 DPT cases. Neal hires him as lead counsel. They agree that the Chicago DPT lawyer will depose the expert witnesses in the case. Neal wants to depose the pediatrician who treated Michael himself. He starts making phone calls. He talks to other pediatricians to be sure they would have listened to Donna about Michael’s seizures. He also calls doctors and nurses back in Elyria. He wants to know everything he can about the pediatrician. Jim Neal is a very persuasive man. He’s physically imposing, tall and bulky, but it’s his voice — smooth and resonant, like a radio announcer’s — that is particularly compelling. On the phone he is a bulldog. He starts talking and doesn’t let up, punctuating his sentences with a rhetorical “right?” that almost forces the person on the other end to agree with whatever he’s saying. Neal made thousands of calls about the Nezhats, collecting all sorts of stories. He talked to everyone who would talk to him: dozens of doctors, particularly other gynecologists and laparoscopic surgeons; former Nezhat nurses and office workers; a half-dozen unhappy former Nezhat patients and their lawyers; hospital administrators; staffers from medical instrument companies; government regulators. It wasn’t typical discovery, but then discovery in the Mullen case in 1994 and 1995 was progressing glacially. Neal and Mixson say it’s because magistrate Barnes never ruled on their seven motions to compel document production. Defense lawyer Green says it’s because Neal has always refused to practice like a regular lawyer. “I wouldn’t even have characterized this as litigation,” says Green, a veteran medical malpractice defense lawyer hired by the Nezhats’ insurance carrier, The St. Paul Companies Inc. “Neal never handled it like a normal lawsuit … . I hate to say it, but it was a campaign of terror.” By Camran Nezhat’s own admission, he and his brothers have not always been popular with other physicians. Nezhat blames it on envy and his social unease. “I’m not part of the social club,” he says. “I don’t know how to talk about American football. That was a mistake.” Whatever the reason, by the early 1990s there was persistent buzz about the Nezhats among their colleagues. Their Atlanta practice was internationally known, they were teaching countless seminars, their work was published in the most prestigious gynecological journals, yet some leaders in laparoscopic surgery were raising questions. Pennsylvania surgeon Harry Reich, for instance, deleted Camran’s data from a 1980s journal article he wrote on laparoscopy and ectopic pregnancy after Camran couldn’t provide a case list. (Camran says that he and Reich are rivals and that he never intended to cooperate on the paper.) Reich talked to Neal. So did Dr. James Daniell, a Nashville surgeon and laparoscopic pioneer who had warned Camran in a 1987 letter that he was overcharging patients and submitting “sloppily written” papers to journals. “There is a fine line between promoting oneself in an acceptable scientific manner and getting beyond that line and becoming subject to criticism by your peers,” Daniell warned. “I’m afraid you are getting very close to that line.” Nicola Spirtos, a gynecological cancer specialist, had been tracking the Nezhats since the 1992 publication of their article on a laparoscopic hysterectomy they performed to treat uterine cancer. After viewing a videotape of the procedure at a conference sponsored by a device manufacturer, Spirtos wrote a letter to the editor of the journal that published the paper, questioning whether the procedure was appropriate for cancer. Spirtos also talked to Neal. The expression of doubts by other doctors was powerful material, and obviously important to Stacey Mullen’s suit. But Neal pushed far afield, probing everything about the Nezhats’ lives. He tossed whatever he found into his filings, an exasperating mishmash of allegations that Neal says was intended to raise doubts about the Nezhats’ credibility and about their attitudes toward women. Neal contends that Camran, for instance, schemed to get his first U.S. medical license in Pennsylvania instead of New York because he was afraid that New York authorities would check his Iranian medical school records more closely; and that Ceana Nezhat, the youngest brother, never completed his medical training in Iran and is not, in fact, a doctor. Neal has repeatedly asserted that every time Ceana — a U.S. licensed physician and board-certified ob/gyn — touches a patient, he commits battery. Neal heard stories that Camran, in the early 1980s, had stalked an ex-girlfriend, another physician, held a gun to her head and asked her to marry him. Though the woman never talked to Neal (she did speak to one of his co-counsel), and her lawyer submitted an affidavit stating that his client did not want to testify and had nothing relevant to say about the Mullen case, Neal has referred constantly to the alleged incident in court filings and mass mailings about the Nezhats. Neal also heard from a hospital lawyer that the Nezhats were known for having sex with patients. When the lawyer checked his records and told Neal that he had been mistaken, Neal claimed witness intimidation. Witness intimidation is one of Neal’s recurrent accusations against the Nezhats and their lawyers. Some of what he says is credible: A Nezhat lawyer certainly did threaten one expert witness with a defamation suit; at least one other expert physician dropped out of the litigation because he was frightened; and a process server probably did scare Neal’s daughter when he came to the Neal house to serve a subpoena. But some is wild. Neal and his wife both say they have been followed onto planes and in their cars, sometimes in their neighborhood, sometimes across state lines. They suspect the Nezhats. Fire extinguishers were left outside of Neal’s home; his tires were slashed; a paintball was shot at a house where he was staying in Atlanta; and a marble was shot through the office window of one of his co-counsel. In every instance, Neal says, something critical was going on in the Nezhat litigation. So in every instance, he says, he suspects the Nezhats. So many of Neal’s witnesses and allies complained to the FBI about alleged Nezhat harassment that agents actually interviewed Nezhat defense lawyers about it. Nothing ever came of the FBI’s inquiries. The Nezhats followed Neal’s campaign with astonishment. “I don’t think you can find any other doctor, any other American, who has gone through this scrutiny and come out as clean as we have,” says Camran. He shakes his head impatiently as he’s asked about Neal’s catalog of allegations. His background? “I have never lied about anything in my background,” he says. “Not about my education, not about my training, not about my clinical practice.” None of the investigative agencies that have examined his credentials, he notes, have concluded there’s a problem. The gun incident? He’s never touched a gun in his life, he says. It was just an argument with an old girlfriend. Sex with patients? He says he won’t even examine a patient without a nurse in the room at all times. Witness intimidation? “Look at me,” he says. “The way they make us seem — this terrible Iranian, 100 feet tall, walking around with machine guns. Do I look frightening to you?” He doesn’t. “How could I have time to do all the bad things he says I do?” Camran says. “If I was as bad as they say, I would have killed many patients.” He knocks on wood. “I have never killed one! … We never hid anything from anybody. We tried to contribute to society.” He continues: “None of us is God. You look around, sometimes you might have said a little fib. But to go and twist it the way he has … ” Camran trails off. “ All I want to do is my work, to help people. It is so ridiculous.” “Obsession II”

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