Eat What You Kill

December 10, 2024 9:57 AM

ProPublica, in conjunction with the Montana Free Press, has published a detailed expose into Helena oncologist Dr. Tom Weiner - detailing a history of questionable diagnoses and patient harm.

Journalist J. David McSwane covers the story with documentation as well as interviews with several principals and families. The investigation covers a pattern of misconduct, including sloppy and questionable diagnoses, aggressive treatments based on such, loose prescription of opioids (including subversion of hospital controls), alteration of DNR requests, and more - leading to patient harm, and even worse.

posted by NoxAeternum (41 comments total)

I read this yesterday and it is angry-making.

There is an episode of Grey's Anatomy much like this and if you are evil enough to be the bad guy on Grey's Anatomy maybe you need to rethink your terrible life choices.
posted by jacquilynne at 10:35 AM on December 10, 2024 [11 favorites]

Jesus christ this is depressing. Guy should be in prison. And the "eat what you kill" billing approach is just the embodiment of what is so wrong with American health care.
posted by caution live frogs at 10:41 AM on December 10, 2024 [5 favorites]

If there is one thing I have learned from Behind the Bastards, it's that there's a lot more predatory scumbag doctors (and/or predatory scumbags pretending to be doctors) than I thought.
posted by Smedly, Butlerian jihadi at 10:54 AM on December 10, 2024 [7 favorites]

God, this was so much worse than the "angel of mercy" killer nurse story that comes out from time to time. The cultlike following, the money, the lack of any real repercussions... I'm sick (and don't send me to this guy)
posted by queensissy at 11:04 AM on December 10, 2024 [3 favorites]

The cultlike following, the money, the lack of any real repercussions... I'm sick (and don't send me to this guy)

Yeah...this is somewhat personal for me because, well...this was the oncology unit that treated my late mother for the cancer that killed her. It's been...a morning after reading that article, and thinking about it. And as creepy as those signs look in those pictures - they're worse in real life.
posted by NoxAeternum at 11:16 AM on December 10, 2024 [63 favorites]

Six years of chemo for someone who didn't have cancer. And three different insurance companies paid for it! This guy is horrendous, and our medical system is too, for allowing someone like him to not just escape detection, but to flourish.
posted by creepygirl at 11:19 AM on December 10, 2024 [7 favorites]

Oh jesus, NoxAeternum. I am imagining the kinds of things you must be thinking and I can't even imagine the kinds of things you must be feeling.

If you are inclined to accept virtual hugs, please accept mine.
posted by jacquilynne at 11:20 AM on December 10, 2024 [14 favorites]

Thank you for posting this. I do think your summary is quite...restrained. My summary was, "There's a story about a bad doctor. Whatever you can possibly imagine, this is worse."

What struck me most wasn't how bad Weiner was. There are always going to be bad doctors, like there are bad cops and bad teachers and bad accountants. But well-functioning institutions have procedures and cultures that stop bad actors. St. Peter's failures as an institution were horrific, and I wonder how many hospitals would have failed in the same way.
posted by Mr.Know-it-some at 11:28 AM on December 10, 2024 [8 favorites]

Periodic reminder to donate to propublica.org if you can.
posted by evilmomlady at 11:34 AM on December 10, 2024 [16 favorites]

Oh jesus, NoxAeternum. I am imagining the kinds of things you must be thinking and I can't even imagine the kinds of things you must be feeling.

Thank you. Speaking to my father helped - they had gotten consults and labwork elsewhere. But yeah - not a fun feeling.

But well-functioning institutions have procedures and cultures that stop bad actors. St. Peter's failures as an institution were horrific, and I wonder how many hospitals would have failed in the same way.

Oh, trust me - I can spend an entire thread on the inadequacy of St. Pete's as an institution. There's a reason that one of the other major health providers in the state (Benefis) has been able to get a foothold in the city.
posted by NoxAeternum at 11:42 AM on December 10, 2024 [8 favorites]

So there's still a fair number of homes with "I stand with Dr. Weiner" signs in town. It will be interesting to see which ones disappear. One person publicly announced his change in perspective today on FB.
posted by CheeseDigestsAll at 11:47 AM on December 10, 2024 [6 favorites]

So there's still a fair number of homes with "I stand with Dr. Weiner" signs in town.

Homes? No, no, no. Those signs are fucking everywhere.
posted by NoxAeternum at 11:48 AM on December 10, 2024 [5 favorites]

Only one question: Why isn't this guy in jail?
posted by tommasz at 11:57 AM on December 10, 2024 [2 favorites]

Americans love psychopaths, and hate when people try to use institutions to defend against them.
posted by biogeo at 12:00 PM on December 10, 2024 [5 favorites]

Only one question: Why isn't this guy in jail?

In jail? They haven’t even taken any action against his medical license.
posted by TedW at 12:00 PM on December 10, 2024 [12 favorites]

By the way, if you want to know how bad doctors are able to stay in place, it's like with bad bureaucrats: you just have to outlast the board members (who are elected, and subject to public pressure).
I serve on a hospital board, and I fully anticipate not being re-elected due to a personnel decision. I can't defend my decision in public because of confidential HR matters, and I cannot discuss the disciplinary record; and so I and the rest of the board are being villified and scuriffied. I just want to scream what this individual said and did to the winds. But I can't.

So yeah, popular doctors have a lot of pull and ways to bend the public opinion to their favor, while matters of the medical examining board remain out of the public eye. The confidentiality of HR matters creates a set of public pressures which allow socially popular doctors to leverage public opinion to retain their privileges even after misdeeds.
posted by LeRoienJaune at 12:02 PM on December 10, 2024 [35 favorites]

Why hasn't he been appointed by Trump to head a health agency?
posted by dances_with_sneetches at 12:08 PM on December 10, 2024 [9 favorites]

“Bad Doctor” stories are so uniquely horrifying, I’m kind of fascinated with them. Like Christopher Duntsch, a case also profiled by ProPublica.

(I was a little “disappointed” that his friend, whose surgery he performed and botched, recanted the claim that they had stayed up doing cocaine together the night before. It had a certain symbolic resonance for me in relation to bad decisions I have made knowingly in the past.)
posted by atoxyl at 12:21 PM on December 10, 2024 [2 favorites]

Read the Propublica article yesterday and it was like an onion. So many layers of awfulness. I work for a hospital and I would hope that routine audits would shed light on bad actors before it reaches the Weiner level.

The worst part is Weiner still has his medical license!
posted by MadMadam at 12:26 PM on December 10, 2024 [1 favorite]

LeRoienJaune:

It sure would be a shame if someone printed out the details of the wrongdoer's actions and left them in the local newspaper's mailbox -- all accidentally, of course.
posted by Saxon Kane at 12:27 PM on December 10, 2024 [5 favorites]

Hey, if anyone's thinking they'll dip into the article ("how bad could it be?"): very bad. CW on basically everything
posted by scruss at 12:29 PM on December 10, 2024 [8 favorites]

Oh, another personal anecdote, this time with regards to his flaunting of opiate prescription protocols. I was a caretaker for my grandmother, and as part of that, I had to get her fentinyl patches for pain management (this was around 2011-2012.) In order to do so, I would have to go to the physician offices run by the hospital, to recieve the script, printed on special paper designed to not be photocopiable.

So for him to subvert those systems to hand out pain meds like he did was a major breach for him and St Pete's.
posted by NoxAeternum at 1:08 PM on December 10, 2024 [5 favorites]

wow. this guy should be in prison. his arrogance and disregard are stunning.
posted by supermedusa at 2:06 PM on December 10, 2024 [1 favorite]

CW on basically everything

As a small mercy, he doesn’t seem to have sexually abused anyone. Or maybe that wasn’t reported.
posted by GenjiandProust at 3:52 PM on December 10, 2024 [2 favorites]

This is really horrifying on so many dimensions and yes, it's way worse than I assumed from the headline/blurb.

My family has our own experiences with oncology care in a rural hospital system and I can see how a specialist like Weiner, who provides quick treatment without referrals to the big city is very comforting for both hospital administrators and for patients.
posted by muddgirl at 4:45 PM on December 10, 2024 [5 favorites]

(I could help but peek at the public Facebook groups and I'm really scratching my head at anyone who thinks this piece was pro-St. Pete's...)
posted by muddgirl at 4:57 PM on December 10, 2024 [3 favorites]

So much horror here in so many directions.

I read this just after the CEO murder and the statement from UHC about how they so carefully ensured only necessary care was provided. It seemed like such a farce already, and then to think of the millions and millions in fake cancer care here. I mean, I'm fortunately pretty naive to cancer specifics, but I thought there were extensive diagnostics (sequencing) and staging to establish the best treatment strategies, as the standard of care. They was all missing?! And yet they just paid? He must have had some -ahem- skill in the appeals process. Too bad he couldn't bottle and sell that, would have done more good.

He's still licensed.
posted by Dashy at 5:21 PM on December 10, 2024 [5 favorites]

But well-functioning institutions have procedures and cultures that stop bad actors. St. Peter's failures as an institution were horrific, and I wonder how many hospitals would have failed in the same way.

It's right there in the article that the primary and most effective whistleblower is still facing a defamation case...

Rich people can weaponize the courts.

I think one of the big takeaways here is to look out for people who run one person kingdoms. It should alway be a red flag when people find ways to isolate people and insulate themselves.
posted by srboisvert at 7:38 PM on December 10, 2024 [19 favorites]

...the script, printed on special paper designed to not be photocopiable.

Cue Marlon Brando

How is this even possible? is what I want to ask -- but it is. And yet this creature is a veritable Byzantine icon with a gilt halo to many people still. The realm of what was previously unimaginable evil expands exponentially in every direction. What a world we live and breathe in.
posted by y2karl at 2:09 AM on December 11, 2024 [1 favorite]

This was horrific to read. I have a complaint ongoing about medical care, or lack of it, that hastened my father's death; but because that was in the NHS, I absolutely know that no-one, nor the hospital itself, profited financially by the decisions that were made. I cannot get my head around the lack of oversight that allowed these deaths to happen in Helena.
posted by paduasoy at 4:59 AM on December 11, 2024 [2 favorites]

I read this just after the CEO murder and the statement from UHC about how they so carefully ensured only necessary care was provided. It seemed like such a farce already, and then to think of the millions and millions in fake cancer care here. I mean, I'm fortunately pretty naive to cancer specifics, but I thought there were extensive diagnostics (sequencing) and staging to establish the best treatment strategies, as the standard of care. They was all missing?! And yet they just paid? He must have had some -ahem- skill in the appeals process. Too bad he couldn't bottle and sell that, would have done more good.

Because the actual patients are just flesh cogs in a machine to make the rich richer. They aren't the purpose of the machine. Convincing nurses and low-level practitioners and patients and families that the patients are the purpose is how the machine keeps going.

They have to have the patients, because they have to have those cogs that move the money along - they can't just go to people's houses and rob them, yet. And robbing people is low-volume. Why rob when you can sit in an office and get the money sent to you at the push of a button? This goes for CEOs, big doctors, hospital administrators, etc. They need patients because otherwise they'd have to, like, be warlords and ride around marauding and potentially get hurt or killed, but it's the same logic.

I would argue that while this logic is intrinsic to capitalism, it has become more and more powerful and less and less restrained by convention, law, religious sentiment, philosophy, etc over time and in the course of financialization until now it's just virtually pure extraction. Even under capitalism, it does not have to be this way and has not always been this way.
posted by Frowner at 7:05 AM on December 11, 2024 [7 favorites]

I think one of the big takeaways here is to look out for people who run one person kingdoms. It should always be a red flag when people find ways to isolate people and insulate themselves.
posted by srboisvert

This. Plenty of great, experienced and passionate professionals make wrong calls in a vacuum. That said, the fact that the hospital seemed not to recognize that in medicine, that translates to preventable deaths, is insane to me. Don't get me wrong-this guy sounds like he did some unspeakable things, but I have no doubt he also did enough well to both a) develop his ego to the point of no return, and b) develop a rabid following of satisfied patients. He comes off as 100% believing what he says, which is what happens when there's no one there to argue with you. Not recognizing how much you need the feedback of colleagues to make you better is such a huge red flag. This whole story also has very Trump-y vibes, ie never ever admitting to any possibility of a person making an error and going after anyone who dares to point out the agregious issues.
posted by Kemma80 at 8:20 AM on December 11, 2024 [5 favorites]

Reminds me of the Swedish Neuroscience Institute and "Dr." Johnny Delashaw and a few other neurosurgeons running unnecessary, incorrect, botched, and overlapping surgeries that maimed and killed patients, but sure made the docs involved all a ton of money.

And Swedish knew and looked the other way for *ages* (despite efforts by a few good doctors to stop these practices) until damning articles started to come out in the Seattle Times.

Spoiler alert: Delashaw got his medical license back and appears to be practicing in Michigan.
posted by cnidaria at 8:29 AM on December 11, 2024 [3 favorites]

" I have no doubt he also did enough well to both a) develop his ego to the point of no return, and b) develop a rabid following of satisfied patients. He comes off as 100% believing what he says, which is what happens when there's no one there to argue with you. Not recognizing how much you need the feedback of colleagues to make you better is such a huge red flag. "

This thought has been stuck in my head over the past day. He mentions the weakness that caused his poor documentation was "a good memory" and I wonder if there's a fleck of truth to this. He probably did have some amazing recall if he was able to establish some sort of relationship with 200 patients at a time, the kind of relationship that would allow everyone to overlook the mountain of cause for concern.

His CV (as reported on LinkIn) is an interest grab bag of smaller institutions with the exception of Drexel/Hahnemann for medical school (which is very large by modern standards). I hear some older faculty around my place of work sometimes remark about an irrational confidence that allows some young doctors to go to a very small hospital and provide care without much oversight or much in the way of resources early in their career. And this story really illustrates the worst case scenario of allow such level of subspecialty care without a matching level of nearby peers. Yes,
posted by midmarch snowman at 12:44 PM on December 11, 2024 [5 favorites]

I would argue that while this logic is intrinsic to capitalism, it has become more and more powerful and less and less restrained by convention, law, religious sentiment, philosophy, etc over time and in the course of financialization until now it's just virtually pure extraction. Even under capitalism, it does not have to be this way and has not always been this way.

Unfortunately, St Peters is a non-profit hospital, and the name suggests it's historical affiliation with the Episcopals, which also built St Peter's Cathedral in Helena. It's not like the churches are somehow immune from greed or gross abuse of power.
posted by pwnguin at 4:02 PM on December 11, 2024 [1 favorite]

You're correct that it was originally Episcopal, but it was transferred to the community in 1931. Recently, it has formed partnerships with the University of Utah and the Huntsman Cancer Institute, and I've heard rumors that there's a strong Mormon contingent at the executive level.

They recently had a disastrous switchover in their medical records system, adopting the Epic system from Intermountain Health, a Salt Lake based company founded by the LDS church.
posted by CheeseDigestsAll at 5:05 PM on December 11, 2024 [2 favorites]

Montana Public Radio has an interview with McSwane regarding the ProPublica article.
posted by NoxAeternum at 11:38 AM on December 12, 2024 [2 favorites]

Unfortunately, St Peters is a non-profit hospital, and the name suggests it's historical affiliation with the Episcopals, which also built St Peter's Cathedral in Helena. It's not like the churches are somehow immune from greed or gross abuse of power.

I did just want to say that non-profits operate under capitalism. Capitalism isn't just "this individual organization wants to make a profit", it's the whole show. And as you can see from the way doctors are compensated at this non-profit, the same old "see as many patients as possible, we'll look away on quality questions, we make more money and we give you bonuses" logic that applies at regular-degular for-profit hospitals is in play, as is the high pay for higher-ups. Many hospitals are formally non-profits and they still union-bust, discriminate and pressure providers to bring in more money just like for-profits. They aren't as bad because they aren't just leeches in the service of finance capital, but they're not some kind of non-capitalist thing.
posted by Frowner at 12:06 PM on December 12, 2024 [7 favorites]

One thing I'm curious about is how the journalist was able to get all of the discovery documents that both St. Peter's and Dr. Wiener wanted to keep sealed. I hope that if someone leaked them, they also don't end up getting sued.
posted by Drowsy Philosopher at 6:19 AM on December 13, 2024 [3 favorites]

Follow-up article about another patient that endured 9 years of chemo for non-existent cancer. Thankfully he survived, and was able to get a donor kidney after chemo was discontinued.
posted by creepygirl at 10:16 AM on December 20, 2024 [3 favorites]

Just saw someone with a "I Stand With" decal on their tailgate the other day, and...it irritated and angered me.
posted by NoxAeternum at 2:44 PM on January 9 [2 favorites]