From the blue yarns tucked in a woven basket to the earth-tone carpeting and the solidity of the stone fire, each element of the Crittenton Hospital Most cancers Heart’s ready room helps anxious sufferers really feel embraced by heat and luxury. Even the vaulted ceiling, crafted of gleaming cherry wooden, suggests a non secular sanctuary, not a medical clinic.
Two years in the past, earlier than St. John Well being System acquired it, this was the lobby to Dr. Farid Fata’s clinic, a tasteful but grand reception space linking his personal clinic to the hospital. It was an association that lent Fata seemingly particular standing and enhanced his fame with sufferers.
But at 10 a.m. on July 1, 2013, Monica Flagg felt dread as she entered this area, a full yr after a routine urine check confirmed an M protein spike that led her doctor to refer her to Fata, a well known oncologist and hematologist. She was 51, the chief director of a state-licensed nonprofit — a reliable lady going through the stress of a life-threatening sickness.
She would wait shut to 2 hours earlier than being known as for this, her first chemotherapy session.
A nurse opened the door for her. “Monica.”
Contained in the clinic, the designer environment light as human chaos seeped in. The infusion nurses argued amongst themselves, unsure about whether or not to ship the therapy by injection or a sluggish drip. In the long run, Flagg was given a single shot. By the point she returned dwelling, she was exhausted and upset.
Later that day, she and her husband Stephen retreated to the deck exterior their Rochester dwelling, attempting to chill out. When a number of raindrops splattered, she went upstairs to shut the bed room window. Turning again round, Flagg stumbled and fell on an open suitcase she had been unpacking.
Virtually two years later, she nonetheless recollects the crunch of bone and her personal anguish as she started to cry.
Inner alarm goes off
That sweltering Fourth of July week, Dr. Soe Maunglay, then 41, a Burmese-born oncologist newly settled in southeastern Michigan, was making hospital rounds for Fata, his employer. Smooth-spoken and meticulous, Maunglay was sporting a swimsuit jacket moderately than a white lab coat, a behavior he’d adopted from a Mayo Clinic-trained mentor.
An accident of timing, private historical past, and unbelievable luck — good and dangerous — was about to unfold in Flagg’s hospital room. The consequence would save lives and unleash a federal investigation right into a long-esteemed doctor, collapsing his elaborate medical empire, whilst particulars about who uncovered the physician’s net of deceit, fraud and struggling remained unexplained.
Subsequent month, earlier than Fata is sentenced in a Detroit federal courtroom, Fata victims will describe the toll of being prescribed poisonous medicine and testing they did not want. They may clarify how their misplaced belief in a physician they as soon as revered tore aside their households, value them the facility to make decisions about residing or dying, and created lingering psychological anguish and sickness.
However it was Flagg’s stumble over a suitcase, and Soe Maunglay’s decided follow-through over the subsequent weeks, that precipitated Fata’s personal fall.
Making Fata’s rounds that July day, Maunglay checked for the primary time on Flagg, hospitalized with two fractures in her left leg. As a result of Maunglay is a most cancers physician, he paid heed to her a number of myeloma analysis, the Velcade injection, and the medical document earlier than him. All of it triggered an inside alarm. .
“Who advised you that you’ve most cancers?” he requested her.
Clinics in seven cities
Fata’s Michigan Hematology and Oncology Inc. (MHO) was the state’s largest personal most cancers follow in 2013, with clinics in seven cities, its personal pharmacy and diagnostic heart, and 1,700 sufferers, just about all of them assigned to Fata, the tireless doctor. Those that wanted proof of Fata’s dedication may look to the physician’s work ethic — he usually labored previous midnight — or to the Swan for Life Basis, a charity Fata established to assist most cancers sufferers and their households.
At the moment, MHO is gone and Fata is behind bars, awaiting sentencing for no less than $34 million in fraudulent Medicare billings and a kickback scheme with a hospice. The legal counts solely trace on the human struggling behind the monetary damages and lift questions on how Fata’s schemes may go undetected so lengthy, regardless of his many contacts, medical doctors, and large roster of sufferers. As Brian McKeen, the malpractice lawyer now representing Flagg, says with outrage: “The one place an individual must be protected is a hospital or physician’s workplace.
Maunglay alone amongst Fata’s former associates is prepared or prepared to talk publicly, whereas no less than two dozen lawsuits goal professionals related to the follow.
Fata had a fame for hiring medical doctors who superficially appeared like Maunglay — youthful, with fledgling practices, usually foreign-born, with few Michigan connections. “It was like ‘The Agency,’ ” says Dr. Gary Salem, vp for medical affairs at McLaren-Lapeer Regional Hospital, the place Maunglay now works — recalling the sinister regulation agency within the John Grisham novel that sought out younger, weak legal professionals.
After a lifetime of geographic dislocation and household tragedy, Maunglay may need appeared ideally solid for the position of a high-performing affiliate unlikely to trigger bother.
But in fact, his life had schooled him in skilled integrity and high-stakes drama: His dad and mom, a doctor and nurse, had given Maunglay and his three brothers a blissful childhood in Rangoon, Burma, now often called Yangon, Myanmar. For a time, his father had been a United Nations volunteer in Sri Lanka, a job he took pleasure in, and each dad and mom have been outspoken opponents of the army authorities in management. Their boys have been anticipated to turn out to be medical doctors: A household picture reveals a smiling four-year-old Soe with a stethoscope round his neck.
That snug, principled and striving world collapsed in 1989, when Maunglay’s father, a vibrant 52-year-old man, received sick. After a analysis of mind most cancers, the sickness progressed swiftly, taking his life three months later. Maunglay’s life turned an epic journey, marked by repeated tragedies and obstacles to his success and survival.
A youthful brother collapsed on the school soccer discipline and died in 1993. The regime closed the medical faculty in Rangoon, time and again.
Decided to help her surviving sons by means of medical faculty, Maunglay’s mom received political asylum within the U.S., transferring to northern California alone, learning for her R.N. certification, whereas working as a nanny and in dwelling well being care jobs at evening.
Her schedule was relentless and absolutely exhausting. In 1994, she swerved off the highway at 7 a.m. right into a concrete fence, and died within the crash. “We have been a household of six,” Maunglay says, eyes clouding with sudden tears. “Then we have been three.”
Maunglay was tempted to stop however as a substitute drew power from his mom’s instance: He labored into the midnight solar at an Alaskan salmon cannery each summer season, amassing 100-hour weeks to pay his medical faculty tuition and bills in Istanbul.
Finally, he made his approach again to the USA, the place he accomplished his internship, residency and an oncology fellowship, and married his spouse Mary. After she started a residency in radiology in Michigan, he took a place with Fata, proud to be related to Michigan’s most profitable oncology follow, one headed by a doctor who had educated on the elite Memorial Sloan-Kettering Most cancers Heart in New York. When he walked into Monica Flagg’s hospital room on July 4, he had labored within the follow for 11 months.
Maunglay has had sufficient
Docs rotated by means of Fata’s follow, maybe staying lengthy sufficient to search out proof of disorganization and dysfunction, moderately than proof of ailing intent. However by July 4, 2013, when Maunglay first regarded in on Fata’s affected person, he was well-situated to uncover deeper wrongs: He had caught Fata in an outright lie a number of months earlier than, when Fata had insisted the clinics have been enrolled in an expert high quality program.
Maunglay’s rising mistrust and disenchantment together with his employer had led him a number of weeks earlier to provide discover of his resignation, efficient Aug. 9 — sufficient time to assist sufferers transfer to new medical doctors, to switch data, with out disturbing their lives or disrupting the follow.
Throughout that window of ready, he encountered Flagg. That July 4 night, after seeing Fata’s affected person at Crittenton in Rochester Hills, he shared the case fundamentals together with his spouse.
Even when she hadn’t been eight months pregnant and drained, she would have been baffled by her husband’s description of the affected person’s situation and therapy. He ticked off the notes from the affected person’s chart — all regular readings — after which the most cancers analysis, the chemotherapy drug used to deal with a number of myeloma.
“Are you attempting to trick me?” his spouse requested, confused.
Flagg talked that evening to her husband, Steve Flagg, too, explaining that the physician who’d visited her requested lots of questions on her analysis. “It was as if he did not suppose I had most cancers,” she confided, with hope in her voice.
‘You do not have most cancers’
Maunglay was shocked by what the hospital chart recommended. A cancer-free affected person being given chemotherapy wasn’t negligence; it was an atrocity. “It is oh my God, if he can do that to an individual who has nothing. …” he mentioned one latest Saturday afternoon. “For me, one case like this was sufficient. How may a physician do that? My father died of most cancers. For many of us” — he waved his arms — “most cancers is private.”
As a most cancers specialist, he had a particular understanding of the horror he was witnessing, its cruelty. Fata’s selection of myeloma, a most cancers of the plasma cells in bone marrow, bespoke a sure shrewdness, due to the subjectivity of analysis. It was a intelligent area of interest for false doctoring. “You can not faux lung most cancers,” he says. “You can not faux a tumor …” However with this illness, a malevolent physician may plausibly use the therapy itself as a smokescreen to obscure future questions.
Myeloma’s early “smoldering” stage is signaled by comparatively minor modifications in blood chemistry. Maunglay and Dr. Craig Cole, an assistant professor of medication on the College of Michigan and myeloma specialist, say somebody with an elevated M protein degree is correctly monitored by means of blood and urine testing. Flagg’s was excessive sufficient to qualify as MGUS — an entry-level situation that may be precancerous, however usually isn’t.
Flagg was as a substitute recognized for the extra critical smoldering myeloma and singled out for Fata’s model of aggressive, unorthodox — and really costly — therapy: she was subjected to a few bone marrow biopsies and prescribed month-to-month intravenous immunoglobin injections (IVIG) that value $4,000 every. Flagg despaired earlier than each check, even preventing the analysis. “Individuals would ask me how I used to be feeling. I felt high-quality. I had no signs!” she mentioned.
When she complained to Fata concerning the invasive testing, he shrugged. She was indignant about her analysis, he mentioned, prescribing 25 doses of Xanax, an anti-anxiety drug. Ten months after their first appointment, Fata recalibrated the analysis to a number of myeloma — an incurable, usually lethal most cancers of the plasma in bone marrow — whereas making ready her for lifelong therapy. She was busy at work, reluctant to push again too strongly. Maybe she was simply upset. “My sister had breast most cancers. My brother died of lung most cancers. I’ve seen what it does to individuals,” she says.
Flagg was youthful and more healthy than most a number of myeloma sufferers, Maunglay knew. Her bone marrow plasma cells — cells that turn out to be malignant in precise a number of myeloma circumstances — have been being handled to obtain insurance coverage reimbursement. The cash stream may circulate for so long as Flagg survived.
That is what Maunglay noticed, what he felt — one thing worse than he had ever imagined. Maunglay knew he needed to act however he additionally had to make sure he was proper.
On July 5, 2013, Maunglay took a deep dive into the affected person’s data. Within the privateness of the MHO Clarkston workplace, he pored by means of the file, recorded on laptop and in handwritten notes, in search of some justification for Fata’s course of therapy. However each check consequence within the medical historical past confirmed his unique response within the hospital: Flagg was being intentionally handled with high-risk medication for a illness she didn’t have.
If the affected person truly had this pernicious illness, Maunglay knew, the myeloma cells could not presumably be vanquished by a single dose of chemotherapy. However they have been nonexistent in Flagg. Her abnormalities have been so slight, Maunglay thinks, that she probably would not want therapy earlier than she was 100 years outdated. Three p.c of individuals 50 and over have this situation — and 5 to 7 p.c over 70 — however just one p.c of these circumstances will progress to most cancers in a yr. “It is a affected person he has been following for an extended time period,” he says. “This isn’t an error. It’s intentional.”
His go to to Flagg within the hospital represented a small miracle of timing: In two or three months, a visiting oncologist would have anticipated to search out her blood counts regular, her most cancers in remission.
Maunglay returned to Flagg’s hospital room at Crittenton over the weekend, insisting she get a second opinion.
He was forceful and clear, decided that she would pay attention. However his personal disaster, he realized, was simply starting.
Fata caught in a lie
In his first months at MHO, Maunglay had tried to grasp and accommodate his unusual employer, Fata. From the start, MHO wasn’t like different practices the place Maunglay had labored. First, there’d been a clumsy job supply dance, with Fata extending the supply in February 2012, after which delaying the beginning date after Maunglay had already left his earlier place in Pensacola, Fla.
As soon as he’d arrived, Maunglay noticed Fata was very busy, with an enormous caseload of sufferers, attributing confusion to easy disorganization. He may assist enhance the follow, he determined. He designed new affected person consent varieties that conformed to an expert commonplace.
Physician who unleashed FBI’s Fata probe describes case
Dr. Soe Maunglay’s discovery of pointless most cancers remedies led to conviction of Dr. Farid Fata.
An electronic mail from his first week at work paperwork his request for a workers assembly and a change in follow. He’d insisted {that a} doctor be current in each workplace the place chemotherapy was being given. “That was simply good follow, the best way I had discovered it,” he says. Fata acquiesced, but in addition moved Maunglay to the Lapeer and Clarkston workplaces, the place neither their hours nor their sufferers overlapped. Fata was so protecting of his sufferers — secretive, the truth is — that he carried a pager with no backup, answering all calls himself. Maunglay requested him to hold a cellphone, like different medical doctors, “however he would at all times say, ‘Let’s work on it.’ “
Maunglay subsequent supplied to assist MHO win credentials from QOPI, a consortium that certifies oncology practices with excessive skilled requirements. Fata stalled, maybe as a result of approval is contingent on offering detailed case data. However after Maunglay continued in a collection of emails, Fata emailed the workers: “MHO has been QOPI licensed for 3 consecutive years with excessive scores … Let’s maintain off.”
It was, Maunglay knew, a flat-out lie. “I see that he has no ethics, no professionalism. I began wanting in a short time for different choices,” Maunglay recollects. A stream of younger medical doctors interviewed for the place — “at all times younger fresh-faced graduates, by no means anybody with expertise.”
When Maunglay determined to resign, Fata tried to dissuade him. He promised Maunglay’s spouse a job when she accomplished her residency after which, when that proved unsuccessful, brandished a non-compete clause in Maunglay’s contract: If Maunglay’s subsequent job wasn’t no less than two hours away, Fata would sue.
“I can’t work with this man,” he determined. He was so intent on leaving that he and his spouse put a down cost on a home in Monroe; he accepted a place with the Case Western Reserve College Most cancers Heart in Sandusky, Ohio. That approach, he and his spouse would every commute roughly an hour every approach.
Now, shocked by Flagg’s case and virtually out the door on the time of this horrifying discovery, Soe Maunglay acknowledged Fata’s benefit: The senior physician’s community of associations, his Memorial Sloan-Kettering coaching, and prolonged affected person roster had impressed him initially, too. Some workers members, nurses and nurse practitioners, had labored there for years. Why would individuals imagine him?
Maunglay could not sleep. Though he had intervened in Flagg’s case, he suspected her therapy would possibly “be the tip of the iceberg.” How would he discover out? It was hardly paranoid to think about a situation the place Fata covers his personal crimes, then concocts tales concerning the oncologist who stop. Who knew what a physician able to diagnosing faux most cancers would possibly do?
On the lookout for proof
Flagg’s case wasn’t sufficient to close down Fata. He was sure of that. So over the 4th of July weekend, Maunglay realized he wanted to search out “very stable, very goal” proof of wrongdoing, an anomaly that even a layperson would possibly perceive readily. However he anxious, too: “What if this takes six months? What if I can not discover it?
Hindsight could also be laser-sharp, however Fata had withstood auditing from insurance coverage firms, no less than one malpractice lawsuit, state regulators and the scrutiny of different medical doctors in and outdoors his follow for a decade. He had disbursed cruelty as casually as Tylenol, with out anybody catching him. Maunglay had witnessed a few of his methods: He had been stored from Fata’s sufferers fully, aside from cursory interactions. “If a affected person has a cough that worries him, he would have the affected person drive half-hour to his workplace as a substitute of coming to me in 5 minutes,” says Maunglay.
Over the subsequent a number of days, Maunglay’s search of the data enabled him to search out apparent breaches {of professional} ethics and sure fraud: He seen a protocol for treating non-Hodgkins lymphoma with rituximab, a focused most cancers drug. He researched using intravenous immunoglobulins (IVIG), discovering that, as he suspected, they have been being prescribed excessively, and with none obvious medical foundation, on numerous sufferers.
Figuring out that he wanted allies, he described his considerations to an infusion nurse and a nurse practitioner, sharing particulars concerning the extreme use of IVIG, and persuading them to intervene (The nurses wouldn’t remark for this story.) At the least certainly one of them confronted Fata straight, earlier than resigning. “At that time, Fata is sort of caught,” says Maunglay, saying Fata agreed to cease utilizing IVIG besides in circumstances the place there have been clearly accepted medical causes for doing so. To Maunglay, that in itself was additional proof of Fata’s deceit.
“If a doctor really believed his personal protocol helps his sufferers, he would by no means discontinue a therapy simply because one other doctor and workers objects. We caught him within the act,” says Maunglay.
Even then, although, there was no clear approach ahead: Maunglay had reported a few of his considerations to George Karadsheh, the follow supervisor, who was not a physician. After the IVIG remedies stopped, he and Karadsheh met once more within the Clarkston workplace. Collectively, they checked out a month of affected person data, everybody who had IVIG, pulling up the data on Maunglay’s laptop monitor. “It was, ‘Take a look at this. Some sufferers are right then, look, this one doesn’t meet the standards. Look, that is Medicare fraud.’ “
“He was satisfied and revealed to me that he had expertise reporting Medicare insurance coverage fraud … and he understands the seriousness of the fraud and abuse,” Maunglay wrote, in a latest electronic mail. Karadsheh had, in 1996, uncovered fraud at Detroit’s Lafayette Clinic and reported it underneath the False Claims Act, the federal whistle-blower regulation.
Karadsheh didn’t reply to repeated phone calls and emails from The Detroit Information. What he did do, based on Maunglay and knowledge in federal paperwork, was assume the position of whistle-blower, as he and Maunglay agreed. It was Karadsheh who first spoke to the Federal Bureau of Investigation on Friday, August 2, 2013.
At 8 p.m. Aug. 5, Maunglay arrived dwelling from work to search out his spouse introducing him to guests: two federal brokers, one from the FBI, one other from the federal division of Well being and Human Providers.
“I have been ready for you guys,” he mentioned, with a slight smile.
That night, he laid out, as particularly as he may, outcomes of his analysis over the previous couple of weeks. The extreme drug remedies, unusually aggressive therapy for terminally ailing and outdated sufferers, protocols that did not meet any accepted standards. The brokers took notes. Maunglay thought: Lastly. One thing is lastly going to occur.
He did not anticipate what occurred subsequent.
Fata arrested subsequent day
At 7 a.m. on Aug. 6 — not even 12 hours later — brokers arrested Fata in his Chevy SUV. By the point Crittenton Most cancers Heart workers arrived at work, federal brokers already have been swarming the workplace. “They didn’t let one other drop of chemo go into anybody. They only pulled the plug,” Maunglay says.
Regardless of Maunglay’s perception that Fata probably handled different wholesome sufferers for most cancers, solely two are recognized: Flagg and one other affected person, who sought a second opinion after Fata’s arrest in 2013. The Flaggs are suing Fata (however not Maunglay) for malpractice.
“Hers is among the evident examples of individuals being abused by his out and out greed. He let greed cloud his medical judgment,” says Flagg’s lawyer, Brian McKeen. “I’ve been doing this for 30 years and that is a number of the most evil conduct I’ve ever seen.”
On Sept. 16, 2014, Fata pleaded responsible to a number of counts of Medicare and insurance coverage fraud, cash laundering, and soliciting kickbacks, whereas publicly admitting that he’d prescribed remedies that have been medically pointless. His belongings have been auctioned, and his spouse and three youngsters have been allowed to go away the nation. Fata is being held on the federal detention heart in Milan, awaiting his court docket look July 6. Federal prosecutors are in search of a life sentence. Fata’s lawyer has steadfastly declined remark however is predicted to file a response underneath seal subsequent week.
However the burden of affiliation with Fata weighs closely on Maunglay. Though his fame as a physician enabled him to safe a place at McLaren-Lapeer/Karmanos Most cancers Heart, he worries that, irrespective of how moral or glorious a physician he could also be, he’s endlessly linked to Fata and one of many nation’s most horrific medical schemes. As soon as once more, the longer term is unsure and virtually actually tough. “The one who speaks out isn’t OK,” he says with a sigh.
Geraldine Parkin, who heads Sufferers and Households Handled by Dr. Fata, an advocacy group, voices the considerations of many who’re appalled by how lengthy Fata’s crimes escaped detection. How may the opposite physicians not have recognized one thing?
“They are saying that he (Maunglay) is the whistle-blower, however I’m nonetheless suspicious. His identify is everywhere in the charts,” says Parkin, whose husband was a Fata affected person.
Maunglay, although, had little entry to Fata’s sufferers. As a result of Maunglay had insisted {that a} doctor at all times be current within the clinic throughout any chemotherapy, he signed charts, as all of the medical doctors did. Fata’s willingness to work 20 hours a day appeared exemplary, moderately than a determined technique to keep away from suspicion.
“It was simply not that simple to know,” Maunglay says.
Bart Buxton, the CEO at McLaren-Lapeer Regional Hospital, the place Maunglay now works, had met Maunglay a yr earlier, recognizing him as an unusually empathetic doctor, and supplied him a job nearer to his spouse’s work, starting that August. “He saved individuals’s lives,” he says. “It goes to the fiber and testomony of the person. He is a hero.”
Regardless of their life-changing encounter at Crittenton Hospital, Maunglay and Flagg haven’t spoken since. Flagg has tried to place the incident behind her and by no means reached out to Maunglay, the physician who warned her about Fata. But their transient conferences had profound and lasting penalties — a potent mixture of circumstance and persona coalescing on the proper second.
If it had not been for Flagg’s damaged leg, on the very first day of what was alleged to be a lifetime of chemotherapy, Fata may be working towards nonetheless. If Maunglay had been much less observant, or maybe much less suspicious of Fata, he would have left the follow as he had deliberate, exiting quietly as so many had earlier than.
It doesn’t matter what lies forward, Maunglay doesn’t remorse his choice to alert Monica Flagg and construct a case towards Fata. In a life that has been shattered by demise, displacement and an ongoing medical horror story, he’s resolute.
To clarify, he sends an image of Daniel, his 18 month-old son, standing in his socks with a Lego in his hand and a lopsided smile.
“You wish to dwell the appropriate approach,” he says.
