St. Louis Post Dispatch uncovers felons making healthcare "affordable"

This is part of my ongoing effort to highlight great investigative work being done outside Big Media.

Blythe Bernhard and Jeremy Kohler have been writing a series of stories in the St. Louis Post-Dispatch that should be carefully studied by anyone wanting to examine physician discipline in a state, region or nationally. Their latest installment, A felon, fit to practice? Disgraced doctor gets a second chance, started with straightforward top:

WASHINGTON PARK - Three years ago, Dr. Krishnarao V. Rednam was the lead partner in a group of eye clinics across greater St. Louis. Now he's working in the back of a church here in one of the nation's poorest communities. His old life ended after an audit of St. Louis Eye Clinic revealed Rednam, 61, was billing Medicare insurance for expensive drugs, but injecting cheaper, still-experimental drugs into his patients' eyes. He also would sometimes split a single-use vial among multiple patients, billing each of them for a full dose.  He repeated the actions at least 284 times, overcharging patients and their insurance more than $600,000. The government said Rednam might have subjected patients to unsterile needles. The doctor insisted patients were never at risk. As investigators closed in, Rednam destroyed records to cover up his wrongdoing.

This story was so full of great information and reporting how-to that I could easily put together 20 different lessons from the piece. Here are my favorite five:

1. Don't settle for he said/she said. Rednam and his attorney, Harvey Tettlebaum, defended the doctor with many different versions of the truth. The medical boards in Missouri and Illinois let him get away with those shades of honesty. Bernhard and Kohler did not: "Tettlebaum repeatedly tried to portray his imprisoned client's crime as merely billing fraud, but he conceded that "it isn't clear" if patients knew what drugs and dosages they got."

Then, they documented all the different ways Rednam tried to shade the truth with his patients, even writing a letter to patients that "suggested patients might have benefitted from Rednam's actions. It said that drugs might have been added to treatments to "enhance the effectiveness" and that doctors were "eager to determine" the results."

2. Define the scope. Reading this story, you might think that there are thousands of convicted felons practicing in Missouri and Illinois, if it weren't for Bernhard's and Kohler's forthright assessment. 

Medical boards don't release statistics on how many active licensees are convicted felons. A Post-Dispatch analysis of Missouri and Illinois records identifies at least eight felons who either regained their license or never lost it. They include doctors convicted of possession of child pornography, false imprisonment, dealing drugs, child endangerment, persistent drunken driving, mail fraud and leaving the scene of a fatal car crash.

So, they found eight, and the potential for many more. Readers can decide for themselves if those types of felonies are worrisome and whether the states should be more transparent.

3. Show the difference between tough talk and action. When taking away Rednam's license, the Missouri Board of Healing Arts said that Rednam should not be allowed to apply for license reinstatement for at least seven years. That was the talk. The board's actions spoke differently.

Inexplicably, the board also agreed to a set of facts that were favorable to Rednam: It agreed that Rednam was a charitable man who took responsibility for his actions. It characterized the dosing scam as a "treatment confusion" that Rednam readily admitted to his patients .Finally, the board agreed that Rednam had a rare skill and that if he got his license back it would be in the public interest to put him in a position where he could resume his good works. Citing that statement, Tettlebaum argued in court that the board had not justified a seven-year ban. An appellate court agreed, and the case was sent back to the board.

What did the board do? It allowed him to reapply for his license immediately.

4. Camp out. Reporters are busier than ever these days at media outlets with smaller staffs, and it is tempting to do everything via phone and email. Kohler and Bernhard made time to visit Rednam's office multiple times, to talk to him in person and to talk to his patients, too.

Mike Adkins, 56, was having vision problems. After Adkins walked out from an hour-long exam, reporters asked him if he knew that Rednam had gone to prison. Adkins stopped in his tracks. "You're scaring the hell out of me," he said. "I would have liked to have been informed about that." Rednam told reporters he has not disclosed his problems to any of his new patients. "No one has asked me about it," he said.

5. Don't forget the details. How's this for a scene setter?

Rednam went to Illinois, where a felony conviction does not automatically trigger the suspension of a medical license. He arrived here in June 2009 at Trinity United Methodist Outreach Center, which faces a junkyard where two pit bulls roamed on a recent Wednesday. His name is stenciled in black spray paint over a sign advertising "affordable healthcare."

It's too bad "affordable healthcare" is often code for substandard care, but, for now, you can count on signs like that showing you the way to a great story.