On rounds with Walt Lillehei, and the gifted Jolene Kriett.
A few weeks later, Najarian sent for me.
“I remember agreeing to give Dr. Lillehei an emeritus position,” he said. “However, I don’t recall allowing you to give him an office.” I was dumbfounded at Najarian’s pettiness. I told Walt I needed the space and I was sorry, but he would have to move out. I figured it would be better if he thought it was my idea and not Najarian’s.
Najarian gave no indication that we would control our own money any time soon, even though two years had gone by and I certainly “knew the ropes” by now. We kept turning over checks to DSA. We had our own accountants, and I talked to them about what to do. I said I didn’t think Najarian had any intention of ever giving us control of our money. In that case, they said, why don’t you simply stop giving it to him? I hadn’t thought of that. But it was an easy call. We opened an account and started making deposits.
Walt Lillehei and me with Jaqueline Johnson, the world’s first open-heart surgery patient when she was five years old. She and I were now thirty-nine.
About a month after we’d stopped handing over checks to Najarian, I was summoned to his office. David Brown (the dean of the medical school) and the CEO of the hospital were there. I had no idea what it was about. The meeting lasted an hour. Najarian had a list of crimes I’d supposedly committed. One claim was that I hadn’t hired a nurse because she was too fat, which wasn’t true. Another was that I’d stolen the key to the operating room. I didn’t even know the operating room could be locked—though if it could have been, possibly one of my staff borrowed a key to get in and would have assumed that there was more than one key. Another charge was that I had misappropriated departmental funds. This was partly true. I had wanted a small gun case for my town house and asked Jim Coggins where I could buy one. He said he knew someone who could get me one. And he did. It wasn’t anything special and only cost a few hundred dollars. Coggins paid for it with department money and neglected to tell me that—or to send me a bill. I was busy in the OR night and day and simply forgot about it. I think now it was a setup, something for Coggins to have in his back pocket for future use.
This went on. It was all so trivial and absurd that I couldn’t believe the three most important people at the hospital were sitting there talking to me about any of it. At one point Najarian claimed to be exhausted, said he couldn’t go on, and handed the list to Brown to continue.
I am sure that I made mistakes, that I was arrogant and demanding at times. I chafed at rules that didn’t make sense. One example that came up involved heart valves. You’d be surprised how many patients ask if they can have their old valve after it’s been replaced. The rule was that any tissue removed from a patient had to go to pathology, but I’d ignore that and give the patient the valve. Why send it to pathology? So the pathologist can say, “yes, that’s a heart valve”—and charge a fee for it?
It would take me longer to figure out what my real crime was. I’d failed to grasp that you could not be seen as better than Najarian. Mediocrity was the key to survival at Minnesota. Najarian was on top, and I was about to find out how far he’d go to stay there.
My mother’s sixtieth birthday was coming up. I was scheduled to fly to England, where she and Philip now lived, the day after the meeting in Najarian’s office. Everyone knew I was going. Maybe that explains what happened the next morning.
It was August 2, 1988. I woke up to find my picture on the front page of the Minneapolis Star Tribune, beneath a headline saying that I was the subject of an investigation. According to the article, I was accused of ordering a coronary-bypass operation on a patient who was clinically dead—plus a second procedure shortly afterward on the same patient, supposedly to control bleeding. The article stated that the surgeon had terminated a procedure that was underway when the patient died, but that I then insisted the surgery be continued. The story went on to suggest that all of this had been done to collect $22,000 from the patient’s insurance company. The article quoted a pathologist who said that the surgery was unnecessary, though it did not say how a pathologist would know anything about it.
That wasn’t all.
The story also reported that I had covered up an incident in which a pair of forceps had been left in a patient’s chest after surgery. The claim was that I told nurses in the OR that a second operation was required to control bleeding, when in fact it was so the forceps could be removed without informing anyone, including the patient’s family. The article said it wasn’t clear whether I had left the forceps in or someone else had done it. Somehow, X-rays of the forceps inside the patient’s chest had gone missing. The bill to the insurance company in that case was $19,000.
I stared at the paper in disbelief. None of it was true. I remembered getting a call from a reporter recently asking me to comment on whether an operation done by my group might have been unnecessary. I’d declined to say anything and forgot about it. Now the timing couldn’t have been worse. I’d be in England by the end of the day.
When I got to the office, my secretary was already there, going over the newspaper article. Jolene Kriett—one of the most composed people I’d ever known—was sitting at my desk sobbing.
“What are we going to do?” she asked.
“Jo, we’re going to do what we always do,” I said. “Work hard.” Angry and in shock, I was sure it would not take long for the truth would come out. The story in the paper was so sloppy I couldn’t understand how it had been published. I hadn’t started to wonder yet where the story had come from. The phone rang all day with calls from reporters. I didn’t take any of them. But Jo did.
On August 3, the St. Paul Pioneer Press, the Star Tribune’s competitor across the river, reported that Kriett told them the report was false. The story said that Kriett “angrily denied” that a useless surgery had been performed on a dead patient. She said she was certain because she had done the surgery herself. She told the paper that not only had I not ordered her to do it, I didn’t even know about the operation and hadn’t been in the hospital when it took place.
Jolene told me hours after the surgery what really happened. The operation had not been bypass surgery. The patient was the mother of young children who’d been brought to the hospital in critical condition after a heart attack. She’d had a cardiac arrest, but was resuscitated with CPR. Considering the young age of the patient, and after consulting the family, Jolene and Carl White, the chief of cardiology, had decided to place her on an assist device. Even though they didn’t know if her brain was still functional, they wanted to give her the benefit of the doubt. When she did not regain consciousness, they discontinued life support.
The Pioneer Press article reported that Jolene and other doctors said the implication that an unwarranted surgery had been performed for financial considerations was outrageous. And several staff members who’d been in the OR for the other alleged incident said that they saw no forceps during follow-up surgery to relieve internal bleeding. The reporter had also spoken to a doctor—unidentified but one more knowledgeable than the Star Tribune’s sources—who said it would have been impossible to conceal the discovery of a pair of forceps in a follow-up surgery. The unnamed doctor went on to suggest that the story had been planted to discredit me, probably by “someone with a grudge against Jamieson, a newcomer who has helped quadruple the hospital’s cardiac and lung surgery caseload in the two years since he arrived from Stanford University.”
Any heart surgeon could have told the Star Tribune that it would be impossible to leave a pair of forceps—which are the length of the heart itself—inside someone’s chest and sew them in. The story would have been funny if it weren’t so awful.
The hospital was in an uproar. I met with the dean, David Brown, plus Najarian and the hospital’s director. I told them I was worried the false accusations would destroy the hard work of the past two years. I said I was sure it would all get straightened out shortly. And then I made a big mistake. I offe
red to stand aside as chief until an investigation was carried out. I did not appreciate that the fix was in. I asked that the investigation be done by outside experts. In the moment it seemed to me the only honorable course of action. But as I would soon learn, I was not dealing with honorable people.
On August 4, two days after its initial story, the Star Tribune published a front-page retraction, signed by its executive editor, Joel Kramer. The brief mea culpa said that the paper should not have reported the story.
“Publishing the account of the events, when we had not confirmed it with anyone who had firsthand knowledge of the facts, was a serious lapse in journalistic judgment, which we regret,” Kramer wrote. Also on the front page that morning was a story reporting that I was temporarily stepping down as the university’s cardiac chief. The juxtaposition could not have been more striking. And when the Star Tribune’s ombudsman, Lou Gelfand, weighed in on August 7, he wrote only about how the paper had made an “error,” gliding past the fact that it was a mistake that could well destroy my career. Gelfand wrote that the reporter had pursued the story after getting a “tip,” but he did not speculate on whether such a tip might have come from someone with an ulterior motive. On the contrary, my situation didn’t seem to bother Gelfand in the slightest. The only hand-wringing at the Star Tribune was over how its mistake had made them look. One sentence in Gelfand’s piece said it all. “How,” Gelfand wrote, “did the paper get in this mess?”
How indeed? Who was behind the tip? Who had a grudge against me? In a blur of follow-up stories that appeared in the wake of the retraction, the Minnesota Daily, the campus newspaper, talked to Arthur Caplan, the director of the university’s Center for Biomedical Ethics. Pushing aside the false accusations, Caplan said this was a classic case of cutthroat academic medicine. “It’s not unusual for an internationally prominent surgeon to be at the center of a controversy,” Caplan told the paper, “because they play in a high-stakes world and our expectations are enormous. They are powerful, and that breeds envy, rivalry, jealousy and turf fights, so difficult controversies swirl around these men.”
I had to wonder what he knew.
When I got back from England, I gave Najarian a list of six surgeons for the investigation. The list included Denton Cooley from Texas, and the chiefs of heart surgery at Yale and the Mayo Clinic. All were internationally known and respected leaders in the field. Najarian selected none of them. Instead, he chose two friends who chaired surgery departments, as he did, plus a third person I had never heard of.
I had been in touch with Shumway throughout the ordeal. When I told him the names of the people who would do the review, he said, “We’re in trouble.” I still didn’t want to believe him. But I was soon set straight. A surgeon named Ed Humphrey had been installed in my place while I was suspended. Ed was chief of surgery at the local Veterans Administration hospital. He’d been around for a long time and seemed to know what was going on with my situation. He came to see me, and after we’d talked a little he got to the point. Humphrey said that he’d been told that if I would give up financial control of the cardiac center, and turn over all the money to Najarian, then “all my problems would go away.”
It wasn’t hard to connect the dots. I told Humphrey I wouldn’t do it.
I still had operating privileges and patients who were counting on me. Shortly after talking with Humphrey, while I was in the OR one day, Coggins had the locks changed on my office. A patient waiting inside to see me wondered what was going on and had to be let out later. My parking permit was also revoked. Then, a few days before my review, I ran into a cardiac surgeon I knew in the corridor. I didn’t have to ask him what he was doing there. Before the investigation even started, Najarian was interviewing prospective replacements.
The review was set for early September. The night before it took place, Najarian took the committee members out to dinner. They all belonged to the same professional societies he was in. They were cardiac surgeons but not active ones. I didn’t know any of them.
I was the first to be interviewed the next morning. They gave me a half an hour. I answered all their questions and asked that I be allowed to meet with them again at the end of the day to respond to any issues that came up in subsequent interviews. I had submitted a list of people from my group I thought should be questioned, but only some of them were. Najarian decided who would be called in front of the committee, and his list was a closely guarded secret. I waited all day to be called back. I never was. Najarian later told me that the committee had had no additional questions for me.
In hindsight, I know the outcome was never in doubt. The facts that I thought would exonerate me were simply ignored. Najarian sent for me a week later and said the review committee had recommended that I not be reinstated. I knew that’s what he wanted. I couldn’t believe any other reasonable person would agree.
I’d underestimated Najarian’s determination to not be eclipsed on his own turf, to rule his kingdom and collect his tribute. I’d been naive. At Stanford, Shumway had protected me—protected us all, like an umbrella, shielding us from university intrigue, never letting territorial feuds or arguments about money come near us. I’m sure there were politics there, but I’d never seen them.
Now I was out. I still had my academic appointment, but I knew I was done in Minnesota. I was forty.
When I finally saw the report of the review committee, it made for interesting reading. It said the creation of the Heart and Lung Institute—the thing I’d come to Minnesota to do—had been “disruptive.” The only thing it had disrupted was the long period of malaise when few cardiac patients were referred to the university. I was criticized for not doing research. This could not have been further from the truth. When Najarian reneged on his promise of lab space, we’d rented space off-campus. In two and a half years, my group had published 148 papers, more than all the rest of the surgical staff combined. After declining to interview most of the people who worked for me, the committee also criticized my leadership style.
There was one charge I could not deny: the committee faulted me for not attending Najarian’s grand rounds.
Two weeks after the review, eager to move on, Najarian announced that my successor as chief “may be named within a month,” though it was no mystery as to whom it would be. It was the man I bumped into in the hallway before the reviewers came.
It was a bitter time for me. I’d been in the right, but the damage to my career and my reputation was real just the same. The future looked bleak. I had enemies now who would work to undermine me wherever I went. What was most difficult for me to accept was that my reliance on honesty and loyalty, instilled since early childhood in Rhodesia, and reinforced by men like Matt Paneth and Norm Shumway, had not carried the day. But one thought kept my spirits up. The people who’d brought me down had no honor. Like hyenas, they were mean and dangerous, but not worthy of contempt.
I heard from colleagues, all of whom offered support. Shumway was unwavering. I got letters and phone calls from Bruno Reichart, Denton Cooley, Sir Terence English, and Len Bailey. They’d all run the press gauntlet before. A friend named Charlie Moore in San Antonio, Texas, may have put it best.
“You’re the proof of that old Texas saying,” Charlie said. “The higher up the tree you climb, the more people there are shooting at your behind!”
I filed a lawsuit against Najarian’s group, the Department of Surgery Associates, and another one against the university. I also sued to find out who had fed the newspaper the story. The Star Tribune argued that I was a public figure, and therefore fair game. But they eventually settled out of court. So did Najarian and the university.
In time, things caught up with Najarian, Jim Coggins, and the dean of the medical school. Within a few years Najarian and Coggins lost their jobs and the dean resigned his position. Najarian’s department was exposed as a cesspool of criminal misconduct after raids by the FBI and IRS. Najarian was indicted by a federal grand jury on seventeen counts of fraud, t
heft, and tax evasion. Charges of conspiracy and obstruction of justice were added. Two members of Najarian’s staff pleaded guilty and gave evidence against him. Coggins died before he could be indicted and was named an unindicted coconspirator. He had been operated upon by Najarian’s new cardiac team and died shortly after surgery. Walt Lillehei, who had never gotten along with Coggins, called to tell me about it. “They’re so short of patients now that they’ve started operating on each other,” he said. “Pretty soon there won’t be anybody left.”
Though it is still published, the Minneapolis Star Tribune filed for bankruptcy and entered a long period of decline, shedding many reporters in the process.
But all of that was a long time ago, when I lived in a place where some hearts were irredeemably cold. I moved on.
CHAPTER TWENTY
CALIFORNIA CALLS
I had immediate inquiries from other hospitals and private practices in Minneapolis. But I wasn’t interested in competing with the program I’d built at the university. It would have seemed too much like revenge, which I believe is a self-destructive instinct.
I knew that wherever I went, I wanted to stay in academic medicine. That may seem strange, given that I’d been victimized by academic politics at their worst. But all of my work had begun with research and continued with experimental procedures. These could only be done at a university hospital. And I had another reason. I’d put together a great team at Minnesota and I wanted to take them with me. I was looking for a package deal.
In October, the month after the review, Dr. Moossa, the chief of surgery at the University of California, San Diego, called. He knew about what had happened at Minnesota and asked whether I wanted to discuss the possibility of coming to San Diego. I said I would meet with him. Although he had a general idea about the situation in Minnesota, Moossa didn’t know what was true and what wasn’t. He wanted to be cautious. He suggested we meet on neutral ground at the airport in Chicago.
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