Wrongful Prosecution of Dr. Richard Paulus

Fifteen years ago, an “anonymous” person contacted the federal authorities and said that Dr. Richard Paulus, a prominent cardiologist, was committing fraud by placing coronary stents in arteries that didn’t need it.  I am always skeptical of anonymous tips to the authorities.  Especially since court records show that the federal government is not above having a member of its own task force call in complaints so they will have “probable cause” to open an investigation into a citizen.

Many anonymous calls to authorities come from disgruntled employees, angry patients, jealous competitors, and exes that often qualify for all three adjectives.  All such calls should be vetted carefully to ensure that law enforcement does not become a weapon to be wielded against anyone we don’t like.  This problem can be epidemic in police states and during witch hunts. Literal and figurative witch hunts.

The Stasi in East Germany employed 91,000 agents, one in thirty citizens, and maintained over 500,000 informants, who readily identified five million of the sixteen million population of neighbors, colleagues, friends, and relatives, as enemies of the state.  Much of the oppression was overt, as any government trying to control its populace will know that what can’t be accomplished by law can be enforced by fear.  A form of “legal” terrorism.  Depending on whether you have a constitution, and if rights are protected.

It’s important to remember, that every witch hung or tortured to death for confession at Salem, had a trial.  A trial that satisfied all the laws and rules of that day.  Thirty of two hundred of the accused at Salem were convicted, fifteen percent.  A dismal failure by modern American federal standards, where the conviction rate has risen from 75% in 1972 to today, when 0.4% of accused citizens are acquitted at trial. A technically correct trial does not assure justice, as Navalny would confirm if he were not in the ground.

This brings up an important point.  What is said on paper is of no importance if it does not control what happens on the street.  In Dr. Paulus case, it seems that the government immediately assumed his guilt and invested a lot of money in trying to prove it.  Your money by the way. But don’t weep for the government.  They can almost always seize or coerce enough assets to come out on top.  In this case the medical center where Paulus worked was forced to give up $41 million dollars in civil proceedings.

Dr. Paulus was indicted in 2015, on charges of falsifying medical records and performing unnecessary procedures to defraud the insurance companies.  This last is important, as federal law enforcement has been essentially rented out to insurance companies as a private police force to target physicians that force those companies to actually give up some income for their beneficiaries’ medical treatment.

In May of 2019, Dr. Paulus went to trial and faced the government’s expert witness.  These witnesses are paid a lot of money to agree with the prosecutor’s argument.  The evidence presented seemed to indicate that Dr. Paulus had carried out unnecessary procedures, exaggerating medical conditions and making it appear that interventional stenting was needed when it was not.  They also accused him of falsifying medical records to get the insurance companies to pay for it.  A serious crime if it were true.

After an analysis of patient records by the FBI, DHHS, and the Attorney General-Medicaid Fraud and Abuse Control Unit from 2008 to 2013, the jury was told that Dr. Paulus had placed seventy-one stents in patients who suffered from blockages of less than seventy percent, the standard for intervention.  The government went on to say that Paulus recorded these patients as being at or near seventy percent, and that a reviewing expert found only one out of eighteen random samples as medically necessary.

What the government did not say was that the prosecution had selected those records after a previous reviewer had found a large majority of the sampled procedures were indeed medically necessary.  This potentially exculpatory information was withheld, which is a violation of law, but who has the power to arrest an assistant US attorney?  They would have to essentially arrest themselves in an environment where winning ,equated with conviction, is everything. Withholding becomes a standard operating procedure.

Dr. Paulus was convicted and sentenced to five years in prison.  An appeal was filed, asking the court to throw out the conviction, for lack of evidence of criminal intent, and with the argument that the government’s case had been “cherry picked” and exculpatory evidence withheld.  Cherry picking is a term often applied to scientific research where it is found that the investigator carefully selected “evidence” to confirm their preconceived conclusion, ignoring anything to the contrary.

Also understand that reading angiograms is not an exact science and there can be differences of opinion on interpretation.  At least before AI takes over. And an acceptable error rate is considered 5 to 10% .  Another study published found a 15% error rate when compared against intravascular ultrasound.

That would mean that Dr. Richard Paulus was prosecuted and convicted, not for being a criminal, but for being less than perfect.

Indeed it would mean that he was prosecuted despite being better than the average cardiologist, which seems to indicate that once they target you, no amount of contrary evidence will keep them from pursuing conviction.  And if they need to hide a few records to convict someone that’s just “part of the game” as I was once told by a defense attorney.  I responded that this is no game, a person’s life is at stake, he just smirked and walked away.  Luckily Dr. Paulus’ attorneys did not see it this way.

A motion for a new trial was filed on appeal and it was granted by US District Judge David Bunning.  Judges, as members of the judiciary branch instead of the executive, are the citizens’ last hope for justice when the latter breaks the rules.  The checks and balances created by the founders of this nation.  The judge didn’t think it stood to reason that a physician who spent decades becoming a doctor would risk everything to earn the hospital or himself a few percent extra.

The government came back to try again in 2023.  Now understand this means Dr. Richard Paulus has, to this point, spent time in federal prison and eight years of his life fighting these charges, costing him his life savings, reputation, livelihood, and over a million dollars taken by the government at the start.  In the second trial the government argued that emails celebrating Dr. Paulus “astronomical procedure volume” and associated financial rewards, were not indicators of a hard-working physician, but a crime.

The defense, now armed with an accurate evaluation of Dr. Paulus work, was able to show that his accuracy had outperformed physicians at the Mayo Clinic.  The prosecution tried to admit statements that the doctor had once fallen asleep in the cath lab, but this was excluded at trial.  I have personally seen surgeons fall asleep standing up during trauma rotations when they were waiting for a procedure to be prepared. This is a good use of time for an exhausted physician whose skills are critical to someone’s survival.

So a physician’s records are combed through for outliers. Scan two hundred records and any expert can find an average of twenty that are equivocal.  Send those to a different expert to review and they could easily find that, in their opinion, eighteen of those twenty don’t make the cut.  That eighteen of twenty is then presented to the jury as a 90% rate of false interpretation by the defendant.  Clear evidence of wrongdoing by the standard applied to citizens; knew, should have known or was willfully blind to.

That brings us to the deluge of prosecutions of physicians treating pain and addiction, where the government will comb through tens of thousands of medical records looking for complicated or compromised patients who needed individualized care, then feed those to a state medical board to get them to panic.  They will usually throw in a few “deaths associated with the doctors practice” to make sure the doctor’s ability to continue his profession and fund a defense is destroyed.

It is important to note something here. From my personal clinical experience as a physician, it has come to my notice that most people die from something at some point in their lives.  Indeed it is a medical fact that sick people die more often than healthy ones.  And most doctors treat sick people. I have even seen where the case of a patient shooting themselves was presented to a medical board as an “opiate related death.”  Doctors have been given life sentences based on these “facts”.  Just ask Dr. Steven Hansen.

Pain and addiction doctors usually see patients every month and long-term.  That means every death of any patient is within thirty days of a prescription, post hoc ergo propter hoc.  A single negative drug screen will also be held up as PROOF of diversion, ignoring the possibility of a false negative, as needed dosing with a good day, a medication holiday to reset receptors and tolerance, or a rapid metabolizer.  And don’t you dare order a genetic test to see if the person is a rapid metabolizer.  Genetic tests are a red flag.

Dr. Paulus’ was acquitted of one charge and the jury could not reach a unanimous verdict on another at the second trial.  The government then finally threw in the towel, begrudgingly, in their mercy, deciding not to put him through a third trial, but telling the public they were still certain of his guilt, and essentially that if it hadn’t been for those pesky constitutional rights, they would have convicted him. Which is almost certainly true.

The doctor’s defense attorney, Ms. LoCicero, spoke out saying of Dr. Paulus:

“He dedicated his life to helping sick patients and he always acted in their best interests.  There was substantial evidence at trial that established this.  Essentially, the case boiled down to legitimate disagreements between experts in a complicated field of medicine.  The government’s attempts to criminalize such disagreements amount doctors was unjustified.  Doctors frequently disagree and there was never any proof of wrongdoing.”

This profound statement could be said of so many physicians that are still behind bars for treating pain or addiction.  Dr. William Bauer comes to mind.  As does Dr. Ruan.  Yes, he’s still in prison.  “Winning” against the federal government is like surviving the attack of a great white shark, whose capacity for compassion probably exceeds some prosecutors.  Even if you survive, it’s going to cost you horribly.

Dr. Paulus will celebrate with his family for a few days.  Then he will sit down, eight years older and having lost everything he dedicated his life to building, and he will ask himself.  Was it worth it?  Is practicing medicine in the United States of America today, with the criminalization of differing medical opinions, worth it?  I will tell you what I told a brilliant young family member of mine who was thinking about going into medicine.  Think long and hard before you swim in those waters.  It’s not safe.