Dr. Strangelove 

Of the many passages in life, a hospital’s geriatric-psychiatric ward no doubt ranks as one of the most unpleasant. It’s here that elderly people, barely holding on to their mental faculties if at all, lie in stages of dementia or explode into full-blown psychotic rages.

Objects small and large are sometimes thrown about. It’s not unusual to see patients strapped down to prevent them from harming themselves or others. The scent of urine and hospital food occasionally wafts through the air.

After completing a residency at the University of California at San Diego, Dr. Robert Weitzel began working in August 1995 at the Davis Hospital and Medical Center in Layton. As assistant medical director of the hospital’s geri-psych unit, it was his job to fine-tune each patient on a regimen of psychotropic drugs and sedatives. Calm patients down, make them manageable through medication, so they can return to their respective nursing homes. Weitzel wrote the prescriptions. His staff of nurses administered them. The patients, lost in the dementia dealt them by old age, ingested drugs with names that sounded like faraway planets: Haldol, Trazodone, Ativan, Risperdal, Fentanyl.

Bringing Out the Dead

Then, between December 1995 and January 1996, people started dying. The first to go was 91-year-old Ellen Anderson. The day after she was admitted to the unit, Dr. Weitzel gave her 20 mg of morphine for “severe pain related to profound osteoporosis.” At her death, he reported signs of pneumonia.

Next was 93-year-old Judith Larsen. Like Anderson, she was a widow. Weitzel noted that she had suffered a stroke that August and had a medical history of heart disease. On Dec. 26, Larsen “had an apparent seizure,” according to Weitzel’s notes. Later, her terminal condition would be diagnosed as intestinal bleeding. Larsen was administered far more morphine than Anderson, at least 150 mg. Years later, experts for prosecutors would look over Larsen’s medical chart and note that the frail old woman received as much as 138 mg of morphine on the last day of her life, Jan. 3, 1996.

Mary R. Crane, a 72-year-old depressive who exhibited psychotic features and drank from toilets, was third. After treatment with 11 different medications, and after exam reports of toxins in her blood, Weitzel prescribed her morphine as well. She died four days after Larsen.

After prescriptions of Haldol and Trazodone, followed by 5 mg of morphine sulfate every three hours around the clock, Lydia Smith, 90, died the day after Crane. She’d had a stroke four weeks prior to admission, Weitzel noted, and suffered from two heart conditions.

Ennis Alldredge, an 85-year-old mountain of a man who loaded gravel for a living, went as well. After a stroke, followed by 10 mg of morphine every three hours and 20 mg more ‘til death, Alldredge was the last of the five released to a mortuary.

To Beverly Foulger, a hospital worker performing group therapy for the elderly patients, it seemed quite strange to lose so many patients so quickly, as if in a row.

“It was a very emotional time to lose so many patients, because that was the unit that wasn’t supposed to lose people,” Foulger said. “On the skilled nursing unit, yes—there they came to us to die. We dealt with death there on a regular basis. But on the geri-psych unit they came to get medication so they could go back home. These were not the people with terminal conditions.”

“Blasted”

But nothing seemed amiss to Dr. Weitzel. These were old people with terminal conditions. He remembers the instructions he was given by family members after he spoke with them regarding their loved ones: End all previous medications and give them morphine so they might die of their underlying conditions in painless peace.

By February 1998, Weitzel was moving back and forth between Utah and Bay City, Texas, where he worked at another geriatric clinic at Matagorda County Hospital. Who would have thought Davis County investigators were on his trail? Bodies were about to be exhumed. Scores of people were being interviewed. Prosecutors slowly assembled a scenario quite contrary to what Weitzel asserted at the Davis Hospital: Anderson did not die of pneumonia. Larsen did not die of intestinal bleeding. Crane did not die of blood disease. Smith did not pass away because of any heart problems and Alldredge did not die of a stroke. They all died, prosecutors alleged, because Dr. Weitzel had first “blasted” them into near comatose oblivion with excessive amounts of psychotropic drugs, then finished them off with still more excessive amounts of morphine.

Larsen’s case stuck out as the most curious of the five, not just because she received far more morphine than the others, but because of the way experts for the prosecution read her chart. If they weren’t mistaken, Weitzel ordered morphine administered to Larsen even after she came out of respiratory arrest, then ordered that nurses stop taking her vital signs after resuming with more morphine doses. But it was 91-year-old Anderson, given morphine the very day of her arrival on the unit, who would lead Davis County Attorney Mel Wilson to accuse Weitzel of “depraved indifference” in the case of her death.

In September 1999, in his native Texas, Weitzel found himself arrested and charged on five counts of murder. He posted $100,000 in bond and $25,000 cash.

“You felt a sense of relief that he wouldn’t be caring for old people anymore,” Foulger remembers when she heard of Weitzel’s arrest. “Did he care about them? That’s been a question asked of me so many times. I don’t think I could even venture an answer.”

Foulger may be an exception to the rule. The story and events surrounding Dr. Robert Weitzel polarize almost everyone who comes into contact with them. One side is convinced he’s guilty. The other rallies to his innocence, insisting the only crime he’s committed is that of being misunderstood. And yet the issues surrounding his first criminal trial are swathed in daunting hues of gray that might only be surmounted by those well-versed in medicine. Even then, it’s easy to find doctors who tag Weitzel a murderer, and others who see him as a martyr.

So far, the only sure product of his criminal trial is confusion and spite. After convictions on two counts of second-degree felony manslaughter and three counts of class A misdemeanor negligent homicide in July 2000 and six months spent in prison, 2nd District Judge Thomas Kay ruled that prosecutors failed to disclose an expert witness in favor of the defense. That expert was a Dr. Perry Fine, who said Weitzel’s medical work might have been substandard, but not criminal. He was released from prison in January, but Weitzel now faces a new trial.

A fighter to the end, Weitzel wasted no time in getting back at those who first went after him. He assembled a website packed with information in his defense. After spending $510,000 out-of-pocket for his first trial, he solicited physicians statewide for funds. And in April, he filed complaints with the Utah State Bar against Davis County Attorney Mel Wilson and three of his assistant prosecutors. They violated Utah Rules of Criminal Procedure and Professional Conduct for withholding the expert witness who could have spoken in his defense, Weitzel charges. The Utah State Bar acknowledged in July that it was investigating the complaints. It’s apparent from Weitzel’s website, www.weitzelcharts.com, that he enjoys getting even. “There is no doubt that these miscreants will take a little of their own medicine,” the site states.

The curious case of Dr. Weitzel also involves much more than his highly publicized, much wrought-over criminal trial. In less than 13 years of professional psychiatric experience, Weitzel has left quite the paper trail.

These days, it might be a misnomer to call him a doctor. There are allegations on file at the San Diego Superior Court that Weitzel carried on a sexual relationship with a former female patient who said Weitzel admitted to her that he was taking medication he prescribed to others, and self-prescribing himself. There are two licensing cases against him on file at Utah’s Division of Occupational and Professional Licensing (DOPL), which led the division to suspend his Utah medical license in August 1999, just one month before his arrest stemming from the deaths at Davis Hospital. The first case incorporates allegations from the same malpractice suit on file in San Diego—allegations that he left unchallenged before the California Medical Board. In February 1997, he surrendered his California medical license. The second case outlines four counts of alleged unprofessional conduct: failing to keep proper records when administering controlled substances; prescribing controlled substances in excess of necessary amounts; demonstrating incompetence or negligence in the practice of medicine; and sexual exploitation of a patient.

“Fairness was betrayed”

Like a football coach seeing his team through a difficult fourth quarter, Weitzel, at the age of 45, believes he’ll come through. He answers every question with utmost confidence. Audibly Texan in accent, he smiles and chuckles with ease. He’s not averse to strong language.

“The prosecutors can flay their arms around all day about this overdosing on psychiatric medications, but it’s just not true. And people who examine the charts and look at the trend of what was going on will see that the prosecution’s claims are bullshit,” Weitzel said. “I want to use that word—bullshit.”

His opponents are “medically ignorant,” “opiophobic,” “ignore the overall view” of proper medical care and frequently resort “to character assassination.” The portrayal of his Davis Hospital patients as victims is “cynical, vicious and wrong.”

Weitzel is without family or children. His mother died of a brain tumor when he was 8. His father, a smoker, died of lung cancer when Weitzel was 17. His only brother, one year younger than him, died in what looked like an accident. That’s all Weitzel will say. These days, he lives with his girlfriend in an Avenues house and takes refuge in the fellowship of his Unitarian Church. The church hasn’t deserted his cause. Following Weitzel’s conviction last year, First Unitarian Church’s Rev. Tom Goldsmith chided the prosecution. “The very essence of fairness was betrayed,” Goldsmith wrote in the church newsletter.

Weitzel doesn’t want for support. “I thought the trial was a travesty of justice. Robert is not a threat to mankind. He’s a very conscientious man who does his very best for patients,” said Sheila Hansen, a nurse of 43 years who worked with Weitzel at the Davis Hospital unit.

Laurie Willson-Stevenson, a practicing nurse for 18 years, also worked with Wietzel at the Davis Hospital. She now lives in Bangor, Maine, and was a witness at Weitzel’s trial. “Because I believe he did nothing wrong, I made significant sacrifices. It’s not as if he was a friend of mine,” Willson-Stevenson said. “The issue is not whether people like him or not—I thought he was very arrogant—it’s whether he acted as a competent, reasonable practitioner. What was so highly underplayed was how ill these patients really were.”

Weitzel has the backing of Oregon’s Compassion in Dying organization as well as Washington, D.C.’s Palliative Care Project.

“I think there’s something really important at stake here. There’s very good research showing that there’s a very high level of untreated pain in nursing homes,” said Mary Baluss, director and attorney with the Project. “They’re the most undeserved of the undeserved. That’s the population that was in Dr. Weitzel’s ward. I think we’re finally starting to get the message out that pain could and should be treated. I’m concerned about Weitzel’s case, because it sends a very different message.”

Dr. C. Stratton Hill Jr., founder of the Pain Clinic and Treatment Service at the University of Texas at Houston, contends Weitzel did nothing wrong. He shrugs off any medical opinion that so much morphine is too much morphine. Morphine can only be prescribed on an individual basis for tolerance levels and pain.

“Numbers don’t mean anything. I have patients who take 4,000 mg of morphine per day and function just fine,” Hill said. “One of the major problems in our society is the misinformation surrounding these drugs and our prejudices and biases about them. The cops and media have created all this hysteria and our policies have all been crafted to prevent addictive behavior. Meanwhile, people with chronic pain are being held hostage.”

One of the strongest voices in defense of Weitzel is the Tucson-based Association of American Physicians and Surgeons (AAPS), headed by Dr. Jane Orient. Contrasted with the more established American Medical Association, the AAPS has turned heads with its opposition to most government involvement in the field of medicine, including the formation of Medicare, Medicaid, the Federal Drug Administration and mandatory immunizations of children. It even questions government licensure of doctors.

“They’re not like the mainstream medicine groups which, in my opinion, appear to be much more interested in safeguarding the economic benefits that physicians enjoy, but not in protecting or standing up for physicians who are being mistreated or wrongly accused,” Weitzel said.

Critics call him more of a spin doctor than medical doctor. But Weitzel believes he’s broadcasting a message few have heard above the din of his murder trial. People must understand that this is not a case of mercy killing, but compassionate end-of-life care. “People come up to me and give me hugs, saying, ‘We’re rooting for you.’ Then you find out that they believe what happened was some sort of Kevorkian thing,” Weitzel said. “That’s not what this is about at all.”

“He really harmed her”

What is it about, then? Some say it’s about making certain Weitzel is never allowed to practice psychiatry again. Weitzel was arrested on criminal charges two years ago. However, his string of legal troubles started in June 1992, when he allegedly terminated therapy sessions with a female patient and then initiated a sexual relationship with her that lasted through April 1994. Business and professional ethics codes in the practice of psychiatry and psychotherapy expressly prohibit any sexual contact with a patient or former patient within the first two years after therapy has ended.

The alleged sexual affair took place soon after Weitzel finished his residency at the University of California-San Diego (UCSD). According to a complaint filed at the San Diego Superior Court, he slowly increased the length of therapy sessions with the patient, then moved sessions out of the office and into the school cafeteria, under a tree, at a picnic table and then to an apartment. “Respondent [Weitzel] methodically manipulated this patient and her treatment in order to use her as an object to gratify his own emotional and sexual needs,” the complaint reads.

Weitzel allegedly told his patient during therapy that sexual intimacy was appropriate as long as they planned to marry once she divorced her husband, the complaint states. Under the employment of UCSD, Weitzel first gave his patient a medical examination for prescriptions, then provided her with psychotherapy to help sort out her troubled marriage. During his affair with her, the complaint states, she had an abortion of Weitzel’s child. The complaint is also littered with allegations that Weitzel self-prescribed narcotics to himself on UCSD prescription pads, took medication he’d prescribed to his former patient, and kept other medication containers lying about.

The alleged relationship continued when Weitzel moved to Ogden in July 1992. “During a visit to Utah, Plaintiff found her medication prescription bottle of Buspar among his belongings with about 12 other medication containers from other UCSD patients that Defendant Weitzel had prescribed,” according to the complaint.

“He was ‘shooting up’ with the narcotics. The fact that Defendant Weitzel was frequently under the influence of controlled substances would partly explain his misconduct,” the complaint alleges.

Weitzel wooed her with letters and poetry written on hotel stationary. One, dated June 23, 1992, was a seven-line ode to his love for her: “I love your wisdom/I love your laughter/I love your strength/I love your body/I love your spirit/I love your child/I love your soul. I love you, Robert.”

Both Weitzel and UCSD, the entity charged with monitoring its resident’s behavior, were sued by Weitzel’s former patient in late 1994. Nancy Sussman, an ex-nurse turned medical malpractice attorney, acted as the former patient’s attorney. The suit was settled in the spring of 1995 for an undisclosed amount and no public admission of guilt by either Dr. Weitzel or the university.

Sussman, who keeps an office in San Diego, still remembers the case, especially in light of Weitzel’s criminal trial years later. “I’m really surprised physicians are coming to his aid. I think the conspiracy of silence is going too far when they’re going to the aid of someone like Dr. Weitzel,” Sussman said. “He really harmed her. She was in bad shape because of him.”

Sussman said the screw that finally turned the suit against UCSD and Weitzel toward settlement was her subpoena to the California Bureau of Narcotics Enforcement for records of patient prescriptions written by Weitzel. “They really freaked out,” Sussman said. “That’s what caused it to settle. Right away they wanted out.”

The San Diego attorney who represented Weitzel in the case, Bruce E. Sulzner, did not return a phone call. Weitzel, however, sternly denies the allegations in Sussman’s complaint.

“That’s absolutely false,” he said of Sussman’s subpoena for his prescription records. “I wasn’t aware of that at all. I settled that case for nuisance value. Those are unproved allegations that never saw the light of day in a courtroom, and many of them are false. The case was settled, and to bring it up now as if it has anything to do with hospitalized patients dying is another prosecution tactic—trial by press—rather than trial by facts.”

Indeed, 2nd District Judge Thomas Kay wanted the jury to stick to the facts of Weitzel’s criminal trial. Evidence or testimony from the San Diego malpractice suit were barred from the courtroom.

It was not barred from officials at the Utah Division of Occupational and Professional Licensing, however. In fact, Weitzel’s troubles in San Diego played a major role in the suspension of his Utah medical license once the malpractice case hit the National Practitioner Data Bank, which provides information about physicians to state licensing agencies.

Weitzel fought the suspension of his Utah license, arguing that he’d been denied due process and a hearing of evidence before his livelihood was taken. He took his case to federal court and lost. He took it to the 10th Circuit Court of Appeals, which upheld the federal decision. His case now rests in state court, waiting to be heard.

Weitzel contends that a California malpractice suit has no bearing on his criminal guilt or innocence. But Utah’s DOPL believed it certainly had bearing on his ability to practice medicine in a professional manner. For the state of Utah, unprofessional conduct in one state is as bad as unprofessional conduct in the Beehive State. Lose your physician’s license in any state and that domino effect will reach Utah. Weitzel can argue that the allegations in the San Diego malpractice suit remain unproven. But that’s not good enough for the forces at DOPL, who reminded Weitzel that, as part of his settlement of the suit, he willingly surrendered his California medical license and agreed that if he ever applied for practice in California again, the charges against him as part of that suit would be as good as admitted true.

“The State of Utah has at least as much right to protect its citizens as does the State of California, and Utah is reasonably entitled to place itself in the same position as California when dealing with exported problem practitioners from that state,” according to a brief written by Utah Department of Commerce attorney Michael R. Medley. “The California surrender of licensure was not a passive act by Weitzel, but possessed all of the trappings and accouterments of a plea bargain whereby he achieved the best results under the circumstances. The Division should not and, under its legislative delegation, cannot allow itself to become a safe harbor for miscreants from other jurisdictions choosing flight over fight.”

DOPL Complaints

Weitzel’s alleged fling with a former patient in San Diego wasn’t the end of his problems with DOPL—far from it. Starting in late 1996, other complaints against him started to surface, including allegations that he failed to keep required prescription records, and prescribed controlled substances in excessive amounts. Sexual allegations arose for a second time as well, in the form of sexual exploitation of a patient.

“In or about October 1993, after establishing a psychiatric practice in Utah, Respondent [Weitzel] kept a counseling appointment at his office in Brigham City, Utah, with female patient Lisa S., whom Respondent was treating for a mental disorder,” according to an April 1999 statement of allegations on file at the Utah DOPL. “With no nurse or other staff member present, Respondent informed Lisa S. to remove her clothing above the waist, Respondent proceeded, for several minutes, to engage in the non-clinical, sexually-oriented fondling of Lisa S.’s breasts.”

Another allegation spans a time that included Weitzel’s employment at the Davis Hospital where five patients died. Between April and December of 1995, DOPL alleges that the doctor, while working a second job at the Salt Lake Headache Clinic, charted medication amounts of morphine and Demerol injected into patients that “was less than the amount prescribed.” In other words, only a portion of the drug ended up with the patient. The rest went missing.

DOPL also alleged that, in the case of several patients at the Headache Clinic, Weitzel treated patients with controlled substances without first obtaining their headache histories or having them undergo medical screening. Between May and December 1995, DOPL alleges, Weitzel administered morphine injections to patients without properly monitoring them afterward.

“Most of those patients were permitted to drive themselves home immediately after receiving an injection either of morphine or Demerol,” according to the DOPL statement of allegations in April 1999. “One of those patients reported falling and sustaining a severe head injury as a consequence of dizziness experienced shortly after leaving Respondent’s office after having received an injection of a controlled substance by Respondent.”

To all this, Weitzel responded that the allegations had no factual basis. In a June 7, 1999, letter through his attorney, he denied that any prescription records weren’t properly maintained. He denied ever improperly administering controlled substances to headache patients. And he especially denied any allegations that he took advantage of a female patient. In his letter of response to DOPL, Weitzel alleged that Lisa S. had been diagnosed with bipolar disorder and schizophrenia and had been repeatedly hospitalized. “There is no factual basis for this allegation, and the sole purpose of including this allegation in the Petition is to maliciously defame Dr. Weitzel and cause him unnecessary embarrassment and humiliation,” according to Weitzel’s response.

DOPL officials weren’t impressed. The division ordered Weitzel to submit to a psychological competency examination if he wanted to keep his Utah medical license. “The board found that there is reasonable cause to believe that you may be unable to practice as a psychiatrist with reasonable skill and safety and that immediate action is necessary to prevent harm to your patients or to the general public,” the division wrote to Weitzel.

The exact details of why Weitzel was required to take the exam are kept confidential by the division. What’s publicly known, however, is that DOPL ordered Weitzel’s examination to rule out the possibility of a “malignant personality disorder.” Weitzel refused. On Aug. 24, 1999, his license was suspended.

“Petitioner [Weitzel] did not lose the use of his license due to the division, but rather by operation of law as a result of his own actions,” Medley wrote.

Weitzel said that at the time he would have been happy to take the competency exam. However, his attorney advised him that under no circumstances should he submit to it, because anything discovered during the exam could have been used against Weitzel at his murder trial. Weitzel said he may yet undergo the exam, except, in his professional opinion, there’s no such thing as a “malignant personality disorder.”

“It’s a good provision to have. I understand it,” Weitzel said. “I’d be happy to show people I have no mental illness. But my lawsuit is still alive in 3rd District Court. The Constitution guarantees due process before the government can take action against you. There was no hearing in this whole [DOPL] process.”

“Too many battles”

While Weitzel challenged DOPL charges that he couldn’t keep his prescription records straight, he eventually capitulated to that charge before U.S. District Judge David Winder.

Facing 22 felony charges of obtaining controlled substances by deception stemming from his work at the same Salt Lake Headache Clinic from March 1995 through June 1996, Weitzel pleaded guilty to two counts. The first count occurred June 1, 1995, when Weitzel wrote a prescription for 200 mg of Demerol for a patient at his West Valley City office. The patient got 100 mg. The rest went missing. More than one year later on June 21, 1996, Weitzel wrote a prescription for 30 mg of morphine for a patient at the Davis Hospital, but gave his patient only 12 mg. Again, the remainder went unaccounted for.

Weitzel awaits a Nov. 26 sentencing on these counts. He could face up to four years in prison for each count, or no time at all. Either way, as part of his plea-bargain, federal prosecutors agreed not to mention the charges that still await him in Davis County.

Davis County prosecutors must have found it interesting that of the 20 charges dismissed, eight of them allege Weitzel obtained controlled substances by deception during the exact months—December 1995 through January 1996—when five of his Davis Hospital patients died. Media accounts of Weitzel’s Aug. 10 pleading said assistant federal prosecutor Stewart Walz asserted that in some cases Weitzel never saw the patients for whom he prescribed medication, and that prosecutors located witnesses claiming they saw the doctor use drugs. Walz would not comment for City Weekly.

Weitzel speaks about this incident in guarded words, partly because he’s still awaiting sentencing, partly because he’d rather concentrate on his Davis County trial. “It is the case that in those two counts I did fail to keep correct records,” he said. “I can’t say a whole lot about that right now, except that it seems like we had to quit trying to fight too many battles at once and concentrate on the battle in Davis County. I mean, I’m charged with murder there.”

His website’s defense manifesto, simply titled “Legal History,” disputes the facts of the case with far more vigor.

“They [federal prosecutors] allege that some of the patients who [Weitzel] saw in his outpatient office at the Salt Lake Headache Clinic got only some or none of the opiate they were prescribed. These charges were finally filed several years after the initial investigations. It is interesting to note that they are based on the recollections of six patients of Weitzel’s who were either seriously impaired (demented, mentally retarded, schizophrenic) or who had an axe to grind with the doctor (had not paid their bill, were hospitalized when dangerous to self, but not willing to be admitted). The vast majority of the over 100 patients that the state or federal authorities contacted were pleased with the care rendered, and corroborated the medical charting; many are willing to testify to this in court.”

In early 1996, when the DOPL and Drug Enforcement Agency first started investigating Weitzel on prescription drug charges, they showed up at the headache clinic to ask the doctor for urine samples. Weitzel’s website notes he’s been subjected to more than 80 urine tests for traces of drugs. All of them, the site states, came up clean.

Has he ever used opiates? He’s been prescribed them. He’s used them after both knee surgery and a dislocated knee, he said, and after an appendectomy. “Opiates are a perfectly rational and acceptable answer to the problem of pain,” he said. “To vilify them is just another aspect of the War on Drugs that we’ve sold ourselves on.”

“An enviable position”

There are plenty of reasons why Weitzel’s criminal case in Davis County has gotten more publicity than his legal troubles with a former patient, federal prosecuters, and his licensing wrangles with the DOPL. It’s more public, brings all the drama of a jury trial and, of course, involves death.

As was the case in his San Diego malpractice suit, the DOPL complaints and federal charges (the two guilty pleas now excepted), Weitzel is confident and clear in conscience.

“I’ve been told that I’m in an enviable position for a criminal defendant,” he said. “All I have to do is tell the truth. The only problem is that it’s a very complicated and easily misconstrued truth.”

Five deaths in such a short period of time roused the hospital’s curiosity, as well, Weitzel said. It brought out-of-state consultants to meet with heads of the hospital for a morbidity and mortality review. No o