CONFIDENTIAL
AAHugh Calkins was the lead author, but Dr. Ron Berger received credit for the journal article about Pam’s complication, as did Richard Wu and Jeffrey Brinker. Quite an impressive byline, it represents more than $1 million worth of the finest education that money can buy — and they are excellent dancers. The authors refer to the patient as our patient and Ron Berger is listed in the medical report as having actually participated in the procedure. So I was quite surprised by the reply from Ron Berger in 2005 concerning my request for his records of Pam’s case.
“I have never been involved in your wife’s care in any way,” he wrote back.
It was four years after the fact and by then I was tired of being taken for a fool. I thought perhaps that tampering with the medical record and academic fraud would be frowned upon at JHU, so I wrote to the provost. I was going to get Calkins and Berger into hot water because of what they did.
Stephen Knapp, (Yale -”Lux et Veritas”) who is now in charge at The George Washington University, was then provost at Hopkins, the top enforcer of academic integrity. He wrote this letter back:
PERSONAL AND CONFIDENTIAL
Office of the Provost
The Johns Hopkins University
June 23, 2006Dear Mr. Walter:
I am writing in response to your e-mail message to me dated July 16, 2005 regarding Dr. Ron Berger’s role in the medical care of your wife.
The School of Medicine conducted a review of Dr. Berger’s role in the medical care of your wife during her admission to the Johns Hopkins Hospital in March 2002 and his role as an author of the case report describing the complication that occurred during her surgery. (Wu, et al., “Circular Mapping Catheter Entrapment in the Mitral Valve Apparatus: A Previously Unrecognized Complication of Focal Atrial Fibrillation,” JCE 13:819-821, 2002.) The School’s review concluded that Dr. Berger had no involvement in the medical care of your wife during her 2002 admission to Johns Hopkins.
You correctly point out that he is listed in the medical record as an “assistant” in the ablation procedure. We have determined that the listing was an error and it will be corrected. The reviewers learned that during your wife’s ablation procedure, the attending physicians informally consulted Dr. Berger concerning the complication that arose. Dr. Berger made no recommendations to the plan of care. Furthermore, because he was not involved in the ablation procedure, he did not compare the medical record and the case report, and was not responsible for any patient-related medical information in the case report.
Sincerely, Steven Knapp, Ph.D.
Provost
The Johns Hopkins University
It appears that when things got ugly down in the EP Lab, somebody called Ron Berger and said “You’ve gotta come down here and see this!” — or something to that effect. So he was alerted to the botched ablation in progress in Room One of the EP Lab, but he “made no recommendations to the plan of care… was not involved in the ablation procedure… did not compare the medical record and the case report… and was not responsible for any patient-related medical information in the case report.”
That’s what passes for authorship in academic medicine. These professors are under a lot of pressure to publish. I assume that when Calkins wrote the final procedure report, he falsified a patient’s medical record to state that Ron Berger assisted him in the procedure — so as to be able to include him as an author in the article he planned to publish in the Journal of Cardiovascular Electrophysiology. I also assume that Ron Berger would return the favor sometime.
Then again, maybe it was an honest mistake. Maybe Hugh Calkins really thought he and Ron Berger had performed the procedure together.
∞
In addition to being confused as to who was actually in the room at the time, the professor had trouble recalling how many sites were ablated inside Pam’s heart. After Jeff Brinker unceremoniously liberated the catheter from Pam’s mitral valve, and it was clear that a full-blown fiasco was in progress in his EP Lab, Doc Calkins must have decided it was time to make himself scarce, go talk to family members or make some phone calls, because apparently he left Pam in acute congestive heart failure with his understudies for a while, and it looks like some enterprising young Fellow or Resident or Intern – could have been anybody – showed some initiative and took the liberty to go ahead and ablate another site (do another burn) while the boss was away.
Because, while Calkins told me he only got two sites done, the medical record shows that three sites inside Pam’s heart were ablated that day. He didn’t know about the third one. When you look at his notes of the procedure, it was clear that 
he had written up his report with the two sites ablated and then the entanglement of mitral valve, and then he signed it. Sometime later he wrote under his signature: “Addendum: We proceeded to isolate the RSPV (Right Superior Pulmonary Vein) successfully.”
The good doctor leaves this detail out of his official version of events. He writes that as soon as the assembled senior cardiology staff saw the shredded particles of flesh clinging to the tip of the catheter they pulled from Pam’s heart, they immediately called the surgeons and rushed to prep her for surgery.
In reality, Calkins had wandered away from a patient who was critically injured — and the ablation procedure was then continued on a patient who had just suffered a life-threatening injury and who was dying by the minute.
But, initially, as far as Calkins knew, two sites were ablated and that’s what he told everyone. That’s what he told me. That’s what he told Pam’s daughter. Given the cascading calamities in progress, the beleaguered Calkins probably felt he had to stick with that story and hope that we’d never find out. How many screw-ups can a doctor admit to in one day?
