Lessons from a Predator Physician

The trial of Seattle gynaecologist Charles Momah has just wrapped up and the jury has convicted the 49-year-old doctor of two counts of rape and two counts of taking "indecent liberties" with former patients, which could result in a 23-year prison sentence. Also pending, are health care fraud charges and civil suits involving more than 30 former patients who claim they were threatened by the doctor, sexually assaulted and even molested while under anaesthesia. A class-action suit against the Washington State Department of Health (DOH) is also in the works and their mismanagement of medical "quality assurance" illustrates not only how flawed the US health care system has become, but also that the same thing can and does happen right here in Canada.

The Washington DOH received complaints against Momah as early as 1997 and the Medical Quality Assurance Commission (MQAC) sporadically investigated him for many years, uncovering a wide range of disturbing information from patients and health care workers at local hospitals where he was also on-call to treat other doctor's patients in the ER. But the DOH didn't suspend his licence until the summer of 2003, when one patient went to the police alleging rape. By then, his Washington health department file was thousands of pages long and included misconduct files dating back to his first years working as a doctor in the late 80s in Upstate New York.

Made in Canada

His training in running a "Little Shop of Horrors" as one former patient calls it, got its start right here in Canada. The Nigerian-born Momah came to Montreal from the University of Nigeria to do his residency training at McGill between 1982 and 1987. He picked up C-grades according to his McGill transcripts and got certification from The Royal College of Physicians and Surgeons before moving to New York City in 1998.

Momah worked as head OB/GYN at one HMO, delivering up to 15 babies a month at area hospitals before being recruited to be the staff OB/GYN at Massena Hospital in Upstate New York, where he also set up a private clinic. New York health department reports chronicle various types of misconduct by Momah, including treating one patient for genital warts by putting an acid compound all over her buttocks and vagina in a "paint brush style." The hospital attempted to take away his hospital privileges, but he launched a discrimination suit and effectively shut them up so that the New York health department couldn't access their reports. The hospital even gave the doctor $5,000 for "relocation expenses."

So, in 1993 Momah went scouting for a new home state and, within a year, had picked up licences in seven states. He decided to settle in the Seattle area and opened up The Northwest Obstetrics, Gynecology and Fertility Clinic. New York State did end up charging him with 25 counts of medical fraud in 1997 and in 1999, the New York health department finally "censured and reprimanded" him for "gross negligence and gross misconduct." But, he was able to keep his New York licence and it wasn't suspended until October 2003, after his Washington licence was suspended. Meantime, for ten years, Momah solicited Seattle-area patients with big yellow pages ads targeting women on welfare, Medicare and with no insurance coverage, in which case, he'd offer them slashed prices. Patients with good insurance coverage were also allegedly talked into seeing Momah bi-weekly and talked into having unnecessary surgeries.

'Nobody's going to believe you'

Jolie Campbell had undergone 13 surgeries before she alleges Momah raped her on the exam table in the summer of 2000. "He said, 'Jolie, I'm going to have sex with you. This'll just be between you and I. I know you like me, you want to have sex with me.' I cried and he said, 'Nobody's going to believe you.' After he'd finished, Momah said, "'Just shut your mouth about this. You and I could become very good friends.'"

Jolie claims that Momah threatened he'd sick "Nigerian gangs" on her. But, her sister Adi convinced her to call a lawyer. "She said she had too many cases," says Jolie who eventually found a medical malpractice lawyer. "They filled out all the forms and I wrote letters to the health department." The DOH denies receiving her complaint, though the sheriff's office confirmed they did speak with her but that there wasn't enough evidence to charge him. "Dr. Momah was right," says Jolie. "Who's gonna believe someone with tattoos all over their body?"

So, fearing Momah would come after them, Jolie and Adi fled to a mobile home three-hours from Seattle. Jolie now has pancreatic cancer and believes that Momah's numerous surgeries have something to do with it. One 2002 Washington DOH report states that one of his patients "developed some kind of growth. Something is going on with the intestines. Dr. Momah may have left something behind."

By the summer of 2003, local police did believe another patient's rape allegations enough to begin a new investigation. The media ran articles and both the prosecutor's office and the DOH were fielding calls from dozens of other former patients, including another rape allegation, numerous allegations of rape with a foreign object, sexual harassment, threats to patients trying to have their medical records transferred to new doctors, medical malpractice for unnecessary invasive surgeries like hysterectomies on patients as young as 21.

Stacked odds

"I have even less respect for the system than I do for Charles Momah, due to unforgivable delays," says Harish Bharti, a civil lawyer representing 38 of Momah's former patients in a civil suit against Momah and also in the midst of a class-action lawsuit against the Washington DOH. "Lack of action for so long in this case is a disgrace to the health department. Instead of admitting their wrongdoing, being ashamed of their inaction, I hear only excuses," says Bharti who got involved in the case when a former patient/employee came to him alleging sexual harassment.

Taking on the medical industry is an incredibly difficult thing to do but Bharti has spent over two years working on this case and has remained hopeful his clients will see justice done, even though the odds are poor; More than half of US medical malpractice suits are lodged against gynaecologists and obstetricians and over half of those claims are dropped, dismissed or settled without payment. If a claim goes to court, ob-gyns win seven out of ten times.

'Dead Ringer'

But the Momah case has an even more bizarre twist, eerily like David Cronenberg's film Dead Ringers: Charles Momah has a twin brother who also works as a doctor in Seattle.

When Bharti started talking to former patients, he noticed that they sometimes discussed the doctor as if he had a split personality: Sometimes he stuttered, had allergies and appeared somewhat thinner; he often didn't remember patients he'd seen the previous week; sometimes he was talkative and cheerful, other times morose and crude.

The twin is Dennis Momah. He got his Washington licence in 2000 and has licences in other states as well, but while his lawyers claims that the media attention has ruined Dennis's career and that he can't find work in Washington, no medical or criminal actions have been taken against him. Eighteen of Bharti's clients have signed depositions under oath and are convinced that both twins were involved in the alleged offences. So, Bharti is in the process of filing civil suits against Dennis Momah, as well.

"Every time these women were subjected to a vaginal probe exam with a one-foot long invasive probe, without any medical reason, a rape was committed," says Bharti. "As many as 50 probe-exams for many of the women, in some cases even more, for no medical purpose. I don't even think these women were considered human beings."

"Rape is penetration with anything," says 27-year old Marie* about the bi-weekly pelvic exams, paps and transvaginal ultrasounds Momah performed on her from 1999 to 2001. Marie originally went in to get the Depo Provera birth control shot. "The way he presented himself was that he was being thorough and other doctors hadn't taken these extra steps, 'We'll find out what's wrong with you and fix it, I'll make sure you're okay.' He made it all seem necessary." Marie shakes her head and gives me an, "I should have known better" look. Her gut instinct was to go elsewhere but she'd look at the clinic walls, filled with photos of Momah with newborn babies and letters from grateful patients and decided, "I must be making shit up in my head. There's something wrong with me." By 2000 Momah had convinced Marie she needed a laparoscopic surgery to check for scar tissue and endometriosis.

'Back room' surgery

"The surgery was done in this back room [of his Burien office] that looked like a storage room; a chunk of the ceiling was missing right above the table. Again, I thought I was being irrational, there's an anaesthesiologist here, even though she was wearing regular street clothes. I woke up from the surgery alone and cold, shaking, groggy. I tried to yell but my voice wasn't loud enough. A woman finally came in and got a blanket. The exam table was just covered in blood. I read the report and it said my blood loss was 100 ccs which is a small syringe full and there was probably that much just on one of my legs. I was so bloody."

Marie bled heavily for three months after that surgery. She asked him to see the tape of the surgery since the procedure includes a probe camera but Momah said they didn't have the tape. She's now worried that he damaged her reproductive organs and did all those exams for his sexual pleasure. Thinking a twin may have been involved is almost too much for her to take in right now, as she juggles full-time work, sign-language courses at night and "the idea of being raped with medical instruments. It's this really intense feeling of powerlessness."

'Drug-induced hallucinatory nightmare'?

"A woman in green jelly shoes put me under," says Ashley*, a 34-year old who underwent a laparoscopy, hysteroscopy and D&C at Momah's Burien clinic in 1999. "I woke up in tremendous amount of pain. I was so sore and raw around my cervix. I had memories, almost like a dream, of Dr. Momah standing in front of me with his penis out in front of my face while I was under."

Ashley tried to rationalize the memory as some sort of drug-induced hallucinatory nightmare. But, anaesthesia doesn't actually put a patient to sleep, so it's not uncommon for people to "wake up" during the procedure and see everything that's happening on the table. Another woman told Bharti that when she woke up from the surgery, Momah's penis was in her mouth. (That woman didn't join in on the civil suit or talk to police since she works in the broadcast news industry and feared media attention.)

Ashley will never know for sure what happened during the operation. "I felt like I'd been raped for months after that. Like my insides had been torn up. But he'd always been very kind and respectful to me. I didn't understand why he'd abuse my trust. So I felt guilty too and I didn't have any evidence anyway. I rationalized it. I'm a big rationalizer." Like Marie, Ashley disregarded her instincts even though she's well-educated, is presently studying for her LSATs and has always done her own research on medical conditions. Post-op, Momah told her she needed a full hysterectomy, which she refused. But he managed to sell her on surgery at Highline Hospital to "remove the gunk" in her uterus.

In the hospital OR, Momah removed one of her fallopian tubes and said he couldn't get all the "gunk" out, so he recommended more surgeries at his clinic. At her follow-up exam, Ashley believes Dennis Momah was acting as Charles. "Charles Momah looked like a Santa Claus, very jolly, red cheeks, shiny eyes. But this man appeared taller and thinner. Usually Charles was very friendly but he didn't even say 'hi,' he was brusque and rude. I didn't go back." Her husband's GP has since diagnosed him with herpes, which he'd already passed on to her. She now wonders if perhaps she contracted herpes from Momah's clinic.

'I felt really stupid'

"He showed me how to sterilize the equipment," says Kelly Acker, 33. She took a job as a receptionist for Momah in 2003, after being his patient for three years and undergoing six surgeries to remove what he called cysts and endometriosis. As with most patients, he'd do the transvaginal ultrasound and point out "cysts" on the screen. Kelly has since had an ultrasound at another clinic: The same kinds of dark spots came up on the screen but her new doctor explained, "They weren't cysts, just free fluid. I felt really stupid." Even if they had been cysts, most aren't life threatening, pre-cancerous growths. Most doctors take the wait and see approach and even if the cysts do grow, they can usually be passed safely like gallstones. But like many of his patients, Kelly says Momah convinced her it was a serious problem, so she followed the doctor's orders.

By 2003, she owed him thousands of dollars for the surgeries and agreed to work off her debt as his receptionist. She thought she'd simply be answering the phone, but he had her cleaning clinical equipment by mid-morning her first day on the job. "He said, you spray this chemical on the speculum and just let it sit there. That was disgusting. He starts laughing, 'I had this girl in here before and when I went to do the examination it burned the girl.' He thought it was funny. I work in a physician's office now and know how to properly sterilize equipment in a machine."

Sterilization?

The Washington DOH also knew he wasn't sterilizing his equipment properly and that his surgery rooms were inadequate. As early as 1999, an internal memo from a DOH staff attorney said that Momah "lies a lot and goes around claiming 'discrimination' - not to mention, he is just a bad doctor." Another 2000 memo said that he "is clearly a bad physician and litigious." Some information was gleaned from hospital reports citing unnecessary surgeries after follow-up pathology reports indicated no need for surgery and various botched hospital surgeries, a few resulting in code-blue emergency situations. The DOH interviewed hospital nurses who claimed Momah was territorial about his patients and verbally abusive with hospital staff. One RN witnessed a face-to-face argument between Momah and another nurse and stated that Momah "became so angry that he 'didn't know what he was going to do,'" and that she "didn't know if Dr. Momah continued to be angry in the operating room as he did surgery." The only hospital worker they interviewed who gave Momah a good review was a surgical assistant who also moonlighted assisting Momah at his clinic.

MQAC investigators spot-checked his two "surgery suites" in Burien and Federal Way in June, 2001. Again, internal reports acknowledge that he was using receptionist-patients as medical assistants, that he had no scrub sink, that "dirty gowns" were shelved, not bagged and that clean surgical instruments were stored alongside "dirty and wet instruments," inside "dirty trays." They also noted that one of the surgery rooms had a back-door entrance and inappropriate window blinds and those removable ceiling tiles Marie mentioned. Momah occasionally brought his surgical equipment to Highline Hospital for sterilization and the DOH interviewed a supervisor there who was shocked to find "instruments used for open abdominal surgery" that were "daunting" and "not appropriate for an office setting" covered with "tissue" and organic material" when the rules said the instruments should be cleaned before being brought into the hospital for sterilization.

By 2001, Highline chose not to renew his hospital privileges and the DOH knew he no longer had hospital privileges anywhere. MQAC reports state they were "real nervous about him opening bellies" in his clinics. But for years, they let him continue operating on patients without adequate sterilizing facilities, without hospital back-up and the scrutiny of nurses and doctors.

Poster child

"This case is a poster child for system dysfunction," says Arthur Levin of New York based Center for Medical Consumers, a health industry watchdog group. "This was a no-brainer but the threshold is really high for bad doctors. It's a gigantic failure that the health departments in both New York and Washington failed to act quickly. This guy was able to fly under the radar all these years? This is a problem everywhere. The state grants the licence, which says this doctor is qualified. They have a heavy burden to make sure that's true." Levin believes the problems start with "flawed licensing processes," and then once an investigation begins "states fail to act quickly against gross misconduct. The process is supposed to be there to protect patients not doctors." But Levin and other health industry watchdogs believe state investigators have "a conflict of interest with organized medicine which has a lot of influences on regulations and the legal ability to sue. The only time we get access is at the end of the process."

Levin is no fan of the US hospital system and the "chilling effect" of physician counter-lawsuits against hospitals who try to de-privilege bad doctors. Twenty-three percent of medical whistleblowers are threatened with their jobs or lose them entirely for narcing on bad doctors. "But, as bad as things are in hospitals, there are at least a lot of eyes and ears," says Levin. "The problem is that more and more complex procedures are being done in physicians offices. There's no excuse that this physician was allowed to continue practicing."

High risk

"He said he'd deliver me there in his office," says former patient 27-year old Jeannine Lapoint. "He said they took his licence away because he's black and they're prejudiced. I took his word for it." Jeannine was pregnant with twins, which is always considered a "high-risk" pregnancy and necessitates a specialist. But Momah said he was qualified. "If I'd gone with my instincts both my babies might be here now," says Jeannine.

Four months into her pregnancy she started having sharp pains and went to the hospital. They did an ultrasound and discovered one of the twins was dead. "I was there two weeks with one baby dead inside me," she says. According to the staff doctor, her twins shared a placenta and there was a blockage so that one twin didn't receive the necessary nutrients. This is not an uncommon issue with twins and if caught early enough, they could have unblocked the vein, in which case her son Wesley had a good shot of being born healthy and the other twin might have also survived. Instead, Wesley was born with hydro encephalitis and spent his first seven months in the hospital. "He's blind, I feed him with a feeding tube, he can't speak, or walk, he has cerebral palsy and just went through another procedure to open up his airway because he has a hard time breathing. He couldn't handle being touched so I never got to snuggle with him."

Jeannine is also convinced "without a doubt" that a twin brother was involved. "Sometimes he was so jolly and happy and other times he was more rough and crude. Sometimes he had a scar on one cheek and then it was on the other cheek. He was like Jekyll and Hyde."

The doctor at home

During my week in Seattle interviewing his ex-patients, I called on Charles Momah at his Cougar Mountain home but nobody answered the door. "He had very young girls coming in late at night," said a neighbour who wanted to remain anonymous. "I'd spot him in a line-up in an eye-blink. You know, you get a weird feeling."

Another patient remembers Momah mentioning a brother prior to her reverse tubal ligation surgery at his office. "He showed up in a real bad mood. He was looking for something and started getting on the receptionist, 'Dennis comes in here and uses all the stuff and I can never find anything.'" For the surgery, a male anaesthesiologist was present along with a male surgery assistant. After she woke from the surgery, she says she "had this vision of the three of them taking turns on me, raping me while I was asleep." But she was groggy from the pain medication and couldn't stay awake. "When I woke up again a 1am [at home] I was sore. There was blood outside the incision and my stomach was yellow. My whole pubic area was really red and raw. Inside, I knew. You know. You know." She cries for a while and then says, "You just don't want to believe it's possible."

She ended up losing a lot of blood and her fiancé took her to Swedish Hospital. She says she overheard the doctor on staff call Momah and gave him a tongue-lashing but when he returned to her bedside, merely said to take vitamins and return to Momah. A nurse on-staff was so disturbed by her condition that she called the following day to check up on her. But, never once did anyone say she should file a report at MQAC.

'Consensual'

Charles Momah's lawyer, David Allen, plans to appeal the verdict and says that the sexual relationships between his client and former patients were consensual. The DOH is set to start disciplinary proceedings against Charles Momah next January. Since 2003, 85 complaints have been collected, though their statement of charges involves only 19 women. They have also reopened an investigation against Dennis. Bharti continues preparing for the civil cases. "This is a national problem," says Bharti. "The system is broken. It has to change."

"If something like this gets brushed under the carpet, how many other women are going to experience this?" wonders Marie who had trouble finding a doctor to give her an honest opinion about her health, post-Momah. "I should be able to say, 'I think a doctor hurt me,' and be taken care of. "I didn't get that. Doctors are protecting their own. It's so sick that this could have been stopped years and years ago."

Kelly Acker hopes for a day when "we can get all these women together and say look at us! But then, what can we show them? The insides of our bodies?"

BC's 'Quality Assurance'

Equally troubling is the contents of BC Ministry of Health's most recent "Quality Assurance" report from 2003 that acknowledges "The British Columbia ministry has not to date, unlike Ontario, articulated a set of principles or expectations for quality assurance programs" and that "consistent with 1997 literature review…there remains little or no literature specifically considering the applicability of QA models to the realm of health professions' regulation and the role of the regulatory bodies…That speaks directly to the role that QA methods might play in regard to the functions carried out by statutorily-mandated regulators and self-regulating health professions' colleges."

Most disturbing is their acknowledgement that the college's "advisory panel on physicians' credentials…is currently inactive because of the enormous changes that are occurring in health regions and the planned regionalization of the credentialing function." They also admit that "a very small number of complaints ultimately result in disciplinary action, the vast majority are handled through remedial and corrective processes" such as "advice from the college as to how such situations should be avoided in the future."

Where now?

So far this year, six licence suspension actions have been taken against BC doctors and half involved sexual misconduct. Out of more than 1,000 complaints lodged against BC doctors in 2004, only five licences were suspended temporarily.

The college itself is also being sued by 18 women who allege that over a 25-year period, their Campbell River doctor sexually assaulted them and that the college was "recklessly indifferent to the consequences for the plaintiffs flowing from its failure to investigate." The college has since tried to strike out this action through the BC Supreme Court and the Court of Appeal. Both courts denied their motion and the case is still ongoing. But at the very least, this case illustrates that even if a number of citizens take very serious criminal charges to The Royal College's "Quality of Medical Performance Committee" they won't always be guaranteed a thorough investigation.

Regardless, citizens can lodge complaints against doctors through the College's website and also check up on their doctors through their physician search engine.

If you're not satisfied with their investigative process, you can contact the BC Ombudsperson; whose primary role is to act as independent, impartial investigator/watchdog of local government, hospitals, health authorities and self-regulating professional associations like the BC College of Physicians and Surgeons which according to the Ombudsman's 2004 report gets the second highest amount of public complaints lodged against BC's professional organizations, after the Law Society of BC.

Unfortunately government budget slashes of 35% over the past few years have forced them to introduce a "holding queue" causing investigative delays of up to six months and the number of their caseload investigators has decreased from 20 to 16.

*Real names withheld to protect the identity of the victim.

Danielle Egan is a freelance writer based in Vancouver.