Nadia Ponsones massaged the doctor's toes, one by one, waiting for him to fall asleep. When he finally dozed off, around 1 a.m. on April 15, she called for the cab driver who had picked up her luggage earlier in the evening.
Ponsones told the driver not to pull in the driveway. She didn't want the engine rumble to wake Emad Atalla, an anesthesiologist at Lutheran Hospital, a part of the Cleveland Clinic Health System.
For eight months, Ponsones, a 47-year-old Filipino, had made the doctor's Sagamore Hills home a castle. In the morning, she laid out his clothes, squeezed fresh juices, and, when the weather was cold, started his car. In the evening, dinner was served at the moment of his arrival. Sometimes she spoon-fed him, so he wouldn't have the burden of lifting utensil to mouth. Body massages were a daily ritual. So, for a time, was sex. Though they met through the classifieds -- Atalla had placed an ad for a domestic -- they lived as husband and subservient wife.
"I treat him like a king," Ponsones says.
Then she made her getaway.
Ponsones later told police that Atalla, 38, beat her on several occasions. She described one thumping that dropped her to the floor: He kicked her as she covered her head, begging forgiveness. Four witnesses can attest to her bruises, say police, who arrested Atalla on suspicion of domestic violence.
As it turns out, Ponsones was the fourth woman in less than a year to report him to authorities.
Two nannies who lived with Atalla last summer complained that he had committed sex crimes against them. Police forwarded the cases -- one for gross sexual imposition, the other for rape -- to the prosecutor's office. No charges were brought, owing to a lack of evidence, but Sagamore Hills Police Chief Dale Struhar says the rape case is still under review.
On Easter weekend, before Ponsones went to the police, a third woman contacted Summit County Children Services. The nanny, who filled the role of woman of the house after Ponsones left, claimed that Atalla's seven-year-old daughter had access to sexually explicit material stored on her father's computer. The computer was seized, and juvenile court placed the girl with her mother, who is divorced from Atalla and lives in Parma.
Atalla is on leave from the Clinic. He pleaded "absolutely not guilty" to the domestic violence charge, according to his attorney, William McGinty. (Atalla referred questions to McGinty.)
His arrest, though, is not the first occasion a Cleveland Clinic anesthesiologist has been accused of mistreating women. Dr. Ayman Basali was arrested after a woman claimed he fondled her during an examination. F. George Estafanous, the head of the department, was accused of sexual harassment in 1989.
All three doctors were born in Egypt, nudging the stereotype that associates a Middle Eastern heritage with the coarse treatment of women. Linking behavior with nationality is obviously dangerous: Abuse regards no borders. Also, health care has been called a "breeding ground" for sexual-harassment claims, for reasons more to do with hierarchical power structures and physically intimate working conditions than cultural differences.
Yet the discussion cannot avoid a group element. Estafanous, Basali, and Atalla are all part of Cleveland's small Coptic Christian community. Basali is also the nephew of Dr. Estafanous, who is among the institution's most influential -- and intimidating -- physicians. "He's got everyone shaking in their boots," says one nurse anesthetist.
Loyalty is apparently another of Estafanous's qualities. The department he has run for more than 15 years is said to prop up and protect Egyptian physicians who sometimes behave badly. "I believe he would wink for any of his buddies," the anesthetist says.
Fawzy Estafanous, 66, trained in Cairo and Newcastle, England, before coming to the United States to build an impressive career.
He joined the Clinic staff in 1970. In addition to writing and lecturing, Estafanous served on a number of hospital committees. In 1985, he was named to the board of governors, and later, the head of anesthesiology. When the Clinic last needed to find a chief executive officer, in 1989, Estafanous chaired the search committee.
It was around the time of the CEO search that Estafanous was accused of sexually harassing the anesthesiology division's administrator.
Desia Kowalysko was then in her late 30s and held a master's degree in health administration from Penn State. In her complaint, she described Estafanous taking her in a bear hug. When she broke away and told him never to touch her again, the doctor said, "What are you going to do? Sue? Ruin your career? It is not worth it."
She described other instances in which Estafanous laid hands on her. Kowalysko claimed that on one occasion, Estafanous approached her from behind and clamped her arms to her side. When she screamed, Estafanous kissed her on the cheek and neck and said, "No, you want a hug." On another occasion, Estafanous expected a goodbye hug and kiss after he asked her to drive him to the airport.
In a federal lawsuit later filed, Kowalysko said Estafanous would "berate, criticize, intimidate, and take other retaliatory actions," such as assign her an impossible task, when she rebuffed him.
Estafanous denied the charges and counter-sued for defamation. (Neither Kowalysko nor Estafanous returned Scene's phone calls.)
Without physical evidence or third-party testimony, Kowalysko's claims were difficult to prove or disprove. One administrator thought the matter "got carried away." Dr. William S. Kiser, CEO at the time, says that he encouraged Kowalysko and Estafanous to reach an understanding. Instead, their dispute was allowed to fester into a front-page story in The Plain Dealer. "It didn't deserve the play it got," Kiser says. He describes both Estafanous and Kowalysko as flirtatious. "I would say there was culpability on both sides."
Others took sides. Christine Cowan-Gascoigne was then the Clinic's acting director of public affairs. The high-achieving daughter of a Cleveland Heights businessman, Cowan-Gascoigne says there was a time when she didn't believe in sexual harassment. She experienced nothing of the sort when she attended M.I.T. and Harvard Business School, or when she worked as a consultant at McKinsey & Company. "I thought it was an excuse for women who didn't have a sense of humor and weren't very bright," she says.
But she believed Kowalysko, and for befriending the accuser, Cowan-Gascoigne says, she was punished. In his authority as head of the hospital transition team, Estafanous asked her to provide detailed financial records. Cowan-Gascoigne says Estafanous was trying to establish that she granted friends huge raises. "The word was out that I wasn't credible," she says.
After a second request by what she calls the "inquisition team," Cowan-Gascoigne resigned. The next year, the Clinic dismantled the department where Kowalysko worked, putting her out of a job.
The sexual-harassment suit was eventually settled, the details wrapped under seal. The parties moved on. Estafanous remained the head of the department.
Cowan-Gascoigne, however, is bound by no confidentiality agreement. She became a consultant and never lost the belief that a bad man went unpunished. "I can still say he's a scumbag," she says, delighted that, 14 years later, someone had occasion to ask.
At 6 p.m. on August 30, 2001, a Canton man came home from work and found his fiancée in emotional distress. For hours that evening, she wouldn't tell him what was wrong. He eventually coaxed the story out of her, then relayed it to Cleveland police.
According to the police report, the fiancée suffered from a back injury and had been referred to the Cleveland Clinic's Pain Management Center by workers' compensation. The woman, who is now 35, was seen by Dr. Ayman Basali. State medical records show that Basali was born in Souhag, Egypt -- the birthplace of Fawzy Estafanous. A hospital source says Basali is Estafanous's nephew.
According to the report, Basali, 39, examined the woman and said she would need to schedule an appointment for an unnamed procedure. She left him to speak with a scheduler. Before exiting the office, she again crossed paths with Basali, who inquired about the date of her appointment. When she told him, Basali said it was too far in the future and invited her into his office to find a nearer date. (The woman declined an interview request through her attorney, and Basali did not return phone calls.)
Once in the office, Basali allegedly told the woman he needed to reexamine her. According to the report, he instructed her to remove her pants and underwear and to lie on the couch. After inspecting her legs and back, Basali began to touch the exterior of her vagina, the woman alleged, and felt her breasts.
The woman told police she felt uncomfortable, but before she could say anything, there was a noise at the door. The doctor quickly closed the door and locked it. The report states that the woman was able to dress and leave the office.
The police's sex-crimes unit investigated the complaint, and Basali was arrested on suspicion of gross sexual imposition. The case was assigned to municipal court, where its resolution is under court seal, according to Sanford Watson, the city's chief assistant prosecutor.
The Clinic seems to have disregarded the matter. Basali remains at the hospital. The Clinic's website lists him as a pain-management specialist at the Lorain Family Health and Surgery Center. There is also no record of the state medical board taking any action.
The matter is not resolved, however. Basali is being sued by the alleged victim.
One year ago, Nadia Ponsones left the Philippines for a vacation in the States. Separated from her husband, she traveled by herself.
Her journey stretched from California to Illinois to Ohio. Ponsones was in no hurry to return to the province of Laguna, where she is a trader, selling meats, clothes, and short-term loans door-to-door. The work is tiring. "It's about time for me to retire, half maybe," she says.
Ponsones is petite, youthful in appearance and manners for a woman approaching 50. Only her hands, which she uses to cover her mouth when she thinks she's misused the English language, show the knots of time.
She met Emad Atalla through the ad for a nanny he had placed. Born and educated in Cairo, Atalla was licensed to practice medicine in Ohio in 1996, near the time of the birth of his daughter, Mareena. He and his first wife, Nargis, divorced in 2001. When they were together, they worshiped with Dr. Estafanous and other Egyptians at St. Mark Coptic Orthodox Church in Seven Hills.
Upon meeting the doctor, Ponsones sensed that their relationship would exceed the terms of the advertisement. "The first time I saw him, I was attracted to him, and I think he was attracted to me," she says.
Ponsones says she wasn't paid. Rather, for 12 days, she and the doctor shared a whirlwind romance. "I had wonderful days with him," she says.
She left when Atalla told her that his second wife -- a woman he married in Egypt a month before his divorce from Nargis was finalized -- was soon to arrive. Ponsones pined for the doctor after returning to the Philippines. "I fell in love with him," she says. "I felt also that he loved me."
Still, there had been warning signs. One day early in her visit, the doctor complained that he had a headache. Ponsones volunteered to massage his head. Her fingers went to work as he lay on the couch. Atalla then suggested that they move to his bedroom, where, Ponsones says, he moved to kiss her. Ponsones says that when she resisted, Atalla told her not to push him away. They kissed. Then they had intercourse.
"I let him do it to me," Ponsones says. "I thought it would be the first and the last time." Instead, they had sex every day of her visit, she says.
In August, Atalla started calling Ponsones at her home in the Philippines. He said that his second wife was gone and not coming back. (According to court records, a divorce was granted in October.) He begged Ponsones to return to him. Ponsones accepted. With his daughter Mareena in the house, they made three. "We lived like a real family," Ponsones says. "He was very good to me. I felt he loved me."
Ponsones, however, did not know that in the time between her first and second visits, Atalla shared his home not with his second wife, who remained in Cairo, but with two live-in housekeepers who later accused him of sexual abuse. According to Police Chief Struhar, one of the women claims the doctor raped her on the day of her arrival.
Ponsones would also claim cruelty. First, Atalla revealed a jealous side. Ponsones says the doctor grew furious when he learned that a male friend of hers had called the house long distance. On another occasion, she says, he grounded her for striking up a conversation with a man in the takeout line of a Chinese restaurant.
One day, feeling ill, Ponsones neglected to answer the telephone. The phone rang and rang and rang. Finally, she heard someone thunder into the house and up the stairs, where her room was. Ponsones says Atalla grabbed her by the hair and struck the back of her head. "I was so surprised," Ponsones says. "I was asking him, 'Why are you doing this to me?'"
Pulling her by the hair, Atalla then led her downstairs, Ponsones says. "Once the telephone rings and you know it's me, you answer it right away," she says he told her. The doctor turned from malevolent to consoling when he saw her tears, Ponsones adds. He tried to comfort her, "as if something bad didn't happen." Then they had sex.
From that point forward, she carried a cell phone. Ponsones says only the doctor knew the number.
She wanted the relationship to work. She says she loved Atalla and grew to care for Mareena, too. But she recognized her self-respect chipping away. "I felt him degrading me. I couldn't take it."
He also seemed to tire of her. Ponsones says he began spending more time on the internet, placing ads for nannies, chatting with women in Armenia and Russia. It sounds as though he used the help wanteds as a dating service. One night, as they watched television coverage of the war in Iraq, the doctor made an observation, Ponsones says: "You know, when the war is finished, those Iraqi women will be looking for jobs in the United States. Iraqi women are beautiful." Ponsones says she asked herself, Does this man want to start a harem?
Atalla had stopped attending St. Mark's after his second divorce and found another church. The doctor, Ponsones says, asked his new pastor to write him a letter of recommendation, as he was involved in a custody dispute over Mareena. (Court records indicate that Nargis had filed for a change in the parenting agreement in January.) But the pastor refused, Ponsones says. Earlier, during a surreptitious meeting at a coffeehouse, she had confided to the pastor that Atalla hit her.
The doctor eventually learned that Ponsones had spoken with the pastor. "He hit me again for that," she says. "He was so violent. His eyes were very sharp."
She says she suffered the worst beating on April 7. This time, he erupted when he learned that Ponsones had left the house and met with the pastor at a coffeehouse, she says. He previously thought they had spoken on the phone. Atalla pulled her by the hair into a bathroom, she claims, twisted her arm, and hit her on the head. When she fell to the floor, he kicked her, she says.
The next morning, bruises showed on her arms and legs, and she popped three Advil. She promised herself she would not wait for him to bury her in the backyard, as she says he had threatened. A week after the incident, she called the taxi.
Ponsones had made other arrangements in the days leading up to her escape. Through the classifieds, she found a man who was wheelchair-bound and looking for a live-in caregiver. She cares for him now.
Ponsones says it was never her desire to put the doctor in jail or humiliate him. In fact, the police contacted her. "I don't know if I truly loved or pitied him," she says of Atalla. "But when I learned about those other nannies, it all collapsed."
For medical students who want to learn or practice in the United States, but who speak English as a second language, anesthesiology is an attractive field. As one nurse says, "If your patient is asleep under anesthesia in the operating room, you obviously don't have to talk to them. It's a specialty they can get into with a certain degree of comfort, and their likelihood of being successful is pretty good." And with Estafanous in such a prominent position at such a prominent clinic, it also makes sense that young Egyptians, such as Hany Iskander, would want to come to Cleveland.
Iskander was an anesthesiology resident at the Cleveland Clinic and University Hospitals before accepting a position with a health system in Virginia in 1999. He was fired within 10 weeks. Two patients and a staff worker accused him of groping them. Iskander did not admit to the allegations, but in signing a consent order with the Virginia Board of Medicine, he agreed not to seek reinstatement of his license for one year. After running into trouble in Virginia, Iskander appears to have been helped by a fellow Egyptian with Cleveland Clinic ties. He worked at veterans hospitals in Kansas City and Huntington, West Virginia. Dr. Hosny Gabriel, an anesthesiologist who practices in Huntington, served as a character witness at Iskander's hearing before the State Medical Board of Ohio. (Iskander was under investigation in Ohio for not reporting that he was under investigation in Virginia. Eventually, his license was suspended for 30 days.) Gabriel told the board that he completed a fellowship in cardiothoracic anesthesia -- Estafanous's specialty -- at the Clinic in 1984.
Whatever ties bind Egyptian anesthesiologists, they extend only so far. Iskander did not resurface at the Clinic. Today, he works at a community hospital in Bucyrus, Ohio. (Reached by Scene, Iskander called the Virginia claims "fraudulent.")
If allegations made against Clinic anesthesiologists trouble the hospital, officials won't let it be known. Spokeswoman Eileen Caruso Sheil says that the hospital has no comment for this story.
Estafanous, meanwhile, is still running the department. In the years since the sexual-harassment claim, his name has stayed largely out of the press. A 1992 society column in The Plain Dealer, however, may offer some glimpse into his clout. According to the article, when Egyptian Prime Minister Atef Sedki was in town for a checkup at the Clinic, he and his entourage were entertained by Art Modell, developer Sam Miller -- and Fawzy Estafanous.
Over the years, the world-renowned Cleveland Clinic has met the health-care needs of a number of wealthy leaders from Arab states. Estafanous, it stands to reason, is part of the welcoming team. As an anesthesiology professional says of the Clinic: "You draw money, you draw power."