There are no shortcuts to a career in medicine. First-year residents at Jewish Hospital in Cincinnati accepted this. It consoled them through 100-hour workweeks, each one more blurred by blood and disease than the last. Residencies are as much a test of faith and stamina as they are of skill.
To the class of 1975, Edward Patrick was an outsider. At 38, he was older than most, a physical presence in the corridors but rarely a voice. In his aloof, distracted way, Patrick tended to a computer in the cardiac unit. A professor of electrical engineering from Purdue, he was merely conducting a study, one that had nothing to do with the hospital's patients or doctors.
Still, one couldn't help but notice that Patrick was a friend -- a shadow, almost -- of Dr. Henry Heimlich, then head of the Jewish Hospital surgery department. Word got around that Patrick helped develop the Heimlich maneuver, a new invention at the time.
Most didn't know that Patrick had recently finished medical school and that he wanted to abandon engineering for the emergency room. Dr. Felix Canestri, the chief resident, supervised residents when they performed surgeries. Most did about 100 surgeries that year. Yet Canestri doesn't remember ever seeing Patrick at an operating table. "I can tell you I'm 100 percent convinced he was not a resident," Canestri says.
"He was there," says Dr. Ed Matern, a resident at the time, "but he was not in the program."
Patrick's real job, in fact, was hours away. Employment records indicate he was a full-time professor at Purdue University in West Lafayette, Indiana. Indeed, a local newspaper from September 1, 1975, quotes Patrick as saying he would spend only one day per week in Cincinnati -- not nearly enough time to tackle the insomniac schedules that were the norm for surgery residents.
So Canestri is baffled to hear that Patrick lists a Jewish Hospital residency on his résumé. "There are some strange things happening here," he says.
The doctor asks what Patrick has done in the decades since. When told that he's spent much of the last 28 years in emergency rooms -- from Cleveland to Cape Fear, North Carolina -- it comes as a shock. "Practicing surgery?" Canestri asks incredulously.
Yes, all based on what appears to be a phantom residency at Jewish Hospital.
While this may be a stunning revelation to Patrick's patients, it's old news to the Ohio Medical Board. Trusted to ensure the qualifications of state doctors, the board has long known of Patrick's questionable history, but has left his license intact. The only mystery is why.
An emergency-room physician encounters human life in its most fragile state -- so he'd better work well under pressure. That's something you can't learn in a classroom. It's why residencies are a crucial prerequisite.
To the med-school grad, however, residencies are filled with high stress and sleeplessness, supervisors barking orders, and modest paychecks quickly swallowed by student loans. It's a recipe for burnout. Studies show that medical residents are often depressed, prone to substance abuse and suicide. Only the strong -- and dedicated -- survive.
There may be some incentive to circumvent this process. But faking medical credentials is foolhardy -- nothing happens in American medicine without a paper trail.
Few paper trails twist like Ed Patrick's.
When he applied for an Ohio medical license in 1976, Patrick claimed to be a full professor at the Indiana School of Medicine. It has record of him working only as an unpaid volunteer.
From there, his résumé gets weirder. On most he lists special emergency medicine training under Heimlich from 1976-'78, but Heimlich disavows this claim.
On his American Medical Association profile, Patrick claims that he spent 1976-'78 as a resident at Cleveland's Deaconess Hospital. This is surely false; the hospital never had a residency program.
In his board certification listing, Patrick cites an emergency medicine residency at the University of Cincinnati hospital. An internal memo leaked to Scene shows hospital executives comparing notes and concluding that there's no record of Patrick there. Executives also indicated he had no record at Jewish Hospital.
In the same listing, Patrick claims an emergency medicine residency at Purdue University hospital. Purdue doesn't have a medical school, much less a hospital.
In the early '80s, Patrick claims to have founded a family residency program at St. Luke's in Solon. He was on faculty there, but did not establish any program, according to hospital sources.
The rest of the decade sees Patrick crisscrossing Ohio, with emergency-room stops in Toledo, Columbus, and Cincinnati, as well as in podunks like Georgetown, Circleville, and Hillsborough. By the mid-1990s, he becomes even more nomadic, getting medical licenses in Kentucky, West Virginia, Georgia, Alabama, and North Carolina. If that isn't strange enough, Patrick lists a birthdate of 1947 on four of the licenses -- though his actual birthdate is 1937.
When interviewed in early August, Patrick refused to authorize the release of his work records. Angry over his treatment in a previous Scene story -- "Heimlich's Maneuver," August 11 -- he declined to be interviewed for this story. "I am not interested in talking to you until you show some credibility in your reporting," he says.
Like any fortress, the medical profession protects itself from invaders by guiding all comers though a series of checkpoints. If Patrick fabricated his residency, the natural question is how he made it through each checkpoint, enabling him to practice medicine for 28 years.
Only a few people have answers -- and none of them makes sense.
Dr. Gordon Margolin was the head of Jewish Hospital's internal medicine department when Patrick was there. First, he claims that Patrick was at Jewish for only one year. Three minutes later, he's sure Patrick stayed for three years.
One moment he says there's no way Patrick did an "emergency medicine" residency there and claims he would have never signed a residency certificate.
But after being told that his signature is on an affidavit saying Patrick practiced at Jewish Hospital for 1.5 years, Margolin reverses course. Suddenly, he is certain Patrick was indeed a resident.
Told that several hospital staffers don't remember Patrick working as a physician, Margolin says, "He wasn't a very apparent resident." Indeed, Margolin could not name a single doctor or former resident who would also remember Patrick practicing medicine -- except Heimlich.
While it was no secret among hospital staff that Margolin had a low opinion of Heimlich and had even less regard for Patrick, his signature was an enormous favor to both. It allowed Heimlich's protégé to get his Ohio medical license.
Before hiring a physician, a hospital checks the doctor's work record. At Jewish Hospital, Mike Bowen handled verification requests relating to residencies, and he soon learned of Edward Patrick.
By the mid-1990s, Bowen had accumulated a massive file of verification requests for Patrick, who was circulating his bizarre résumé far and wide. It naturally raised eyebrows.
"In my business, if you see something time and time again, you start to wonder," says Bowen. "It didn't take a rocket scientist to figure out something was amiss. What was this guy up to?"
Good question, but Bowen ignored it. Over the next several years, he received requests from hospitals around the nation, asking about Patrick's credentials. Bowen was aware that Patrick's claim to an emergency residency was false -- no such program had ever existed at Jewish -- but he verified the residency anyway.
"From my standpoint, I knew he was at Jewish for a year," says Bowen. Yet he admits he knew nothing about what Patrick was actually doing there, and he never alerted hospitals that were considering hiring Patrick about this fact. "I'm not a policeman," says Bowen. "That's not my job."
Patrick, it seems, seized this opportunity, applying for licenses in four states during Bowen's tenure. Each time, Bowen verified his residency.
Bowen says he once mentioned Patrick's name "in passing" to someone from the Ohio Medical Board, but doesn't remember whom. He assumes the board looked into the matter. If those officials never found cause to yank Patrick's license, that's good enough for him.
The first meeting between Patrick and Henry Heimlich has become a point of contention -- especially over the last year. Since then, Patrick has more forcefully asserted his role in inventing the Heimlich maneuver.
Heimlich, now 84 and still living in Cincinnati, has stated that he met Patrick at Jewish Hospital in 1975 -- one year after Heimlich published the first article on the maneuver. Through a spokesman, he says that "Dr. Patrick had no role in the origin or development of the maneuver."
Both doctors have histories of making questionable claims, so it's hard to know whom to believe. What is certain is that, by the end of the 1970s, they were working in tandem to make the Heimlich maneuver the first response to choking. They were also marketing it as a rescue technique for drowning victims.
As Scene reported in August, Patrick claimed to have saved a two-year-old girl in Lima. She had been submerged for 20 minutes, according to his estimate. During the 20-minute ride to the hospital, CPR had failed to revive her. In a case report published in 1981, Patrick claimed to have saved her by using the Heimlich maneuver.
Yet Patrick has refused to release work records proving he was working in the Lima ER at the time. Moreover, other scientists found it impossible to believe that a young girl could be revived after 40 minutes without breathing.
Most conspicuously absent from the report, however, was the fact that the girl was not saved at all. She slipped into a vegetative state and died four months later. Patrick refused to provide Scene a hospital report that would verify his version.
If the Lima case is a fake, it leads to a host of new questions about Patrick's work at Jewish Hospital.
At an American Red Cross Conference in 1976, for instance, Patrick presented a case in which he used the Heimlich maneuver to save a stroke victim from choking on pea soup. He never explained what he -- an engineering professor -- was doing handling a stroke victim at Jewish Hospital. Nor does he explain why the patient, who had no ability to swallow, was being fed pea soup by spoon rather than through tubes.
Peter Heimlich, son of Dr. Henry Heimlich, remembers Edward Patrick as a regular visitor to the family's Cincinnati home in the early 1970s. The last few years, as he researched his father's career, he kept encountering Patrick's name.
The Lima case looked suspicious to him, as did Patrick's Jewish Hospital residency. So in June 2002, he filed a complaint against Patrick with the Ohio Medical Board.
The board is heralded as one of the nation's most stringent medical regulators, filing more actions against doctors than the board of any other populous state. Peter Heimlich was immediately put in touch with executive director Tom Dilling. "I thought, 'Okay, I've come to the right place,'" he says.
He had several long conference calls with Dilling and Mark Michael, an attorney with the Ohio Attorney General's office.
Dilling never questioned Peter Heimlich's doubts about the Lima case or the Jewish Hospital residency. But according to Heimlich, Dilling said that "faking a residency was no big deal." The board was more concerned with chasing doctors who wrote illegal prescriptions.
"I was astonished," says Peter Heimlich. "It seemed to me that the issue was whether an untrained doctor had access to emergency rooms in seven states, including Ohio. That was no big deal?"
In September 2002, Dilling cut off communication, failing to return e-mails and letters. Two years later, Peter Heimlich still hasn't heard back.
Because medical-board complaints are confidential, Dilling won't discuss Patrick or even confirm that an investigation occurred. But Dilling did say that, in 1976, the year that Patrick should have completed his residency, post-graduate training was not a requirement for licensure.
Still, the board can pull the license of any physician who publishes false credentials. Given the glaring inconsistencies of Patrick's résumé, it's amazing that it passed board scrutiny. Attorney General Betty Montgomery and her successor, Jim Petro, were also informed of Patrick's history, but neither pursued a case against him.
Patrick's career is made all the more flammable due to the time that's elapsed since his alleged Jewish residency. If it's bogus, and if Jewish Hospital has nonetheless been verifying it all these years -- even after suspicions were raised -- it may be liable for all that Patrick has done in 28 years of emergency-room work.
"In the case of an emergency-room doctor, the hospital is vouching to the public at large that it is staffed by people who are adequately trained, and we as patients have to rely on that," says Michael Djordjevic, a malpractice attorney in Akron. "What's at stake here is potentially life and death."
And that could present legal consequences for Jewish Hospital -- the expensive kind.
It appears that Health Alliance, the corporate overseer of Jewish and five other Cincinnati hospitals, understands this problem. In September 2002, Gary Harris, general counsel for the Health Alliance, took the Patrick file. Today, Mike Bowen says that file is locked in Harris's office, safe from the prying eyes of lawyers and reporters. Harris did not return phone calls.
At one point in his career, Patrick fancied himself something of a Horatio Alger. Born to a humble family in Wheeling, West Virginia, he studied his way into M.I.T., then into the U.S. Naval Academy, then into a tenured professorship at Purdue -- all before age 40. If Patrick is to be believed, he single-handedly changed national choking and drowning rescue techniques.
Meeting Henry Heimlich may have seemed providential. It was through Heimlich that Patrick met astronaut Neil Armstrong, with whom the two doctors teamed for a study of a new oxygen delivery system that could be used as an artificial lung.
It was with Heimlich, too, that Patrick found himself lecturing the nation's scientific experts at the American Red Cross, the National Academy of Sciences, and the Institute of Medicine. When former Surgeon General C. Everett Koop announced his endorsement of the Heimlich maneuver for choking in 1985, he cited Patrick's research on the dangers of backslaps, used to rescue choking victims before the Heimlich maneuver. As a lecturing team, Heimlich and Patrick also succeeded in convincing the American Heart Association to recommend the Heimlich maneuver as a second response to drowning rescue -- in the event that CPR fails.
Today, the relationship stings of betrayal. Heimlich has undercut Patrick's claims to inventing the maneuver and even denies Patrick had any effect on swaying Koop's opinion.
Recent years have also been hard on the Heimlich legacy. He's been widely denounced for his campaign to make the Heimlich maneuver the first response to drowning. Most believe it's counterproductive and possibly fatal. He's also campaigned for malariotherapy, contending that AIDS and perhaps cancer can be cured by giving patients malaria. His attempts to conduct human experiments have drawn condemnations from immunologists around the globe. Unfazed, Heimlich will be giving a presentation at the Pan Africa AIDS conference in Nashville this week. His appearance has caused several other presenters to boycott the event.
Heimlich always coveted fame. Today, he's notorious.
Patrick has achieved neither. Heimlich may have helped him get an Ohio medical license based on questionable credentials, but if that gave Patrick a head start, it's been the bane of his career since. His résumé makes it hard to get a good faculty job in a hospital.
Most doctors in their 60s are either retired or settled comfortably into their last years of practice. Patrick, now 67, was last seen working at Cape Fear Valley Medical Center in Fayetteville, North Carolina. He left in August for unknown reasons. Now living in northern Kentucky and navigating his third divorce, he is looking for work.