LIES!: Surgery for Money

Monte Sereno doctor accused of faking patients' need for surgery By Barbara Feder Ostrov Mercury News

On the day of his cancer treatment, 87-year-old Dung Le lay on a table, his frail body sedated as needles loaded with radioactive seeds were inserted into his prostate to destroy the malignant tissue his doctor told him was there.

But Dung Le never had cancer, and his doctor knew it.

Now that doctor, Ali Moayed of Monte Sereno, faces felony charges of battery, elder abuse and fraud for his treatment of Le, in a bizarre case that has deeply unsettled local physicians. Two other men in their 70s, their medical files falsified by Moayed, narrowly escaped the same unnecessary procedure, according to a state medical board investigator's report.

Santa Clara County prosecutors are also investigating whether Moayed - who has pleaded not guilty to the charges - may have harmed 13 other men in a similar scheme.

"He doctored the pathology reports to induce a patient to undergo a procedure that carried a significant risk," said Santa Clara County prosecutor Bill Butler. "The conduct was so egregious, it goes beyond simply medical malpractice."

Sparked by a colleague's discovery of altered lab reports, the unraveling of Moayed's alleged deceptions spanned two years of investigation by several agencies, leading to his arrest in late June.

But the question remains: Why would a prosperous doctor risk his career this way? Was it greed? A misguided sense that he was doing the right thing for his patients?

Free on $500,000 bail but currently barred from practicing medicine, the 41-year-old urologist faces more than seven years in prison and potential civil lawsuits that could bankrupt him.

Moayed did not return phone calls or e-mails from the Mercury News and his attorney declined to comment. Yet hints about Moayed's motivation are found in the normally confidential medical board investigator's report placed in his court file.

Missing report in '05 A missing pathology report proved to be Moayed's undoing. In May 2005, Dr. Abhinand Peddada, a Los Gatos radiation oncologist, was reviewing the medical files of one of Moayed's patients, identified only as "S.B.," 75, who was scheduled for a prostate cancer treatment known as brachytherapy.

The procedure isn't pleasant: It involves sedating the patient, then inserting radioactive seeds the size of rice grains into the prostate to shrink tumors.

As Peddada scrutinized the file to confirm the patient's post-surgery treatment plan, he noticed that a crucial lab report confirming the cancer diagnosis was missing.

He called Moayed's medical office in Los Gatos first, then the lab that had examined a sample of tissue taken from the patient's prostate. Two pathology reports came in. The first one, from the lab, said the patient was cancer-free. The second - from Moayed's office - said the opposite. Peddada suspected that the report from Moayed's office had been altered. S.B.'s procedure was immediately canceled.

Good Samaritan Hospital in San Jose, where both Peddada and Moayed were on staff, began to investigate. When Peddada, hospital administrators and other physicians reviewed the files of Moayed's other patients, they found that pathology reports for Dung Le and another patient, referred to in medical board documents as "B.T.," 75, were falsified. They were able to cancel B.T.'s upcoming brachytherapy.

But for Dung Le, it was too late.

Hospital findings Good Samaritan officials quickly reported their findings to the state medical board, law enforcement and Los Gatos Community Hospital, where Moayed also was on staff. The medical board and the Santa Clara County District Attorney's Office opened investigations.

By August 2005, Moayed, on the advice of his lawyer, had resigned from the medical staffs at both hospitals.

He relinquished his medical license the next month, and his practice was taken over by Dr. Farshad Nowzari, according to the investigator's report. Until this incident, Moayed had never been investigated or disciplined by the state medical board.

Once Moayed stopped practicing medicine, investigators could take their time to build a case. As Peddada dug deeper into Moayed's patients' files, his concerns grew. There were other aspects of Moayed's treatment of cancer patients that were difficult to fathom.

Moayed gave some of his patients hormone injections to prevent their prostate cancer from progressing, but according to their medical files, they didn't appear to show effects of the treatment - almost as if they had been given a placebo, Peddada told investigators.

He called Moayed to ask if he had received "a bad batch" of hormones, the report says. After Moayed got that call, Peddada told investigators, the patients began to show the response to the treatment that should have occurred all along. Peddada declined to speak with the Mercury News.

Much to lose Moayed had a great deal to lose from his apparent deceptions. A 1991 graduate from the University of Cincinnati Medical School, Moayed owns a medical building and lives in a Monte Sereno mansion with an estimated value of more than $3 million.

He admitted to the medical board investigator that he had falsified the reports for three cancer-free patients, inserting lab results from patients who did have cancer.

He said he didn't do it for the money. Each brachytherapy procedure would have netted him only $600 because they are performed alongside a radiation oncologist, he told investigators.

Why, then, would he lie to his patients? The investigative report isn't clear, but Moayed appears to claim that the brachytherapies would help them by preventing future cancers. At least one of his patients had displayed early warning signs, including an elevated PSA (prostate specific antigen) level. Moayed "felt the patients were on the brink of getting cancer and that he wanted to give them a definitive answer," the report says.

"He knows he messed up and that he will no longer be practicing medicine," the investigator wrote in the report. "He stated that there was no justification for what he did."

Moayed said "he was under a lot of stress," logging many after-work hours on his computer instead of spending time with his children, the investigator reported.

Treatment debated In medical circles, the best way to treat prostate cancer is fiercely debated.

The disease afflicts more than 218,000 American men each year, many of them elderly. An estimated 20 percent of American men will be diagnosed with the disease between the ages of 70 and 75, according to the National Cancer Institute.

Once cancer is detected, treatment options range from "watchful waiting" (in which patients are closely monitored but not treated) to hormone or radiation therapy, to surgery.

But an independent doctor who reviewed evidence in the case told medical board investigators that Moayed's apparent conviction that his patients ultimately would develop cancer, based on the early warning signs, simply wasn't valid. Nor should a doctor pursue cancer treatments for a patient whose cancer has not been confirmed, the independent doctor said.

Many doctors believe that elderly patients are more likely to die of other causes, such as heart disease, before they die of prostate cancer. Moayed told the investigator he had "messed up" with only three patients, but local prosecutors and the medical board investigator are examining his treatment of more than a dozen other patients from Los Gatos Community Hospital. Dr. Domenico Manzone, a Los Gatos urologist, told the medical board investigator that Moayed had performed 13 other brachytherapy procedures at the Silicon Valley Urology Center at Los Gatos Community Hospital. But when Manzone reviewed the patients' charts, he found no reports documenting their cancer - only a statement from Moayed that they had the disease, the investigator's report says.

Manzone declined to speak about Moayed. But in an e-mail, he said, "The dedicated and hardworking physicians" of the Silicon Valley Urology Center "deplore the apparent breaches by Ali Moayed of some of the most fundamental principles of our profession."

Hearing not set A date for Moayed's preliminary hearing hasn't been set yet, but the criminal charges against him are the only the start of his legal woes. He could face malpractice lawsuits that wouldn't be subject to California's $250,000 damages cap because of the age of the victims, said prominent San Jose attorney Dick Alexander. If a jury finds him guilty of willful misconduct, the doctor's malpractice insurance would not cover him.

It's unusual, but not unheard of, for prosecutors to file criminal charges against doctors over medical treatment, said David Magnus, a Stanford University medical ethicist. Such cases are typically handled by state medical boards, which can revoke a doctor's license, and in civil courts through malpractice lawsuits.

If the facts of Moayed's case are true, Magnus said, they represent a doctor out of control.

"That kind of blatant paternalism might have been common in this country in the 1940s and 1950s, but it's inappropriate and something that won't be countenanced today," Magnus said. "You can't knowingly, intentionally lie to patients to get them to do what you want."