Home - Patient Safety

Gary Malakoff, M.D.

It is both a criminal and a civil offense to prescribe controlled substances fraudulently. Doing so can result in imprisonment and the suspension of a license to practice medicine. Knowledge of a physician's having done so must be reported to both the Medical Board and the D.E.A. This is a federal law mandating reporting in medicine as well as every where else in every state.

Federally Required Mandatory Reporting

Malakoff prescribed controlled substances fraudulently, but no one reported him to the appropriate agencies. While chairman of George Washington University Medical Center's General Internal Medicine Division, he prescribed drugs for himself by using the name of a physician under his supervision. Eventually a suspicious pharmacist alerted the physician. The physician reported it to Alan Wasserman, the chairman of George Washington University's Department of Medicine where the reporting stopped. He did not report it to the appropriate agencies.

Business as Usual

Abusing prescriptions is something Malakoff had been doing for years. The fact that he was the personal physician of Vice President of the United States, Dick Cheney, should make it more, not less, alarming that it was swept under the carpet. Unfortunately, there is nothing unusual about failing to report negative things in medicine. In fact, that is what is usual (see Medical Reporting).

Malakoff had an addiction he could not moderate even after being caught. He lost a few positions, but was allowed to continue practicing medicine. When asked to comment on it, supervisors insisted that they had seen no evidence of Malakoff's problems having impaired his medical judgment. How could they when medicine is adamantly against having anyone objectively assess outcomes?

A custodian in a public school automatically gets fired for engaging in criminal activity even when it did not occur on school property and did not involve students. They don't consider it safe to have him in the presence of children even if they see no evidence of his/her problems impairing his/her floor sweeping judgement. The problem is that he/she is around people who are vulnerable, children, and he/she is someone who has proved to have such poor judgement in that other area of his/her life that he/she cannot be trusted with the well being of children.

Who is more vulnerable than patients?

He breaks laws. He lies about it. He gets caught and continues to break laws and lie about it like an out-of-control addict would. But his medical judgment seems fine so he is above the law? He is breaking federal law and the people who are not reporting this are breaking federal law. None of them should have access to patients.

No Biggie?

This is the norm. But this is wrong. It corrupts the system. It makes medicine as a whole less trustworthy as a caretaker of children and the elderly and anyone who is sick, anyone in a position of needing to trust this system and the people in it. This is an abuse of power. Not being held accountable because he is a doctor all by itself is an abuse of power.

There are providers who injure patients because of sick passions, because of greed, and because of all of the other unworthy motivations in which humans indulge when they feel they can get away with them. It is not acceptable to turn a blind eye to it. This is a prima facie case of the system and the people in it having as the first priority the well being of itself and the people working in it rather than the patients they are supposed to protect.

You can get away with it

The stakes are low in medicine. Sin until caught. You might never get caught. You might spend your whole career under the influence, or being predacious, or worse, and get away with it. If you don't get away with it, moderating your behavior after being caught will be enough to avoid consequences. So the downside isn't a deterrent because there is almost no downside. And the odds of getting caught are miniscule. Who is going to report it? And who is going to believe any patients who complain about being injured as a result of it? Medicine is provider driven. The number of patients who get injured in addition to the ills that happen to them after they do (see Blacklisting) is not on their radar. And they don't know that. So they don't recognise when a provider's medical judgement has been compromised. They worry, instead, about the provider's reputation and career.

The patient community needs to put itself in a position that makes it so that the well-being of patients no longer depends on providers policing providers. Until then having an M.D. after your name will be a get-out-of-jail-free card no matter what the cost to the patient community.

Information from The New Yorker magazine, July 12; 19, 2004, page 39-40, "In the Beltway, The Vice-President's Doctor" by Jane Mayer.