Roy Kerry has finally been charged with involuntary manslaughter, endangering the welfare of a child and reckless endangerment two years after Abubakar “Tariq” Nadama died as a result of treatment he received at Kerry’s clinic in Portersville, Pennsylvania. Kerry also faces an enquiry into his competency from the state medical authorities and is being sued by Tariq’s parents. Amazingly, on the day that charges were filed against him, Kerry was unavailable for comment because he was too busy treating patients!
Kerry gave Tariq an IV push of disodium EDTA (Endrate). This was wrong in so many ways.
- Endrate is a chelating agent that draws calcium out of the body and can cause heart failure.
- It’s only indications are for the emergency treatment of hypercalcemia and for the control of ventricular arrhythmias associated with digitalis toxicity.
- Even then it should only ever be administered as a slow infusion, never as a rapid push.
- The label recommends a 3 per cent saline solution. Kerry used a 50 per cent solution.
Much has been made of the fact that Kerry may have inadvertently used the wrong type of EDTA. There is a “safer” version, calcium disodium EDTA (Versenate) which, according to the FDA is indicated for lead poisoning (acute and chronic) and lead encephalopathy. Even this carries dangers.
Calcium Disodium Versenate
Generic Name: edetate calcium disodium
Dosage Form: Injection, usp
WARNINGS: Calcium Disodium Versenate is capable of producing toxic effects which can be fatal. Lead encephalopathy is relatively rare in adults, but occurs more often in pediatric patients in whom it may be incipient and thus overlooked. The mortality rate in pediatric patients has been high. Patients with lead encephalopathy and cerebral edema may experience a lethal increase in intracranial pressure following, intravenous infusion; the intramuscular route is preferred for these patients. In cases where the intravenous route is necessary, avoid rapid infusion. The dosage schedule should be followed and at no time should the recommended daily dose be exceeded.
The International Herald Tribune reports that
Kerry has argued that the boy’s symptoms improved after the first two treatments. He acknowledged there may have been a “miscommunication” about which medication to give the boy during the third treatment, but said that did not amount to gross negligence.
This suggests that maybe Kerry used the “right” version of EDTA on the first two occassions and his assistant administered the fatal dose of the “wrong EDTA in his absence. But this contradicts these statements in the official record of the Pennsylvania State Board of Medicine.
72. Respondent stated to Inspector Reiser that disodium EDTA is the only form of EDTA that he stocks in his office.
73. Respondent admits that CaNa2EDTA is available but he has never used this agent.
All three treatments used the same medication, Endrate. By the time of the third treatment Tariq’s young body could no longer withstand the depletion of calcium from his system and he died. Would Tariq have survived if Kerry had used Versenate? Perhaps. But Versenate is indicated for lead poisoning and Tariq did not have lead poisoning according to the same official record of the Pennsylvania State Board of Medicine
43. A physician who previously treated Tariq. recommended treatment with CaNa2EDTA as recently as June 2005.
44. Respondent obtained a “post provocative” urine sample from Tariq on July 22, 2005.
45. A “post provocative” sample is a urine sample taken after the patient has been subject to drug therapy or chelation.
46. The laboratory report of this sample was completed on July 29, 2005 and sent to Respondent.
47. This laboratory report listed Tariq’s lead level as “elevated” but not in the “very elevated” reference range.
48. It should be noted that this laboratory report has a notation in bold print that reads “Reference ranges are representative of a healthy population under non-challenge or nonprovoked conditions.”
49. Tariq had a minimal elevation of his lead level.
50. The result of Tariq’s urine test also revealed a marked depletion in the iron present in Tariq’s body.
51. Controlled studies have shown a correlation between learning problems and low iron levels in children.
52. Respondent subjected Tariq to a second round of Disodium EDTA chelation on August 10, 2005.
53. In Tariq’s medical chart for the date August 10, 2005, Respondent writes, “The last IV EDTA produced 15mcg of lead level per gram of Creatinine. We really expected a higher output. Recommend repeating the IV again. Use the 1 gram of EDTA … on the next IV we’ll do another collection … IV given in the right antecubital fossa with no difficulty over about a 5-minute span. He gets a little sleepy afterwards and then he recovers in about 5 minutes. Recheck in 2 weeks.”
54. Theresa Bicker, a medical assistant employed by Respondent, stated she administered the Disodium EDTA On the second treatment on August 10, 2005.
55. The Respondent ordered his second treatment.
56. Respondent was in attendance during the August 10, 2005 round of Disodium EDTA chelation.
57. The August 10, 2005 chelation treatment was administered by a five to ten minute IV push.
58. On August 23, 2005, a third and final round of Disodium EDTA chelation therapy was administered to Tariq.
59. Theresa Bicker administered the IV Disodium EDTA to Tariq.
60. Bicker requested Doctor Mark Lewis, D.O.) to come to the treatment room to help restrain Tariq for the IV push of Disodium EDTA.
61. Respondent was not present when Tariq received chelation on August 23, 2005.
62. Theresa Bicker administered the Disodium EDTA pursuant to Respondent’s orders.
There is no evidence for misinformation about medication here. Indeed there is strong evidence for continuity of treatment over the three sessions. Even with the evidence that Tariq’s lead levels were normal Kerry persisted in chelating the poor child. Kerry stated in his notes that “we really expected a higher output [ … ] Recheck in 2 weeks.” I would expect a doctor to check the levels before initiating a further round of treatment, especially as Tariq found the procedure so distressing that he had to be strapped to a papoose board and restrained by 4 adults during treatment.
In the immediate aftermath of this tragic affair DAN! did their best to distance themselves from any involvement. Kerry was not a DAN! practitionr. His treatment was not part of the DAN! protocol. But once the fuss died own Kerry was admitted onto the list of DAN! Healthcare Practitioners. Furthermore, DAN! have never acknowledged their part in Tariq’s treatment. Tariq was referred to Kerry by DAN! practitioner Anju Usman.
21. The July 22, 2005 entry in Tariq’s medical chart reads, “We don’t have the entire record at all. Mother left her entire volume of his records home. But we have been in communication with Dr. Usman regarding EDTA therapy. He apparently has a very high aluminum and has not been responding 10 other types of therapies and therefore she is recommending EDTA, which we do on a routine basis with adults.
She presumably is the “physician who previously treated Tariq, [and] recommended treatment with CaNa2EDTA as recently as June 2005.” So a DAN! practitioner used all her dark arts to cure Tariq of aluminium poisoning. When that did not work she sent him to ACAM practitioner, Kerry for IV treatment with Versenate, even though Endrate is ACAM’s drug of choice. Kerry went against Usman’s advice on three separate occasions.
Was Usman following up on her patient?
Should she have known that Kerry was using Endrate instead of Versenate?
When did Usman’s duty of care end towards Tariq?
Why isn’t she in the dock with Kerry?
Maybe we will find when this case comes to trial and Usman has to take the witness stand.
It is good that there is now a criminal trial. I think that under the rules of evidence, that witnesses can now be compelled to testify. Witnesses such as Dr Usman may use their 5th Amendment right to not incriminate themselves for criminal behavior, but they must do so in open court.
Do most physicians follow up on their patients once they’ve been referred to a new specialist? My experience is that this is pretty darned rare (unless the first doc is admitting a patient to the hospital).
IMHO, this was a case of (almost certainly unintentional) malpractice on the part of Dr. Kerry. Whether or not chelation is an appropriate treatment for autism is an entirely different issue – and one that can legitimately be addressed by DAN! But I wouldn’t place Dr. Kerry’s use or misuse of a particular drug at the doorstep of Autism Institute – any more than I would place any type of malpractice on the doorstep of the AMA.
If the ARI endorsed an unproven and unsafe practice like chelation, then they are just as in fault as Roy Kerry… and the American College of Achievement in Medicine, ACAM.
If you did not know, ACAM is a group that promotes chelation for various ailments, especially the use of EDTA:
Also DAN! and ARI cannot be blameless if they gave Kerry DAN! credentials AFTER he murdered the boy with an IV push of EDTA.
Well, considering the Lack of Peer reviewed studies I have read about from the danites, use of their acronym and the word legitimate do not belong in the same sentence.
Nice try with that unintentional either, how about something closer to ignorant/negligent, as the texts quoted state that even the previous provider recommended the CA form of Edta.
You would do your readers a great service if you would tell them plainly that all the children whose parents say they are “mercury toxic” or “heavy metal poisoned” and who are getting that idea from DDI and other bogus lab reports (that’s almost all or all of the Internet using DAN! and biomed parents) are being misled.
It’s quite obvious that Tariq never needed any form of chelation. Its right there on his DDI lab report if you know how to get past the way they misrepresent their findings, in Tariq’s case even the DDI lab report didn’t show that he had any indication of needing to be chelated at all.
The chelator itself may have had lead or mercury in it besides, which explains why some parents keep “pulling” heavy metals for ages. They likely keep putting the heavy metals back into their kids with the chelator and with contaminated supplements.
I think you are doing the autism community great harm Mrs. Rudy by your blythe and uncritical acceptance of quackery and lies.
And still the obsession with mercury ….
Some geezer was shot on the M40 but I suppose since that was only the Hell’s Angels and nothing to do with mercury it doesn’t matter.
Get yourself a dx of OCD very fashionable very cool, and you can be sure that mercury is to blame as well.
I am thoroughly sick of the M word.
I personally feel that the legal system is used far too often against doctors in the US (both as malpractice as well as criminal charges).
That being said, if ever there was a case where both civil as well as criminal charges needed to be brought, this is it.
If the wrong drug was ordered by mistake, or the dosage or infusion time was wrong, that’s malpractice.
But the treatment had no medical basis at all, the patient was not monitored properly, and the patient was killed as a direct result of gross negligence on the doctor’s part. He might as well as shot him.
There’s no gray area here.
Mrs Rudy – are you aware that Roy Kerry joined the DAN! movement after he killed Tariq?
Regarding the use of criminal charges I think that every legal system is different. But we should not have to wait 2 years for a decision on whether to prosecute. Similarly with the hearing before the state medical board. If a doctor is unfit to practise medicine we need a much speedier process.
Regarding ARI/DAN! I think Kev gets to the nub of it. We are not condemning them because of the actions of one of their members. I condemn them for welcoming Kerry into their ranks after he killed Tariq. And this is after they spent a great deal of effort distancing themselves from Kerry and his treatment methods at the time of Tariq’s death and have never been forthcoming about the role of leading DAN! healthcare practitioner, Dr. Usman in Tariq’s treatment.
Regarding an obsession with mercury, I am sorry Larry, but it is not just about mercury. There are a disturbing number of parents who believe that because their child is autistic they have an obligation to try and micro-manage every aspect of their child’s life and development. They are persuaded by the quackery of ARI/DAN! that they can do this with all sorts of biomedical interventions.
A parent writes in that their four year old gets erections and plays with himself. Another parent says to check his testosterone and another chimes in about Lupron.
It breaks my heart to read about kids who are treated as a collection of symptoms rather than a human being.
About bloody time too.
That guy made a serious error of professional judgement if he thought that he knew better than the prevailing science. And it’s clear that he was disregarding the label-use of the chelator; and – as AD points out – was totally ignorant (wilfully or otherwise) of the lack of need for this treatment.
One of the persistent mistakes made in the reporting of Dr. Kerry’s “misadventure” is that he “used the wrong drug” or that it was a “medication error”.
It is true that he “used the wrong drug” in the sense that [a] chelation is not an effective treatment for autism and [b] EDTA is not a first-line drug for treating mercury, lead or aluminium “toxicity” and [c] NaEDTA is never supposed to be used except in cases of dangerously high calcium levels.
On the other hand, it is not true that he used NaEDTA by “mistake” – it was a deliberate choice, not a case of grabbing the wrong bottle. In fact, he apparently never stocked NaCaEDTA (the other drug he shouldn’t have used because it’s ineffective for treating autism) in his office.
In short, it wasn’t a medication error because [a] the drug Dr. Kerry meant to use was the drug that was administered (and killed poor Tariq), [b] the route of administration was the route chosen by Dr. Kerry and [c] the rate of administration (“IV push” – a rate that is explicitly warned against in the product information sheet) was exactly the rate which Dr. Kerry chose.
Now, does this degree of medical malpractice rise to the level of murder? That’s for a jury to decide. I think that, given the egregious nature of the errors – and the fact that these weren’t “one off” errors but were instead features of Dr. Kerry’s routine practice – that the District Attorney was justified in submitting an indictment.
I just wonder why it took two years to do it.
Could the prosecutors have been waiting on the medical board to complete its investigations? I imagine that the medical board findings would be important evidence in a susequent criminal trial.
I’m not sure that the medical board findings would have much impact on the criminal case. Unfortunately, medical boards in the US are generally unwilling to use their authority to discipline physicians, except in cases where there is no “controversy”, such as sexual abuse of patients, alcoholism, gross incompetence or drug addiction.
It is often protrayed as “protecting their own”, but medical boards have been beaten pretty regularly by the legislatures whenever they try to regulate physician practices – with the exceptions, noted above, of sexual abuse, alcoholism gross incompetence and drug abuse.
As soon as the medical boards try to discipline a physician for using “therapies” that are out of the mainstream (i.e. “alternative”, “complementary” or “quack”), the board is immediately deluged with call, letters and e-mails from angry patients (followed soon by letters and phone calls from legislators).
Some states have gone so far as to pass laws which make it impossible to discipline a physician for “unusual” practices if even one other physician in the state agrees with the practice.
No, it would be foolish to wait for the medical boards to act – they won’t act unless they see a clear mandate. It will likely be that the medical board will wait to see the outcome of the criminal trial and “pile on” if Dr. Kerry is found guilty (little risk in that) and will dismiss the charges if he’s found innocent (ditto).
thanks for the clarification. I will classify it under “sad but true.”