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.