The roof of the Grant Sawyer Building curves like a slice of melon early on this Saturday morning, surrounded by wet black asphalt and a hesitant gray sky. The building is quiet and virtually empty. Pink signs direct a handful of people to a conference room on the second floor, where the fate of Dan Carpenter will be decided.
The 39-year-old ophthalmologist has ruddy features, sun-blond hair and a round face. He suffers from Bell's Palsy, a temporary paralysis of muscles in the face that has caused the left side of his mouth to droop. When he speaks, his words come out a bit as if he's chewing gum. "I'm nervous," he says.
His father, Ed, who wears a camel-colored blazer and drove in from the Palm Springs area, is nervous, too. "It's like they're picking on my kid."
The "they" is really an "it": the Nevada State Board of Osteopathic Medicine. The board licenses the 300 or so doctors of osteopathic medicine, or D.O.s, in Nevada. D.O.s make up around 10 percent of the state's total physicians. M.D.s, who receive essentially the same training, account for the rest. The osteopathic board has taken disciplinary action against physicians 11 times since 2000, but never has it faced a hearing so contentious.
Acrimony between Carpenter and the board has been brewing for years, until it exploded last July, when the board filed a formal complaint against Carpenter alleging gross malpractice and unprofessional conduct in the care of 10 patients between 2001 and 2003. A Review-Journal story last summer mentioned that, according to the board, Carpenter had "blinded a patient, billed patients for procedures he never performed, and performed unnecessary surgeries."
Carpenter responded by filing a lawsuit against Dr. Rudy Manthei, a fellow ophthalmologist, chairman of the osteopathic board, and, Carpenter claims, the mastermind behind the charges against him.
Carpenter has gone to the extraordinary length of hiring a team of attorneys, private investigators, and even a publicist, to try to repair his reputation. Before the hearing gets under way, he confers in the hallway with his team. They talk in lowered voices.
"The truth will prevail," says his publicist, Elizabeth Trosper.
"I pray so," Carpenter tells her. "My life's an open book."
But it won't prevail today. The seven-member board is missing several of its members. Two of them, Paul Mozen and Rota Rosaschi, are snowed in in Northern Nevada. On speakerphone, Mozen says that given the adverse publicity of the case, he needs to evaluate evidence and witnesses in person. Though the board has a quorum sufficient to hold the meeting, it votes unanimously to put the meeting off for a month.
"We're going to continue in a fair manner," board member Matthew McMahon explains.
Carpenter is pleased. The more publicity he can generate, the less likely he feels the board will rubber-stamp a ruling against him. "I'm fortunate enough to be able to put up a fight. This is Rudy's best shot, and I'm still standing."
Manthei, who recused himself from the hearing and wasn't present, is a major player in the state's medical community. He headed Keep Our Doctors in Nevada, an organization that spearheaded medical-malpractice reform in last November's election. Yet, for Carpenter and a handful of other physicians, Manthei is hardly the beneficent protector of physicians. To his critics, Manthei has been, ironically, trying to run fellow ophthalmologists out of town.
"It's about money and power, and he's here to stomp on me because I'm in direct competition with the guy."
"It's not a matter of competition," Manthei responds, "just a matter of ethics, competence, of which, unfortunately, there's a problem here."
Carpenter's lawsuit claims that Manthei abuses his power as head of the osteopathic board and is fraudulently billing patients under other physician licenses at the UMC Free Clinic. Their conflict is more than a simple spat between doctors—it's shining a light on the maneuvering doctors employ to stay on top. As he fights for his professional life, Carpenter's assessment of Manthei is blunt, if exaggerated for effect.
"He kills people."
Rudy Manthei, who has the weathered features of pitcher Randy Johnson, has always been a hands-on doctor. The son of an anesthesiologist, he is the product of the medical system known as osteopathy, which historically emphasized treatment of the body's musculoskeletal system and still trains doctors to place their hands on people to diagnose illness. "To be a good physician you have to feel comfortable talking and be able to touch people," Manthei says.
The delicacy of eye surgery also required a deft hand. "Even if you've got good hands, just the smallest mistake can create a complication that will take an hour to address," Manthei explained last week in his Henderson office. "It's an art. There are a lot of ophthalmic surgeons who are not very good. You either have it or you don't have it."
When Manthei moved to Nevada 18 years ago, he was the first D.O. ophthalmologist in the city. He had to receive approval from the M.D. ophthalmologists in town before he could take calls at the hospital. He became an advocate for other D.O.s, to help them overcome the misperceptions of M.D.s and get on staff at area hospitals. A few years ago, the osteopathic board raised its residency requirements from one year to three years, bringing D.O. licensure requirements in line with M.D. requirements.
"I basically worked to get a lot of those things changed," he says.
He's parlayed that professional activism into leadership posts at the Las Vegas Ophthalmology Society, the Nevada Ophthalmology Society and the Nevada Osteopathic Medical Association. He has testified in Carson City to prevent optometrists from muscling in on ophthalmologists' turf, which includes medical care and surgery. (Optometrists receive less training than ophthalmologists.) "I became very unpopular with the optometrists," he says.
But he became popular enough in Carson City for then-Gov. Bob Miller to ask him to join the state osteopathic board in 1994. Manthei, then a young 37, took it as a compliment and accepted.
In 2002, a weak medical-malpractice reform bill passed the state legislature. A group of physicians and politicians asked Manthei to lead an effort to draft a stronger initiative that would close the bill's loopholes. "Even though I had very little knowledge, they asked me and I said I would do it."
The result was Keep Our Doctors in Nevada, the organization that spearheaded Ballot Question 3 in last November's election. The ballot initiative, which passed resoundingly, limits non-economic "pain and suffering" awards in medical malpractice suits to $350,000. "It would not have passed without him," says Scott Craigie, a consultant who worked on the initiative. "I can say that without hesitation. The guy was huge."
Craigie credits Manthei's unflappable demeanor. "I never saw the guy get even slightly cross, once," Craigie says. "Never saw him lose his cool. Never saw him get anywhere near angry. He is the most calm, careful, guy I've ever met."
Dan Carpenter wanted to be a fighter pilot when he was growing up in Southern California, but less-than-perfect eyes sent him to the optometrist. There, he became mesmerized by the eye and the technology used to treat it. During his high school and college years, he spent as much time as he could among the eye surgeons at USC.
"In all of medicine there's nothing like ophthalmology," he says. "You can get people to see. It's so bitchin' to have such a sharp gratification."
When he finished his residency, in Pittsburgh, and moved to Las Vegas in 2000, he did what most other doctors do: "Hang my shingle, borrow a lot of money and start practicing."
The osteopathic board received the first of seven complaints against Carpenter in September 2001, but it took almost three more years before it filed a formal complaint against him last July. Of the 28 counts he faces, Carpenter maintains that all but one charge is false—he is mistakenly listed at the secretary of state's office as an M.D., not a D.O., which he chalks up to a clerical error by his attorney. "I am not outside any standard deviation of the norm of a bad doctor," Carpenter says. "I've done over 8,000 surgeries in the three to four years I've been here."
In Carpenter's North Las Vegas office there is a painting that depicts a scene from the Book of Daniel, where the prophet Daniel is placed in a den of lions for disobeying the King of Babylon's edict demanding that his subjects worship only him. Daniel prays to God, who seals the mouths of the lions and spares his life.
Carpenter is a religious man; there is a cross in his office and one around his neck. But he's leery of proposing any relationship between the painting and the current pit of trouble he finds himself in. "I don't believe in coincidence," he says. He sees Manthei's hand behind his problems.
Five patients filed complaints against Carpenter between September 10, 2001, and July 31, 2002. They essentially allege billing disputes—patients felt they were being overcharged by Carpenter for minor tests or procedures.
The remaining five patients were mentioned in complaints filed by other ophthalmologists between December 2002 and September 2003. Dr. Helga Pizio filed her complaint on behalf of Renee Collier and Margarita Fleites in December 2002, claiming that the two women sought second opinions from her after they "both suffered disastrous results from cataract surgery." Pizio refused to speak about the case with the Weekly, but, according to her complaint, Collier, 67, was first seen by Carpenter in 2001, complaining of sensitivity to the sun, headaches, night vision difficulty, hypertension, cataracts and light sensitivity.
After Carpenter operated on her, Collier's visual acuity diminished and her left eye became inflamed. Both sides admit the surgery did not go so great: Carpenter's post-operative notes indicate that Collier had "excessive movement" during the procedure. The instrument used to break up and vacuum out the cataract malfunctioned, but "virtually all the fragments [of the cataract] were removed."
But according to Pizio's complaint, a follow-up by another physician, Muzzafar Kirmani, a few weeks later, revealed that "large fragments of crystalline lens" remained, as well as a "large retinal tear." Kirmani repaired the tear, but according to Pizio, who saw Collier in August 2001, Collier suffered "permanent scarring and retinal damage"—the result of Carpenter's earlier surgery.
The other patient Pizio saw was Fleites, a 51-year-old woman living in a nursing home. Carpenter had performed cataract surgery on her left eye in September 2001; in November, Fleites was sent to Pizio, complaining that she could not see out of her left eye. Pizio's examination turned up damage to the eye, which after surgery by a specialist hadn't gotten much better. "She had permanent vision loss [in the left eye] due to severe damage on the undersurface of the cornea that almost certainly occurred during cataract surgery," Pizio wrote. She also alleges Fleites tried to visit Carpenter after her initial surgery but was never seen.
Carpenter didn't specifically respond to the allegations of complications arising from his surgery, but said Fleites was a no-show at a follow-up appointment four days later, and believes Fleites was pestering him for narcotics. Carpenter's staff went to see her at the nursing home in December, and Fleites said she was angry with Carpenter because she was in pain and couldn't open her eye after surgery. Nevertheless, Carpenter stated, "At no time during this interview did Ms. Fleites state that she had come to the respondent's offices, waited several hours and wasn't seen."
In September 2003, another doctor, glaucoma specialist Dan Eisenberg, weighed in against Carpenter with a letter to the board detailing his concerns with three other patients, two of whom were included in the board's complaint. The first, Maurice Butler, was an 81-year-old who went to see Carpenter after being previously diagnosed as being blind in his left eye. Carpenter performed cataract surgery June 13, 2001.
"The details of his exam are not known to me but it is difficult to imagine how [Carpenter] could justify doing cataract surgery on a completely blind eye," Eisenberg wrote. Carpenter responded that "it would be impossible to determine blindness in the left eye with the type of cataract present obstructing light entering the eye." Butler's eye didn't get any better, but Carpenter maintained that Butler "was well aware of this possibility when the risks and benefits were discussed."
The other patient who saw Eisenberg was 77-year-old Richard Truman, in April 2003. Truman's left eye had been going blind for some time, and when changes in medication didn't help, he went to see Carpenter about installing an Express Mini Shunt to help reduce the pressure in his eye. Carpenter installed the device but it failed.
Truman's eye later collapsed and eventually went blind. The board's complaint stated that due to Truman's complicated medical history, he wasn't a good candidate for the mini-shunt procedure. But, says Carpenter, Truman knew the odds were low and wanted to try it anyway as a last-ditch effort to reduce the pressure in his eye associated with glaucoma.
The final physician to file a complaint against Carpenter was Joseph Shalev, who declined to discuss his allegations in detail with the Weekly. Shalev alleged to the board that Carpenter performed an unnecessary operation on patient Carol Lepczynski in 2002. Carpenter, Shalev writes, "decided to proceed with cataract surgery in the only good eye the patient had, without obtaining previous records, without finding out about the presence of tumors in the patient's orbits. ... The patient never recovered good vision in the operated eye and needed three additional surgical procedures, the end result of which left her with only finger-counting vision in that eye. ... The surgery was botched."
According to Carpenter, Lepczynski had a history of mental illness, and her ongoing injuries came as the result of numerous falls. Carpenter claims that Lepczynski stated she "bangs her head against the wall to 'drive out demons.' This was evidenced by the large laceration on her head and other injuries observed and recorded in the emergency room."
Carpenter contends that Lepczynski's vision deteriorated in both eyes after head-banging incidents but improved when she stopped—yet Carpenter had only operated on her left eye, suggesting that it was the head-banging, not the cataract surgery, that left Lepczynski with impaired vision.
Carpenter believes that Shalev, Eisenberg and Pizio were put up to writing letters by the board, to prove the board had an agenda to bring him down, a charge which Shalev and Eisenberg both deny.
Eisenberg, the only one of the trio of physicians who spoke with the Weekly, says physicians would love to be able to "get rid of other problem physicians in a community," but anti-trust regulations make that next to impossible. Any physician who has been ratted on by another physician can counterclaim that it's all about competition, which is exactly the claim Carpenter is making.
Nevertheless, Eisenberg was approached by board investigator John Hambrick to write the letter. "I didn't call him, he called me." While several doctors interviewed for this story indicate it's unusual to see doctors complaining about other doctors, a board official says the move is perfectly legitimate.
"If we find other doctors who are involved, it's certainly within our jurisdiction to query those doctors," says Trey Delap, deputy executive director of the osteopathic board. Still, none of those patients were "involved" in complaints until the board reached out to their doctors.
Manthei says the board has heard many more anecdotal complaints about Carpenter over the years. "I turned in information also"—but he says he can't discuss it. When asked whether Carpenter was a good ophthalmologist, Manthei thought for a moment, and then said, "Let's put it this way: I wouldn't have my mother or any of my relatives have surgery with him."
Manthei and Delap say the board is not set up to allow one person to ramrod his agenda past the others. "The system is such that one board member is not capable of exercising that kind of influence," Delap says.
"He's done a lot for the medical community, politically, but I don't have a feeling he has any real significance," Shalev says. Carpenter doesn't buy it—he's convinced that Manthei pulls the strings of the board. "Everybody knows about Manthei," he says. "Nobody comes in and goes in direct competition with this guy. I didn't think it would be this bad. I didn't think someone could have this much power and destroy someone like this."
"I don't feel the desire to defend myself," Manthei responds. "I don't feel like I really need to prove anything. My involvement in the community speaks for itself."
Dan Carpenter is not the only physician who has gotten entangled in complaints or suits with Rudy Manthei. Ophthalmologist Gerald Brown worked for Manthei from 1997 through July 2003. In a lawsuit filed in 2003, Brown alleges that as soon as he complained to Manthei, in December 2002, that he wasn't receiving the bonus compensation he was due, Manthei responded by filing a complaint against him to the board, accusing Brown of volatile behavior. As a result, the board ordered Brown to submit to a mental-health evaluation. Manthei says Brown had twice been sent to a treatment program for doctors with drug, alcohol or behavioral problems because of his "erratic, explosive behavior at times."
Yet one week before Manthei fired Brown, in May 2003, he wrote a memo praising Brown on the "great job you are doing. ... Your performance as a physician makes me proud to be a D.O., and I want personally to thank you for being a part of Nevada Eye and Ear." And the psychologist who evaluated Brown concluded that Brown wasn't a danger to other staff members, patients or the community at large. Thus, in July 2003, the board dropped the matter, citing a lack of evidence. All of which left the compensation dispute unaddressed until Brown's lawsuit. Brown claims he is due more than $300,000 in damages, including some $275,000 in unpaid bonuses. Manthei claims that Brown's employment contract had been terminated. He says the suit involves only a "dispute of contract. Anything more than that has been fabricated."
Brown, through his lawyer, George Foley, declined comment for this story. Carpenter tells the Weekly that Brown is "floating around with a wife and kid, a real person, a real eye surgeon just like me, and he's bankrupt. He's scared to practice."
The co-plaintiff in Dan Carpenter's lawsuit, Michael Jenkins, tried to get licensed in the state and hit a roadblock at the osteopathic board. A native of rural Montana, Jenkins had three and a half years of residency training in ear, nose and throat, as well as cosmetic surgery. He wanted to pick up another specialty in family practice. He says he planned to practice family medicine in rural Nevada and open a cosmetic surgery practice in Las Vegas.
He applied for licensure in October 2002 and enrolled in Lake Mead Hospital's family practice training program from December 2002 to the end of June 2003, when the hospital was sold and the program cut short.
Jenkins' application was scheduled to be heard by the board in August 2003, nearly a year after his application. Jenkins says he had to pester the board to be heard even then, and doesn't know why things took so long. Delap agrees that it is "unusual for a license to take that long," but says the board couldn't get "sufficient information from Jenkins' residency programs."
Jenkins asked Manthei for his advice about handling the delays, and says the board chair baited him into drafting a harsh letter about Delap, which Jenkins sent to the entire board. When he finally met with the board, he received a cold reception, and Manthei didn't support him. "If he asked me to write the letter, why didn't he back me up?"
Like Carpenter, Jenkins believes the board denied his license because his planned cosmetic surgery practice might have been a potential competitor to Manthei's practice. "I would have been in direct competition with him, and I'm an easy target because I hadn't completed a residency."
Manthei claims the reason he voted for the denial was simple—Jenkins had too many specialties to be sufficiently qualified in any of them. Though he had achieved the minimum three-year residency requirement, Manthei doubted Jenkins was clinically qualified to practice medicine.
"He's a great doctor. He's very qualified," says Carma Kreitler, an RN and office manager at Desert Trails Medical practice in Pahrump, where Jenkins completed the rest of his family practice residency. "He would have been really good for Pahrump"—a growing community that is short on physicians.
"We don't agree," Manthei says. "For an underserved area to accept a physician we don't feel is qualified to practice is not acceptable. They're also not the ones best to judge as far as whether someone is clinically competent to practice."
In 2004, the board invited him to reapply, but Jenkins refused. "At that point I was so obviously frustrated with them. The damage is done."
Jenkins hasn't worked since June 2004. He moved his wife and four kids back to Montana. His savings are almost gone, but he is seeking work in Michigan.
"I think the concern is, he unethically employs his status as an eye-care physician to basically try and harm and injure other practices," says ophthalmologist Jon Siems, who says he has been a target of harassment from Manthei over the years.
Manthei told the Weekly he was asked by the board of medical examiners, which oversees M.D.s, to investigate Siems' use of a device called a Nidek laser, and in his report to the board found he wrote that Siems used the laser "inappropriately."
Twelve years ago, Manthei's life took a detour. He was stopped one morning on Sunset Road, waiting for a school bus on the other side of the street to pick up children. Another bus came hurtling down a hilly section of Sunset, its driver blinded by the morning sun. The bus smashed into the rear of Manthei's car full-force, without breaking.
The car was totaled. Manthei shook off the crash and went in to work that day, but before long he began feeling the effects of the crash, and a month later he went to have an MRI. He had herniated seven discs along his spinal column, four in his neck and three in his back. A pinched nerve cost him function on his left side until he had surgery; even then, his recovery lasted nearly two years. When he was doing cataract surgery, he would experience severe pain in his back, like someone was stabbing him. He had to give up cataract surgery.
And then his hands failed him.
"Unfortunately it doesn't do you a lot of good to be an ophthalmologist when you can't feel your fingers," he says. Even now, when his wrists tilt inward, the last two fingers on each hand curl in toward his palms and freeze.
"The thing of it is, dealing with the fact that I can't practice and do surgery, something I trained my entire life for, basically, I don't know. I probably deny it more than I accept it."
Because he was hit by a state employee driving a state vehicle, his compensation from the accident was $50,000. "The fact is, I'm permanently disabled from ever doing ophthalmology."
Nevada statutes require that board members be actively practicing medicine, which Manthei has indicated several times over the years in insurance forms that he has not been doing. Carpenter maintains Manthei is in violation of statutes.
Board appointments are made by the governor. "I was asked by the governor to run an additional term and help the board," Manthei says. "You have to realize, this is voluntarily. If this is an issue with I'm not qualified, then I have no problem stepping down."
For all the animus between the two physicians, it is ironic they have met face to face only twice. The first was during Carpenter's licensure application back in 1999. "I don't even remember when we licensed him," Manthei says.
Carpenter isn't surprised. "I can definitely grant him his doubt that he doesn't recollect reaming my ass," he said, "because he does it all the time."
The other time was three years ago, during a meeting where Manthei was trying to get an ophthalmology residency started at Lake Mead Hospital. Carpenter opposed the program—he saw it as an effort by Manthei to build a power base at the hospital, right next to where Carpenter was practicing.
"I saw him on Channel 8 last week," Manthei says. "I didn't really know what he looked like, to be honest with you."