The Murder in Exam Room 15

He expected doctors to perform a miracle. When they couldn't, he sought revenge at the Brigham. Are hospitals the new front line in the escalating battle between patients and healthcare?

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Stephen Pasceri was insistent. The 55-year-old accountant, clad in khakis and a snug sweater that hugged his belly, stood at the reception desk in the gleaming lobby of the Shapiro Cardiovascular Center at Brigham and Women’s Hospital on January 20, quietly demanding to see Dr. ­Michael Davidson. He conceded to the secretary that he didn’t have an appointment, but he had risen early in the sharp winter morning to make the hourlong drive from Millbury, and he wasn’t leaving until he met with the heart surgeon.

Possessed with superb technical skills, Davidson was a rising star, but it was his bedside manner that set him apart. Sometimes doctors don’t like to discuss their failures, but Davidson was known for spending hours talking to patients and their families regardless of whether a surgery ended flawlessly or something went wrong. Pasceri’s mother, ­Marguerite, had been ­Davidson’s ­patient in 2014 and had died recently of heart and lung complications at another hospital. So it wasn’t out of the ordinary when ­Davidson welcomed Pasceri into exam room 15, knowing full well that the domino effect of this unscheduled visit could delay a dozen other appointments and encroach on the precious ­evening hours that belonged to ­Davidson’s three young children and his wife, who was seven months’ pregnant with their fourth child, a girl.

As Davidson closed the door behind them, Pasceri peppered him with questions about a drug called amiodarone, which he was sure had killed his mother. This wasn’t foreign territory for Davidson—he understood the confusion that accompanies losing a loved one, and he wanted to help Pasceri find clarity and peace. Davidson explained that it was a commonly prescribed medication for ­patients suffering from an irregular heartbeat, and that if they walked upstairs to the cardiac unit, Pasceri would see that one-third of recovering patients were taking it. But Pasceri was persistent: The grieving son’s calm demeanor held steady as he challenged the doctor’s judgment in prescribing the medication. After 15 minutes and little progress, Davidson asked his physician’s assistant to leave the room and check on patients whose appointments were now running late.

For 20 more minutes, the two men continued to talk. No one outside the exam room heard a sound, until all at once two blasts from a .40-caliber pistol tore through the morning calm. Davidson burst from the room, clutching his left hip and back, yelling, “He’s shooting, he’s shooting!” He made it to the end of the hallway before collapsing on the carpet in front of a secure door. After more than eight hours of emergency surgery, Davidson would not survive. The moment shots rang out, a hospital worker in his cubicle pushed a panic button rigged to his desk and within seconds, security guards and Boston police officers on hospital detail swarmed the building. Thanks to a controversial change in procedure at the Brigham months earlier, instead of sounding a vague “Code Grey” warning, a woman’s voice came over the public address system: “A life-threatening situation now exists at Watkins Clinic B—Shapiro 2. All persons should immediately move away from that location if it is safe to do so. If it is not safe to move away, shelter in place immediately.”

Grief is often depicted as a phase of gentle contemplation from which one emerges wiser and comforted. But for a few, grief can be a wellspring of destructive ambition. Still standing in the exam room, Pasceri pushed the barrel of the gun against the roof of his mouth and pulled the trigger. In a final note to his family found on a USB drive after his death, Pasceri wrote that a lawsuit would not have sufficed. To escape the demons of his mother’s death and ease his pain, he needed to murder Davidson.

It wasn’t the first time a gunman with unmet expectations had sought revenge on a doctor, and chances are it won’t be the last.

Across the United States, hospital shootings are now a monthly occurrence. In the year leading up to Davidson’s murder, there were more than a dozen, claiming 15 lives, and the trend is clearly on the rise. Between 2000 and 2005, an average of nine hospital shootings ­occurred each year. Over the next five years, from 2006 to 2011, the average spiked to more than 16, resulting in 161 deaths, according to a recent article in the Journal of the American Medical Association.

While not all hospital shootings are aimed at doctors, many are. In 2009, a former ­patient murdered Edna Makabenta and killed himself in her Las Vegas office ­after reportedly filing a complaint against the doctor. In 2010, at Johns Hopkins Hospital in Baltimore, 50-year-old Warren Pardus shot a physician in the chest after being updated on the condition of his ailing mother. Pardus then entered his mother’s hospital room, shot her in the head, and killed himself.

Two years later, Jason Letts—­dissatisfied with the care his wife was receiving at a hospital in Birmingham, Alabama—opened fire on a cardiac unit, injuring three before police shot him dead. The following year, in 2013, urologist Ronald Franklin Gilbert was shot eight times in an exam room. The killer, who is awaiting trial in southern California, said he harbored deep resentment over a botched prostate surgery performed two decades earlier, though records later revealed that Gilbert most likely never operated on the assassin. And two weeks before Davidson’s death, Jerry Serrato gunned down psychologist Timothy Fjordbak at a Veteran Affairs clinic in El Paso, Texas, before killing himself. Serrato, a former soldier and ex-VA employee, had reportedly expressed anger over being ­denied a claim of post-traumatic stress, though it appears the doctor he targeted played no role in the decision.

In each shooting, the killer was driven to extremes by a perceived failure of the healthcare system—to sustain an ill mother, repair a damaged body part, or deliver a desired diagnosis. Each time, a doctor became the target of that discontent.