A Fayetteville, Arkansas, pathologist was indicted on three counts of involuntary manslaughter, falsifying medical records, and working while impaired, according to an August 20 news release from the Department of Justice (DOJ), US Attorney's Office, Western District of Arkansas.

Robert Morris Levy, MD, 53, former chief of Pathology and Laboratory Medical Services, Veterans Health Care System of the Ozarks, was arrested on August 17 after a year-long investigation into allegations that he worked while under the influence of alcohol, purchased an illegal substance for personal use to evade drug testing, falsified medical records, and made errors resulting in at least three deaths.

Dr Robert Morris Levy

He was charged with 12 counts of wire fraud, 12 counts of mail fraud, four counts of making false statements in certain matters, and the three counts of involuntary manslaughter by a grand jury. Levy pleaded not guilty at a hearing on August 20, according to reporting by the New York Times.

He also allegedly received bonuses in 2016 and 2017 that were given on the basis of his reported clinical error rate of less than 5% when it was actually almost twice that, according to the Associated Press .

Medscape Medical News reported in January that 3007 (8.8%) of 33,902 cases of Levy's that were investigated by outside pathologists revealed an error or misdiagnosis. Earlier reports claim Levy may have been responsible for at least 12 deaths.

The indictment alleges that Levy was noncompliant with drug and alcohol testing and that he deliberately defrauded the Department of Veterans Affairs (VA) and obtained "money and property from the VA in the form of salary, benefits, and performance awards he would not have received had the VA known Levy was intentionally concealing his non-compliance with the drug and alcohol testing program," according to the news release. In related actions, he allegedly "concealed a material fact and made material false and fraudulent representations."

The indictment charges Levy with making false statements to a special agent of the Office of the Inspector General (OIG) of the Department of Veterans Affairs on two occasions and with making "false statements in health care matters by entering information in a patient's medical records that Levy knew to be false and by making a false statement during a grievance hearing related to his employment."

Levy is also alleged to have entered "incorrect and misleading diagnoses" in the medical records of three patients and twice falsified "entries in the patients' medical records to state that a second pathologist concurred with the diagnosis Levy had made." Levy's incorrect and misleading diagnoses resulted in the deaths of three veterans, according to the DOJ release.

In one case, prosecutors allege that a patient with prostate cancer died after Levy determined his biopsy was negative for cancer, according to the Associated Press.

A second patient, with squamous cell carcinoma, died after Levy diagnosed another type of carcinoma, and a third patient, with small cell carcinoma, was misdiagnosed and treated for a different type of cancer, the Associated Press reports.

"This indictment should remind us all that this country has a responsibility to care for those who have served us honorably. When that trust is violated through criminal conduct, those responsible must be held accountable. Our veterans deserve nothing less," Duane (DAK) Kees, the United States Attorney for the Western District of Arkansas, said in the DOJ news release.

Years of Problems

Levy was issued a medical license by the Mississippi State Board of Medical Licensure in 1997 and began working as the chief of Pathology and Laboratory Medical Services at the Veterans Health Care System of the Ozarks in 2005.

In 2015, an administrative fact-finding panel interviewed Levy about reports that he was impaired by alcohol while on duty, which he denied. The following year, he appeared to be impaired while on duty and a drug and alcohol test showed he had a blood alcohol content of 0.396 mg/dL. In Arkansas, a person driving a motor vehicle is considered intoxicated if their blood alcohol content is 0.08% or higher.

The Fayetteville VA immediately suspended Levy's privileges to practice medicine and "issued Levy a written notice of removal and revocation of clinical privileges." The indictment alleges that Levy admitted the reasons for this were "unprofessional conduct related to high blood alcohol content while on duty." He voluntarily entered a 3-month inpatient chemical dependency treatment program in July 2016 and completed that program in October 2016.

Near the conclusion of the treatment program, Levy entered into a contract with the Mississippi Physician Health Program and the Mississippi State Board of Medical Licensure with the expectation that he would return to the Fayetteville VA to practice medicine.

In it, he agreed to completely abstain from alcohol and mood-altering substances to ensure that he would be able to "practice medicine with reasonable skill and safety to patients" and to comply with random urine and/or blood testing for drugs, with the understanding that he could potentially lose his medical license and employment if he were noncompliant. He went back to work at the Fayetteville VA in October 2016.

Every urine specimen and blood sample for drug testing submitted from November 2016 through June 2018 was negative for drugs and alcohol. From June 2017 through 2018, while Levy was contractually required to undergo random drug and alcohol screens, he is alleged to have purchased for personal use 2-methyl-2-butanol (2M-2B), a chemical substance that enables a person to become intoxicated but is undetectable in routine drug and alcohol testing, on 12 separate occasions, according to the DOJ.

The Fayetteville VA suspended Levy again in October 2017, alleging that he worked while impaired again; he was terminated in April 2018, according to media reports.

"The arrest of Dr. Levy was accomplished as a result of the strong leadership of the US Attorney's Office and the extensive work of special agents of the VA Office of Inspector General, supported by the medical expertise of the OIG's healthcare inspection professionals," Michael Missal, inspector general of the Department of Veterans Affairs, said in the DOJ news release. "These charges send a clear signal that anyone entrusted with the care of veterans will be held accountable for placing them at risk by working while impaired or through other misconduct. Our thoughts are with the veterans and their families affected by Dr. Levy's actions."

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