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The date was September 27, 1991, and Dr. Stephen Gould, a La Jolla psychiatrist in private practice, wrote a memo regarding an unpaid assignment he had been given by the University of California San Diego Medical Center. Gould had been asked by Dr. Sidney Zisook, another psychiatrist then employed by UCSD's Gifford Clinic, to keep track of a second-year psychiatric resident by the name of Dr. Robert Allan Weitzel.

"I have been supervising Doctor Weitzel now on a regular basis. I was specifically asked to see him by Dr. Sidney Zisook because of Doctor Weitzel's self-reported confusion about patients having sexual feelings for him and how to handle that in a therapeutic manner. Doctor Weitzel has been prompt and timely in appearing for supervision. He has been involved. He has been sincerely interested in understanding, within the supervisory context, his own feelings and behavior that have resulted in patients having sexual feelings for him. He has been very open about trying to introspect about his own feelings and behavior.

"We have discussed that part of his difficulties were conceptual in that he had the feeling from his reading and previous work that sexualized transferences were part of the 'gold' of psychotherapy...that one would dig for. As he began to understand that in fact these feelings were, in part, resistances to the therapeutic process or that they were not universally ubiquitous or that they were more obvious in patients that had in fact a history of sexual problems as opposed to others, he was able to modify his own expectation of what good therapy was and was not about."

Concluded Gould: "Doctor Weitzel very much values being a good psychotherapist and is attempting to become one. I think he is finding that it is more complicated than he had first realized."

Was that a deadly prophecy?

Today, Weitzel, 44, is on trial for the murder of five elderly patients in a Utah geriatric-psychiatric clinic, and a San Diego attorney is charging that UCSD contributed to the tragedy. Nancy Sussman, an ex-nurse who practices medical malpractice law from an office just north of downtown, says the University of California "did everything in its considerable power" to protect Weitzel after she filed a sexual-abuse suit against him and UCSD on behalf of a female patient in late 1994.

In addition to having conducted a sexual affair with the patient, the complaint alleged, Weitzel was shooting up drugs such as Demerol, which he obtained by writing illegal prescriptions on UCSD prescription pads. "The university is extremely powerful and has tremendous financial resources to fight these types of cases. They refused to blow the whistle on this guy."

The result of UCSD's failure to warn the public about its wayward doctor, Sussman says, is that Weitzel was able to retain his license to practice medicine in both Texas and Utah even after the State of California's Board of Medical Quality Assurance had yanked his California medical license. That happened in May 1997, more than two years after Sussman's malpractice case against Weitzel and UCSD was settled out of court for a sizable amount of cash, with no public admission of guilt by either the doctor or the university.

"I think University of California did everything to keep the information about this case from everyone involved. They didn't do anything to cooperate with the medical board and its investigation. They refused to do anything that might have resulted in forewarnings to the other enforcement agencies or other states. They told absolutely no one. They took the position that we're going to sweep it all under the carpet and protect ourselves from further liability."

Weitzel voluntarily gave up his California license rather than challenge the medical board's allegations that he had "methodically manipulated a patient and her treatment in order to use her as an object to gratify his own emotional and sexual needs." But he didn't lose his Utah license until 1999, when he refused an order to undergo a mental examination to determine if he had a "malignant personality disorder."

By then, the psychiatrist was in Texas, running another geriatric clinic at the Matagorda County Hospital in Bay City, where he had gone to work in February 1998. Though the U.S. Drug Enforcement Administration had pulled his permit to prescribe controlled substances, the hospital allowed Weitzel to write prescriptions using its own federal control number. Weitzel's Texas medical career finally came to an end after he was arrested on September 20, 1999, on a warrant charging him with the deaths in Utah. Texas authorities are now investigating the suspicious death of an elderly patient that occurred at Matagorda County while Weitzel was there.

Weitzel began work at the Davis Hospital and Medical Center in Layton, Utah, near Salt Lake City, in August 1995, about a year after arriving from San Diego, and left the clinic in September1996. During 16 days between December 1995 and January 1996, prosecutors charge, the psychiatrist administered a combination of psychotropic drugs and lethal doses of morphine to five elderly patients in the clinic under his command. The victims are alleged to be Ennis Alldredge, 85; Ellen B. Anderson, 91; Mary R. Crane, 72; Judith Larsen; and Lydia M. Smith, 90. The state has charged Weitzel with five counts of first-degree felony murder, which could put him in jail for life.

Weitzel's defense attorney Peter Stirba has countered that the murder charges against his client are a bum rap, and that, if anything, the allegations of negligence, poor patient care, and improper diagnoses belong in civil, not criminal, court. In addition, Stirba has argued that much of the evidence against his client is circumstantial and based on the flawed, five-year-old recollections of nurses who administered the drugs on Weitzel's orders. The defense attorney has also convinced the Utah trial judge to bar admission of any evidence or testimony regarding Weitzel's past history, including the San Diego malpractice case against him.

The description of life in the geriatric ward is not for the faint of heart. As told during trial testimony, the Davis clinic serves as a way station for violent, mentally unstable elderly patients who become hard to manage in convalescent hospitals. In some cases they have fought with nurses and injured staff and other patients by throwing wheel chairs and cutlery. At Davis, they are treated with psychiatric drugs and sedated with morphine to change their behavior, then sent back to their rest homes within a few weeks. Many suffer chronic heart and kidney conditions and senile dementia; they do not have long life expectancies.

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