NEJM Doctor Lies

THE NEW ENGLAND JOURNAL OF MEDICINE: 

DOCTOR MISQUOTES ARIZONA LAW

TO SWAY VOTE ON ILLEGALS

By Gloria Merle Huffman

(7/20/2010)

(924 words)

The prestigious New England Journal of Medicine (NEJM) (10 Shattuck St., Boston, MA 02115-6030; (617) 734-9800) did not print a correction of the errors it published on June 2, 2010 by a Phoenix neurologist, Dr. Lucas Restrepo-Jiménez, regarding the Arizona immigration law (SB-1070).

While it is useful for a doctor to express fact-based opinions on a law that affects or could affect his or her medical practice, it is less than admirable for a doctor to misquote that law in the media to create fear and feed the flames of opposition to the law. Spreading misinformation and then offering authoritative commentary on it in a respected medical journal requires a retraction and a public apology.

NEJM has become the East Coast/international mouthpiece for a few doctors afraid of losing money if their illegal-alien client base in Phoenix disappears. Dr. Lucas Restrepo-Jiménez’s letter to the NEJM editor immediately began to be quoted on the internet as a respected doctor’s opinions in opposition to Arizona’s immigration law. Dr. Restrepo's comments were given added weight by being published in "the most widely read, cited, and influential general medical journal in the world."

1. First, four doctors, all neurologists at the Barrow Neurological Institute and Barrow Neurosurgical Associates (in the Neurology Clinics department of St. Joseph’s Hospital and Medical Center, 500 W. Thomas Rd., Ste. 300, Phoenix, AZ 85013 (800) 227-7691) wrote a letter to the Arizona Republic newspaper, "Doctors being put in a bad position."

They claimed to be unsure whether the law required them to report illegal-alien patients "based on a vague suspicion of illegality," saying that asking patients for their passports violated doctor-patient trust, and that the Arizona law violated "one of the oldest traditions of medicine: Physicians shall protect patients regardless of nationality or race." The ambiguity of the word "protect" was exploited to shift it from medical privacy to immigration status, and to cloud the issue of immigration legality.

See the short letter by four Phoenix neurologists to the Arizona Republic, posted April 24, 2010, at AZ Central (see also Appendix A below):

http://www.azcentral.com/arizonarepublic/opinions/articles/2010/04/24/20100424satlets244.html

The four doctors who signed that letter were:

1) Dr. Robert Frederick Spetzler, Chairman of Neurosurgery

2) Dr. Roy Andrew Patchell, Chairman of Neurology (formerly of the University of Kentucky Hospital, Lexington, KY, till Sept. 2009)

3) Dr. William Richard Shapiro, Director of Neuro-Oncology

4) Dr. Lucas Restrepo-Jiménez, (Neurology Faculty)

2. Second, Dr. Lucas Restrepo-Jiménez wrote a letter to the editor of the New England Journal of Medicine (NEJM), "Arizona Immigration Law and Medical Practice," which was published online at the NEJM website on June 2, 2010.

See Dr. Restrepo’s June 2, 2010 letter to NEJM at its June 24, 2010 website page (and see also Appendix B below):

http://content.nejm.org/cgi/content/full/362/25/2432?query=TOC

(Dr. Lucas Restrepo-Jiménez’ letter to NEJM was also included in the 6/23/2010 emailing by nejmtoc@nejm.org of their Thursday newsletter, "The New England Journal of Medicine, June 24, 2010.")

Dr. Restrepo’s letter misquoted the Arizona law out of context (and he did so in quotation marks). He inaccurately claimed that it "specifies" that anyone at all who conceals, harbors or shields an illegal alien is guilty of a class 1 misdemeanor and is subject to a $1,000 fine. He falsely said health care providers could be considered criminals if they don’t report illegal aliens, and claimed that the law gives no guidance as to what constitutes "reasonable grounds" to suspect someone is an illegal alien (though he opined that whites would not be "reasonable" suspects). He went on to say that racial profiling could extend to requiring doctors themselves to carry their passports at all times, and he repeated that the bill threatens the "medical tradition" that physicians are to "protect patients regardless of nationality or race." He was implying protection from legal prosecution for behaviors unrelated to medical conditions.

In a footnote of implied proof of this latter item (the "medical tradition" of implied legal protection), he referenced his own 4/24/2010 letter (by himself and his three office mates) to the Arizona Republic.

3. A rebuttal was sent to NEJM immediately at the end of June, but was not accepted for publication. (NEJM is located in Brookline, Massachusetts, which adjoins the illegal-alien "sanctuary city" of Cambridge.)

Sanctuary city list: http://www.ojjpac.org/sanctuary.asp

The short Arizona immigration bill (which is about people who violate traffic laws or who transport/employ illegal aliens), is not about health care providers. Read it here:

http://www.scribd.com/doc/31005811/SB-1070-Signed

If NEJM had published the rebuttal, it would have (a) allowed the doctor’s misinformation to be contradicted by the facts, (b) allowed the whole world to quote the rebuttal, just as people have already quoted the doctor’s misinformation online as if it were valid, and (c) exposed the way four respected physicians and NEJM itself used NEJM’s reputation and worldwide distribution in the service of the doctors' own financially-motivated propaganda regarding Arizona’s anti-illegal immigration law.

Because NEJM did not publish the rebuttal, it had to release the submission, which could then be published elsewhere with the revelation that NEJM refused to publish fact-based corrections to blatantly inaccurate information which it had published. That casts doubt on the reputation of the respected journal, as their refusal demonstrates (1) the inherent dangers of using a computerized submission system for medical articles, and, more importantly, (2) the lack of editorial vigilance on the part of the staff at NEJM, who did not check to see whether the Arizona law was accurately quoted by Dr. Restrepo.

Dr. Restrepo’s letter was not about a medical study which required specialized knowledge for the NEJM editors to understand. If he did not intentionally misconstrue the law, but made a mistake in a hasty reaction to something he had perhaps read or heard, he would not have used quotation marks to make it look like he was carefully quoting the text of SB-1070. Neither would he have tried to make it look like he could support his main thesis (that doctors have to protect their patients, and therefore must "protect" illegal aliens from discovery) by adding a sham self-referencing footnote to that statement.

The attempt to link the protection of medical privacy to the hiding (protection) of a patient's identity and immigration status is sadly misguided. Furthermore, this entire line of thought is irrelevant with regard to SB-1070, which says nothing about health care providers.

On the other hand, the good result of drawing national and international attention to this particular medical office is that now the Phoenix police know to stake themselves around St. Joseph’s Hospital and Medical Center, watch for illegal aliens, and try to catch one in a routine traffic violation.

#

APPENDIX (A-G)

APPENDIX A

[This is the first letter that was published 

(by Dr. Lucas Restrepo and his three colleagues):] 

"Doctors being put in a bad position"

http://www.azcentral.com/arizonarepublic/opinions/articles/2010/04/24/20100424satlets244.html

Arizona Republic, Apr. 24, 2010, 12:00 AM

As physicians, we are concerned about the immigration bill signed by Gov. Jan Brewer.

We care for many patients who may appear foreign based on superficial impressions. It is unclear whether health-care professionals like ourselves will infringe on the law if we don't report patients or their families to the police or immigration authorities based on a vague suspicion of illegality.

Asking patients to produce a passport violates the trust that we endeavor to earn from them. Realistically, physicians don't have time for yet another bureaucratic routine; the professional call of a doctor is quite different from that of an immigration officer.

Senate Bill 1070 tacitly prescribes a break with one of the oldest traditions of medicine: Physicians shall protect patients regardless of nationality or race.

~

Dr. Robert Spetzler, chairman of neurosurgery; Dr. Roy Patchell, chairman of neurology; Dr. William Shapiro, director of neuro-oncology; and Dr. Lucas Restrepo (neurology faculty), Phoenix

The writers are with Barrow Neurological Institute

#

APPENDIX B

[This is the second letter that was published

(by Dr. Lucas Restrepo only):]

(The New England Journal of Medicine declined twice to print a correction of the following error-filled letter of 6/24/2010 regarding Arizona immigration law SB-1070:) 

CORRESPONDENCE

ARIZONA IMMIGRATION LAW

AND MEDICAL PRACTICE

http://content.nejm.org/cgi/content/full/362/25/2432?query=TOC

N Engl J Med 2010; 362:2432 | June 24, 2010

By Lucas Restrepo, M.D.

To the Editor:

The new Arizona state immigration bill (SB-1070) signed into law on April 23 will seriously obstruct, if not undermine, the practice of medicine in the state of Arizona. It specifies that those who "conceal, harbor or shield or attempt to conceal, harbor or shield" a foreign person who came to the United States illicitly "are guilty of a class 1 misdemeanor" punishable by a fine of at least $1,000 (Sec. 5, Section 13-2929).1  It can be argued that health care providers who neglect to report illegal immigrants under their care will violate the law and be considered criminals. The bill provides physicians with no guidance as to what constitutes "reasonable grounds" to suspect that somebody is in the country illegally, leaving the particulars of such scrutiny to anyone's imagination (although the fact that Arizona shares a border with Mexico rather than a European country suggests that whites will not be "reasonable" suspects). One interpretation is that health care providers in Arizona will need to ask for a passport before seeing certain patients (and providers themselves will need to carry their own passports at all times, depending on their physical appearance or accent).

Arizona practitioners, hospitals, and medical associations need to ponder the extent of their liability under the new law and draft clear institutional policies to defend their patients and employees from potential harassment. Asking patients to produce immigration documents violates the trust that physicians, nurses, and other health care workers endeavor to earn from them.

This bill threatens one of the oldest traditions of medicine: physicians shall protect patients regardless of nationality or race.2  This legislation, if unchallenged, will force health care providers to choose between the dignity of their profession and the indignity of violating the law.

Lucas Restrepo, M.D.

Barrow Neurological Institute, Phoenix, AZ

lrestrepo@ucla.edu

~

Disclosure forms provided by the author are available with the full text of this letter at NEJM.org.

~~

This letter (10.1056/NEJMc1004884) was published on June 2, 2010, at NEJM.org.

2 References

FOOTNOTES:

 1 State of Arizona Senate Bill 1070, 2010. (Accessed June 1, 2010, at http://www.azleg.gov/legtext/49leg/2r/bills/sb1070h.pdf)

 2 Spetzler R, Patchell R, Shapiro W, Restrepo L. Doctors being put in a bad position. Letter to the Arizona Republic April 24, 2010. (Accessed June 1, 2010, at http://www.azcentral.com/arizonarepublic/opinions/articles/2010/04/24/20100424satlets244.html)

#

APPENDIX C

ARIZONA IMMIGRATION LAW

NOT DR. BORDER PATROL

By Gloria Merle Huffman

(6/29/2010)

(173 words)

To: The New England Journal of Medicine

June 24, 2010

To the Editor:

Arizona’s short April 23, 2010, immigration law amendment SB-1070[1] does not address healthcare providers. They need not request their patients’ passports or report suspected illegal aliens to authorities as alleged by Dr. Lucas Restrepo in his June 2, 2010, letter to the editor.[2]

Law enforcement officers are reminded to check citizenship status upon “reasonable suspicion” after stopping a traffic violator or the driver of a vehicle transporting illegal aliens. (Potential racial profiling would be eliminated by checking citizenship status for everyone.)

Section 5, section 13-2929, says that within the context of transportation or employment of illegal aliens, “It is unlawful for a person who is in violation of a criminal offense to … conceal, harbor or shield an alien from detection … if the person knows or recklessly disregards the fact that the alien [is in the United States illegally].”[3]

Note, incidentally, that American hospital employees already wear a photo ID. Medical record privacy can be waived by law.[4] The doctor-patient relationship is not attorney-client privilege. There is no medical tradition of obstruction of justice.

G.H.

References

1.   Full Text of Arizona’s April 23, 2010, “Support Our Law Enforcement and Safe Neighborhoods Act,” Senate Bill 1070 (SB-1070), an amendment to existing anti-illegal immigration laws regarding traffic violators and transporters or employers of illegal aliens (21 short pages) (Accessed June 25, 2010, at http://latimesblogs.latimes.com/washington/2010/05/full-text-arizona-illegal-immigration-law-jan-brewer.html

[Author's note 8/9/2012: The text of SB-1070 is no longer at that url. Instead, see the 21-page PDF file here: http://www.scribd.com/doc/31005811/SB-1070-Signed or here: http://www.azleg.gov/legtext/49leg/2r/bills/sb1070h.pdf]

2.   Restrepo, Lucas, Letter to the Editor, Arizona Immigration Law and Medical Practice, N Engl J Med 2010 Jun 2; 362(25):2432 (Accessed June 24, 2010, )

[a] at http://content.nejm.org/cgi/content/full/362/25/2432?query=TOC

and [b] in a June 24, 2010, email from nejmtoc@nejm.org [NEJM]

3.   (See the relevant text of the SOLE SaNe Act via footnote 1: p. 5 lines 28-29, and p. 6 lines 8-12 and lines 18-22)

4.   From a Connecticut pharmacy’s privacy notice, “Your Right to Privacy.” See also Health New England’s medical privacy information (Accessed June 28, 2010, at http://www.healthnewengland.com/quality/privacy/index1.html): “We may use or disclose your protected health information to the extent we are required to do so by state or federal law.”

#

APPENDIX D

[The following courteous rejection was received from NEJM:]

(7/26/2010) 

In a message dated 7/26/10 11:22:31 AM Eastern Daylight Time, letter@nejm.org writes:

Dear Ms. Huffman,

I am sorry that we will not be able to print your recent letter to the editor regarding the Restrepo article of 24-Jun-2010. The space available for correspondence is very limited, and we must use our judgment to present a representative selection of the material received. Many worthwhile communications must be declined for lack of space.

Thank you for your interest in the Journal.

Sincerely,

Gregory Curfman, M.D. Executive Editor

New England Journal of Medicine, 10 Shattuck Street Boston, MA 02115 (617) 734-9800 Fax: (617) 739-9864  http://www.nejm.org

#

APPENDIX E

[The following objection to the rejection was sent.]

By Gloria Merle Huffman

(8/12/2010)

(402 words)

To: The New England Journal of Medicine

August 12, 2010

Dear Dr. Gregory Curfman,

Thank you for your 7/26/2010 response to my 6/29/2010 letter to the New England Journal of Medicine rebutting the 6/24/2010 letter to NEJM from Dr. Lucas Restrepo of Phoenix, Arizona, regarding the impact on medical practice of the 7/29/2010 Arizona bill enforcing federal immigration laws.

Within the challenging confines of a 175-word limit, I refuted a half dozen of his errors in both fact and logic.

I realize that Dr. Restrepo has placed your highly-respected journal in a difficult position. However, it has always been your policy to publish corrections of erroneous material. Dr. Restrepo's letter contained such blatant misrepresentations that, if unanswered, it threatens to place your journal's reputation in jeopardy.

Within the honor system in the peer review process, it is to be expected that sometimes you will unknowingly publish false, flawed or misleading articles. However, in the interests of truth and scientifically-sound thinking, it is important to publish a counter-balancing exposition of such falsities.

Your busy readership depends on you for accuracy and fact-checking. They are too busy to read the Arizona law. I made the same mistake myself when I began to write my letter to NEJM: I assumed that what Dr. Restrepo had said was right. After I took the time to read the short law, I realized that he had constructed a complex edifice upon a faulty premise.

You have published a letter that was representative of an example of sloppy scholarship and wrong thinking. By means of a self-referencing footnote to his own letter to the Arizona Republic  newspaper (which inaccurately purported to point to the primary source validating that there is a medical tradition of protecting patients regardless of nationality or race), Dr. Restrepo made it seem that his three colleagues (Dr. Robert Frederick Spetzler, Dr. Roy Andrew Patchell, and Dr. William Richard Shapiro, who all signed the letter to the Arizona Republic with Dr. Lucas Restrepo-Jimenez) were aware of his letter to NEJM and agreed with its contents. Their reputations are now involved via this lateral-association process.

I would like to respectfully request that you reconsider publishing my letter (10-07379). It demonstrates accurate scholarship and correct thinking, and it is a representative sample of a statement of the facts that contradict Dr. Restrepo's errors.

If Dr. Restrepo declines to respond to my rebuttal, you could indicate this by printing after my letter that "The original author has no comment."

Awaiting your timely reply,

G.H.

#

APPENDIX F

[A second rejection was received, clarifying

that this decision was intentional:])

In a message dated 8/13/10 2:41:19 PM Eastern Daylight

Time, letter@nejm.org writes:

Re: 10-07379 - Arizona Immigration Law

Not Dr. Border Patrol

Dear Ms. Huffman:

Thank you for your email, which was forwarded to Dr. Curfman.

Please understand that your letter was read and received the careful consideration of our editors. Unfortunately, we can publish only a small fraction of the letters that we receive. Many letters with potential merit have to be declined.

Again, we are sorry that the decision here was to decline publication of your letter, and we thank you for your interest in the Journal. However, the editor's decision is final.

Sincerely, Elise DeVoe Editorial Assistant

New England Journal of Medicine

10 Shattuck Street

Boston, MA 02115

(617) 734-9800

Fax: (617) 739-9864

http://www.nejm.org

#

APPENDIX G 

[A final communication acknowledged the end of the

correspondence on this matter:]

By Gloria Merle Huffman

(8/13/2010)

(48 words)

To: The New England Journal of Medicine

Fri., Aug. 13, 2010

Dear Elise Devoe (Editorial Assistant),

Thank you very much for your email clarifying that the rejection of my 29 June 2010 letter to the editor was the result of a careful and considered deliberation on the part of the Executive Editor. I appreciate your time and effort in conveying this fact to me.

Respectfully,

G.H.

© 2010 Gloria Merle Huffman

#

[Rebuttal not accepted for publication:]