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Janae Pierre: Welcome to NYC NOW. I'm Janae Pierre. It's Saturday morning, and that means it's time for Episode 2 of our five-part series called Imminent Danger: One Doctor and a Trail of Injured Women produced in partnership with the Pulitzer Center. Here's our investigative editor at WNYC and Gothamist, Christopher Werth.

Christopher Werth: Hey, everyone. If you haven't listened to part one of this series, I suggest you go back and listen to last Saturday's episode on NYC NOW or at gothamist.com. In that episode, reporter Karen Shakerdge told us a story about a 34-year-old mother named Amy Lam, who died at Harlem Hospital in New York City after giving birth in 2016.

Karen Shakerdge: It was difficult to see Amy in a casket. She shouldn't have been there. She should have been alive, enjoying her newborn.

Christopher Werth: What we learned is that one of the doctors who treated Amy at Harlem Hospital, an OB-GYN named Thomas Byrne, had a long history of medical malpractice, and that he'd lost his medical license in New York in the early '90s, only to get it back years later after practicing in other states.

Karen Shakerdge: He went to Oklahoma and he went to New Mexico, and lawsuits followed him to every state.

Christopher Werth: Karen has tracked Byrne's career and investigated what his story tells us about the failures of the American medical system to stop doctors with questionable track records. This is Episode 2: License Revoked. A quick heads up, this story deals with detailed accounts of medical injury, loss, and grief. Here's Karen.

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Karen Shakerdge: The details I learned about Dr. Byrne's past were troubling. New York State health officials had declared him to be an imminent danger in the '90s. I wanted to understand what happened to earn him that label. While I was digging through court records, I came across a list of names, patients that had settled lawsuits with Byrne back then. It was just a list of names and settlement amounts, no other details, but I tracked down one of those former patients, a woman named Danetta Henry, to see if I could learn more.

She was pretty surprised to get a message from me.

Danetta Henry: Because actually, to be perfectly honest with you, when you get a message out of the blue, I did look you up, and I'm like, "Okay, she's legit." I don't know you, you don't know me. Obviously, there's things that you never forget, but I'm not really sure I wanted to dredge up all these memories either.

Karen Shakerdge: What I learned is that Danetta's case was central to Dr. Byrne losing his medical license more than 30 years ago.

Danetta Henry: It's amazing, once I started talking about it, the stuff that you do remember.

Karen Shakerdge: She actually testified about what happened to her and her daughter Megan as part of a series of hearings in a New York state investigation. It looked into whether Dr. Byrne was fit to practice medicine. There's an incredibly detailed public record of what happened with a number of patients. At the time, the hearings were a big deal. There were 12 of them, 12 sessions held over the span of four months in Rochester, New York.

A local paper there, the Democrat and Chronicle, followed the investigation pretty closely and ran headlines like "Obstetrician Faces Charges of Negligence" and "State Panel Urges License Be Revoked."

Danetta Henry: Considering what he did to my daughter and other children, I just remember being told that Megan's case was pretty much a straw that broke the camel's back, that they were watching this guy.

Karen Shakerdge: What did happen in your case?

Danetta Henry: On May 3rd of 1990, I went in for a regular checkup.

Karen Shakerdge: Back in 1990, Danetta was 25 years old and she was living in the Finger Lakes area of Upstate New York. She was nine months pregnant and seeing Dr. Byrne for care.

Danetta Henry: This was my first child, so I did not know what to expect. I'm going to trust my doctor, obviously. He had told me my blood pressure was high, and he said, "Okay, if you don't go into labor, I need to induce you."

Karen Shakerdge: At 8:00 PM that same night, Danetta was admitted to Newark-Wayne Community Hospital.

Danetta Henry: I do remember that I just wasn't going into labor, and they had to break my water.

Christopher Werth: I know that's sometimes done to speed delivery, but are there any risks to doing that?

Karen Shakerdge: Yes, well, if labor goes on for a long time after breaking the water, the mother and the baby can develop an infection, basically, because bacteria can then get into the uterus.

Christopher Werth: And how long had Danetta gone after Byrne broke her water?

Karen Shakerdge: Well, 24 hours later, she still hadn't given birth. By that point, her temperature shot up to 102.2. The baby's heart rate was rising, and Danetta was still not fully dilated. The state's public record says Dr. Byrne told her to start pushing anyway, which an expert witness for the health department would later say was the wrong thing to do.

Were you there in the room when all of this was unfolding?

Michelle Durham: Yes.

Karen Shakerdge: Michelle Durham was a labor and delivery nurse at the time. She was working that night, taking care of Danetta and assisting Dr. Byrne. What was it like in there?

Michelle Durham: From what I recall, I had an impending feeling of I don't want to sound dramatic, but doom. Like, "This is not going the way it should." Her temperature started to creep up. She developed fetal tachycardia, and she wasn't showing the cervical change that she should have. I think that when you do something in medicine long enough, you develop like a sixth sense, and there are certain cases and bad outcomes, specifically, you just don't forget.

Karen Shakerdge: Can you describe Dr. Byrne? I mean, I'm interested in what your impressions of him were.

Michelle Durham: I would say, compared to the many physicians that I had worked with. I don't know how to say this. He was kind of a cowboy. He would just be much more aggressive in the care of a patient, and I think it made a lot of people uncomfortable.

Karen Shakerdge: Michelle also testified as a witness in the investigation into Dr. Byrne. She refers to Danetta as Patient E, because the state records anonymize patients to protect their privacy.

Michelle Durham: Prior to the case in question, he already sort of had an established reputation, because Patient E, whose case I was involved in, was not the first bad outcome. I mean, there had been many previous bad outcomes.

Karen Shakerdge: Just after 10:00 PM that night that Danetta was in the hospital, records show her temperature continued to climb to 104.4. An OB-GYN who I asked to review this record told me that kind of temperature for a patient in labor is like a five-alarm fire because it is a sign that an infection is most likely brewing, and that the baby needs to be delivered as soon as possible. Dr. Byrne initially ordered an emergency C-section, but 15 minutes after that, he started using a vacuum extractor to deliver the baby instead.

Michelle Durham: He liked the vacuum extractor, and he used it a lot. I remember that distinctly. When you are appropriately using a vacuum extractor, it's an assistance, and the baby should be easily delivered, and there shouldn't be trauma.

Karen Shakerdge: What were you witnessing in that moment?

Michelle Durham: I was witnessing way more traction and pull than should have ever been done.

Christopher Werth: Karen, just so I'm clear, what exactly is a vacuum extractor, and what's the risk in using it in the way that she's describing?

Karen Shakerdge: A vacuum extractor essentially is a tool with a suction cup at the end that a doctor puts on the baby's head and then pulls while the mother pushes the baby out. If it's used improperly, though, that can hurt the baby and even cause brain damage.

Michelle Durham: I knew that vacuum extractor should never have been put on that infant's head.

Karen Shakerdge: That was totally clear to you in that moment.

Michelle Durham: 100%. I just remember thinking, I can't believe he's pulling, and that I needed to make sure I documented very proficiently and very accurately, even if it contradicted what he wrote. Because 32 years ago, you didn't question the physician. The physician made decisions, and as a nurse, you carried them out.

Karen Shakerdge: The baby, Megan, was born at 10:40 PM. By that point, records show that Danetta did have an infection. She was in severe septic shock, and that Dr. Byrne hadn't prescribed enough antibiotics to fight the infection.

Danetta Henry: I do remember she lost a lot of blood giving birth to her. Sorry. She was tiny. In fact, when they weighed her after they pumped her full of fluid, she was probably just six pounds. I remember giving birth to her, not knowing what was going on. At this time, I had no clue.

Karen Shakerdge: Danetta says that in that moment, she turned to Dr. Byrne.

Danetta Henry: I had said to him, and I remember this because I'm thinking, wow, okay, that's pretty cold. I said to him, "How is she doing?" He said, "To be perfectly honest with you, not very good." I thought, "Whoa, okay." I can remember somebody commenting on the blood, my blood that was on the floor. She was born May 4th at night, and she died May 5th.

Karen Shakerdge: Doctors later determined that the infection had also spread to Megan. She suffered cardiopulmonary arrest, birth, asphyxia, and profound sepsis. She was kept alive for just 23 hours.

Danetta Henry: It was hell, obviously. I didn't have my daughter. I was told that had he done a C-section, and it was discussed. Had he done the C-section, like an hour or two before, I would still have my daughter, and she would be fine.

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Michelle Durham: I remember saying to the nurses who were there, my peers, saying, "Do you all understand that this did not have to happen? This was preventable. Do you all understand that?" I left that night, and I'm pretty sure that might have been my last shift I ever worked there.

Karen Shakerdge: You just didn't want to go back?

Michelle Durham: No.

Christopher Werth: Do we have any sense of how Dr. Byrne reacted to what happened to Danetta and her baby?

Karen Shakerdge: I did reach out to Dr. Byrne for comment on Danetta's story, specifically as well as other cases, and he hasn't responded. I know from records that he continued to deliver babies at this particular hospital after Megan's death. Danetta told me that she spoke with Dr. Byrne sometime after this all happened.

Danetta Henry: I don't know if he contacted me or if I contacted him. I remember meeting with him after office hours, and him going through my records with me, trying to explain what happened. I had told him before, I can't keep the prenatal vitamins down. I keep throwing them up. He basically said, "Well, that didn't help the situation." Blaming me, I felt at that time, you're telling me because I kept throwing up my prenatal vitamins, my daughter died.

Karen Shakerdge: One of the things that sticks out so much to me about Danetta's experience is the aftermath of her daughter's death, because she was trying to make sense of what happened to her and her daughter. At least initially, she didn't yet think that Dr. Byrne was necessarily to blame for what happened.

Danetta Henry: My mother had kept telling me, "Danetta, there's something going on. There's something doesn't feel right." I kept saying, "No, it wasn't his fault. It wasn't his fault." She's like, "I'm telling you, you need to dig further."

Karen Shakerdge: Danetta's mother had a friend who worked at that local paper, the Democrat and Chronicle in Rochester, the one that was covering the state's investigation, and they managed to get transcripts of people who testified.

Danetta Henry: This is while the whole hearing or trial, or whatever it was, was going on in Rochester. She said to my mom, "You and Danetta need to come up and read these transcripts." That's when I found out it was him.

Karen Shakerdge: Danetta told me that reading those transcripts is what motivated her to testify in the state's investigation herself because it confirmed for her that Dr. Byrne was at fault.

Danetta Henry: I was reeling from the realization that my doctors, whom I trusted with mine and my child's life, was the cause of this whole thing.

Karen Shakerdge: The state found other cases besides Danetta's, a total of 11 patients, which included five pairs of mothers and babies, and one woman who got gynecological surgery. The state ultimately concluded all of them had been harmed by Byrne in a span of two years. In all, three babies died, including Megan. Two other babies suffered severe brain damage. The state charged Dr. Byrne with using a vacuum extractor improperly in three of those cases, although not in Danetta's. The state did find that Dr. Byrne deviated from acceptable medical care 15 times while caring for her, which a medical expert for the state testified, caused, or contributed to her daughter's death.

Christopher Werth: Did Byrne testify in these hearings?

Karen Shakerdge: He did. I wasn't able to get access to his testimony through the health department, so I can't tell you what he said. The state did reference it in a summary of the hearings. I'll just read you this part. It says, "Respondent's testimony was purely self-serving and replete with misrepresentations and false statements." They also say, "Respondent repeatedly demonstrated an unmitigated lack of the basic knowledge and understanding necessary to practice medicine, as well as a complete disregard for the well-being of his patients." Respondent is devoid of any semblance of professional integrity and honesty.

Christopher Werth: When the state stripped Byrne of his medical license at that time, was there much chance of him ever getting it back?

Karen Shakerdge: New York's Board of Regents voted to revoke his medical license, and that decision went into effect on November 20th, 1991. That made it impossible for him to practice anywhere in the state. To answer your question, that day, a health department spokesperson was quoted in the Democrat and Chronicle, saying it would be very difficult for Byrne to get his license back. Not impossible, but very difficult. In 2014, that's exactly what he did. He got his license back in New York.

This is news to you, it sounds like you're surprised to hear that.

Danetta Henry: Oh, yes. Oh, Yes, I'm very disappointed. I cannot believe that they did this because it wasn't like Megan was the only child that he did anything to. I almost died. He doesn't need to be practicing.

Karen Shakerdge: Considering what officials concluded after their investigation, I wanted to know why New York had given him his medical license back so many years later. To figure that out, I felt like I needed to know what happened in the time between what happened to Danetta and Amy's death at Harlem Hospital 26 years later. One of the first things I found is that about a year after New York revoked Byrne's license, he managed to get another license elsewhere in another state.

Michelle Durham: How could somebody who had their license revoked under the saddest of circumstances be able to continue? I have to assume that there has to be a paper trail of other poor outcomes.

Christopher Werth: Coming up, we meet the person Dr. Byrne turned to after he lost his medical license.

William Grant: Practicing physicians are expected to be infallible and make zero mistakes 100% of the time. It's one of the few professions where that is absolutely true.

Christopher Werth: That's next.

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Christopher Werth: Karen, just to recap some of the things that we've heard, Byrne loses his license in 1991, Michelle and Danetta testify against him in New York state's hearings. Where did he end up after that?

Karen Shakerdge: About a year after he loses his New York license, he gets one in New Mexico. I did manage to get a whole bunch of documents from the New Mexico Medical Board through a public records request. Between those records and others from other state medical boards, over 600 pages, I was able to piece together what happened. The first thing I want to tell you about is what Dr. Byrne did in that year between New York and New Mexico because he went through a pretty unique program that seems to have played a really big role in his being able to continue practicing. I tracked down the guy who created it, an educational psychologist named William Grant.

William Grant: I work on the whole issue of how people learn, why they learn, why they don't learn, and how to make their learning experience better.

Karen Shakerdge: The program was called the Physician Prescribed Educational Program. It was based at SUNY Upstate Medical University. That's State University of New York in Syracuse. It was for doctors who for all sorts of reasons were in some kind of trouble. Mainly doctors dealing with substance abuse, but other issues too.

Do you think it's fair to think of the program as a last chance or last attempt for doctors?

William Grant: For some of them it was. If you are a physician and lose your license, nobody wants you. You can't go in a hospital and work as a phlebotomist. You can't go do other things that are medically related because the lawyers will say, "We don't want the liability of dealing with someone who was a physician and lost their license."

Karen Shakerdge: You are meeting them not in the best moment of their career.

William Grant: Yes, no kidding.

Karen Shakerdge: Doctors would go through a series of evaluations, some retraining if need be, and then William would write up a final report and make a recommendation about whether he thought the physician was fit to continue practicing.

William Grant: We had to explain, we ain't saving you, and whatever we find is what we're going to report. We're not here to gloss over anything. It is what it is, and that's what gets reported.

Karen Shakerdge: The program wasn't huge. William told me that roughly 300 physicians went through it over the 10 or so years it existed. It no longer is running.

William Grant: One of the issues with physicians, especially in the American public, is that practicing physicians are expected to be infallible and make zero mistakes 100% of the time. It's one of the few professions where that is absolutely true. Public will not countenance any errors from physicians. It doesn't matter what the error is and whose fault it is.

Karen Shakerdge: Were there physicians that you struggled with or for you, was it always very clear because you had a data-focused approach?

William Grant: No, there's always physicians you struggle with. The more you do it, the harder it gets because the implications of your decisions become clearer. The magnitude of the implications, your decisions. Even the ones that I would recommend go back and practice medicine, those are no easy decisions. Those are really no easy decisions.

Karen Shakerdge: Why was it not easy for physicians who you were recommending that they return to practice?

William Grant: Because you don't know. It's like anything else. We think we got them, we think we've got it fixed, we think we've got it sorted out and they seem to be doing very well and they've got a lot of support system and so on, but you just don't know. You just don't have a clue.

Christopher Werth: Were you able to find out where Dr. Byrne fell in all of this?

Karen Shakerdge: William didn't want to talk about any particular doctors with me who went through his program to protect their privacy. That was one of the conditions of our interview but I did manage to get some records from the Oklahoma State Medical Board. Another state Byrne would go on to practice in. Those records show that the program was pretty involved. Byrne completed a number of exercises and evaluations, including writing an extensive 40-page paper on the proper use of vacuum extractors.

Christopher Werth: We should just say improper use of a vacuum extractor that's one of the reasons Byrne was stripped of his license in the first place.

Karen Shakerdge: Yes, that's right. In the end, William recommended that Dr. Byrne should go back to practice as he did before, meaning practice with a medical license that doesn't have any restrictions on it. William writes to the Department of Health in New York, and he also eventually writes to the boards in other states where Byrne goes on to practice. I have one of the letters and his take on what happened in New York is basically that yes, Dr. Byrne had some issues, but that he was also really overworked and that he just had taken on too many patients and couldn't keep up.

Christopher Werth: This is the thing that helps Byrne to keep practicing.

Karen Shakerdge: Yes. As far as I can tell, New Mexico gives him a license not too long after, and he starts practicing in a rural area about an hour or so from the Mexican border. He bounces around to a few other places in the state. Then in 1997, six years after he lost his license in New York, he applies for a medical license in Oklahoma. I actually got a written statement that Byrne submitted as part of that application.

Besides depositions, this is actually one of the few instances where I've been able to hear him in his own words since he hasn't responded to any of my requests for an interview. It says, "I began to work in a small town called Alamogordo, New Mexico. I was refused hospital privileges but practiced in an office called Thunderbird Ob/Gyn. I worked there for a year and decided to do a mini-residency at the University of New Mexico in order to be able to restart hospital practice."

Christopher Werth: Is that a big deal being refused privileges, redoing a residency in the way that he's describing here?

Karen Shakerdge: Well, I think what it shows is that Byrne was really trying to continue practicing, but that it wasn't necessarily easy. He goes on to say, "I have made mistakes in my life and in my practice of medicine. I have strived both with self-honesty and hard work to correct the mistakes I have made and to better educate myself so that I can make fewer errors in the practice of medicine. New Mexico took a chance in granting me a licensed practice in 1992. I took that chance and rewarded the state by bringing good care to the patients I cared for, both at the university and in rural areas of the state I have visited and practiced in. Please call any or all of the places where I have worked. They will uniformly give me good recommendations, both as a person and as a physician. Please allow me the same chance to practice in Oklahoma. You will not be disappointed if you do."

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Christopher Werth: In our next episode, what happens in Oklahoma?

?Speaker: I held onto these records all this time. I always knew somebody somewhere was going to get in touch with me someday because of what he did to me.

Christopher Werth: We take a closer look at what state medical boards do to vet doctors.

?Speaker: You know, somewhere you have to hope that they're all being honest when they renew their license and answer questions.

Christopher Werth: Imminent Danger: One Doctor and a Trail of Injured Women was reported by Karen Shakerdge, and edited by me, Christopher Werth. It was produced in partnership with the Pulitzer Center. Our executive producer is Ave Carrillo. We had additional editing by Nsikan Akpan, Stephanie Clary, and Sean Bowditch. Ethan Corey is our researcher and fact checker. Jared Paul is our sound engineer. He also wrote our theme music. We had additional reporting and producing from Jaclyn Jeffrey-Wilensky, Owen Agnew, and Catherine Roberts. Special thanks in this episode, go to Rob Christiansen, Karen Frillmann, Dr. Katherine Kula, Dr. Benedict Landgren, Maggie Stapleton, and Adam Remonda.

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Janae Pierre: Thanks for listening. Be sure to check out NYC NOW every Saturday morning for the next three weeks to hear the continuation of Imminent Danger. I'm Janae Pierre, and we'll be back with the local headlines first thing Monday morning. Until then, have a great weekend.

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