Ill Treatment

Dr. Carlos Fernandez is battling malpractice charges and his business associates at the Bellaire Cancer Treatment Center

When Moises Garcia got his first doses of radiation late in 1995, he felt immediate relief from the wrenching pain in his shoulder. Diagnosed with prostate cancer two years earlier, Garcia had endured surgery and chemotherapy, but the cancer had already taken hold and spread. Eventually the pain, which throbbed throughout his body but was most concentrated in his shoulder, wore Garcia down, and his doctor decided that more intensive treatment was in order.

Garcia was referred to Carlos Fernandez, a radiation oncologist who practiced at the Bellaire Cancer Treatment Center. Fernandez prescribed a course of therapy using the center's showpiece linear accelerator, a $1.25 million piece of equipment that zaps tumors with radioactive beams. Within days, Garcia was better able to function: gardening, cooking and taking care of his wife, who has Alzheimer's. "My dad was fine," says Rosa Carbajal, his stepdaughter. "He could do his work."

But the pain recurred, and on April 2, 1996, the doctor injected Garcia with 4 millicuries of strontium-89, a powerful radioactive agent that is effective in easing pain from bone cancer. On May 22, he repeated the strontium treatment. After each shot, Garcia experienced temporary relief.

In between doses, Fernandez started his patient on another round with the accelerator. That still wasn't enough juice, apparently, because the doctor decided to perform a gold seed implant, a procedure in which tiny radioactive bits of gold are surgically placed around a tumor. Fernandez operated on June 25.

Garcia never recovered. Three days after the surgery, he slipped into a coma. Two weeks and various complications later, he contracted pneumonia and died.

Carbajal and her mother are suing Fernandez for malpractice, claiming that the combined treatments constituted a serious overdose of radiation that led directly to Garcia's death. When the case comes to trial, they'll have several grenades to lob. Among the more explosive: The manufacturer's instructions warn that strontium-89 injections should not be administered less than 90 days apart. The reason? Too much of the stuff can send blood counts plunging to lethally low levels. Indeed, after Garcia's second injection, his blood counts dropped precipitously, which made it difficult if not impossible for him to fight off infection or other trouble.

Equally damaging is the fact that, if pain relief was the primary objective, less dangerous alternatives to a second hit of strontium-89, such as morphine, were readily available. Yet Carbajal says Fernandez never informed her of any such options or told her of any risks associated with the strontium. "He didn't say, 'We can do this or this or this,' " Carbajal recalls. "He just said, 'We'll give him another injection, make him feel better.' "

Fernandez says that since Garcia had done so well with the first shot of strontium-89, he went with what had already worked. "If the patient has a response to the treatment, and his pain comes back in four or five weeks, why deny that patient the treatment?"

Besides, he argues, it wasn't the radiation that killed Garcia, but the cancer, which had affected many of his vital organs. "His blood count might have dropped off a little bit," Fernandez concedes, "but he died because of massive liver problems."

As for alternatives, Fernandez says, a patient can experience unpleasant side effects with any medication. "He can also die with the morphine," the doctor says. "He can also have constipation."

Proving just what caused Garcia's demise or how much time he had left may be tough for either side, but Fernandez has more pressing problems to worry about: On April 7, the State Board of Medical Examiners temporarily suspended his medical license. The action came after an investigation that lasted 18 months and included seven cases of questionable patient treatment, including Garcia's. "Available evidence and information indicate that [Fernandez's] continuation in the practice of medicine would constitute a continuing threat to the public welfare," the board's order read.

Harold Ward, a radiation oncologist who practiced with Fernandez at the Bellaire Cancer Treatment Center and testified against his colleague before the board, takes the criticism one step further. "He's a disgrace to our profession," says Ward.

In his defense, Fernandez says he's the victim of a vendetta by treatment center owner Bill Kubricht, with whom he's feuded since the two decided to form the business together in 1992. Kubricht and the center staff, he says, funneled information to the State Board of Medical Examiners to make him look bad, and most of the testimony against him has come from people connected to the center. "My accusers are not my patients," he told the board panel that heard his case. "They are guided by a nonmedical person trying to hurt me, my family and my reputation."

That explanation didn't satisfy the board, but it may be enough to sway a jury. Fernandez plans to fight the suspension, which will eventually end up in court if the board holds its ground. And if that happens, more people than Fernandez are likely to be dodging bullets on the witness stand. State regulators will have to explain, for example, why it took so long to act if the evidence against the doctor was so damning, especially since the board had reprimanded Fernandez only a few months before the investigation began. And a number of hospital administrators with connections to Fernandez may find themselves squirming when asked why he left their institutions -- or why he's still there.

Moreover, the story of the Bellaire Cancer Treatment Center, a tangled tale of lies, threats, lawsuits and unpaid debts, may distract enough from Fernandez's apparent misdeeds to get him reinstated. "I'm not gonna lily-white it for you," says center president Russell Mackert. "I'll be honest -- it doesn't look that great."

Inside the Bellaire Cancer Treatment Center, the odor of stale cigarette smoke lingers like an especially bad joke. Colorful abstract prints that were once almost repossessed hang on the walls, breathing a hint of life into the collection of offices and waiting rooms. The decor offers little hint of the building's purpose, save for a few piles of cancer brochures and a radiation warning on the door to the room that houses the linear accelerator.

Bill Kubricht leans back in a chair in the center's kitchenette and finishes a Benson & Hedges Menthol Light 100, which he drops into a plastic cup filled with butts and water. A burly, easygoing man prone to cracking jokes, Kubricht describes practically everyone as his good friend, at least at one time. The center is technically owned by a family trust controlled by his daughter, but it's clearly his place, and he makes all the big decisions. Since the center opened in 1993, scraping together the cash to keep the center afloat and fending off creditors has been his primary function. "I owe a ton of money," Kubricht says.

That doesn't especially bother him, though, because he approaches business with the same relaxed attitude with which he approaches life. "The key to it is, never loan more than you can afford to throw away," he says.

Owning the center wasn't part of Kubricht's original plan. A native Houstonian, he had trained as a medical physicist at M.D. Anderson, a job that involves administering and measuring radiation in the treatment of cancer. He later worked at the Mary Bird Perkins Cancer Center in Baton Rouge before resigning in the mid-1980s, the result of a radiation leak for which he says he took the fall, and consulted on the design and construction of several freestanding cancer centers in Louisiana before moving back to Houston in 1990.

When Carlos Fernandez heard about Kubricht from a mutual associate, he made contact immediately. Fernandez, a Bolivian-born radiation oncologist who had also trained at M.D. Anderson, wanted to build a cancer treatment center, though he didn't have the expertise to manage the technical details. The two hit it off, and Fernandez hired Kubricht as a consultant in late 1990.

The two scouted various locations, but nothing materialized until Bellaire Hospital contacted Fernandez and proposed that he build the center adjacent to the institution. On September 5, 1991, the mayor of Bellaire, a representative from Houston Mayor Kathy Whitmire's office and other functionaries attended a groundbreaking ceremony.

Shortly thereafter, however, Bellaire Hospital encountered some internal distractions and the deal fell through, putting Fernandez in a tight spot -- after more than a decade at Memorial Southwest Hospital, he'd been forced out when that facility signed an exclusive contract with two other doctors to provide radiation oncology services. He maintained a private office, but without access to the equipment necessary to do the job, he effectively had no practice, and no income. "I was desperate," Fernandez says.

The doctor's fortunes turned the following April, however, when Bellaire Hospital was sold to Columbia Hospital Corp., and the new owner decided to move forward with the project. Fernandez and Kubricht arranged to buy the land from Columbia and worked out a deal with General Electric Medical Systems to finance the center's construction and equipment, including the big-ticket linear accelerator.

To help defray the up-front costs, Kubricht recruited Florida investor Bryan Miller, who supplied a $300,000 letter of credit in exchange for a chunk of the business. Kubricht himself was now a minority shareholder, having taken a percentage of the business in lieu of pay for his consulting work.

The partnership began to unravel before the $2.6 million facility, dubbed the Houston Cancer Care Center, was even finished. Kubricht says that Fernandez wouldn't come up with any down payment, and that Miller threatened to torpedo the whole thing unless the doctor relinquished his majority stake. Fernandez counters that he unloaded his share after it became clear that his partners would never be able to make the business succeed (though he claimed at the Board of Medical Examiners hearing that the pair had taken the business away from him). "They were not the right people to be mixed with," he says. "I didn't see it as a profitable business venture."

Regardless, Fernandez traded his ownership for a contract that gave him exclusive rights to practice at the center, an annual salary of $125,000 to serve as the official medical director (a job that essentially amounted to supervising himself) and an additional $40,000. By then, the center had held its grand-opening celebration and was supposed to have been up and running, but a dispute with the city of Bellaire over right-of-way stalled the process. Finally, in October 1993, Houston Cancer Care Center saw its first patients.

One of them, Dorothy Peterson, had been seeing Fernandez since before the grand opening in May. Peterson had a tumor on the back of her tongue that needed radiation therapy, and he performed a gold seed implant at Bellaire Hospital. But he couldn't use the linear accelerator until the center officially opened, and rather than refer Peterson elsewhere for that procedure, he waited for months to begin treatment. By then the cancer had spread to the bone, and Peterson died soon thereafter.

Fernandez says Peterson only waited "a month or two" for access to the linear accelerator. "The disease was stable," he says. "There was a delay, but I don't think [her condition] had anything to do with the delay."

Marie Johnston begs to differ. A close friend of Peterson's who frequently accompanied her on visits to the doctor, Johnston says Fernandez stalled for at least six months until the accelerator was available. She's convinced that immediate action might have saved her friend, and she holds Fernandez responsible. "He just literally sealed the woman's death warrant," Johnston says.

Naturally, the bills soon began to arrive, but there was little corresponding revenue to pay them. Neither Kubricht nor Miller spent much time at the center, and Fernandez was slow to build the practice, which depends almost entirely on referrals from other doctors. Designed to break even at about 16 patients a day, the center rarely saw more than five or six.

Kubricht had access to cash, but not all of it went to the business. Just three months after the center opened, Kubricht pulled together $150,000 from several sources and invested it in a get-rich-quick scheme involving overseas currency that was going to return $30 million in a matter of weeks. Not surprisingly, more than four years later, the money still hasn't materialized. "Supposedly, it's still alive," says Kubricht without embarrassment.

In Kubricht's hands, money generally seems to have a strangely gaseous quality. Quick to lend and quick to borrow, with little time for paperwork or other niggling details, the physicist has a knack for running up obligations without an ability to cover them. "If you want to say I'm a crummy businessman," he says, "I guess I don't have an argument for that."

Early in the center's existence, for example, Kubricht decided to donate a mammography unit to The Rose, a nonprofit women's health-care organization. Kubricht made a number of payments on the equipment, but when the center's finances tightened, the payments ceased, and The Rose had to pick up the tab at no small expense. "[The center] got into trouble," Kubricht sighs. "I had overloaded my ability once again."

In 1994, the relationship between Miller and Kubricht fell apart. The Florida investor sued his partner, accusing Kubricht of "numerous acts of misconduct, negligence and wrongdoing," including failure to pay the bills and plundering the center's bank accounts. In addition to the letter of credit, the suit charged, Miller had advanced an additional $225,000 to launch the center, based on Kubricht's promises of fat returns.

Typically, Kubricht blames Fernandez for the row, saying that the doctor fed Miller false information in order to undermine the relationship. "He managed to convince Miller that I had embezzled money from the center," says Kubricht.

Apparently, the judge in the case was also concerned, though, because he issued a temporary restraining order against Kubricht that forced him to open the center's books. Eventually the matter was settled, with Kubricht buying out Miller's share, though the money still hasn't been paid. "The note still exists," he says. "I would still honor it."

That's easy for Kubricht to say, because he's lost touch with his former partner. "I don't hear from him anymore," Kubricht says. "I don't even know where he is."

As the debts mounted, Kubricht had to juggle the finances, hold the repo man at bay and find new pots of money to keep the doors open. Despite some success getting investors to lend large sums (some with no formal agreement for repayment), conditions at the center deteriorated. At one point, the water was cut off for nonpayment. Paychecks were sporadic. One day, a deputy arrived to collect a debt and was about to take the artwork in lieu of payment when someone rustled up the necessary funds.

More alarmingly, the equipment was being neglected, which increased the risk that patient care might be compromised. Medical physicists, critical to ensure proper administration of radiation to the patients, were in short supply, as the center was unable to pay them. "I am concerned that the Houston Cancer Care Center is operating without adequate medical physics coverage," wrote Baylor College of Medicine physicist Stewart Bushong in December 1994.

Bushong, who acted as the center's official radiation safety officer, a position required by law, noted that state law also mandated that spot checks of the linear accelerator be conducted by a physicist at least once a week. "I just want you to be aware of this requirement, which I believe is not being filled at this time," he wrote.

A longtime acquaintance of Kubricht through whom the center had been contracting physicists, Bushong finally terminated his association with the center entirely the following May. "We have now finished two years with marginally acceptable medical coverage," Bushong wrote in a letter to Kubricht. "Because of my deep concern about the safe operation of that facility, it is necessary that I resign as radiation safety officer."

The question of safety would later haunt those patients and family members who received radiation treatment from Fernandez during that period. A number would file suit.

As summer waned, the center's ever-deepening financial hole was rapidly threatening to bring down the business. "The center has not been cleaned since April 1, 1995," radiation therapist and center employee Denise Clements wrote in a letter to Kubricht on July 24. "This is a health hazard to the employees and patients. The floors have not been mopped, the garbage cans are running over, the commode and sinks are horrible with filth. We have no linens and are unable to change the sheets between patient treatments."

Rather than solve the problems plaguing the facility, however, the principals seemed more interested in casting blame. In fact, they still do. Fernandez says that although he may not have been bringing in enough patients, Kubricht failed to market the center properly and wouldn't join any managed-care plans, which kept patient numbers low. In addition, he says, rumors about the sorry state of the books -- and conditions at the center -- had spread throughout the medical community and had a chilling effect on referrals. "That's why the practice didn't build up," he states emphatically.

Kubricht is equally emphatic about the source of the malaise: Fernandez. No referrals meant no income, and the referrals weren't there, he says, because of the doctor's poor reputation among his colleagues. "Everyone in the medical community knows he's a bad doctor," Kubricht says.

On September 5, Kubricht appeared at the building with Russell Mackert, an attorney who had represented him in the dispute with Miller. They had an important announcement: Houston Cancer Care Center no longer existed. In its place now stood the Bellaire Cancer Treatment Center. Everything had changed.

Ask Bill Kubricht and other principals why Houston Cancer Care Center became the Bellaire Cancer Treatment Center, and a variety of conflicting answers emerge. In order to beef up the referral numbers, Kubricht initially told the Press, a new doctor had to be brought on board, which was prohibited under the contract with Fernandez. (Actually, the terms stipulate that the center could have hired another doctor anyway, because Fernandez didn't meet a specific patient quota, but no attempt to enforce the agreement was made.)

In a second interview, Kubricht said that the decision came after a Connecticut lender called about a $900,000 debt that had been incurred by Miller. "They said it was for equipment and a building," he remembered vaguely, "but I never heard where the equipment and building were supposed to be."

Such a burden would have crushed the already fragile center. "I guess it's illegal to sell something to avoid debt," says Kubricht, "but in this case it was debt that we didn't know anything about."

Minutes later, however, Kubricht said he could never find any evidence that the center owed the money. The real reason to make the change, he says, was Fernandez. "It was not an attempt to get rid of Fernandez," Kubricht states. "It was an attempt to get control of Fernandez."

Attorney Mackert, who took the title of president of Bellaire Cancer Treatment Center, also has more than one version of events. The financial situation, he says, was just too unstable to continue as before. "It had debts and potential liabilities in the form of possible malpractice suits," Mackert says.

Pressed on the details, however, Mackert finds a similar bottom line to Kubricht's. "The real reason?" he asks. "[Fernandez] was a danger to his patients."

And in a rare show of unity, Fernandez likewise agrees on at least one of the motivating factors, though he takes it a step further. "They committed fraud to get me out of there," he says.

In addition to changing the name of the facility, Kubricht had restructured the business by shuffling the ownership between several entities. The new owner was Oncology Resources Inc., a Nevada corporation that was in turn owned by a family trust controlled by Kubricht's daughter. With the exception of GE and a few other creditors that had negotiated arrangements, the debts of the old company were technically left behind.

So, in theory, were other obligations, including the contract with Fernandez. Kubricht fired the old staff and brought in a second radiation oncologist, Shailesh Gupta, and early in 1996 both he and Fernandez were asked to submit applications for privileges. Gupta's application was accepted, with conditions; the center turned Fernandez down, claiming that his application contained "irregularities."

As he had done after Memorial Southwest Hospital bumped him out, Fernandez sued to uphold the terms of the contract and retain his privileges. Not only would he have no place to practice medicine, he argued, but his patients would be denied the care they so desperately needed.

Fernandez lost his Memorial suit. But this time, swayed by the thought of seriously ill patients left to fend for themselves, the judge in the case issued a temporary restraining order in April that required the center to allow Fernandez to treat patients there. The order specifically named three of them, including Moises Garcia. That was two days after Garcia's first shot of strontium-89.

The temporary restraining order turned into an injunction, and Fernandez continued to treat his patients at the center. Gupta lasted a few months, though the patient load at the facility didn't increase enough to make a significant difference in the bottom line, and Mackert says the center eventually pulled his privileges for alleged shoddy record keeping. "That's a bunch of nonsense," responds Gupta, who charges that the center improperly billed for his services and that he walked out.

Like so many people associated at one time or another with the center, Gupta says he's still owed thousands of dollars. "That guy's a nut," responds Mackert. "[Mackert's] such an idiot," parries Gupta.

In the wake of the court order, relations between Fernandez and center staff deteriorated. Arguments were commonplace, sometimes while patients were within earshot. New radiation therapist Lana Miller, who doubled as the center's director and managed the day-to-day operations, frequently clashed with Fernandez. Eventually she would file an assault charge against him after a disagreement about the treatment of a patient.

More than a year later, Bellaire Cancer Treatment Center settled the case with Fernandez. The doctor would get full privileges to practice at the center and a promissory note for $350,000, to be paid in installments after the center's income reached a manageable level. Those privileges could only be terminated if Fernandez somehow got in trouble and lost his license or faced other restrictions.

In addition, according to the settlement agreement, the staff would be notified that everyone was now satisfied, and that "in the future, all parties are to treat each other with respect, and without acrimony of any kind."

If there was a lull in hostilities, it didn't last long. Less than a month later, Miller tape-recorded a heated exchange with Fernandez about the doctor's parking space. At one point, he warned that if she had his car towed, "I'm going to insult you, I'm going to hit you and I'm going to do everything."

Carlos Fernandez is proud of his career. He ticks off his many civic and professional accomplishments: born to a distinguished family of physicians going back four generations, board certified as a radiation oncologist in 1971, trained at M.D. Anderson, president of the southwest branch of the Harris County Medical Society, member of the international committee of the International Medical Graduates of the Texas Medical Association, president of the Institute for Hispanic Culture. He is a member in good standing of the staffs at four area hospitals -- Bellaire, Sharpstown, Twelve Oaks and Specialty Hospital of Houston. In March he was named president-elect of the Hispanic American Medical Association of Houston.

Fernandez, whose lower lip tends to jut out suddenly in a massive pout, considers himself a victim of a vendetta. Most of the charges against him, he points out, were fed to state regulators by the cancer center staff. And almost all of the witnesses against him, including the physicians who labeled his treatment methods as dangerous, have some connection to the center or Bill Kubricht. Harold Ward, for example, who testified at the State Board of Medical Examiners hearing that Fernandez had committed "gross malpractice," is currently medical director at the center.

And the board, Fernandez says, was predisposed to find him guilty as charged and suspend his license. "They had it already in mind that that's what they wanted to do," he says.

In particular, Fernandez believes that his accusers scoured the records and selected only the most egregious examples involving extremely sick patients. Having treated more than 12,000 patients in his career, he says, that's simply not fair. "These are the worst that they picked," he says. "Why don't they pick on the other 11,900-something cases?"

Besides, he says, of the seven cases presented at the hearing, four of the patients are doing well. Three traveled to Austin to testify on his behalf. The others, he insists, died of their disease, not his treatments.

But the board didn't buy it, and hammered Fernandez on the cases at hand. That included those of the patients who were on his side. One, Frank Newson, had received a gold seed implant for prostate cancer from Fernandez in May 1996. Rather than using ultrasound or another accepted method to see what he was doing during the procedure, the doctor implanted the seeds blindly and failed to check their location afterward. Later, an x-ray revealed that he'd completely missed the prostate and instead clustered the 13 seeds several centimeters away.

Though Newson hadn't suffered any ill effects from the botch, others weren't so lucky. Maria Trevino, who had what was described as a curable skin lesion on her leg, got a concentrated one-two punch of gold seeds and beam radiation that proved too much, too soon. The lesion turned into a severe ulceration that penetrated to the bone. Trevino's leg had to be amputated.

And Esperanza Moreno, who was treated by Fernandez for cervical cancer, received four gold seed implants and a number of beam treatments for a combined dosage of more than 21,000 rad. John Wilbanks, an independent physician who evaluated the charts for the state, testified that the amount of radiation was "excessive," and that "anything over 10,000 rad, you're really getting into serious problems."

When Moreno died in 1996, her pelvic area was so badly burned it looked like it had been grilled.

In addition to overdosing his patients, Fernandez was accused of other improprieties. Maria Trevino's daughter, Norma Gonzales, submitted an affidavit that Fernandez had been "rude and unprofessional" and at one point had shouted at her mother when she questioned the treatment. "Dr. Fernandez slammed his hand down on the desk and yelled, 'I have already explained that to you,' " Gonzales testified. Various witnesses stated that Fernandez failed to apprise patients of the risks associated with radiation or offer alternatives. Billing improprieties were alleged. He refused to appear before the cancer center's peer-review committee to discuss concerns about treatment, a serious breach of protocol.

All in all, concluded Courtney Newton, the attorney who represented the state at the hearing, the cases show "a pattern of patient care that is substandard, sloppy and reckless."

"Dr. Fernandez is out of control," Newton told the panel. "Dr. Fernandez is practicing with virtually no checks in place."

Though he presented a strong case that the center had tried to sabotage him, Fernandez offered only weak excuses when it came to the questionable treatments themselves. He made claims about the condition of the patients that were not reflected in their charts. He said that in some cases the referring physicians knew of the treatments and gave their blessings, though he produced no witnesses to that effect. He blamed a lack of physics support for not taking films to check his work, but couldn't explain why he did the procedures in the first place without adequate resources.

In Frank Newson's case, Fernandez acknowledged that perhaps he should have taken pictures to ensure proper placement of the gold seeds, but stated that "you can't argue with success."

But even if things didn't always work out perfectly, Fernandez refuses to admit that he did anything wrong. What the board doesn't get, Fernandez says, is that he's often dealing with patients on the verge of death who need immediate relief from the pain and suffering of their illness. To punish him for trying to help them, even if it means trying something you wouldn't try with a curable patient, is the height of injustice. "Sometimes you have to get out of the book," he says. "I really don't know why they'd revoke my license."

Though Fernandez can't practice medicine for the time being, his saga is far from over. A State Board of Medical Examiners panel will hold an informal settlement conference with Fernandez in May, and might offer to reinstate him with restrictions -- for example, he could be banned from his specialty but allowed to practice family medicine. If the two sides reach agreement, the full board will decide his fate in mid-May.

On the other hand, Fernandez says that anything short of full vindication is unacceptable at this point, so the matter will first go before an administrative law judge, then to civil court if either party remains dissatisfied. "I'm gonna defend myself until the end," Fernandez says.

One key reason the board suspended his license was that Fernandez lacked any peer support at the hearing to counter the physicians who claimed that he mishandled the cases in question. He says he's subsequently recruited three doctors who will testify on his behalf. Former cancer center radiation oncologist Shailesh Gupta hasn't decided whether to testify, but says that the board's punishment was unduly harsh. "There are some flaws in the treatment," Gupta says, "but trust me, I can find similar flaws in many treatment plans in Texas."

Richard Jaffe, who successfully defended Stanislaw Burzynski against repeated efforts by the feds to shut down his alternative cancer clinic and is also representing Fernandez, gave a hint at the hearing of the strategy he'll likely employ in any future litigation. In addition to hacking away at the Bellaire Cancer Treatment Center's soft underbelly, Jaffe will attack the state at its weakest point -- if the allegations against Fernandez were such a big deal, why did the board wait so long before taking any action?

In fact, the state Bureau of Radiation Control, which had conducted its own investigations of Fernandez and the center in 1995, '96 and '97, had referred several matters to the board over time. The board itself had reprimanded Fernandez for inadequate record keeping. Even after the board received the expert testimony of John Wilbanks on five of the cases in question, however, it took almost ten months to schedule a hearing.

Not only that, but Lana Miller says that as the cancer center's staff grew more concerned about the level of patient care Fernandez was providing, they called the state repeatedly to find out why nothing was happening. "We were screaming," Miller says.

Contrast this foot-dragging with the rush job once the hearing was scheduled. Though on several occasions Fernandez requested extensions to adequately pull together his defense, he was only given two weeks. No matter the weight of the evidence, two weeks is hardly enough time to gather expert witnesses, especially doctors who must find the time to read the charts and render an opinion. "It felt a little like rearranging the deck chairs on the Titanic," Jaffe says of his frantic preparations.

The state's answer may satisfy a jury, but won't do much to inspire confidence in the system's ability to protect the public against dangerous doctors. Addressing the delay in general terms, board general counsel Tony Cobos admits that sometimes the process doesn't move as quickly as it should. "If there are problems, they are directly attributable to a lack of adequate resources, such as staff," Cobos says. "We don't have enough people. That's a problem we face quite often."

That, combined with the center's thinly veiled efforts to shuck him, which a jury might view as an attempt to weasel out of financial obligations instead of an effort to protect life and limb, Fernandez might prevail in court. In which case he'd be back at the Bellaire Cancer Treatment Center -- at least until it closes, which Kubricht vows to do rather than work with the doctor again. "It can't go on," he says. "Enough's enough."

Kubricht hopes that Fernandez's absence will jump-start the Bellaire Cancer Treatment Center toward a profitable future. Ever the optimist, he envisions new doctors affiliating with the center, bringing in truckloads of referrals as well as ties with other institutions, such as M.D. Anderson, for instant credibility. And he hopes that the center's tainted past -- and mountain of debts, all of which Kubricht swears he'll pay -- won't ultimately kill the place.

The center already has a new hurdle to leap. Citing burnout, Lana Miller resigned on April 24, leaving the center without an executive director and radiation therapist. Mackert says a search is under way for replacements, but Miller is about the only person with a working knowledge of the business, and her departure may again throw the center in chaos. But she's adamant about not returning. "I'm tired," Miller says.

Russell Mackert has less confidence about the center's prospects. The associations with a doctor who has been stripped of his privileges, not to mention the line of creditors stretching to the horizon, may prove fatal. "It will probably create such a black stain within the medical community," Mackert says, "we probably won't be able to survive."

E-mail Bob Burtman at bob_burtman@houstonpress.com.

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