WASHINGTON PARK • Three years ago, Dr. Krishnarao V. Rednam was the lead partner in a group of eye clinics across greater St. Louis. Now he's working in the back of a church here in one of the nation's poorest communities.
His old life ended after an audit of St. Louis Eye Clinic revealed Rednam, 61, was billing Medicare insurance for expensive drugs, but injecting cheaper, still-experimental drugs into his patients' eyes.
He also would sometimes split a single-use vial among multiple patients, billing each of them for a full dose.
He repeated the actions at least 284 times, overcharging patients and their insurance more than $600,000. The government said Rednam might have subjected patients to unsterile needles. The doctor insisted patients were never at risk.
As investigators closed in, Rednam destroyed records to cover up his wrongdoing.
After a felony conviction for obstructing a health care investigation in 2008, Missouri regulators gave him the harshest penalty allowed by state law: They revoked his license and said he couldn't reapply for seven years.
But different states' medical boards have different rules, and a discredited doctor can move to a place where the government still lets him practice.
Rednam went to Illinois, where a felony conviction does not automatically trigger the suspension of a medical license.
He arrived here in June 2009 at Trinity United Methodist Outreach Center, which faces a junkyard where two pit bulls roamed on a recent Wednesday. His name is stenciled in black spray paint over a sign advertising "affordable healthcare."
Rednam's story is part of a series of investigations by the Post-Dispatch this year into how patients are kept in the dark about problems with their doctors and hospitals, and a disciplinary system that seems geared toward protecting doctors' livelihoods.
Rednam's case shows how a doctor can keep practicing medicine even after a felony conviction.
Although most states revoke a license after a felony conviction, it's rarely permanent.
Medical boards don't release statistics on how many active licensees are convicted felons. A Post-Dispatch analysis of Missouri and Illinois records identifies at least eight felons who either regained their license or never lost it.
They include doctors convicted of possession of child pornography, false imprisonment, dealing drugs, child endangerment, persistent drunken driving, mail fraud and leaving the scene of a fatal car crash.
Arthur Caplan, chairman of the medical ethics department at the University of Pennsylvania, believes a doctor who has any felony conviction has demonstrated a lack of integrity and credibility.
Patients should be outraged if their medical board has allowed a felon to resume practicing, Caplan said. "Medical treatment depends on being able to trust your physician. You have to be able to share secrets, speak honestly, and talk about sensitive subjects."
But doctors don't have to disclose their histories to patients. It's up to the patients to do their own research in news archives, county courthouses or government websites.
Illinois State Rep. Mary Flowers, D-Chicago, has sponsored legislation that would make doctors' criminal and malpractice records easily accessible.
Flowers said doctors found guilty of felonies should be permanently stripped of their right to practice. "Can a bank robber go to work for a bank?" she asked.
The fraud of switching and splitting drugs was motivated by greed, federal prosecutor Andrew Lay wrote in asking the court for 'serious punishment" for Rednam.
When the doctor realized he was under investigation, his "first impulse ... was to destroy or alter patients' medical records," Lay wrote.
He rebutted claims that Rednam had substantially cooperated with the government and rejected any argument that his penalty should be reduced to let him practice again.
Rednam "can be useful to society and provide meaningful service with or without a medical license," he wrote.
Rednam was sentenced to six months in prison and four months of home confinement, and fined $30,000. He agreed to repay $304,000 to Medicare and $65,000 to Medicare contractors. He and his four partners, who got a share of the overbilled money, agreed to repay $16,000 in patient co-pays, and the partners agreed to repay $252,000 although none of them was criminally responsible. They declined to comment.
The revocation of Rednam's Missouri license came up in July 2008, while he was in prison.
His attorney, Harvey Tettlebaum, conceded that the Missouri Board of Registration for the Healing Arts could revoke his client's license, but urged members to let him reapply for it at any time.
The board's president at the time, Dr. Jean Hausheer, also an ophthalmologist, called Rednam's actions "horrible, horrible" and said "the potential for harm existed with what he did."
Board members criticized Rednam's care; Hausheer said she doubted that patients would know they were harmed and said no one could be sure what drugs were administered and when.
Tettlebaum repeatedly tried to portray his imprisoned client's crime as merely billing fraud, but he conceded that "it isn't clear" if patients knew what drugs and dosages they got.
"Obviously you're the specialist, I'm not," Tettlebaum told Hausheer. He said that if the board wanted to talk about harm to patients, it should ask Rednam when he reapplied for his license.
The board took a hard line at the hearing. One member noted that the board could ban Rednam for the maximum seven years "if we think he's a menace."
That's what the board did.
Inexplicably, the board also agreed to a set of facts that were favorable to Rednam:
It agreed that Rednam was a charitable man who took responsibility for his actions. It characterized the dosing scam as a "treatment confusion" that Rednam readily admitted to his patients.
Although Rednam was convicted of obstructing a health care investigation — and the government complained that he destroyed evidence and wasn't helpful — the board paradoxically agreed that Rednam had been cooperative.
Finally, the board agreed that Rednam had a rare skill and that if he got his license back "it would be in the public interest to put him in a position where he could resume his good works."
Citing that statement, Tettlebaum argued in court that the board had not justified a seven-year ban. An appellate court agreed, and the case was sent back to the board.
Rednam and his attorney took it as another opportunity to plead for mercy.
At a hearing on Oct. 22, he tearfully read letters of support from family members, friends and patients. He testified that he had brought dishonor to his extended family.
Tettlebaum and Rednam spent an hour imploring the board to give the doctor a chance to reapply.
Rednam said it was "irrational insanity" and not money that had driven him to the crime. He insisted that patients were not harmed by switching or dividing drugs.
Tettlebaum touted Rednam's service in Washington Park as proof of his rehabilitation.
Not only was Rednam needed at Trinity Eye Clinic, he argued, but another group of clinics in Metro East was poised to hire him to treat needy diabetic patients.
Tettlebaum insisted: "If you don't give him that chance, the public is not protected."
Tettlebaum told the board that Rednam saw patients at the eye clinic every Wednesday.
The first Wednesday after the meeting, Oct. 27, Rednam saw just one patient.
Mike Adkins, 56, was having vision problems. After Adkins walked out from an hour-long exam, reporters asked him if he knew that Rednam had gone to prison.
Adkins stopped in his tracks.
"You're scaring the hell out of me," he said. "I would have liked to have been informed about that."
Rednam told reporters he has not disclosed his problems to any of his new patients.
"No one has asked me about it," he said.
The office looks like any other doctor's. A white coat hung from a coat rack. Business cards stacked on the front desk said, "Trinity Eye Clinic: We Care."
A framed certificate on his wall recognized him for specialized training in ophthalmology. Board certification is the mark of a highly trained physician.
But the American Board of Ophthalmology says he is not certified.
"I was," he insisted to reporters who visited his office.
On the following Wednesday, Rednam didn't come to the office.
Reached by phone, he said he wasn't expecting any patients that day and had other things to do.
"It's a 50-mile round trip," he said.
WHAT PATIENTS KNEW
After an internal audit at Rednam's clinic revealed the dosing scam, his medical partners turned the case over to federal investigators. Then Rednam stayed in his office after business hours and destroyed patient files, he admitted in court. Other employees told investigators they saw him leaving his office with bags of records.
The government ordered Rednam to tell his patients about the misdosing — or the FBI would do it for him.
But the questionnaire sent by Rednam to 162 patients did not acknowledge any scam.
The letter told patients they may have received one drug when they signed a consent form to get another. The letter asked patients "to assist in determining the effectiveness of the treatment" by filling out a simple questionnaire that asks about any changes in vision or side effects.
An alternative version of the letter sent to some patients suggested patients might have benefitted from Rednam's actions. It said that drugs might have been added to treatments to "enhance the effectiveness" and that doctors were "eager to determine" the results.
Gearline Holtgrave showed the letter she got in the mail to her daughter, who thought it was strange. Then she sought a lawyer's advice.
After news coverage of Rednam's arrest, Holtgrave sued the doctor for medical malpractice, blaming him for her loss of vision in her right eye. The case is scheduled to go to trial next year.
Holtgrave is "real angry, and I don't blame her," said her attorney, Michael Stokes. He didn't think the questionnaire satisfied patient concerns, and no one ever called to explain the full story to her.
Another patient said he was grateful because his eyesight improved.
"I can't really speak poorly of him," said H. Russell Heath Jr. of Crestwood.
A friend of Adkins — Rednam's lone patient on the recent Wednesday — sees good in the man.
"He just made a mistake," said Jimmie Griffin, 59. "He paid his debt. Gotta keep living."
Missouri Healing Arts board members seem to agree.
Last week they reversed course, citing Rednam's volunteer work.
He can reapply for his medical license immediately.