The New York Times - USA (2020-07-28)

A6 Y THE NEW YORK TIMES, TUESDAY, JULY 28, 2020

Tracking an OutbreakDoubts and Skepticism

publishing business.
“You couldn’t trust what he
said,” said Dr. Vanessa Olcese, a
former chief resident who worked
with Dr. Desai at Duke University
Medical Center. “You would verify
everything that he did and take
everything he did with a grain of
salt.”
His performance there and dur-
ing a later fellowship at the Uni-
versity of Texas Health Science
Center raised questions about
whether he would be permitted to
move to the next level of training.
In both instances, he was.
More recently, in February, Dr.
Desai left his job at a community
hospital in a Chicago suburb
where he had worked as a surgeon
since 2016. He was named as a de-
fendant in three medical malprac-
tice lawsuits last year, court
records show. His spokeswoman
said he “deems any lawsuit nam-
ing him to be unfounded.”
The New York Times inter-
viewed more than two dozen peo-
ple who have known Dr. Desai
over the past two decades.
Dr. Desai, who declined to be in-
terviewed for this article and did
not respond to repeated requests
for comment, has defended his
company’s data. In an interview in
late May, he said it was his “life’s
work” to build a company that
could provide lifesaving clinical
insights to make “the world a bet-
ter place.”
“We did this because it was an
opportunity to help. We’re not
making any money from this,” he
said. “This is why I went into
medicine.”

A Fast Rise

Dr. Desai was always a striver.
During high school in the Chicago
suburbs, he took 13 Advanced
Placement classes, according to
an article in The Daily Herald, a
local newspaper. He acquired
enough college credits to gradu-
ate from the University of Illinois
at Chicago at 19.
“His goal was to be the first per-
son at U.I.C. that ever graduated
college in one year,” said Peter
Okkema, a biology professor in
whose lab the young undergradu-
ate worked. He seemed eager to
impress people, the professor re-
called, but never sought advice or
guidance.
He entered a joint M.D.-Ph.D.
program at the university; his
doctoral adviser, Prof. Anna
Lysakowski, remembers him as
“very bright, very quick.” She also
said he told her he was enrolled at
John Marshall Law School. (The
school has no record of him, a
spokeswoman said, and the de-
gree is not on his résumé.) Several
doctors who knew Dr. Desai after
he moved to Duke for his residen-
cy in 2006 recalled his saying he
had a law degree and described
his license plate listing his sup-
posed credentials: M.D., J.D. and
Ph.D.
Over the next five years, his
performance and a pattern of be-
havior at the North Carolina hos-
pital worried colleagues, accord-
ing to physicians who worked
with him there.
In interviews, Drs. Olcese, Mani
Daneshmand, Dawn Elfenbein
and 10 others — who spoke on the
condition of anonymity because
they were not authorized to talk to
the media or feared retribution
from their employers or Duke —
said there were broad concerns in-
side the surgery department
about Dr. Desai.
The doctors, many of whom
were also residents, said they
could not trust information he pro-
vided about patients’ medical con-
ditions or test results. Several doc-
tors said it became standard prac-
tice to double check anything Dr.
Desai said about a patient, such as
how the person had fared
overnight or whether a test had
been ordered.
Several former colleagues said
that often he did not follow
through on directives about treat-
ing patients, and that when he was
questioned about it, he sometimes
passed blame or offered implausi-
ble explanations.
In one instance, Dr. Desai did
not respond to pages from nurses
during an overnight shift while on
call, recalled Dr. Olcese. When she
asked about the missed pages, he
said he had been resuscitating an
infant by performing a rare, com-
plicated procedure — an incident
the charge nurse said never oc-
curred, according to Dr. Olcese
and another doctor present for Dr.
Desai’s explanation.
“He was essentially a giant
roadblock that you had to work
around,” said Dr. Olcese, now a
neurocritical care doctor at Wex-
ner Medical Center in Columbus,
Ohio. “You didn’t want him to
bring you down with him.”
In 2008 or early 2009, Dr. Olcese
and another chief resident shared

concerns about Dr. Desai with

their supervisors — senior physi-

cians and faculty at Duke — dur-

ing discussions about whether to

promote him to the next year of

residency. It is unclear what the

faculty members discussed dur-

ing their private deliberations, but

ultimately, Dr. Desai was moved

up. A Duke spokeswoman would

confirm only his time there.

After his residency, Dr. Desai

obtained an M.B.A. in three

months from Western Governors

University, an online university

based in Salt Lake City, the school

confirmed. Then, after starting a

vascular surgery fellowship at the

University of Texas at Houston, he

ran into trouble. He had so antago-

nized some supervisors that they

asked the department chairman

to expel him, said Dr. Hazim Safi,

who was then in that role.

“Some of the attending staff did-

n’t like his behavior, and didn’t

want him to graduate,” Dr. Safi

said in an interview.

While Dr. Safi said that Dr. De-

sai could be abrasive, he had

worked on papers with the young-

er physician and was convinced

the complaints were driven by

personality differences and pro-

fessional jealousy, not substantive

deficiencies in surgical skill or pa-

tient care. Instead of failing him,

he said, he gave Dr. Desai an op-

portunity to work on his profes-

sionalism and interpersonal

skills.

“I intervened and he graduat-

ed,” the former chairman said.

At Dr. Desai’s most recent post

at Northwest Community Hospi-

tal in Arlington Heights, Ill., he be-

came involved in at least four

medical malpractice cases that

are still pending, including three

filed in 2019.

Those suits include a claim that

he failed to properly perform

surgery to restore circulation to

an accident victim’s leg, which lat-

er required partial amputation.

Another alleges that negligent

treatment by Dr. Desai and other

doctors resulted in the removal of

a substantial portion of a patient’s

bowel.

The earlier case against the

hospital contends that Dr. Desai

performed surgery in 2016 to re-

move plaque buildup from a 60-

year-old man’s carotid artery,

then failed to report to the hospital

after the patient developed

swelling in his neck that caused

difficulty swallowing and breath-

ing. The patient later died.

Data and Dreams

By the time Dr. Desai left the

hospital earlier this year — a hos-

pital spokeswoman said he volun-

tarily resigned for personal rea-

sons — the novel coronavirus was

raging in China and spreading to

other countries.

For Dr. Desai, whose entrepre-

neurial projects had grown to in-

clude a health data analytics com-

pany, the crisis was an opportuni-

ty to fulfill his dream of using big

data to study outcomes and im-

prove care. The public’s appetite

for information was insatiable and

journals were publishing studies

faster than ever.

Over the years, Surgisphere

had developed a product called

QuartzClinical that offered health

centers a platform using data ana-

lytics to improve outcomes. Dr.

Desai said the product had en-

abled Surgisphere to amass a gi-

ant registry with anonymized

electronic health records from

more than 1,200 hospitals and

health centers, with data about

more than 240 million patient en-

counters in 45 countries.

While the existence of the data-

base has not been confirmed — Dr.

Desai cited contractual obliga-

tions to keep confidential the iden-

tities of participating hospitals —

he said he had been building it for

a decade with fewer than a dozen

employees. Few people were

needed, he said, because hospitals

could easily input anonymized pa-

tient data from disparate elec-

tronic health record systems,

translating the information into a

single, homogenized registry

without technical assistance.

One former Surgisphere em-

ployee, Ariane Anderson, was sur-

prised by Dr. Desai’s assertion,

given the difficulties of combining

information from disparate insti-

tutions with various electronic

records systems. Ms. Anderson,

who was hired to market Quartz-

Clinical to hospitals and other

health centers in 2019, said in an

interview that generating interest

in the company had been an uphill

battle, and that entering data into

Surgisphere’s system was labori-

ous. When one hospital wanted to

try out the system last July, she

said, she spent two days there ex-

tracting data from a sampling of

200 patients to put into a spread-

sheet.

By the end of 2019, Ms. Ander-

son said, she knew of only one hos-

pital that had signed a contract

with QuartzClinical, declining to

identify it.

The new coronavirus put the

company on the map. One of Dr.

Desai’s projects early this year

was to develop a Covid-19 severity

scoring tool using data he said

came from tens of thousands of

registry patients. He offered the

tool free to a nonprofit based in

Cape Town, South Africa, saying it

could identify high-risk patients

and help allocate scarce medical

resources in remote areas. (The

group, the African Federation for

Emergency Medicine, rescinded

its endorsement of the tool after

the studies were retracted.)

Dr. Desai also teamed up with

Dr. Mandeep Mehra, a Harvard

Medical School professor, and sev-

eral others to turn out papers

about Covid-19 that were ostensi-

bly based on the patient registry.

In May, he won the equivalent of

academic medicine’s jackpot:

publication in two of the world’s

most prestigious journals.

The first paper, citing data from

8,910 Covid patients at 169 hospi-

tals in Asia, North America and

Europe, reported that cardiovas-

cular disease increased the risk of

bad outcomes, but put to rest con-

cerns that blood pressure medica-

tions were harmful (it even

seemed to suggest a benefit). It

was published May 1 in The New

England Journal of Medicine.

The next paper, published May

22 in The Lancet, evaluated anti-

malaria drugs that Mr. Trump has

promoted as antidotes to the coro-

navirus. The researchers claimed

to have analyzed the outcomes of

nearly 100,000 Covid-19 patients

from 671 hospitals on six conti-

nents. The results were sensa-

tional: Patients treated with

chloroquine and hydroxychloro-

quine were up to five times as

likely to have abnormal heart

rhythms as other patients — and

were at higher risk of dying.

Though it was an observational

study, considered to provide rela-

tively weak scientific evidence,

the paper’s impact was felt around

the world. A physician comment-

ing on CNN called it “the mother

of all studies,” and investigators

including the World Health Orga-

nization halted clinical trials of the

drugs. (Some have since re-

sumed.)

The paper soon drew scrutiny

from scientists who demanded to

know more about the data and be-

gan questioning the New England

Journal study too. Dr. Desai’s co-

authors, conceding they had

never seen the raw data, called for

an independent review, but Dr.

Desai balked, invoking confidenti-

ality agreements. On June 4, both

journals retracted the studies.

Surgisphere’s flashy website

has been dismantled. Dr. Desai,

who gave several interviews be-

fore the studies were retracted,

has gone silent.

THE RESEARCHER

Behind Retracted Covid Studies, Big Talk and Big Plans

From Page A

Dr. Sapan Desai, center, in 2015. He produced two studies in May related to coronavirus treatment that were later retracted.

RICH SAAL/THE STATE JOURNAL-REGISTER VIA USA TODAY NETWORK

Dr. Desai spent five years at Duke University Medical Center.

Colleagues there said they raised concerns about his work.

PETE KIEHART FOR THE NEW YORK TIMES

One retracted study linked drugs like hydroxychloroquine to increased deaths of Covid-19 patients.

GEORGE FREY/REUTERS

Research was contributed by Su-
san C. Beachy, Jack Begg, Alain
Delaquérière and Sheelagh Mc-
Neill.

SEOUL, South Korea — The au-

thorities in South Korea con-

firmed on Monday that a 24-year-

old man who had defected from

North Korea in 2017 had secretly

returned to the North, crossing

one of the world’s most heavily

fortified borders during a pan-

demic and possibly bringing the

coronavirus with him.

On Sunday, North Korea

claimed that a man had crossed

into the country from the South,

and that he was likely infected

with the virus. South Korean offi-

cials went in search of any defec-

tors who had gone missing, and by

Monday they had zeroed in on the

24-year-old man, identified only

by his family name, Kim.

In 2017, he swam across the

western inter-Korea border,

which traces a path through a nar-

row sea strait, to defect to South

Korea. On July 19, he swam back

across the border into Kaesong, a

city in the North, after crawling

through a drain under barbed-

wire fences, his family said.

It was not immediately clear

why the defector had returned to

the North. The South Korean

news agency Yonhap reported

that the man had been wanted by

the South Korean police for ques-

tioning after a fellow North Kore-

an defector accused him of raping

her last month.

North Korea said on Sunday

that the man was “suspected to

have been infected with the vi-

cious virus,” adding that he could

be the country’s first virus case.

The reverse defection prompted

the North’s leader, Kim Jong-un,

to order a total lockdown of

Kaesong, a city of 300,000 people

on the border with South Korea,

and to declare a “maximum” na-

tional emergency.

Until Sunday, North Korea had

repeatedly said that it had no

Covid-19 cases. The claim was

questioned by outside experts

given that the country shares a

long land border with China,

where the virus erupted late last

year. The North also lacks equip-

ment and medicine to fight an epi-

demic.

But South Korean officials could

not say whether the man might

have carried the coronavirus

across the border.

He had never been tested for

the virus, Yoon Tae-ho, a senior of-

ficial at the South’s national dis-

ease-control headquarters, said

on Monday, and he was not known

to have been in contact with a co-

ronavirus patient. The South Ko-

rean health authorities have

tracked down two people who had

frequent contact with the defector

while he was in the South, and

both tested negative, he said.

South Korea’s military said on

Monday that its investigators had

found a bag belonging to the de-

fector abandoned on Ganghwa Is-

land, west of Seoul. They also

found signs that he had crawled

through a drain beneath the bor-

der’s barbed-wire fences.

“We spotted the specific loca-

tion from which he crossed over to

the North on Ganghwa Island,”

said Col. Kim Jun-rak, a spokes-

man for the South Korean mili-

tary’s Joint Chiefs of Staff, during

a briefing on Monday.

The defector’s current location

is not known. South Korean offi-

cials said he was a native of

Kaesong and was apparently fa-

miliar with the terrain around the

western front line, where the Han

River divides North and South Ko-

rea before emptying into the Yel-

low Sea. At some spots, the two

sides are separated by over a mile

of water.

He apparently swam across the

same general area where he had

originally defected. At least four

other North Koreans have swum

across the western river border to

the South since 2012.

The vast majority of the 33,

North Koreans who have fled to

the South since the early 1990s

have gone through China. But

some, like Mr. Kim, have crossed

the inter-Korean border, which, in

addition to being fortified by lay-

ers of tall, barbed-wire fences, is

guarded by armed sentries and

minefields.

North Korea

Says Defector

Brought Virus

South Confirms

Man Swam Back

By CHOE SANG-HUN

An arrival is accused

of being a nation’s

first case of Covid-19,

but experts doubt it.

BORDER CROSSING