Day or night time, Marc Cohen, a serious donor to Dana-Farber Most cancers Institute, had a direct line to one in all its main oncologists. No query was too large or too small, and virtually no hour was off limits for a session.
Cohen and his physician, Kenneth C. Anderson, exchanged lots of of emails and texts over twenty years about Cohen’s illness, a number of myeloma, a uncommon and incurable blood most cancers that’s Anderson’s specialty. It was no downside for the doctor to pause a Sunday morning stroll together with his spouse to weigh in on take a look at outcomes, reply to a 5:50 a.m. e-mail on a Saturday to recommend remedy for insomnia-inducing leg ache or soar on the cellphone at quick discover.
So after Cohen died in 2022 of issues from Covid-19 at a hospital close to his suburban Washington, D.C., residence, it got here as a shock to his brother when, he stated, a lawyer for Dana-Farber claimed Anderson was not Cohen’s physician and by no means had been. Slightly, he supplied recommendation out of friendship.
Consequently, Dana-Farber stated it didn’t have any medical data of Anderson’s most cancers care to share with Cohen’s household, data that might make clear the remedy he obtained in his last days.
Now Cohen’s brother has filed a grievance in opposition to the esteemed oncologist with the Massachusetts Board of Registration in Medication, contending that Anderson’s failure to maintain medical data violated state laws and moral requirements for physicians. Medical data are essential for protected affected person care as a result of they permit docs to trace progress, monitor allergic reactions, and recall failed remedies.
The unraveling of the Cohens’ relationship with Dana-Farber — the place Marc was additionally a trustee and each he and his brother invested in hospital start-ups — has not solely created potential authorized issues for the hospital and Anderson. It additionally illustrates the potential dangers for establishments when star docs give particular off-the-books entry to trustees, donors, and different VIPs — a not unusual association at prestigious tutorial medical facilities.
If Anderson believed he was offering casual recommendation to a key supporter and shut buddy, was he as vigilant as he would befor an official affected person? Was he accountable if errors have been made? And who precisely was in cost?
Marc Cohen had a group of docs looking for him. His major care doctor was close to him within the D.C. space, and he obtained most cancers remedy from Robert Siegel, an oncologist affiliated with George Washington College College of Medication.
However Siegel was not an skilled particularly in a number of myeloma. For that, Cohen relied on Anderson, his brother stated.
To make sure, Cohen was removed from a typical affected person.
A enterprise capitalist who made his fortune as a expertise entrepreneur, he turned a multimillion-dollar donor to Dana-Farber and to Anderson’s analysis lab after he developed potential indicators of most cancers within the early 2000s. The institute appointed Cohen a trustee in 2004. And he and his brother, Alain, invested in 5 startup firms grounded in Dana-Farber analysis between 2008 and 2021 in hopes of making marketable most cancers remedies — one in all Dana-Farber’s most prolific partnerships.
Marc Cohen knew he was lucky to have unfettered entry to Anderson, a broadly printed researcher and training doctor who has garnered many high nationwide awards for his contributions to the remedy of a number of myeloma. However, given their connection to Dana-Farber, he and his household additionally anticipated a sure degree of consideration from Anderson.
“Is he his physician or is he not his physician?” Alain Cohen requested, talking of Anderson in a current interview with the Globe. “You may’t give the impression and act such as you’re the physician and even make selections and provides recommendation and inform the affected person to do issues and provides path after which say, ‘However I’m only a pleasant adviser.’ It’s a grey space of care.”
Anderson didn’t reply to requests for an interview. His lawyer, John Faggiano, stated in an e-mail, “There can be no remark right now.” Dana-Farber executives additionally declined to reply questions concerning the dispute, together with whether or not Anderson’s relationship with Marc Cohen was typical for its docs and VIPs.
Dana-Farber spokeswoman Ellen Berlin stated in a press release that every one sufferers “get the identical world-class care” there “irrespective of their zip code or their relationship to the establishment.”
Berlin stated Dana-Farber officers wouldn’t touch upon the medical board grievance “to guard the integrity and confidentiality of an ongoing course of.”
Alain Cohen’s lawyer, Stephen Pierce, shared with the Globe the 275-page grievance that he filed with the medical board in November 2023. It included dozens of emails between Anderson and Marc Cohen in addition to medical data from his hospitalization for Covid and docs’ appointments that checklist Anderson as a part of his remedy group.
The medical board wouldn’t touch upon its investigation.
Marc Cohen was first recognized with an irregular protein in his blood, a situation known as monoclonal gammopathy, which later developed into a number of myeloma. On the time he swore his brother to secrecy. Not even his dad and mom knew he had most cancers till he was admitted to the hospital for Covid January 2022. Alain Cohen stated he doesn’t know precisely the place or when his brother was recognized, however that it was someday within the early 2000s.
In an interview with the Globe in 2021, Marc Cohen stated he acquired taken with Anderson’s work as a result of he had family with most cancers. He didn’t mentionhis personal sickness.
Over time Cohen’s donations to the hospital totaled about $4 million, his brother stated, with the overwhelming majority supporting Anderson’s lab. The quantity doesn’t embody investments Marc and Alain made in firms shaped from Dana-Farber analysis.
Alain Cohen stated he wasn’t positive precisely when or how Anderson started advising his brother on his most cancers remedy. However he stated the aim of his brother’s donations was twofold. “Not solely do I wish to be Ken Anderson’s affected person, however I wish to assist Ken Anderson get a few of his analysis out into the world.”
For years, Marc Cohen felt fairly good, his brother stated. He married a veterinary neurosurgeon in 2016 and the couple had three kids. (Marc Cohen’s spouse didn’t reply to requests for an interview.) Within the decade earlier than the pandemic, he labored extremely lengthy hours on the funding agency he owned together with his brother, launched firms, and performed tennis till he started to expertise ache and numbness in his legs. A sequence of medicines, together with chemotherapy, stored his most cancers largely in test.
Then the coronavirus tore by way of the world, a disastrous improvement for somebody with a weakened immune system from most cancers. Marc Cohen examined constructive on Jan. 7, 2022, and the subsequent day, his brother drove him to the emergency room at Virginia Hospital Middle.
The next months have been a curler coaster. He was transferred to a much bigger hospital, George Washington College Medical Middle. He was on and off a ventilator and contracted infections within the hospital 4 separate instances, his brother stated. His kidneys shut down, and he required dialysis. He developed seizures. For the final a number of months within the intensive care unit, he was so sedated he couldn’t speak or transfer, his brother stated.
“Marc was trapped in his physique,” Alain Cohen stated. In June 2022,docs suggested Alain, who was legally empowered to make medical selections for his brother, to take away life help. “They stated he is likely to be in plenty of ache, so I felt I needed to observe their recommendation.’’
Days after Marc Cohen died on June 28, 2022, Alain and Marc Cohen’s spouse wrote Anderson a few lengthy emails, charging that docs had failed him. Regardless of Marc Cohen’s immense assets, “he fell between the cracks within the medical system,” they stated, as a result of “no one took the bull by the horns.”
5 physicians and an lawyer, all of whom focus on medical ethics, advised the Globe that the brink for a doctor-patient relationship is an space of frequent debate.
“It isn’t in any respect uncommon for VIPs, donors, and others who’re vital to request issues that aren’t usually carried out for individuals,” stated Susan Dorr Goold, an internist and well being coverage professor on the College of Michigan.
An off-the-cuff dialog in a restaurant a few rash or chilly signs wouldn’t rely as a doctor-patient relationship, ethicists stated. Neither would a so-called “curbside session,” when a physician provides a colleague recommendation on a case. However the connection between Anderson and Marc Cohen clearly went far deeper.
In a September 2020 e-mail to docs at Johns Hopkins Hospital, Anderson wrote, “Marc Cohen is my affected person with a number of myeloma” and acknowledged he’s medically cleared to bear hernia surgical procedure. The next January, Anderson wrote a letter saying Cohen had been his affected person since 2014 and requested he obtain precedence for a Covid vaccine. The e-mail and letter have been supplied to the Globe as a part of the medical board grievance.
“If he wrote letters for the affected person talking because the affected person’s physician, to me, that’s proof of a doctor-patient relationship,” Goold stated. “He’s rendering an opinion based mostly on his data of the affected person.”
The American Medical Affiliation Code of Ethics merely states that “a patient-physician relationship exists when a doctor serves a affected person’s medical wants,” usually by mutual consent.
Alain Cohen stated he doesn’t consider Anderson billed his brother, and it’s unclear if he ever examined him in his workplace at Dana-Farber. However docs interviewed by the Globe stated that an in-person examination is just not obligatory to satisfy the factors of a doctor-patient relationship, particularly with the rise of telemedicine.
Siegel stated he noticed Marc Cohen repeatedly and regarded himself to be accountable for his care, however that he collaborated with Anderson due to his appreciable experience in a number of myeloma.
However he stated Anderson and Marc Cohen have been additionally buddies, and “that’s the place it will get slightly murky. Is that this a doctor-patient relationship or is that this a buddy? It’s a singular factor that I haven’t seen elsewhere.”
Pierce, Alain Cohen’s lawyer, stated a Dana-Farber lawyer, Christina Lau, advised him throughout a Could 2023 cellphone name that Anderson was performing as a “good buddy” and adviser to Marc Cohen as a consequence of their friendship and since he was a trustee.
Dana-Farber officers disagreed with Pierce’s characterization of the dialog however wouldn’t specify why.
In her assertion, Ellen Berlin at Dana-Farber appeared to attract a distinction between when the hospital’s docs share their experience with different physicians and when Dana-Farber docs deal with sufferers on-site.
“It’s common for our medical groups to work together with docs throughout the nation and globally to supply our experience,“ Berlin wrote. ”It doesn’t matter if the affected person beforehand obtained care right here, does now, or has by no means stepped foot in our clinic.”
“Dana-Farber requires applicable file holding for care supplied at or by way of our clinic,” she added.
The medical board wouldn’t touch upon why its investigation continues to be open 16 months later. Whether or not Anderson faces disciplinary motion for not holding medical data might hinge on whether or not the board believes he and Marc Cohen had a doctor-patient relationship.
“I might see how this might occur, the place it builds over time beginning as a cocktail celebration dialog and ends with these emails the place he’s actually directing care with out ever formalizing the connection,” stated Dr. Matthew Wynia, director of the Colorado College Middle for Bioethics and Humanities. “We educate medical college students to be slightly cautious.”
Of their emails to Anderson after Marc Cohen died, his brother and wifeaccused Anderson and the opposite docs of not working exhausting sufficient to get Marc Cohen a sure monoclonal antibody to battle the Covid an infection. Marc Cohen, they stated, ought to have gotten the extent of care afforded to the US president, however he didn’t. President Trump obtained an experimental antibody when he turned sick with Covid in 2020.
Anderson responded about an hour later that he did every little thing he might. He stated he requested Dana-Farber’s pharmacy for a more moderen antibody however was advised it was not accessible there.
“I helped you each persuade Marc he wanted emergent care and helped you get Paxlovid,” an antiviral remedy, Anderson wrote in an e-mail that was included within the medical board grievance.
Siegel additionally took exception to the criticism, saying Marc Cohen had many docs specializing in his care, particularly as soon as he entered the hospital. “Marc Cohen was an especially beneficiant man. He was a major donor right here as properly. Everybody concerned wished to do their greatest for his care.”
Anderson’s e-mail didn’t make clear what has turn into a vital query of whether or not he and Cohen have been physician and affected person.
“I’ve tried my greatest every day ever since I met him 20 years in the past to take care of him as I might a cherished buddy and member of the family,” Anderson wrote. “We have been companions and brothers in myeloma and in life.”