Personal Reflections on Waking up Blind

Tom Harbin, Waking up Blind: Lawsuits Over Eye Surgery, Langdon Street Press, 2009.

Personal Reflections on Waking up Blind

By Ronald G. Boothe

Professor Emeritus, Emory University[1]

Shortly before 6 pm on September 12, 1983, I found myself sitting in the surgery suite at Emory University Hospital in Atlanta, Georgia. What I did not know at the time, but learned later, was that a horrible mistake was about to happen right after I left. The next patient in line, an elderly African American man named Sargus Houston was scheduled to have surgery performed on his right eye, but the surgery was done on the left. That accident set in motion a chain of events that was to alter the lives of countless individuals, including my own, over the next several years. The facts are now spelled out publicly for the first time in Tom Harbin’s just published book (Waking up Blind: Lawsuits Over Eye Surgery, Langdon Street Press, 2009). I was a direct witness to some of the happenings detailed in the book, but mostly what I knew about these events as they were playing out was revealed via the grapevine of whispers in the shadows of the hallways at Emory University. I was only a bystander, but not an emotionally neutral one; more akin to an eyewitness to a mugging.

So how did I end up sitting in the surgery suite on that fateful day? Let me back up a year to put these events in perspective. At the time, I was an Associate Research Professor at the University of Washington in Seattle. I am a psychologist by training, but I had joint appointments in both the Department of Psychology and Ophthalmology because my research on perception had direct relevance to a group of disorders that can lead to blindness in children. One day I received a phone call from Allen Gammon, Chief of Pediatric Ophthalmology at Emory University. He was assembling an interdisciplinary team of scientists to conduct research on how to treat children born with cataracts, and he wanted to recruit me to move to Emory University and join this team. At the time I was firmly entrenched at the University of Washington and had no interest in leaving the Pacific Northwest to move to Atlanta, so I turned him down.

I discovered that Allen was not an easy person to turn down when, soon after, he appeared at my doorstep making a sales pitch about why I should join his research team. He told me stories about his patients: Desperate parents of babies with infantile cataracts who had been referred to the Eye Clinic at Emory University, a major regional medical center. Allen revealed how he agonized over what treatment to recommend to these parents because, at the time, there was no consensus about the best way to treat children with this disorder. The particular treatment an infant with cataracts would receive at the time depended mostly on what region of the country the child was born in. A child born with cataracts in Seattle, for example, and referred to a pediatric ophthalmologist at University of Washington, might receive a totally different treatment from one born in Chicago, or New York, or Houston, or Atlanta. So Allen was attempting to assemble an interdisciplinary research team, a group that was to include eye doctors, contact lens specialists, neuroscientists, and bioengineers to carry out a program of scientific studies to establish what treatments were the most effective for preventing blindness in these children.

Eventually, Allen persuaded me to come to Emory University for a visit. During this visit I was scheduled to meet with Dwight Cavanagh, Chair of the Department of Ophthalmology. When I arrived at his office for my appointment late in the afternoon I was informed that his surgery schedule was running late, but that he could still see me if I came by the surgery suite about 6 pm that evening. When I arrived Cavanagh was sitting in the rest area of the surgery suite, between patients, wearing his scrub suit. I had arrived expecting, based on experience with how these kinds of interviews usually go, that he would not even know who I was, and that this would be a perfunctory interview along the lines, “So nice to meet you, hope you will consider joining our wonderful department, sorry I have to run now to take care of important business…” Instead, he greatly impressed me by relating his vision of where he wanted to take his department, and how my own research would fit in with that vision, and astoundingly, he did this with sufficient detail that it was clear he had actually taken the time to read some of my published papers in preparation for our interview. I was to learn later that this was characteristic of Cavanagh. He is one of those charismatic and brilliant individuals who seemingly works around the clock with little or no sleep, reading prodigiously, remembering everything he has read, and approaching every aspect of his job, even a perfunctory interview with a junior faculty recruit, with meticulous preparation.

Cavanagh had already performed 12 eye surgeries that day before our interview. Typically, eye surgeons doing these kinds of complicated, delicate surgeries would schedule far fewer than that, perhaps 5 or 6 even on a long day. Residents working with him frequently stated that Cavanagh was one of the fastest surgeons they had ever worked with and were often amazed at his stamina. Similarly, in his office on non-surgery days, Cavanagh would sometimes see 50 or 60 patients, spending only a few minutes with each, sometimes after they had sat in the waiting room for 5 or 6 hours waiting to see him. But the downside was a growing concern by Cavanagh’s colleagues that his workload was so far off the scale of what a typical doctor would perform that quality of care of his patients almost certainly had to be suffering.

The reason Cavanagh was taking a break before his next surgery (the break during which he met with me, and I learn now from reading Waking up Blind also included a meeting with an official in the administration at Emory University about financial matters) was because it was taking a long time to get the next patient ready for surgery. The patient was in poor health and his vital signs were not good enough to allow him to undergo surgery without first getting extensive prepping. In fact the anesthesiologist had recommended that surgery be postponed because the patient was in such poor shape that it could be dangerous. Why, one might ask, was the powerful chair of the ophthalmology department sitting around at 6 o’clock at night waiting to do surgery on a sick patient? Was this a medical emergency? A patient in crisis who absolutely had to have this eye surgery completed this day? No; it turns out that there was no compelling medical reason for this patient to be getting eye surgery today. But if this frail elderly black man lying on a gurney in the wings of the hospital having potassium pumped into his system so that he could be stabilized sufficiently to allow him to receive eye surgery that evening was a questionable candidate on medical grounds, it turns out he was an excellent candidate for something else. Medicare could be billed for the eye surgery that was about to be performed. And Cavanagh was desperate to generate income to cover the 10’s of millions of dollars he had over-committed in the process of trying to build up the reputation of his department, money for items such as covering the startup costs of new faculty being recruited (like me), and to construct a new building for the Eye Center.

Finally, Sargus Houston was prepped sufficiently that surgery could proceed, and he was wheeled into the surgery suite. Dr. Dwight Cavanagh, Chair of the Department of Ophthalmology at Emory University and surgeon extraordinaire, performs his 13th surgery of the day. It was a success with one caveat; it was performed on the wrong eye!

Now comes one of those moments in time when choices are made that change the course of history irrevocably. Let me first describe a choice that Cavanagh could have made, but did not. He could have immediately admitted that a horrible mistake had been made. The consequences of that choice would probably have been that large sums of money would have had to be paid to the patient along with apologies for the mistake, and the protocols for the Emory Hospital Eye Surgery Suite would have had to be scrutinized to try to prevent this mistake from ever happening again, and perhaps Cavanagh would have been disciplined, even perhaps had his surgery privileges removed, at least for a time.

But that is not the choice Cavanagh made. Standing at a metaphysical fork in the road of existential moral choices, he chose to inform the patient that the surgery had been a success, and to bill Medicare for the costs of the surgery. Medical records were altered in a manner indicating that both eyes needed surgery, and the patient was informed that he would have to come back later for a remaining surgery on his other eye.

It is fascinating to speculate about why Cavanagh came to make this choice. No one knows the answer to this question, of course, except Cavanagh himself. However, it is possible to construct a hypothetical scenario of what might have happened that is consistent with all of the documented facts laid out in Waking Up Blind. Consider for a moment that you were a powerful surgeon who desperately needed to generate income, and on a given surgery day suppose there were only 4 patients who clearly needed surgery, but 2 other patients who were borderline and might benefit from surgery. You might be inclined to schedule, and bill, all six. And if this pattern continued over a period of weeks or months, the criteria for what patients get scheduled for surgery on a given day might, ever so gradually, get more lax. Eventually so lax that charts of patients, which did not originally indicate they needed surgery, were sometimes altered. These would be borderline cases, and the alteration of charts would not be done blatantly. Instead, a comment might be made to a young resident working in the hospital. Something along the lines, “Remember that Medicare patient out on the wing of the hospital that you examined last week and noted in the chart that his acuity was slightly abnormal? Maybe you should go back and examine him again, because I think you might have failed to measure it accurately, and if his acuity was actually a little bit worse than what you recorded in his chart, he would be a good candidate for surgery. And I just happen to have an open slot this afternoon! Perhaps you can even assist me with the surgery.” Soon the medical chart is altered indicating that in fact the patient does have acuity just poor enough to qualify under Medicare rules for receiving surgery. Eventually, a pattern emerges in which it is not that unusual to have patients scheduled at the end of the day, typically elderly or poor patients, most African American, whose bills will be paid by Medicare or Medicaid, whose charts did not initially indicate that they needed surgery, but shortly before the surgery were “updated” to reflect the fact that they did qualify for surgery.  If you were a powerful surgeon who had been doing this for a long period, and then one day you did surgery on the wrong eye, it might not seem that unusual, in your own mind, to simply alter the chart to indicate that surgery was needed on that eye. After all, this does not seem to be that much different from what has been happening at the end of long surgery days for a long time.

Even before the wrong eye surgery, strains had developed between Allen Gammon and Cavanagh. The residents and fellows working in the clinic “would often ask Gammon to examine Cavanagh’s pediatric patients so the young patients and families wouldn’t have to wait the typical four to six hours [to see Cavanagh].” In the course of seeing these patients, Gammon discovered that Cavanagh was frequently leaving the eyes of infants patched for many weeks following surgery. With his training in pediatrics as well as ophthalmology, Gammon was aware that this was a dangerous practice and could easily lead to permanent blindness. Gammon confronted Cavanagh about this. Cavanagh responded that “he wanted support from Gammon, not criticism.”

Gammon became particularly upset about one particular case. He saw a two-year-old patient of Cavanagh who had received a corneal transplant. The transplant had developed an ulcer, an eye condition that should be treated as an emergency because it can lead to permanent blindness if not treated promptly. Gammon arranged for the child to be seen by Cavanagh, and then went about his business assuming the child had been taken care of. “A few weeks later, the child reappeared in Gammon’s office. The eye was blind, and Cavanagh had never carried out any treatment. Gammon was greatly upset.”

Allen Gammon was not the only faculty member with concerns about Cavanagh. Several other faculty members in the department had been confronted with evidence that was troubling. For example, there were repeated instances in which residents and fellows confided to senior faculty, always confidentially behind closed doors, that they had seen instances of medical charts being altered. Also, the clinical pathologist in the department had documented repeated instances where corneal tissue had been removed during one of Cavanagh’s surgeries, ostensibly because it was diseased, but turned out to have nothing wrong with it. An inside joke started to circulate among the residents and fellows in training at the Eye Center about a new condition called the “Cavanagh syndrome.”

Some of the nurses and other technicians working in the eye surgery suite were also developing concerns. It appeared to some that the presumed operating rule about how many surgeries should be performed on a given day had been turned on its head. Instead of the number of surgery slots being determined by the number of patients needing surgery, it sometimes appeared that the number of patients who needed surgery was being adjusted to fill the number of surgery slots available. Worse, nurses and other technical personnel working in the surgery suite knew that corneal tissue being used for transplantation was graded according to it viability, and they noticed that the best tissue was always used for the first surgeries of the day, with progressively poorer tissue used as the day went on. The first patients to get surgery each day were usually well-to-do and prominent members of the Atlanta community. For example, one day a Coca-Cola executive was scheduled for surgery in the 6th slot. On discovering this, Cavanagh moved him to first. Patients squeezed in at the end of the day were predominantly poor African Americans. These concerns had already prompted some of the staff to start accumulating evidence to demonstrate objectively what was happening. But mostly these were only impressions.

However, Cavanagh’s simple act of changing the medical chart on Sargus Houston’s normal eye changed everything. An invisible ethical line had been crossed that could no longer be ignored by those who worked with Cavanagh. One consequence of this was that multiple copies of various records began to be made secretly, and hidden in locked file cabinets in offices, or secretly taken home. There was fear in the air. Everyone with information about what had happened knew that at some point a scapegoat would probably be needed.

A meeting of the faculty of the Department of Ophthalmology was scheduled to take place three days following the wrong-eye surgery. By now, the rumors about what had happened had made the rounds of the department. David Campbell, a senior member of the faculty had had enough, and he made an arrangement with Travis Meredith, another senior member. On the day of the faculty meeting, David would make a motion that a faculty committee should be appointed to review what had happened. Travis had agreed to second the motion. On the fateful day of the faculty meeting, David Campbell made his motion. This was a courageous act. It was unprecedented for anyone to challenge the authority of the Chair of Ophthalmology, one of the most powerful persons on campus due in large part to the millions of dollars of income he was generating for Emory University. The motion was received in stunned silence. In the glare of the eyes of Cavanagh towards those faculty who were present, Travis Meredith apparently lost courage. He did not second the motion. A terrifying silence fell over the room. And then an event happened that was to have long lasting effects, not only on the Department of Ophthalmology at Emory University, but also, indirectly, on me. Allen Gammon, the faculty member who had recruited me to come to Emory and join his research team, who was at the time only an untenured assistant professor, a junior member of the faculty, piped up from the silence of the room and stated, “I second the motion.” Cavanagh had momentarily lost control of the situation, and as a result of this motion, a departmental quality-review committee was formed to look into what had happened, chaired by George Waring, and commonly referred to as the Waring Committee.

What followed is a horror story that further compounded the original horror of the wrong-eye surgery. I know first hand only that part that pertains to Allen Gammon, but the consequences for David Campbell were similarly grim, and what happened to both are detailed in Waking up Blind.

In the immediate aftermath, fear of retribution was the prevailing emotion in the department. Philip Newman, a young Corneal Fellow in the department who had assisted Cavanagh with the operation, had first discovered the mistake, and was aware of the alterations to the medical charts and of the lies told to the patient, was so terrified in the months that followed that he sometimes could not get up enough courage to start his car, afraid of a bomb.

Genevieve Switz, Cavanagh’s physician assistant who had been present during the wrong-eye surgery, was fired within months, as was one of Allen Gammon’s personal secretaries. These firings were ostensibly due to budgetary reasons. That justification seems hard to reconcile with two other events that happened near the same time.

First, Cavanagh received an end-of-the-year bonus check, over and above his regular salary, in the amount of $250,000 (equivalent to over $500,000 in current dollars), far more than he had ever received before The person who awarded Cavanagh the bonus was Charles Hatcher, the CEO of Emory Clinic. Hatcher paid himself a salary in excess of a million dollars that year (more than two million in today’s dollars).

Charles Hatcher was a member of Atlanta’s social elite. He and James Laney, the president of Emory University, frequently attended the downtown Rotary Club where Atlanta’s business leaders met weekly. Allen Gammon had earlier scheduled a meeting with Hatcher to discuss the incident where the 2-year-old child had gone blind, seemingly due to Cavanagh’s neglect. Hatcher’s response to Gammon’s concerns had been, “You win some you lose some.” Then to Gammon’s surprise, what he had thought was a confidential meeting with Hatcher had been reported back to Cavanagh

Two images come to my mind. The first is that of Charles Hatcher’s Rolls Royce idling in the driveway of the President’s Mansion at Emory, waiting to pick up president James Laney for their weekly trip downtown to have lunch at the Atlanta Rotary Club. The second image is the sound of a parent crying quietly at a home where a child has gone blind following treatment at Emory Clinic.

The departmental quality-review committee headed up by George Waring did not even meet until September of 1984, one year after the wrong-eye surgery took place. A curious thing happened just as the committee was getting ready to start its work. Cavanagh sent a memo to all three members of the committee stating that he was going to reduce his patient load, and turn his former patients over to the members of the committee.

Just in case the impact of this action was not clear to the committee members, he spelled it out for them in his memo: They should expect to each be able to, “increase your salaries somewhere between $15,000 and $50,000 depending on who does what…”

The Waring Committee report was released to the ophthalmology clinical faculty in the Fall of 1984. The report was classified confidential and was not to be leaked to anyone outside of the clinical faculty. Regarding the wrong-eye-surgery case of Sargus Houston, the Waring Committee concluded that, “the chart was altered [but] we have no evidence [italics added] that Dwight [Cavanagh] was the author of those changes.” This is no doubt technically true, since they did not take testimony from any witnesses, and did not make any attempts to have a handwriting expert examine the altered charts. The committee appears to have accomplished something similar to the proverbial three monkeys who, by covering their eyes, were able to see no evil.

Regarding the issue of fraudulent billing by Dwight Cavanaugh, the Waring Committee concluded, “We cannot determine whether the data presented represents purposeful [italics added] billing for surgery not performed.” Once again, this conclusion was technically correct, with the caveat that the committee did not interview any witnesses or make any other attempts to determine whether the obviously fraudulent billings were “purposeful”. And so it went. When the report was discussed during a meeting of the clinical faculty, many parts of it were reacted to with “widespread hoots.” For example, when George Waring was asked to explain how the committee arrived at the conclusion that,  “…Cavanagh did not intentionally [italics added] misrepresent the [surgical procedures] for financial gain.” One member of the faculty asked “How many times was it done?” Waring answered, “Oh, it would be a few hundred.” This entire procedure was beginning, for some within the department, to look more like an episode from The Three Stooges than a serious attempt to determine what had happened and why. But one goal had been accomplished, and accomplished well. The ophthalmology department could claim that a “quality-review committee” had looked into the matter and found “no intentional wrongdoing.” And perhaps even more important, those who had seen the contents of the report were sworn to secrecy, so the details would never see the light of day.

One senior faculty member, Bob Allen, seeing what was happening, had already decided to leave Emory, stating as his reason for leaving that, “he would no longer have his name and reputation associated with this type of program”, and that, “he refused to work for a sociopath.” In March of 1985, a second faculty member, pathologist John Wright, also decided to leave Emory. He had repeatedly sent “Code 3” reports to the Tissue Committee on campus that was supposed to look into cases where surgery was performed but the pathology failed to support the reason for the surgery, and the committee had not responded to a single one.

The fault lines in the faculty who remained were now starting to form. Waking Up Blind describes three groupings. The first was composed of a few faculty members who were staunch supporters of Cavanagh. The second group consisted of David Campbell and Allen Gammon, the only two members of the clinical faculty who openly refused to accept the conclusions of the Waring Committee Report. Third, was the remainder of the faculty who remained neutral, at least publicly. For those in the uncommitted group, a lesson was soon to be provided about what could be expected to happen should they decide to join Campbell and Gammon.

In July of 1985 David Campbell sent an official letter to Charles Hatcher, who by this time had been promoted by Emory University’s President James Laney to the position of VP for Health Affairs, formally requesting an inquiry from outside of the ophthalmology department. A copy of that letter was distributed to the ophthalmology faculty. Shortly thereafter, Campbell was in a meeting with Louis Wilson, a strong Cavanagh supporter. He noticed that Louis, “had a small piece of cord in his hands, looped into a noose. As he and Campbell talked, Wilson kept tightening the noose around his index finger. … David Campbell got the picture.”

In July of 1985, Hatcher, in response to the official request from David Campbell, sent the matter for review by the Professional Standards and Ethics Committee on campus, commonly referred to as the Ethics Committee. This will be the first time a committee outside of the ophthalmology department will have a chance to officially look into the matter. The Ethics Committee did take some testimony from a few witnesses. George Waring testified, somewhat defensively, that his departmental quality-review committee had not interviewed any witnesses. He stressed that the Waring Committee had only been charged with being a review committee. They had reviewed the medical charts and billings associated with the wrong eye surgery, and from some of Cavanagh’s other patients, and that is all they had done. Given that testimony, it appears surprising (or perhaps not?) that one of the conclusions of the Ethics Committee when they issued their final report was that the departmental Waring Committee investigation had been “very thorough.”

The only recommendation of the Ethics Committee with regard to Cavanagh was that his clinical practice should be monitored for 12 months. The charge that Hatcher had given to the Ethics Committee included answering the question, “Is there evidence of current [emphasis added] impropriety in the section of ophthalmology?” They were able to answer this artfully phrased question in the negative.

But the Ethics Committee’s work was not done. When Charles Hatcher passed along the original complaint from David Campbell to the Ethics Committee, he asked them to also address two other questions. “Has Dr. Campbell acted responsibly and correctly?” “Has Dr. Gammon acted responsibly and correctly?” The Ethics Committee took testimony from Cavanagh that was prophetic. In typical Cavanahesque style, his testimony included the following,  “The moving finger writes and having writ moves on. Nor all your piety nor wit shall have it back to cancel half a line, nor all your tears wash out a word of it. … [Campbell and Gammon] have to go.” The final report of the Ethics Committee included a formal reprimand of Campbell. Gammon was spared for now, but not for long.

As soon as the Ethics Committee report was finished, Emory University did something extraordinary. They made the results of the report public, including sending a news release to the Atlanta Journal Constitution newspaper. This was unprecedented because the deliberations and reports of this Emory University in-house committee had heretofore always been treated as internal deliberations that were protected by the legal status of “peer review”. This claim was dropped on the day the report was released to the newspaper, but only for that one day. Then the Emory University lawyers went to work, arguing that nothing else could be released due to the important principle of protecting confidentiality of in-house peer review. And this tactic worked for years, delaying the multitude of pending lawsuits that were eventually filed against Cavanagh, Hatcher, Emory Clinic, and Emory University, and dragged through the courts for over a decade.

The Atlanta Journal Constitution wrote a story based on the released Ethics Committee Report on September 11, 1985. I still remember the awful, sinking feeling I had when I read that day in my local newspaper, “There has not ever been [italics added], nor is there now, any impropriety in Dr. Cavanagh’s practice.” I now invite the reader to go back a few paragraphs to see if you notice a subtle change from what was really in the Ethics Committee Report, compared to what was released to the media. Neither I, nor any of my colleagues at Emory University at the time, with the exception of those who were on the Ethics Committee, or others who had access to the confidential report, knew about this discrepancy.

Seeing all this, David Campbell prepares a letter of resignation. However, he is not able to get out of town fast enough to avoid one final public humiliation. On September 17, 1985, Garland Purdue, the head of Emory Clinic, attended a meeting of the faculty in the department of ophthalmology and directed David Campbell to come to the front of the room and stand while Garland read the official letter of reprimand from Emory University. Included in that letter was the following sentence, “You are perceived to have asserted a moral superiority to your colleagues and peers … You are therefore reprimanded for your actions.” Tom Harbin, in Waking up Blind, primarily sticks to the facts and does not inject his personal opinions. However, he does interject a personal comment at this point in the book, “And so Emory University, owned by the Methodist Church, with a board partially comprised of Methodist bishops and headed by an ordained minister, reprimanded one of its faculty for asserting moral superiority.”

Now David Campbell was leaving and only Allen Gammon remained as the conscience of the ophthalmology department. But not for long. As a junior member of the faculty without tenure he did not have a chance against what was to come.

The Atlanta Journal Constitution newspaper story had quoted Cavanagh as stating he was, “the victim of professional jealousy within his department.” Cavanagh wasted no time. He sent out a letter to department chairs and friends around the country celebrating his “exoneration.” Included in his letter, “One [original italics] of the individuals involved in continued furtherance of these issues has been formally reprimanded for inappropriate actions and has submitted his resignation from the University.” The clear implication is that another jealous individual is still lurking in the department, and will need to be taken care of soon. As a result of the Emory University Press releases and this letter, Allen Gammon came to be perceived as a pariah by many ophthalmologists on a national level.

Those of us on Allen’s research team did what little we could, but we were bit players in a drama that involved players powerful enough to swat us like mosquitoes if they had chosen to do so. Furthermore, the information we had was hearsay. All we could really do was vouch for Allen’s character based on our personal experiences. We sent a message to the president of the University, James Laney, about our concerns. We also alerted some prominent members of the Emory University Board of Regents. I personally called an 800 whistle blower number for Medicare fraud and asked them to investigate the billing of eye surgery for Sargus Houston. All to no avail.

Allen Gammon soon lost his office and his space in the Emory Clinic where he treated his patients. He was banished to seeing his patients in a hospital in downtown Atlanta, far from Emory campus. He had lost his academic secretary earlier, and now his clinic secretary and technician were also taken away. His wife had to take on the role of volunteer secretary so that his patients would have someone to contact. He was also demoted from being the Chief of Pediatric Ophthalmology. All of this was particularly humiliating to Allen because his patients, to whom he had dedicated his life, could see all these changes happening, and did not know what to make of it.

When this was not enough to force Allen to leave, Emory University tightened the screws still further. He had been scheduled to participate in a large national clinical trial sponsored by the National Eye Institute of the National Institutes of Health, but at the last moment Emory University decided he should not be allowed participate in the project.

Those of us who knew Allen personally during this period started to become concerned about his mental well-being. Allen became convinced that a private detective was following him whenever he drove. He began using phone booths for sensitive phone calls. He was exhausted, he was haggard, it was obvious that he was not getting enough sleep, he was embarrassed, he was humiliated, and, worst of all, it was beginning to become more and more obvious to all of us that he had lost the battle.

Under the inquisition, even Galileo recanted; But not Allen Gammon! He persisted, a lone man who it turns out, as we now know, had justice and the truth on his side, but nothing else. And for a brief moment it looked as though his strategy of quietly refusing to leave, but at the same time refusing to recant his disagreements with the official line being propagated by Emory University, might have worked. Cavanagh did not resign, but he did agree to take a formal leave of absence, albeit with full pay, in the Spring of 1986. At his point, “Gammon hoped that Cavanagh’s departure would increase his options to remain at Emory with [his interdisciplinary research team of which I was a part], enabling him to continue his academic career.” But, “noose tightening” Dr. Louis Wilson, now interim chairman of ophthalmology, “wreaked the ultimate revenge on Allen Gammon by simply firing him. … Wilson didn’t even give Gammon the courtesy of a face-to-face meeting.”

After being fired by Emory University, Gammon scrambled and was able to secure a position at the King Kahled Eye Specialist Hospital in Riyadh, Saudi Arabia in July 1986. But prior to leaving town, he had earlier filed a formal complaint against Cavanagh to a national organization of eye doctors, the American Academy of Ophthalmology. The Academy scheduled a hearing, but it was scheduled for a date when Gammon, the official accuser in the ethics complaint, was known to be in Saudi Arabia, and furthermore was known to have signed a contract that would not allow him to return to the USA on that date. The hearing began on September 11, 1986. The day before the hearing was ready to begin, Gammon surprised everyone when he unexpectedly showed up back in Atlanta. Waking up Blind describes what happened, “Gammon had appealed the rule in the contract [with the Saudis] prohibiting a leave in the first ninety days, prevailed, dug deep into his own pocket for airfare, and flown to Atlanta. … Gammon reported to the hotel room assigned him by the academy. There he awaited the summons to the committee. He was ready. He had reviewed his written complaint and all the documents he had saved. He didn’t really need to reread this; the facts were burned into his soul. He waited and no summons came. He waited some more. Finally the phone rang, and [the chair of the committee] dropped his own bomb. The hearing was over. The committee didn’t need to talk to Gammon. … What about David Campbell? He had flown in from New Hampshire and was waiting. Same deal. No need to talk to him either.”

The academy had done a “plea bargain” with Cavanagh, officially called an “alternative disposition.” Cavanagh had to withdraw from practice for two years, and after he resumed practice he would have to have his practice monitored for three years. This would all be kept confidential. He would never be named in any public documents released by the Academy. Cavanagh resigned from Emory University and accepted a position at Georgetown University. Cavanagh later moved to University of Texas, Southwestern, at Dallas where he holds the Dr. W. Thomas Maxwell chair in ophthalmology and is vice chairman of the department.

Those of us on the interdisciplinary research team that had been originally assembled by Allen did the best we could to carry on the research project in his absence. We did some good research, published some good papers in scientific ophthalmology journals, and found answers to many of the questions Allen had first posed that day back in 1983 when he first recruited me to come to Emory University. But the enthusiasm present at the beginning of the project had faded, replaced by jaded cynicism brought on by the events we had witnessed.

For years afterward, whenever I taught undergraduate courses, I would always spend part of one lecture to tell a shortened version of the story I write here. I left out the names of the villains since the information I had about them was only second hand. However, I did make a point to always include the name of Allen Gammon, the hero of my story.

A quarter of a century has passed since these events occurred, and I am now retired from Emory University. Over the years I heard rumors via the grapevine that numerous lawsuits pertaining to the events I had witnessed had been settled, and that Emory University had been forced to pay out millions of dollars to various injured parties. However, the results of these settled lawsuits were sealed, and I had resigned myself to accepting the reality that the details about what had happened, the good, the bad, and the ugly, would never see the light of day

Early in 2009 I received an email from a colleague. “Had I heard, she asked, that Dwight Cavanagh was being considered for a prestigious award to be given out by a national organization that supports academic research in ophthalmology?” For the first time in many years an old, but still familiar, nightmare recurs. I wake up with the words resonating in my head, “You were a witness to what they were able to do to Allen Gammon.”

Not long ago I watched the film, Das Leben der Anderen, in which a Stasi agent in former East Germany has been given the job of conducting surveillance, including wiretapping, on a playwright and his lover. In the course of his job the Stasi agent decides to perform a small act of kindness towards the individuals under his surveillance. He does this simply because it is, in his mind, the right thing to do. This small act of kindness ends up putting him at great risk, as one unforeseen consequence leads to another, until he is forced eventually to perform many courageous heroic acts to protect those under his surveillance. Furthermore, those who he is protecting have no idea of the sacrifices he is making on their behalf. Years go by and he does not think anyone even knows what he did earlier in his life. In the last scene of the film, we see this character, many years later, walking slowly down a street, an anonymous member of the crowd. Then he comes upon a bookstore and sees a book in the window. The book tells the story of a hero, and the hero is him! As I watch this film in the dark theater, I fight back a flood of tears. If only real life could be like that! Then something else happens. I receive another email from the same colleague. “Have you seen the book just published by Tom Harbin, Waking up Blind?” I get the book and open the cover. I see the dedication:

“To Dr. David Campbell and Dr. Allen Gammon, two men never honored for their courage in speaking out at great personal sacrifice for the well-being of patients and the integrity of their university.”

[1] Feedback and comments are welcomed.

About Ron Boothe

I am a Professor Emeritus at Emory University, currently living in Tacoma Washington USA.
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21 Responses to Personal Reflections on Waking up Blind

  1. Harold Jackson says:

    Ron — Great story. Too bad that it is true. Dr Gammon paid a high price for his integrity but, I’m sure, he felt that there was no alternative. My hope is that more people will read of things like this and choose the road of Dr Gammon. My fear is that our health care system will only continue to breed Dr Cavanaughs. By the way, did Dr Cavanugh receive the award?

  2. Gina Pyke says:

    I teach in the clinical psych program at Emory and am also a faculty member of Emory’s newly enlarged interdisciplinary Center for Ethics. Your narrative has been circulated to those faculty, some of whom have never heard the story, and they find it very powerful. I hope you’ll be hearing directly from some of them. You may be interested to know that the Cavanaugh case has been taught every year in the Medical Ethics course for 3rd year med students by one of the Center’s med school faculty members. So there’s some constructive institutional memory at work. Thank you for this.

  3. Ron Boothe says:

    I would like to acknowledge and thank the dozens of individuals who have sent personal comments to my email account about this essay. It has been gratifying to hear from so many friends and former colleagues who have expressed empathy for Drs. Gammon and Campbell in terms of what happened to them. Many of the comments I received expressed a combination of shock over what happened and the fact that it was able to be covered up for a quarter century, and dismay over what this episode teaches us about the ethical values that were promoted by Emory University during this long, sorry period. But I have also received many replies that give reason for hope, including the reply posted here by Dr. Gina Pyke from Emory. Perhaps redemption is possible through remembrance, and perhaps now that the facts have been made public for the first time, Emory University will do the right thing. I am hopeful that the Emory Center for Ethics will work to remedy the lack of acknowledgment of the sacrifices Drs. David Campbell and Allen Gammon made to try to protect the well-being of their patients and the integrity of Emory University.

    With regard to the specific question asked by my good friend Harold Jackson, I suggest a visit to Dwight Cavanagh’s personal website where he lists his Distinguished Academic Honors. [NOTE added: In my original posting I had included a link to Cavanagh’s website. I decided to remove that link because I do not want my posting here to be viewed as being vindictive. That is not my intention. I intend my posting to be 1) a tribute to the courage of Dr. Gammon and Dr. Campbell, and 2) a prod to my former colleagues at Emory to set about remedying the harm done to these individuals (and others) by Emory University. It is not too late, but alas, I have not, to date, heard from anyone at the Emory Center for Ethics about plans to to try to remedy the situation. David Campbell still has an official letter of reprimand from Emory University, and Allen Gammon still goes to bed every night dealing with the fact that his children and grandchildren know he was once fired from Emory University. Please, can’t Emory University put a stop, once and for all, to this madness, by at least acknowledging publicly what happened and perhaps even offering a public apology?, Ron Boothe, March 2, 2010]

  4. Well said. Please forward my best to JAG!!!


  5. Ron Boothe says:

    Any hopes I might have had that the Emory Center for Ethics of Emory University might make a positive contribution to remedying some of the injustices that were done in the past to Dr. Campbell, Dr. Gammon, and others were dashed by an email I received from:

    Paul Root Wolpe, Ph.D.
    Director, Center for Ethics
    Emory University
    1531 Dickey Drive
    Atlanta, GA 30322

    After chiding me for bringing the existence of this blogsite posting to his attention (apparently he thinks that by blaming the messenger, he is off the hook as far as having any responsibility to respond to the ethical issues inherent in the message), he then informs me that:

    “The fact that one of my faculty members was one of the most responsive people to your article does not confer on the Center an obligation to collaborate with you about the case.”

    Paul Wolpe’s assertion is no doubt technically correct. However, I must confess that my own reaction to Wolpe is somewhat similar to that of the fictional character Laura in Margaret Atwood’s novel, The Blind Assassin (2000). In the novel, Laura’s father had pushed to have a memorial erected on the town square. On the day the memorial was unveiled, “…even the Catholic priest was allowed to say a piece. [Laura’s] father pushed for this, on the grounds that a dead Catholic soldier was just as dead as a dead Protestant one. [Another fictional character in the novel] said that was one way of looking at it. ‘What is the other way?’ said Laura.”

  6. byard edwards says:

    And do you think Nietzsche’s Übermensch does not thrive today in this environment?

  7. Robert L says:

    Emory plans world-class ethics center

    Atlanta Business Chronicle – by Urvaksh Karkaria Staff Writer Monday, August 23, 2010

    The Emory Center for Ethics plans to raise up to $20 million to transform the two-decade-old institute into a global think tank on ethical issues.

    The proposed expansion, in scope and square feet, has the potential to draw new business and ideas to the region, its supporters say.

    “Atlanta is an international business center,” Paul Wolpe, the center’s director said. “It needs a world-class ethics presence.”

    Atlanta is ideally suited to host a global ethics center because it has the transportation infrastructure to convene experts from around the world, said A.J. Robinson, president of Central Atlanta Progress.

    Being a global business hub and having a cluster of universities and research centers, such as the Centers for Disease Control and Prevention, makes Atlanta a natural congregating point for business and biomedical ethicists.

    Emory’s ethics center serves as an economic development tool, Robinson said, helping expose the city to visiting corporate leaders, who might later expand or relocate to the area.

    Emory’s Center for Ethics aims to be not just a place of academic scholarship, but a resource for the community — business, nonprofits and government, said R. Anthony Joseph, president of Atlanta-based Concessions International LLC.

    The center plays an indirect economic development role, enhancing the city’s reputation as a global center of culture and thought, Joseph said.

    “The success story of Atlanta has not just been one of business and the Olympics,” he said. “It’s also been of a progressive city.”

    Focus areas

    Ethics isn’t just about judgments of right and wrong, but about understanding human behavior in relation to values, Wolpe said.

    “Every decision that you make in your life is based on some … ethical assumption,” he said. “Ethics is exploring, understanding and questioning our own deepest values, in order to make decisions.”

    The center “announces the intent of this region to insist that ethical behavior is at the center of how we live, including how we do business,” Emory University President James Wagner said.

    The importance of having an ethics program as an educational institution seems more evident today than ever before, he noted.

    “It does appear over the last decade or so, that we’ve suffered the consequences of people who have not had a well-developed facility with the practice of ethics,” said Wagner, who was appointed vice chairman of President Barack Obama’s Presidential Commission for the Study of Bioethical Issues last November.

    Emory’s ethics center facilitates conversation, is a place for mediation, and trains workers in problem-solving around ethical issues.

    In addition to studying ethical dilemmas, the Emory ethics center hosts public programs, and partners and consults with private and public community organizations.

    Wolpe, who was hired two years ago from the University of Pennsylvania, wants the center to focus on ethical issues that affect businesses, the environment, public health and social welfare.

    “Those are the areas, right now, where we’ve got the greatest expertise, having to do with who our existing faculty are,” Wolpe said.

    The potential investment, he said, “would allow for a much richer program in more areas of ethics.”

    An expert on bioethics, Wolpe said the life sciences arena is rife with ethical controversy as technology and medicine has enabled man to replicate nature, and in some cases speed up evolution.

    “We are able to manipulate human, animal and plant life in ways that are creating novel organisms,” Wolpe said. “The decision on how to apply our biotechnological powers is a profoundly important ethical conversation to have.”

    Bulking up

    About $10 million of the planned raise would be used to relocate, and nearly double, the center’s physical footprint at Emory.

    Wolpe also wants to beef up the number of researchers, visiting scholars and administrative staff.

    “We want to create endowed chairs — full-time scholars — in business, environmental and public health ethics,” Wolpe said.

    Raising the $20 million, amidst a sputtering economy that has drained individual investment portfolios and foundation coffers, won’t be easy.

    The biggest challenge, he said, is in educating would-be donors on the need to have a robust ethics center in the city.

    “People need to understand what an ethics center does,” Wolpe said. “It isn’t natural or intuitive to most people, exactly what we do.”

    Reach Karkaria at

  8. Ron Boothe says:

    When all the work is done, the lie shall rot;
    The truth is great, and shall prevail,
    When none cares whether it prevail or not.

    Coventry Patmore as quoted in The Anthologist

  9. Sandy May says:

    I read the book ‘Waking Up Blind’ and by googling found this blog. Ron’s comments really illuminates the context of the whole affair and add a lot to Dr Harbin’s account. It is horrifying to read about Cavanagh’s ethics and in a way even worse to realize the so called Ethics Committee didn’t care at all. Drs Campbell and Gammon are true American heroes – but the good guys often get little reward. This should be scripted for a movie, it is an incredible story!

  10. Nicholas Bujak MD says:

    Touching article. I had tears in my eyes. I feel in my medical training I have seen and experienced similar occurrences of medical misconduct. Probably not at the level and extent that this book illustrates bur nevertheless patients were hurt, cover ups occured, individuals became scapegoats while other got away ruled and governed via intimidation. Some of the most dishonest people I have met in my life are doctors. I am sorry to say that because I am a physician. I would like to think I have been unlucky or my opinion is a result of a selection bias but really deep down inside I think physicians are no more moral than you’re average human being.

  11. Pingback: 2010 in review « Tacoma Retired Men's Bookclub

  12. Charlie Schooler says:

    If I had to name my best friend ever, it would be Allen Gammon. Best friends in high school together, college roommates thru our undergraduate days, and best man at my wedding (twice), we were about as close as two friends can be. In the aftermath of his firing from Emory, Allen provided only the sketchiest of details, and has been reluctant to discuss the subject for the past 25 years.

    Earlier this week Allen and his wife Annie were in San Diego for a medical conference, and we took the opportunity to get together over lunch. Prior to his dashing out the door, he gave me a copy of Waking Up Blind, with the inscription “To fill in those gaps – before we forget them all.”

    I am simply delighted that this story has finally been told, gratifed by the support shown on this blog, and hopeful that more MD’s will learn from the mistakes made at Emory.

    Kudos to Dr. Tom Harbin for writing a story that is long overdue, and to Dr. Ronald Boothe for a superb summary, augmented by touching personal reflections that will hopefully be included in the next edition.

    A special thanks to Allen Gammon for finally filling in those gaps.

    And raspberries to Paul Wolpe, whose comments are more reflective of Dwight Kavanaugh than of any ethics expert.

  13. Mike Robinson says:

    Charlie: Not knowing the book you mention, I can’t help thinking of a different one that seems very relevant. JOSE SARAMAGO won the Nobel Prize for BLINDNESS a few years ago. Perhaps you all discussed that alraady. But an equally compelling pair of stories could amuse you.

    One is the famous HG Wells piece, IN THE COUNTRY OF THE BLIND.
    Another is THE BOUND MAN, by Ilse Aichinger. (it involves a man literally bound by ropes from head to toe.)

  14. Ron Boothe says:

    A one hour panel discussion of Waking Up Blind will take place at the upcoming Annual Meeting of the American Society of Bioethics and Humanities, October 13-16, 2011 at the Hyatt Minneapolis in Minneapolis, MN.

  15. JOHN BALDINGER says:

    I never knew the details of the Cavanaugh situation and have re-educated myself over the past 4 hrs.. I will read the book shortly. I am a 1976 Emory college grad and a very busy practicing ophthalmologist in the Washington DC area. I find it unbelievable that Emory has NOT wanted to publicly exhonerate Dr Campbell and Gammon, for their courage in telling the truth. Shame on them!!!! It is not too late!!! JOHN C BALDINGER MD

  16. Suzy says:

    Four months ago, I met with Dr. Campbell in New Hampshire to discuss having an iridotomy. I didn’t know his background other than his being highly regarded by the eye care center I use. He immediately impressed me as being a compassionate person of great personal integrity. This was confirmed again when I went in for the procedure and later on for the followup.

    Today, I was telling my GP about the procedure, and he told me he is personal friends with Dr. Campbell. He also told me about what Drs. Campbell and Gammon had gone through at Emory and recommended I read “Waking Up Blind.” So, I ordered the book then Googled to learn more. It was heartbreaking to read this account of what these two doctors endured, and it’s no understatement to refer to them both as heroes. Having met Dr. Campbell, I am astounded that he remains such a warm and open person. As sort of a funny aside and before learning about his history, I was thinking to myself that he would be the ideal person to teach an ethics course!

    I’m glad that Harbin wrote a book on this ordeal, which I look forward to reading, and that Ronald Boothe wrote this review. We don’t meet many heroes in real life, so I feel very lucky to have met one and to know they still exist.

  17. Disappointed EU Alumnus says:

    I wonder if Dr. Hatcher’s book mentions this episode. I’m guessing not. Thank you for writing this, it’s still getting new readers.

    “Emory celebrates 50th service anniversary of Charles Hatcher” — July 17, 2012

    “…Despite officially “retiring” in 1996, Hatcher maintains an office on campus and continues to bring his leadership and skill to the service of Emory every week”

    Best wishes from a (non-medical) Emory alum who should have heard about this at the time, but didn’t. Surprise.

  18. Stacy Clark says:

    I am a patient of Dr. Gammon. He’s just become my new hero. Stacy Clark, Manteca, CA

  19. Brent Swenson says:

    Ron – I came across your post by the merest coincidence. While I knew of the travesty that occurred with Allen and David, and the cover-up, I was not aware of the details. They are entirely consistent with the Emory University that I knew. The culture had not changed noticeably when I was invited to leave and I would be enormously surprised if it were different today. Allen and David were uniquely courageous and could easily have served their own interests by simply doing nothing but they did not. As Edmund Burke noted: “All that is required for evil to triumph is for good men to do nothing.” Allen Gammon and David Campbell are indeed good men.

  20. Adalyn Watts says:

    Fortunately for me, I married and left the ophthalmology department at Emory right before these things happened. Before I left, Dr. Wilson said to me that he intended to get out and go down to Crawford Long. “Dwight is doing too many surgeries. He is lining people up outside his doors, and something bad is going to happen.” Later, I got a call in Chattanooga asking what it would take to get me to come back to the department from Cavanaugh’s secretary, but told her there was no way I could. Drs. Wilson and Campbell and others always got photographs; Dr. Cavanaugh, not so much. But, what happened was a tragedy for everyone involved and even for us on the sidelines.

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