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Theranos Founder and Former CEO Elizabeth Holmes’ Federal Criminal Fraud Trial Finally Is Under Way in California

Court documents show Holmes’ defense strategy includes accusing ex-boyfriend and former COO Balwani of ‘intimate partner abuse’ that impacted her ‘state of mind’

It has started! The long-awaited criminal trial of former Theranos CEO Elizabeth Holmes is underway in a federal courthouse in Silicon Valley. Across the profession of medical laboratory medicine, there is keen interest in the story of Holmes and her now-defunct clinical laboratory company Theranos.

This next chapter in the drama began on September 8 with opening arguments. Federal prosecutors came out strong, claiming Holmes was “a manipulative fraudster who duped investors and patients alike and knew the whole time that she was hoodwinking them,” according to NPR.

“This is a case about fraud, about lying, and cheating to get money,” said Assistant US Attorney Robert Leach, NPR reported. “It’s a crime on Main Street, and it’s a crime in Silicon Valley,” he added.

Not surprisingly, Holmes’ defense team had a different take, claiming Holmes was simply “a hardworking, young startup executive who believed in the mission of the company, only to see it buckle in the face of business obstacles,” NPR reported. “They argued that she placed blind faith in the No. 2 executive at the company [Balwani] and overly trusted lab directors, who the defense team says were legally responsible for how the labs were run.”

Holmes Claims Abuse at the Hands of Former Theranos COO Balwani

Many pathologists and clinical laboratory managers are ready to watch and learn what unfolds in the opening stages of Holmes’ long-delayed federal criminal fraud trial. During the jury selection process, recently unsealed court documents showed that Holmes’ defense planned to include claims she was abused by her then boyfriend, Theranos Chief Operating Officer Ramesh Balwani.

This surprising development adds yet another twist to the tale of the disgraced Silicon Valley executive and her defunct clinical laboratory testing company.

The hype surrounding the once-high flying startup, which in 2015 reached a peak valuation of $9 billion, began unraveling that same year when a Wall Street Journal (WSJ) investigation exposed the company’s alleged deceptions and questionable practices related to its finger-prick blood-testing technology.

Fast-forward six years—Theranos is now gone but its top executive continues to make headlines, not as a laboratory science wunderkind, but as a criminal defendant.

Holmes, 37, has pleaded not guilty to all charges. Her former consort and ex-Theranos COO Ramesh Balwani also pleaded not guilty to all charges. He will be tried separately from Holmes.

Elizabeth Holmes and her husband William Evans

Elizabeth Holmes, founder and former CEO of defunct clinical laboratory testing company Theranos, is seen leaving the Robert F. Peckham US Courthouse with husband William Evans following opening arguments in her federal trial on September 8. (Photo copyright: Reuters/Peter DaSilva.)

Dozens of Potential Jurors Removed for Alleged Bias

On August 31, in-person questioning of prospective jurors began in Holmes’ federal fraud trial in San Jose, California. The process did not go well. As CNBC reported, dozens of potential jurors were removed from the jury pool due to potential bias in the case.

“Thirty to forty of the remaining jurors have consumed substantial, and I mean lengthy extrajudicial material, about the case and about the defendant,” defense attorney Kevin Downey, JD of Washington, D.C.-based Williams and Connolly, LLP, told Judge Edward Davila, CNBC reported. “We’re very vulnerable to any of the jurors commenting in some ways as either the court or lawyers conduct voir dire about the content of the media they’ve seen.”

Voir dire is the legal term for preliminary examinations of jurors, which in this initial screening was done by reviewing potential juror questionnaires.

Holmes’ defense attorneys, according to CNBC, previously expressed concerns about “inflammatory” media coverage of the case. However, Assistant US Attorney Jeffrey Schenk maintained, “Less than half of the individuals that filled out the questionnaire had prior exposure to Holmes and Balwani. One juror saying something during the voir dire process that could be overheard is a risk in every court case,” CNBC reported.

Holmes Claims ‘Mental Condition Bearing on Guilt’

A report by the Independent notes that newly unsealed court documents which were first reported by NPR reveal that Holmes will mount a defense that includes claims of “intimate partner abuse” by Balwani, 56, during their past relationship.

 “The documents show that Ms. Holmes will describe how Mr. Balwani controlled what she ate and drank, how she dressed, and who she spoke to, while also alleging he threw ‘sharp’ objects at her,” the Independent reported.

NPR reported that court documents indicate Holmes is likely to take the stand and testify at her trial. She will not be presenting an insanity defense but will put forth a “defense of a mental condition bearing on guilt” that was the result of partner abuse and that impacted her “state of mind” at the time of the alleged crimes.

Court documents filed by Balwani’s defense attorneys label Holmes’ allegations as “salacious and inflammatory.”

“In truth, Ms. Holmes’ allegations are deeply offensive to Mr. Balwani, devastating personally to him and highly and unfairly prejudicial to his defense of this case,” defense attorney Jeffrey Coopersmith, JD, Principle and founder of Coopersmith Law and Strategy, wrote in the filing.

The Theranos Saga Continues …

In “Former Theranos CEO Elizabeth Holmes Is Pregnant, Causing a Further Delay in Her Trial Date,” Dark Daily reported that Holmes’ trial had been delayed multiple times since she was first was indicted on 11 counts of wire fraud and conspiracy to commit wire fraud in 2018. The COVID-19 pandemic, and more recently Holmes’ pregnancy, delayed the start of her trial until August.

CNBC reported that Holmes gave birth on July 10, 2021, in Redwood, California. The baby’s father is William Evans, heir to the Evans Hotels chain in California, The Sun reported.

Balwani’s criminal fraud trial is scheduled to begin with jury selection on January 11, 2022. Both Holmes and Balwani face maximum penalties of 20 years in jail and a nearly $3 million fine, plus possible restitution if found guilty on all counts.

It is a rare thing for owners of a clinical laboratory company accused of fraud to come to trial and receive so much media attention. In the weeks leading up to the trial, medical laboratory managers and pathologists could read a wide variety of news stories about the impending trial and the legal strategies expected by the attorneys for both the plaintiffs and the defendants.

Thus, everyone interested in this trial and its outcome will likely have the equivalent of a front row seat because so many journalists are covering this trial.

Andrea Downing Peck

Related Information

Hot Startup Theranos Has Struggled with Its Blood-Testing Technology

Dozens of Potential Jurors in Elizabeth Holmes Trial Cut for Potential Bias

Case 5:18-cr-00258-EJD Document 973

Case 5:18-cr-00258-EJD Document 976

Elizabeth Holmes Claims Abuse by Ex-Boyfriend Who Controlled What She Ate in Theranos Fraud Trial Defense

Elizabeth Holmes Plans to Accuse Ex-Boyfriend of Abuse at Theranos Fraud Trial

Elizabeth Holmes Gives Birth as Fraud Theranos Fraud Trial Nears

Former Theranos CEO Elizabeth Holmes Is Pregnant, Causing a Further Delay in Her Trial Date

SUNY Upstate Medical University and NUAIR Complete Trial Delivery Service of Medical Supplies on Campus Using Unmanned Drones

Goal of university’s yearlong CHURP test was to validate the use of unmanned aircraft systems (UAS), commonly known as drones, in the delivery of medical supplies across SUNY’s campus

Just as hospital systems worldwide are exploring the feasibility of using drone technology to deliver clinical laboratory specimens and medical supplies between healthcare settings and medical laboratories, SUNY Upstate Medical University also has joined the growing list of healthcare providers that have added unmanned aerial vehicles (UAVs), or drones, to their specimen/supplies delivery services.

As part of the COVID-19 Humanitarian UAS (Unmanned Aircraft Systems) Response Partnership (CHURP), in January, State University of New York (SUNY) Upstate Medical University in Syracuse, N.Y., along with project partners NUAIR, a nonprofit alliance that provides expertise in UAS operations, and Virginia-based drone services provider DroneUp, began testing delivers of a COVID-19 test kit from one rooftop to another on SUNY’s campus.

Traditional delivery of similar items normally takes about seven minutes. The drone delivered the same test kit in just two minutes, according to Government Technology(GT).

Then, “To prove that drone deliveries can be scaled up, the team conducted more medical deliveries in three locations throughout Syracuse two weeks ago, sending supplies from the hospital to a medical laboratory, from the hospital to a surgery center, and from a pharmacy to a second hospital,” GT reported.

Tony Basile, Chief Operations Officer at NUAIR, told GT the flight was a “proof of concept demonstration to show that medical deliveries can be made by drone when speed is essential, such as when tissue samples taken from a surgery patient must be delivered rapidly to a laboratory in a different building.”

Special FAA Waiver Allows Drone Flights Over Certain People

Working with the Federal Aviation Administration (FAA) to secure a 107.39 Operations Over Human Beings waiver to transport the testing kits, DroneUp operated the flights over Syracuse.

The FAA’s 107.39 waiver allows a drone operator to fly over people who are not participating in the operation and over those who are not covered under a structure or within a stationary vehicle. The January flight marked the first time the FAA’s 107.39 waiver was used for such a drone operation, a DroneUp press release notes.

The SUNY and the NUAIR alliance began formulating the concept of using drones to make medical deliveries more than a year and ago. At that time, there were concerns that a nearby highway project would disrupt normal clinical laboratory specimen delivery operations. The highway separates the hospital from a surgery center and finding a way to expedite deliveries despite slow traffic was essential, GT reported.

“They’re not going to want to wait 20 minutes for a tissue sample to get to the lab because the highway is coming down,” Basile told GT.

Challenges Encountered with Drone Delivery of Clinical Specimens and Supplies

In late spring, the team conducted additional deliveries to further prove the efficacy of using drones to transport medical supplies. They successfully transported supplies via UAV from the SUNY hospital to a clinical laboratory, from the hospital to a separate surgery center, and from a pharmacy to another hospital in the area.

“We conducted 52 successful deliveries throughout the week and were able to streamline the process, getting to about five deliveries an hour,” Basile wrote in a NUAIR article he penned, titled, “Making Drone Deliveries Scalable and Economically Viable.”

NUAIR drone

The drone used during the NUAIR test flights was equipped with a parachute in case of a mechanical failure and was only flown late at night. Basile believes the FAA will likely require medical delivery drones to have six to eight motors (shown above) as a security measure in case one or two motors fail. A common type of drone, known as a quadcopter, has only four motors and it is unable to fly if even one motor fails. (Photo copyright: NUAIR.)

Although the unmanned delivery flights were successful, SUNY experienced challenges with using drones to make medical deliveries. Those challenges included:

  • Economics: The NUAIR test flights required five people to conduct the flights, which is more costly than paying one driver to deliver the supplies.
  • FAA restrictions: The FAA currently does not allow biohazardous materials or controlled substances to be transported by drones due to the risk of public exposure if a crash occurs.
  • Device approval: The FAA is still in the process of evaluating which drone models will be permitted to carry medical supplies.
  • Weather: Drones cannot fly in inclement weather conditions.

“[Drones] are susceptible to strong winds and icing,” Basile told GT.

However, Basile believes that with more research and test flights the challenges will be resolved, and that drones will be used for medical deliveries in the future.

“I think they’re certainly going to be used,” he told GT. “Whether it’s soon depends on what you mean by soon.”

Drones Deliver Clinical Laboratory Specimens and Medical Supplies Worldwide

Other countries are increasingly using drones to deliver COVID-19 test kits and samples to and from remote areas.

In, “Hospitals in United States and Germany Team Up with Matternet and UPS to Make Medical Laboratory Deliveries by Drone the New Normal,” Dark Daily reported on California-based Matternet’s launch of the first beyond-visual-line-of-sight (BVLOS)-operated medical drone network in Europe. Its unmanned aircraft will be flown without the requirement that a pilot always maintain a visual line of sight on the aircraft. Matternet launched its BVLOS operations at Labor Berlin, Europe’s largest hospital laboratory, which includes facilities in 13 hospitals across Berlin.

In 2018, Dark Daily reported on automated logistics company Zipline’s use of fixed-wing drones called “Zips” to provide on-demand access to vital blood supplies in Rwanda and Tanzania. The Silicon Valley company transported more than 5,500 units of blood in 2017 to 12 regional hospitals from a base in the east of Rwanda, reported The Guardian. Zipline began operating in the African nation in 2016 and quickly cut blood delivery time from four hours to an average of about 30 minutes.

And in “Swiss Post Medical Drone Carrying Clinical Laboratory Specimens Crashes in Switzerland,” we reported that the medical drone revolution experienced a setback when drone-pioneer Swiss Post (Switzerland’s postal service) saw one of its American-made Matternet drones crash into Lake Zurich, Switzerland. According to a Swiss Post news release, the drone went down carrying a “non-vital” blood sample (one that had been previously analyzed). The flight was part of a recently launched pilot program transporting blood samples between Zurich’s central laboratory and the Hirslanden Klinik Im Park, a private clinic on the opposite side of Lake Zurich.

Although not all drone delivery flights end in success, these projects clearly demonstrate how safe and reliable drone delivery of medical supplies and clinical laboratory specimens could one day be beneficial to medical communities.

Such drone deliveries will likely help medical professionals expedite diagnoses and treatment options for patients, especially in remote areas where land transportation would be much less timely.

JP Schlingman

Related Information

Syracuse, N.Y., Hospital Tests Medical Delivery Drones

In Fight against Coronavirus, Ghana Uses Drones to Speed up Testing

Drone Jobs: CHURP Drone Package Delivery at SUNY

California Company Creates ‘Uber for Blood’ to Speed the Transport of Life-Saving Medical Laboratory Supplies and Blood Products in Rwanda

Hospitals in United States and Germany Team Up with Matternet and UPS to Make Medical Laboratory Deliveries by Drone the New Normal

Swiss Post Medical Drone Carrying Clinical Laboratory Specimens Crashes in Switzerland

Johns Hopkins’ Test Drone Travels 161 Miles to Set Record for Delivery Distance of Clinical Laboratory Specimens

UPS and WakeMed Now Use Aerial Drone for Daily Transport of Clinical Laboratory Specimens; In Australia, Google Wing Initiates Drone Delivery Service

UPS Expands Drone Delivery Service for Transporting Clinical Laboratory Specimens Across Healthcare Systems to Include Delivering Prescriptions from CVS Pharmacy to Customers’ Homes

Amazon’s Prime Air Drone Fleet Receives FAA Approval to Make Deliveries to Customers, Could Clinical Laboratory Specimens and Supplies be Next?

Walmart, Quest Diagnostics, and DroneUp Collaborate on Pilot Project to Deliver COVID-19 Laboratory Tests to Consumers in Select Cities

American Robotics Gets FAA Approval to Operate First Fully Automated Drone for Commercial Use ‘Beyond Visual Line of Sight’ Bringing Unmanned Delivery of Medical Supplies and Clinical Laboratory Specimens a Step Closer to Reality

Ransomware Strikes Hospitals, Clinical Laboratories, and Medical Clinics without Warning and Is Now a Major Threat to all Healthcare Organizations

Across the nation, healthcare attorneys and others report that ransomware attacks are happening weekly, and that once providers’ data systems are encrypted, they have few options to regain control of their information systems

Ransomware is now the single biggest threat to your hospital, clinical laboratory, and anatomic pathology group’s ability to operate a viable business. Few practice administrators and managers are fully aware of this threat. And yet, many still have not taken even basic steps to protect their organizations from ransomware attacks.

Encryption attacks that shut down a hospital or lab’s information services come without warning, rendering the provider unable to access electronic healthcare records (EHRs), to schedule appointments, or conduct most other normal business activities.

Further, negotiating with the ransomware attackers to obtain a de-encryption key can take weeks. During that time, the hospital or lab cannot access its essential information systems and that disrupts or even stops patient care.

Think this cannot happen to your hospital or lab? Think again.

Just this spring, Scripps Health of San Diego was hit with a ransomware attack. Key information systems were encrypted, and it did not take patients long to notice that they could not email their physicians, access their medical records, or see their test results.

The ransomware attack became the headline story on the San Diego nightly news. Scripps would only admit that many essential information systems had been encrypted and that the organization was using paper to conduct business.

The ransomware attack on Colonial Pipeline of Houston, which took place one week after the Scripps Health attack, also became global news. Colonial Pipeline supplies gasoline and similar fuels to 14 states—from Georgia in the South to New York and New Jersey in the North. Dark Daily readers living along the Atlantic Coast personally experienced the shortage of gasoline in their communities because of the ransomware attack on Colonial Pipeline.

No Ransom Payment, No De-encryption Key

Ransomware is probably the single biggest threat to every hospital and every clinical lab in this country. But few healthcare organizations are taking the essential steps needed to make their information systems more resistant to an encryption attack. Even fewer hospitals and labs have policies or procedures in place that outline how management should react when an encryption attack is first discovered. Yet these attacks are hitting medical providers every week across the US.

Dark Daily surveyed several major law firms that have sizeable healthcare practices. Each firm stated it is contacted weekly by one or more hospitals, labs, and medical clinics that have had their digital systems encrypted, followed by a demand for ransom. The healthcare providers were told by the hackers that if they did not pay the ransom, they would not receive the de-encryption key required to bring their software, apps, and digital systems back into service.

“This is the biggest story in healthcare, yet it gets little attention,” stated Robert L. Michel, Editor-in-Chief of Dark Daily’s sister publication The Dark Report. “The reason why you don’t read more news stories about ransomware attacks on hospitals and labs is simple. If it becomes known that a hospital or a lab paid ransom to obtain the de-encryption key needed to restore access to its information systems, that encourages other hackers to attack the organization as well, since the hackers know the organization will pay the ransom. They figure if the provider paid the ransom once, the same provider will likely pay it again.”

Payment of Ransom Does Not Guarantee Restoration of Critical Systems

As bad as a ransomware attack on a hospital, lab, or a medical clinic can be—it can get worse. “Experts involved in helping hospitals and labs respond to a ransomware attack say there is no guarantee the de-encryption key provided by the hackers after payment of ransom will restore access to the encrypted systems,” Michel noted. “We hear reports of hospitals and labs that spent more on their efforts to bring the encrypted systems back online and functioning than they did on the actual ransom.”

To help laboratory managers, CIOs, IT directors, safety and compliance officers, and anatomic pathology laboratory managers and administrators better understand the legal issues triggered by—and your obligation in response to—a ransomware attack, Dark Daily is conducting “Ransomware Protection and Response for Clinical Labs, Hospitals, and Pathology Groups: Effective Steps for Protecting Your LIS, EHR, and Other IT from an Encryption Attack,” on Thursday, August 19, 2021, from 1-2:30 pm Eastern.

This is a must-attend webinar—not only for you—but for everyone in your hospital, health system, or clinical laboratory who will be working to prevent ransomware attacks, or who is involved in restoring digital services following such an attack.

Two experts who are contacted each week by multiple hospitals, labs, and medical clinics that were attacked, had their digital systems encrypted, and received a ransom demand for hundreds of thousands—even millions—of dollars from hackers, will be sharing their knowledge and experience in the legal implications of—and the recovery from—ransomware attacks.

Emily Johnson and Paul Caron

The panelists (above) are:

Johnson and Caron will cover best practices designed to provide crucial training and decision-making skills for handling a ransomware attack on hospital and health system clinical laboratories and anatomic pathology practices. These best practices include:

  • Legal issues triggered by a ransomware attack: What to do when an incident is a breach and when it is not.
  • Your obligations in response to a ransomware attack: HIPAA privacy and other regulatory rules, contractual arrangements (e.g., reference labs), and crisis communication to patients and other stakeholders.
  • Responding to and negotiating with ransomware perpetrators—including the expected “etiquette” in dealing with cybercriminals—and collaborating with consultants who are experienced in how to deal with ransomware demands.
  • And much more.

The roundtable discussion will help you understand how a security incident can occur with or without a breach of protected health information (PHI). Johnson and Caron also will discuss how knowing what to do in each scenario is essential to reducing collateral damage to both patients and your organization, and how to educate your hospital, lab and the broader medical community to address—both proactively and in response—the surging risk of ransomware attacks.

Act now to guarantee your place at this critical webinar. Click HERE to register, or copy and paste the URL https://info.darkdaily.com/ransomware-protection-response-for-clinical-labs-hospitals-and-pathology-groups into your browser.

And because so many healthcare administrators, physicians, and pathologists are working remotely, Dark Daily has arranged special group rates for hospitals, practices, and physicians that would like their essential leaders to participate in this important webinar and roundtable discussion on protecting against—and recovering from—ransomware attacks.

Inquire at info@darkreport.com or call 512-264-7103.

—Michael McBride

Related Information

Ransomware Protection and Response for Clinical Labs, Hospitals, and Pathology Groups

Scripps CEO Says Cyberattack Was Result of Ransomware

Colonial Pipeline Ransomware Attack

OIG Report Finds Management Deficiencies at VA Hospital Kept Alcohol-Impaired Pathologist on the Job

VA Office of Inspector General recommends changes in management processes after doctor is sentenced to long federal prison term

In a compelling report, the US Department of Veterans Affairs (VA) Office of Inspector General (OIG) found that a host of management failures and “deficiencies in the facility’s quality management processes” at an Arkansas VA hospital contributed to “thousands of diagnostic errors” throughout the tenure of the facility’s Chief of Pathology and Laboratory Medical Services Robert Morris Levy, MD.

Levy oversaw pathology and medical laboratory services at the Fayetteville VA Medical Center from 2005 until 2018. The hospital is part of the Veterans Health Care System of the Ozarks.

The OIG’s report, titled, “Pathology Oversight Failures at the Veterans Health Care System of the Ozarks in Fayetteville, Arkansas,” pointed to “deficiencies in quality management processes” and a “failure to foster a culture of accountability,” which allowed Levy to practice at the facility despite staff concerns that he appeared to be impaired by alcohol while on duty.

“Any one of these breakdowns could cause harmful results,” the report states. “Occurring together and over an extended period of time, the consequences were devastating, tragic, and deadly.”

The OIG report’s findings on how hospital and laboratory administrators dealt with Levy over the years of his employment at the Fayetteville VA Medical Center demonstrate why clinical and pathology lab leaders need to be constantly vigilant in how various quality and compliance procedures are administered in their laboratories. When people and processes are not meeting acceptable standards, it is patients who are at risk of being harmed.

In January, the federal court in Arkansas sentenced Levy to “240 months in federal prison, followed by three years of supervised release and ordered [him] to pay $497,745.70 in restitution for one count each of mail fraud and involuntary manslaughter,” according to court documents.

Robert Morris Levy, MD

In its coverage of the federal case against Robert Morris Levy, MD (above in a jailhouse photo), former Chief of Pathology and Laboratory Medical Services at the Fayetteville VA Medical Center, The Washington Post wrote, “Levy’s supervisors failed to heed early warnings that he was endangering patients and then were slow to act, according to internal VA documents, court filings, and interviews with 20 congressional officials, veterans and current and former VA employees.” Clinical laboratory managers and hospital pathologists would be well advised to study the VA’s conclusions in its recent report. (Photo copyright: The Washington Post.)

VA Pathologist Received Multiple Suspensions, then Termination

Following his removal in April 2018, the OIG assembled a team of pathologists to review nearly 34,000 cases interpreted by Levy since he began working at the VA hospital. They identified more than 3,000 errors, of which 589 were classified as “major diagnostic discrepancies” potentially having a negative impact on patient care.

Of the 589, 34 were deemed serious enough to require institutional disclosures, defined as a discussion with the patient or the patient’s representative revealing “that an adverse event has occurred during the patient’s care that resulted in or is reasonably expected to result in death or serious injury.”

The OIG report cited at least two deaths likely resulting from misdiagnoses.

Levy’s hospital privileges were initially suspended in March 2016 following a blood alcohol test indicating he was legally intoxicated while at work. He was reinstated about six months later after completing a treatment program and agreeing to submit to random drug testing.

His privileges were suspended again in October 2017 after he showed signs of impairment during a hospital committee meeting. He was terminated in April 2018 after he was arrested for allegedly driving while intoxicated (DWI) during work hours.

Federal Court Indicts Levy on Multiple Counts

Shortly after the OIG team began reviewing Levy’s cases, a separate OIG group launched a criminal investigation. Levy admitted to investigators that he had been an alcoholic for 30 years, the report stated, and that he had “purchased a substance, 2-methyl-2-butanol (2M2B), online that could be ingested, was similar to alcohol but more potent, and was not detectable using routine drug and alcohol testing methods.”

Citing the federal indictment, the OIG report noted that Levy passed 42 drug and alcohol tests following his reinstatement at the hospital in 2016.

In August 2019, federal authorities charged Levy with three counts of involuntary manslaughter along with multiple counts of wire fraud, mail fraud, and making false statements. The wire and mail fraud charges were related to his 2M2B purchases.

Levy pleaded guilty in June 2020 and was sentenced on January 22, 2021. In addition to the 20-year prison term, he was ordered to pay approximately $498,000 in restitution to VA. The OIG report noted that Levy has appealed the sentence.

In “Pathologist, Neurosurgeon, and Critical Care Specialist Face Criminal Charges in the Deaths of Dozens of Patients,” which covered the Levy case, Dark Daily asked, “At what point might criminal investigators hold medical laboratories accountable for not notifying authorities about lab test utilization patterns by physicians who could be reasonably understood to be putting their patients at risk of harm?”

And in “Arkansas Pathologist Faces Three Manslaughter Charges,” Dark Daily’s sister publication, The Dark Report, noted that “The outcome of [the Levy] case could be a precedent that gives other prosecutors the confidence that they can file criminal charges in cases where evidence shows that a pathologist’s actions contributed to diagnostic errors that directly contributed to the death of one or more patients.”

Michael J. Missal

“This sentence should send a strong message that those who abuse their positions of trust in caring for veterans will be held accountable,” said VA Inspector General Michael J. Missal in a federal Department of Justice (DOJ) press release. “Our thoughts are with all those harmed by Dr. Levy’s actions, and we hope they find some small measure of comfort from what happened here today.” (Photo copyright: Military Times.)

OIG Finds Numerous ‘Deficiencies in Quality Management’

In its report, OIG found deficiencies in quality management going back to Levy’s original appointment as Pathology and Laboratory Medical Services Chief.

He was initially hired in September 2005 as a locum tenens (temporary) provider and appointed as full-time service chief a month later. This was despite a DWI conviction from 1996 and a stay of only eight months with his previous employer.

Neither would have barred the doctor as a potential candidate; however, the OIG report states, “the OIG is concerned that a rigorous process was not in place to better evaluate his clinical competency at the time he was hired.”

And that was just the beginning.

In his role as service chief, Levy was responsible for the Path and Lab quality management program with assistance from a subordinate staff pathologist, “which made the process susceptible to subversion,” the report states.

The VHA requires a second pathologist to review certain findings, such as diagnosis of a new cancer malignancy. But in some cases, “it was determined that Dr. Levy was entering concurrence statements into some patients’ electronic health records (EHR) when a second pathologist had not agreed with the interpretation or diagnosis,” the OIG report states.

In addition, second reads sometimes “were communicated by sticky notes, which provided Dr. Levy the opportunity to alter or ignore the results,” the OIG reported.

Inherent Conflict of Interest, Fear of Reprisals, and OIG Recommendations

The periodic privileging process, which grants ongoing hospital privileges, was based in part on a “10% peer review” conducted by the staff pathologist. “The involvement of a subordinate in the peer review process of a supervisor creates an inherent conflict of interest,” the OIG report stated. And in some cases, appraisals of the doctor’s competence came from non-pathologists.

The OIG report suggested that the Veteran’s Health Administration (VHA) re-examine its guidance on the peer review, which requires cases to be randomly selected. Instead, the report suggests that targeting specific kinds of cases, such as those with higher risk of interpretation error, could be more effective in analyzing a pathologist’s performance.

The OIG report also noted failures in dealing with the doctor’s impairment and fostering a “culture of accountability.” Hospital staff, apparently, reported signs of impairment as early as 2014, including incidents when the doctor smelled of alcohol and displayed hand tremors. But hospital leadership failed to “vigorously address allegations of impairment,” the OIG report states. And in interviews with the OIG, some staffers expressed fear of reprisal if they reported what they saw.

The OIG report offers 10 recommendations to the VA, including practices related to hiring processes, the 10% peer review, and alcohol and drug testing. It makes two additional recommendations to the director of the Ozarks VA health system: one related to the credentialing processes and the other aimed at ensuring staff and patients can report concerns without fear of reprisal.

Clinical laboratory managers and hospital pathologists may want to review these recommendations and consider the value of applying them in their own practices.

—Stephen Beale

Related Information

Pathology Oversight Failures at the Veterans Health Care System of the Ozarks in Fayetteville, Arkansas

VA Hospital Allowed Alcoholic Pathologist to Go Unchallenged, Resulting in Patient Deaths: Watchdog

Convicted VA Pathologist Oversaw Himself, Federal Study Concludes

Fayetteville Doctor Sentenced to 20 Years in Federal Prison for Mail Fraud and Involuntary Manslaughter

Ex-VA Doctor Who Misdiagnosed Patient Sentenced to Prison

Fayetteville Doctor Arrested on Charges of Wire Fraud, Mail Fraud, Making False Statements, and Involuntary Manslaughter

Pathologist, Neurosurgeon, and Critical Care Specialist Face Criminal Charges in the Deaths of Dozens of Patients

Arkansas Pathologist Faces Three Manslaughter Charges

On-demand Video Service Hulu Gets Underway on TV Miniseries Documenting Rise and Fall of Former Theranos CEO Elizabeth Holmes

Six-episode show is based on popular ABC Radio podcast “The Dropout,” which focused on the three-year investigation that brought down clinical laboratory test developer Theranos

While former Theranos CEO Elizabeth Holmes awaits the start of her August 31 criminal fraud trial in a federal court in Northern California, one streaming video service is lining up a star-studded cast to tell the story of the Silicon Valley executive’s fall from grace and the demise of her clinical laboratory blood-testing company.

This six-part series is being produced by Hulu, an on-demand video streaming service offering live and on-demand content. Back in 2019, it announced that it would produce the “The Dropout,” a limited series chronicling Holmes’ rise and fall from Founder and CEO of $9 billion tech company Theranos to criminal defendant.

Hulu says the series will launch this fall, so pathologists and medical laboratory managers have time to set their recorders to capture what may be a compelling story of hubris that took investors and the news media on a wild ride. The Theranos publicity machine was so effective that many hospital CEOs went to their clinical laboratory administrators and told them to delay equipment purchases because Theranos would be able to do the same medical laboratory tests at just pennies on the existing lab-cost dollar.

Holmes’ carefully-crafted public image as Theranos’ CEO drew comparisons to the late Apple CEO Steve Jobs, Business Insider noted. This has made her a popular topic not only among clinical laboratory scientists but also Hollywood moviemakers.

“The Dropout” took its inspiration from the ABC Audio podcast of the same name, hosted by ABC Chief Business, Technology and Economics correspondent Rebecca Jarvis. The ABC Audio podcast’s description provides a glimpse into the direction the miniseries will take.

“Money. Romance. Tragedy. Deception. The story of Elizabeth Holmes and Theranos is an unbelievable tale of ambition and fame gone terribly wrong. How did the world’s youngest self-made female billionaire lose it all in the blink of an eye? How did the woman once heralded as ‘the next Steve Jobs’ find herself facing criminal charges—to which she pleaded not guilty—and up to 20 years in jail? How did her technology, meant to revolutionize healthcare, potentially put millions of patients at risk? And how did so many smart people get it so wrong along the way?” the ABC Audio website states.

The Hulu series originally was to star “Saturday Night Live” cast member Kate McKinnon as Holmes but was recast with Amanda Seyfried in the starring role. According to Variety, the series will include a notable lineup of guest stars including:

Naveen Andrews will play former Theranos President and COO Ramesh Balwani, whose own criminal fraud trial is expected to begin early next year.

A release date for the limited series has not yet been announced, Town and Country reported.

Elizabeth Holmes

Elizabeth Holmes (above), former CEO of now defunct company Theranos, faces 11 counts of fraud for alleged false claims that the clinical laboratory testing company had created a revolutionary finger-prick technology capable of performing a wide range of clinical laboratory tests. Among the charges are two counts of conspiracy to commit wire fraud and nine counts of wire fraud, for which Holmes could serve up to 20 years in jail if found guilty of all charges, according to court documents. She has pleaded not guilty. (Photo copyright: The Wall Street Journal.)

The ‘Real World’ Wall Street Journal Investigation of Theranos and Holmes

Dark Daily has reported extensively on the Holmes/Theranos saga, including the recent development that Holmes’ repeatedly-delayed trial would be pushed back from mid-July to August 31 because Holmes is due to give birth in July.

Theranos’ alleged deceptions first were brought to light in a series of 2015 investigative reports in The Wall Street Journal (WSJ). Then-WSJ investigative reporter John Carreyrou alleged Theranos had not disclosed publicly that the vast majority of its tests were not being done with proprietary technology, but instead with traditional machines purchased from Siemens AG and other companies.

Carreyrou’s reporting became the basis for his bestselling book, “Bad Blood: Secrets and Lies in a Silicon Valley Startup,” which led to “The Inventor: Out for Blood in Silicon Valley,” a 2019 HBO documentary film.

And for those looking for even more drama centered around the Theranos saga, a feature film starring Jennifer Lawrence as Elizabeth Holmes, titled, “Bad Blood,” remains “in development” according to People magazine. Though the project was announced in 2016, filming has yet to begin.

Meanwhile, clinical laboratory scientists will soon get to watch the next “real world” chapter in the Holmes’ saga play out in federal court later this summer. They will also have multiple opportunities in the coming years to be “entertained” by the Theranos scandal on big and small screens.

—Andrea Downing Peck

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Executive War College on Clinical Laboratory and Pathology Management Returns in November with Emphasis on New Clinical and Financial Opportunities

Following a nearly two-year disruption due to the SARS-CoV-2 pandemic, pathologists and clinical laboratory professionals once again have an opportunity to gather and learn from each other

It is good news that the daily number of new cases of COVID-19 continue declining here in the United States. That fact, and the growing number of vaccinations, have encouraged state and federal officials to lift many restrictions on business and social activities.

Clinical laboratories are watching a big drop in the daily number of COVID-19 tests they perform, even as routine test volumes climb and more patients show up in doctors’ offices for the typical mix of ailments and health conditions.

It’s true that many familiar routines are back. But it is also true that things are not exactly the way they were pre-pandemic. And that’s the rub. Going forward, what should medical laboratory managers and pathologists expect to be the “post-pandemic normal” in how patients access care and how providers deliver clinical services? How will healthcare in this country be different from what it was pre-pandemic?

Preparing Clinical Lab Leaders for What Comes Next

These questions and more will be front and center when the Executive War College on Lab and Pathology Management returns on Nov. 2-3, 2021, at the Hyatt Riverwalk Hotel in San Antonio. The theme of this first live gathering since the spring of 2019 will be “Preparing Your Clinical Laboratory and Pathology Group for Post-Pandemic Success.”

“Today, lab managers have the interesting challenge of understanding the new opportunities they can use to advance their labs, both clinically and financially,” stated Robert L. Michel, Editor-in-Chief of Dark Daily and its sister publication The Dark Report, and founder of the Executive War College. “It isn’t that the pandemic changed healthcare in fundamental ways. Rather, it is that the pandemic accelerated changes that were underway before the outbreak began.

“That’s true of telehealth as well, for example,” he continued. “Once the nation was locked down, utilization of virtual physician visits and telehealth services skyrocketed. Today, national surveys confirm that as many as 50% of all patients and physicians have used a telehealth service, are comfortable with this type of appointment, and are ready to continue to use virtual office visits.

Robert Michel

Robert Michel (above), Editor-in-Chief of Dark Daily, its sister publication The Dark Report, and founder of The Dark Intelligence Group, will host the first live edition of the Executive War College since May 2019 in San Antonio. The theme will be “Preparing Your Clinical Laboratory and Pathology Group for Post-Pandemic Success.” Attendees from clinical laboratories and pathology groups will gain critical insights they can act on immediately. (Photo copyright: The Dark Report.)

“Another trend accelerated by the pandemic is patient self-testing at home,” Michel added. “Government health officials saw the benefit of clearing for clinical use different specimen collection systems and COVID-19 test methods designed for use by consumers in the comfort of their home. Today, consumers can choose from multiple specimen collection products and SARS-CoV-2 tests designed for in-home use. Clinical laboratory managers should consider this development to be a consumer home-test baseline. Federal officials have created a regulatory pathway that will make it easier and faster for federal regulators to clear other types of diagnostic tests for consumer home use.”

What if the FDA Approves More Consumer At-Home Tests?

There are implications to each of the two trends described above. In the case of telehealth, if patients see their doctors virtually and the doctors order medical tests, how do clinical laboratories access these patients to collect the specimens needed to do this testing?

Similarly, if, in coming years, the federal Food and Drug Administration (FDA) increases the number of diagnostic test specimen-collection kits that consumers can use from home, how should local clinical laboratories position themselves to receive those kits and perform those tests?

These are two examples of important questions to be answered at sessions scheduled for the Executive War College in San Antonio on Nov. 2-3. Case studies by innovative lab leaders will address topics ranging from high-level strategy to daily management, operations, marketing, and managed care contracting.

Attendance Limited at This Fall’s Executive War College

At the first live edition of the Executive War College since May 2019, attendees will notice one significant difference from earlier years. By design, and for the safety and well-being of attendees, the number of attendees will be limited to 300. The hotel follows the Centers for Disease Control and Prevention (CDC) guidelines and is prepared to adjust those numbers as CDC guidance evolves. Thus, those interested in attending this year’s conference are advised to register early to guarantee their place and avoid being disappointed.

Suggestions for session topics and speakers are welcome and can be sent to info@darkreport.com. Conference details, session topics, and speakers will be updated regularly at www.executivewarcollege.com.

So, register today because seating is limited at the 2021 Executive War College Presents “Preparing Your Clinical Laboratory and Pathology Group for Post-Pandemic Success.” To ensure your place at this valuable conference, click HERE or place this URL (https://dark.regfox.com/2021-ewc-presents) into your browser.

—Michael McBride

Related Information

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