First off, I won’t play the political blame game concerning Jane Brady and Beau Biden on this issue until we know whether Beau is going to be fine. Today, I am just reporting the substance of the Bradley Report, or more specifically the findings and recommendations of Widener Univerity School of Law Dean Linda Ammons. The Bradley Report, as prepared by Ammons, spreads the blame all around, rightfully so. The report “pinpoints a multitude of failures and lack of action by people in position to stop Bradley dating back to 1994.”
“A tragedy of this magnitude may have been pre-empted if the individuals directly involved had been more focused and alert, less willing to give Bradley the benefit of the doubt, and if they had scrupulously followed the law,” Ammons wrote. “Systems were in place to catch a perpetrator, but, they were either not properly accessed, or when called upon, human and mechanical error prevented the appropriate actions from being taken.”
FAILURE NO. 1Delaware’s Board of Medical Practice issued Bradley a medical license in April 1994 even after knowing that there was a complaint pending against him in Pennsylvania. In June later that year, the Pennsylvania’s board did dismiss the complaint and the Philadelphia police decided the complaining mother’s statement was not credible. Still, with a pending abuse complaint against an applying Doctor, our medical board should have never issued a license.
FAILURE NO. 2 No one in law enforcement or the medical community contacted Delaware’s medical board about Bradley’s inappropriate contact with girls after a 1996 investigation by Beebe Medical Center, despite a state law requiring police, prosecutors, doctors and nurses who “reasonably believe” a doctor is guilty of misconduct or unfit to practice medicine to file a written complaint to the board.
The first known complaint against Dr. Bradley in Delaware occurred in 1996, when Joan Davis, a nurse who worked with Bradley at Beebe, complained to her supervisor about what she thought were too many catheterizations of female patients for urine samples by Bradley in his annexed office next to the hospital. Davis’ allegations regarding Bradley also included allegations of excessive kissing of patients, inappropriate remarks about females, and that Bradley was taking pictures of patients’ without out their parents consent or knowledge and putting them on his computer. The hospital did conduct an internal investigation and after consulting with three independent doctors, deemed that the catheterizations were medically appropriate and closed the investigation. Relying on Delaware’s peer review statute, the procedures of their accreditation standards, federal statutes, and the fact that other experts in the field had cleared Bradley’s actions as accepted medical practice, Beebe Hospital did not report Davis’ allegations to law enforcement or the Board of Medical Practice. It does not appear that Beebe’s internal investigation addressed Davis’ other allegations.
It does not appear that the records of Beebe’s investigation in 1996 were ever given to law enforcement until after Dr. Bradley was arrested in 2009. That is true even though Bradley’s records at Beebe were subpoenaed in 2005, but more on that in a second. That is simply astonishing.
FAILURE NO. 3 No one in law enforcement or the medical community contacted Delaware’s medical board about a 2004 report to the Medical Society of Delaware, a trade association of and for Delaware physicians, by Bradley’s sister, Lynda Barnes, despite a state law requiring police, prosecutors, doctors and nurses who “reasonably believe” a doctor is guilty of misconduct or unfit to practice medicine to file a written complaint to the board.
In October 2004, Dr. Bradley’s adopted sister, Lynda Barnes, sent a letter to the Delaware Medical Society alleging that Dr. Bradley was self-medicating, writing prescriptions in the name of a relative for himself, that he physically and emotionally abused his son, that he had abused a stepchild in another state, and she mentioned complaints from parents concerning improper touching of their children. Several of the above allegations were supposedly not contained in the version of Barnes’ letter that was received by the Medical Society.
Regardless if the Medical Society was aware of the allegations of improper touching, the letter appeared to provide enough allegations to at least put into doubt Bradley’s fitness to practice medicine. Therefore, the Medical Society should have filed a formal complaint with the Board of Medical Practice, even if all it did was forward the Barnes letter.
FAILURE NO. 4 The then-society president Dr. James P. Marvel Jr., a colleague of Bradley at Beebe, refused to recuse himself in deciding on the 2004 Barnes report, despite the obvious conflict of interest.
FAILURE NO. 5 Dr. Marvel decided the 2004 tip from Mrs. Barnes should be dismissed because, outrageously, “it was a family matter.”
FAILURE NO. 6 No one in law enforcement or the medical community contacted Delaware’s medical board about a 2005 investigation into complaints about Bradley by Milford police, which was overseen by Attorney General Jane Brady, despite a state law requiring police, prosecutors, doctors and nurses who “reasonably believe” a doctor is guilty of misconduct or unfit to practice medicine to file a written complaint to the board.
In March 2005, the Milford Police Department initiated an investigation of Dr. Bradley after a three-year old patient stated that Dr. Bradley had “kissed her tongue”. As part of the investigation, the Milford Police Department identified three additional victims and five witnesses who alleged Dr. Bradley was performing improper examinations and /or exhibited unusual behavior. One of the witnesses Milford Police interviewed was Lynda Barnes, who provided police with the letter she had faxed to the Delaware Medical Society in October 2004. […]
Besides allegations of sexual abuse, Barnes and others told Milford investigators that Bradley was self-medicating, that his office was in disarray, and that he had abused his own children. Such allegations seemingly put into question Bradley’s fitness to practice medicine, and therefore such allegations should have been reported to the Board of Medical Practice. While there appears to be a factual dispute regarding who assumed the responsibility for reporting the results of the Milford Police Department investigation to the Board of Medical practice, the bottom line is that the Board never received a written complaint regarding Bradley, which the law required.
FAILURE NO. 7 Attorney General Jane Brady refused to prosecute or open her own investigation after the Milford PD reporting the findings of their investigation.
On May 23, 2005, after Milford Police presented the findings of their investigation to the Attorney General’s Office, who decided not to prosecute Bradley based on the evidence that they had at the time, the Milford Police Department investigation was closed. Without opining on the propriety of the decision not to prosecute, and regardless of the criminality of Bradley’s alleged
conduct, the Attorney General’s Office should have reported the findings of their investigation to the Board of Medical Practice.
FAILURE NO. 8 No one in law enforcement or the medical community contacted Delaware’s medical board about the 2008 state police investigation, which was overseen by Attorney General Beau Biden, despite a state law requiring police, prosecutors, doctors and nurses who “reasonably believe” a doctor is guilty of misconduct or unfit to practice medicine to file a written complaint to the board.
FAILURE NO. 9 Even though Bradley’s practice of using a catheter on young girls to take urine samples was so widely known that Lewes area mothers jokes about it at parties (JOKED!!!), no one filed a report or a complaint save the above referenced individuals.
FAILURE NO. 10 The mysteriously unnamed, even now, Superior Court judge refused to grant a search warrant for Dr. Earl B. Bradley’s office in December 2008, even though, inexplicably, he (aha, the judge is a man) told investigators he would sign a warrant for the pediatrician’s arrest. So, there was enough probable cause to arrest him for abuse, but not enough for a search warrant. That does not compute. That Judge should be named, and I want to hear his legal theory behind his decision.
Ammon’s Recommendations
1. Ammons recommends that current Delaware law be amended so that the Board of Medical Practices and other peer review groups’ records are not held strictly confidential, but may be available under certain circumstances, including via subpoena by law enforcement.
2. In order to better ensure that mandatory reporters fulfill their duty to report, the General Assembly should couple reporters’ immunity in the statute with stiffer penalties for failing to report. In addition, all licensees of the Board of Medical Practice should receive mandatory training regarding their duty to report.
3. The General Assembly clarify whether law enforcement are exempted from the duty to report allegations against medical professionals to the Board of Medical Practice during the course of a criminal investigation. In addition, all complaints to the Board, whether they are written or oral should be documented and investigated by the Board.