Monday, June 17, 2019


Mariah Martinez was 9 years old when she got bad news about her chronic headaches: A doctor said she had epilepsy.

Over the next four years, the suburban Detroit girl took anti-seizure medicine that made her feel sluggish and was occasionally hooked to a machine that recorded her brain waves. She was told to avoid activities that would rouse her heart, making her the target of teasing by other kids at school.

But then a different doctor delivered astonishing news in 2007: Mariah didn't have epilepsy.

"How could that be?" her mother, Laura Abdel-Slater, recalled. "Epilepsy is something that's not curable."

Martinez, now 26, is the first of what could be many former patients to go to trial accusing Dr. Yasser Awaad and his former employer, Oakwood Healthcare, of malpractice and negligence. Jury selection starts Monday.

Awaad ordered tests on hundreds of Detroit-area children and intentionally misread the results, telling them they had epilepsy or some other seizure disorder, say lawyers for Martinez. The diagnoses disrupted their lives, forcing them to take medicines they didn't need and to undergo further tests during repeat visits. 

The lawyers allege that Oakwood was running an "EEG mill," a reference to an electroencephalogram, a test to measure brain activity. The Dearborn medical center was "ecstatic with Dr. Awaad's suspiciously high productivity because all it cared about was making money," they argue in a recent court filing....

Awaad was Oakwood's first pediatric neurologist when he was hired in 1999. Over nearly a decade, his annual salary rose from $185,000 to $300,000. He also qualified for a bonus as high as $220,000 if certain billing targets were met, documents show.

Awaad left Oakwood in 2007 for a job in Saudi Arabia. When his former patients visited new doctors, many diagnoses were reversed. Even other doctors consulted by defense lawyers said he misinterpreted EEG tests.

"If I made a mistake, I came up with a diagnosis to the best of my ability," Awaad told attorney Brian McKeen during a quarrelsome deposition in 2017. "That's a different story than intentionally telling them that you have epilepsy and they don't have epilepsy."

Oakwood merged into Beaumont Health in 2014, years after the first lawsuit was filed.

"While we cannot comment on the specifics of this case because of pending legal proceedings and patient privacy laws, it continues to be our position that patients were treated appropriately," Beaumont spokesman Mark Geary said.

In 2012, Awaad struck a deal with state regulators to settle claims that he unnecessarily gave anti-seizure medications to four children. He paid a $10,000 fine and agreed to have his work reviewed by another doctor for a period of time.

Lawyers representing about 300 former patients lost their bid to make this case a class-action lawsuit, so the first trial will center only on Martinez, who was sent to Awaad in 2003 over her headaches. She was given Lamictal, an anti-seizure medicine, and Awaad performed many follow-up EEGs until another doctor said she didn't have epilepsy.

Martinez's attorneys declined to make her available for an interview before trial. But in a deposition, she recalled being withdrawn as a child and teased by other kids because the epilepsy label limited her physical activities. She said her grades suffered.

"Once I was weaned off medication, my headaches became less frequent, less severe," said Martinez.

Attorneys for Oakwood asked the judge to give the medical center a separate trial, but he declined.

"You can't just look at the malpractice and not consider whether Oakwood should have and could have stopped what was happening," said Wayne County Judge Robert Colombo Jr., who last fall called some evidence "very damning."

Courtesy of a colleague


  1. A Detroit-area doctor accused of intentionally misdiagnosing hundreds of Michigan kids with epilepsy has reportedly left the country, according to plaintiffs' attorneys.

    The case against Dr. Yasser Awaad has been dragging on for almost 10 years now. Some 250 patients and their families filed a class action suit in 2008, claiming they came in to see the pediatric neurologist with symptoms like headaches, only to be told they had epilepsy and needed extensive treatments, medications, and sometimes, surgeries...

    Dr. Awaad has repeatedly denied any wrongdoing. His attorney’s office declined to comment today about the case or Dr. Awaad’s current location.

    In a deposition last month, Awaad said his contract with Beaumont Health had ended, and he was planning on taking a vacation to Egypt, after which he’d starting looking for work there. Now, the plaintiff’s attorneys wants the Wayne County Circuit Court to force him to return to the U.S. for further deposition.

    “We’re entitled to … more hours of discovery deposition time,” says attorney Brian McKeen. “And this information about him planning to leave the country was not shared with us until shortly before he left. Therefore we were unable to complete the depositions before his departure.”

    Back in 2012, Dr. Awaad was placed on probation by the Michigan’s Board of Medicine Disciplinary Subcommittee, which required he pay a $10,000 fine and complete 30 hours of continuing education in “the area of epilepsy and/or neurophysiology.”

    He was discharged from probation on August 31, 2015. Just days later, Beaumont Health hired him full-time, putting him in charge of developing and teaching pediatric neurology curriculum for medical students, with a base pay of $260,000.

    That contract also required Awaad to get permission before doing any clinical work on the side, while forbidding him from 1) doing any clinical work at Beaumont and 2) identifying himself as a Beaumont Health clinician.

    A spokesperson for Beaumont declined to comment Monday, citing pending litigation. So why did Beaumont hire Awaad after he’d been disciplined by the state and was facing lawsuits from former patients?

    “I have racked my brain trying to find an answer to that question, and I keep coming up short,” says McKeen. “I cannot come up with any reason why Beaumont Hospital would hire this individual, who I think has been so severely discredited. And it’s curious that when Beaumont hired him back, they expressly forbid him from seeing any patients … and he was not allowed to tell anybody he was a Beaumont doctor.”

    McKeen says he’s hoping to get a response from the court in the next 30 days regarding Awaad’s return.

  2. McKeen & Associates announced Monday it won a jury verdict of $3,024,000 on behalf of its client Mariah Martinez.

    McKeen & Associates attorneys Brian McKeen and Anthony Randazzo tried the case in Circuit Court for the County of Wayne before the Honorable Robert J. Colombo, Jr.

    The verdict found Yasser Awaad, former Oakwood Healthcare and William Beaumont Hospital physician, negligent in misdiagnosing and treating Martinez for epilepsy.

    Martinez, now an adult, was treated for epilepsy for years as a child. She never had the condition.

    “We are delighted the jury found this physician responsible for his egregious behavior,” said Brian McKeen, managing partner of McKeen & Associates. “Unfortunately, this is just the first in many cases that will be brought against this doctor.”

    McKeen & Associates has 250 additional clients who are bringing cases against Awaad.

    It was found during the trial that Oakwood administration ignored reports from a parent as well as a Oakwood pediatrician who shared offices with Awaad. The pediatrician alerted administration on several occasions over years of Awaad’s excessive use of EEGs and prescription of anticonvulsant drugs to children who did not need them. The administration did not investigate more than a dozen red flags that were reported and Awaad continued to practice until he left Oakwood in 2006.

    “Experts who testified in the case all agreed that had Awaad been investigated early on it would have been apparent that he was systematically labeling normal EEGs as showing evidence of seizure activity,” said McKeen. “If the administration had done their duty, hundreds of children would not have been mistreated at his hands.”

  3. Mariah Martinez was just 9 years old in 2003, when she went to Oakwood Healthcare in Dearborn for headaches.

    She was diagnosed with epilepsy, and for the next four years would take anti-convulsant medication. However, she never had epilepsy.

    A Wayne County circuit court jury on Monday awarded Martinez $3,024,000, coming to the conclusion that the doctor she saw was negligent, and Oakwood Healthcare was also negligent in its supervision of the pediatrician.

    McKeen Associates Attorney Brian McKeen, who represents Martinez, says Dr. Yasser Awaad prematurely ordered EEG’s, then made the epilepsy diagnoses and prescribed Martinez Lamictal, which left herfatigued from 2003 - 2007.

    “She was never allowed to have a normal childhood,” McKeen said.

    Mckeen believes his client should have never been in a position to be misdiagnosed by Awaad if warnings were not overlooked.

    According to McKeen, a parent got a different diagnoses by a different hospital in 2001 after Awaad diagnosed their child with epilepsy as well. Then later that year, a coworker of Awaad’s came forward.

    “A developmental pediatrician blew the whistle on Dr. Awaad,” McKeen said. “She told Oakwood administrators that she thought he was doing an excessive amount of EEG’s, he was diagnosing children with epilepsy that didn't have it and he was prescribing prescription drugs they didn't need.”

    Beaumont Hospital, who took over Oakwood Healthcare, released this statement in response to the verdict:

    While we respect the jury's verdict, we disagree with the outcome and will appeal this decision. The litigation involving Dr. Yasser Awaad, and Oakwood Healthcare, dates back more than a decade to 2007. While we cannot comment about the specifics of this case because of other pending legal proceedings and patient privacy laws, we believe patients were treated appropriately and disagree with allegations of improper oversight of Dr. Awaad by Oakwood Healthcare.

    McKeen says Martinez is just the first of more than 200 people expected to bring similar cases against Awaad.

    “We had evidence in this case that Dr. Awaad had labeled 1,751 EEG’s on 251 children as showing seizure activity where as in fact they were all stone cold normal,” McKeen said.

    An appeal date has not yet been set.

  4. The headaches started when Mariah Martinez was 10 years old. It was 2003, and she was living in Dearborn, Michigan, with her mother and two sisters. Whenever a headache struck, she would want to put her head down, stay in the dark, and be alone.

    Martinez saw her primary-care physician, who referred her to Yasser Awaad, a pediatric neurologist at a hospital that was then known as Oakwood Healthcare. Right away, Martinez told me, Awaad ordered an electroencephalogram, or EEG, a test that uses electrodes to detect abnormal electrical activity in the brain. In a small room, Martinez was wrapped in bandages and had wires placed all over her head. The procedure required her to be sleep-deprived; she came in on one or two hours of sleep after staying up much of the night watching TV.

    After performing two EEGs a week apart, Awaad, according to court documents, told Martinez’s mother that her daughter had what are called atypical partial absence seizures. Rather than full-body convulsions, absence seizures are those in which a person stares off into space, blinks, or makes small, repetitive motions. Martinez was confused by the diagnosis; she didn’t know what epilepsy was. Awaad, she said, told her that headaches or staring spells could be signs she was having a seizure, or had just had one. So each time she caught herself daydreaming, she thought, Oh my God, I had a seizure!

    Awaad put Martinez on the anti-seizure medication Lamictal. Several months later, her headaches had gotten even worse, and Awaad increased her dose, court documents say. Over the next four years, Martinez underwent 10 more EEGs under the care of Awaad. He told her that most of them were abnormal. Eventually, Martinez was taking a high dose of 400 milligrams of Lamictal daily. The medication made her tired and withdrawn, to the point where she didn’t feel like herself. But she continued taking it, thinking it was good for her health.

    Four years after she first saw Awaad, Martinez went to see another doctor, Brian Woodruff, because Awaad had left his practice. Woodruff performed his own EEG, and the result was so surprising, Martinez’s mother didn’t believe it at first. It was completely normal. “I have come to the determination she never had seizures,” Woodruff would later testify in court. What’s more, he said, “You don’t get headaches like this with absence epilepsy.” In fact, Lamictal can cause headaches.

    More than a decade later, Martinez is one of hundreds of patients who have accused Awaad of intentionally misreading their EEGs and misdiagnosing them with epilepsy in childhood, all to increase his pay. In June, Martinez’s case became the first to go to trial in Michigan. The case shines a light on the grim world of health-care fraud—specifically, the growing number of doctors who are accused of performing unnecessary procedures, sometimes for their own personal gain. (continued)

  5. (continued)At Awaad’s trial, Martinez’s lawyers painted a portrait of a man on a quest to conduct as many EEGs as possible, and of a hospital that looked the other way as red flags flew up around him. The lawyers accused Awaad of being hired by Oakwood Healthcare on a contract that compensated him for each EEG he performed. In his time at the hospital, from 1999 to 2007, his salary rose from $185,000 to $300,000, and he qualified for bonuses up to $220,000 if he met certain billing targets. Brian McKeen, Martinez’s lawyer, told jurors that Awaad had “turned that EEG machine into an ATM.”

    In court, Awaad denied Martinez’s accusations. He claimed that there were “many reasons” to do an EEG, such as to confirm a diagnosis or to see if a medication was working. Awaad was born in Egypt, and after stints at New York University and the Children’s Hospital of Michigan, he told the court, he went to Oakwood to serve the area’s many Arabic-speaking patients. (Awaad and his lawyer did not return requests for comment.)

    Soon after his arrival, however, there were signs that many of his supposedly epileptic patients did not actually have the disease. In 2001, two years before Martinez saw Awaad, a patient’s mother wrote Awaad a letter claiming that he had misdiagnosed her son with epilepsy and mis-medicated him. She wrote that when she asked to view her son’s EEG, the office claimed it could not provide it, because it didn’t own a printer. She requested that Awaad’s office withdraw her $523.60 bill. Instead, McKeen told jurors, Awaad turned the bill over to a collection agency.

    Several doctors surrounding Awaad also spoke out against him. In 2002, a developmental pediatrician named Susan Youngs, who worked with Awaad, sounded an alarm. Youngs was contractually obligated to refer patients to Awaad, McKeen said, but she demanded an alternative referral source. “I was concerned that he was diagnosing kids with seizures who didn’t have them,” she testified in her deposition. Later, two doctors spoke up about Awaad misdiagnosing kids with epilepsy in a department meeting. Even then, the hospital, McKeen said, did not launch an investigation.

    Woodruff, Martinez’s second doctor, said in court that he had treated a half-dozen patients whom Awaad had “labeled as having seizures,” and that he “never found a single patient” who had epilepsy. He said Awaad’s EEGs were repeated more often than other doctors would typically repeat EEGs.(continued)

  6. (continued)For his part, Awaad told the jurors that he did not know “where those numbers” in his contract came from—in other words, why they appeared to show that he would financially benefit from performing more EEGs. He said he increased Martinez’s Lamictal dose because she was growing. He denied misdiagnosing Martinez intentionally, and said he gave her the best care he could…

    Whether or not Awaad was seeking to enrich himself, he might be parting with his earnings soon. A jury recently decided that he owes Martinez $2.8 million—though this amount will likely be reduced because it exceeds Michigan’s cap on damages. Awaad’s hospital, Oakwood Healthcare, merged with Beaumont Health after the lawsuit was filed, and Beaumont plans to appeal. In an emailed statement, a Beaumont spokesman told me, “While we respect the jury’s recent verdict, we disagree with the outcome and will appeal. We cannot comment about the specifics of this case or others because of pending legal proceedings and patient privacy laws, but we believe patients were treated appropriately.”

    Today, Martinez is 26, and she is no longer on Lamictal; Woodruff weaned her off of it. Though she still has chronic migraines, for reasons that aren’t totally clear, she said she doesn’t trust the medical system much. She goes to the doctor only if she really has to. The court’s decision, she said, “was definitely a relief.” It was the kind of relief Awaad had failed to provide.

  7. Cases like Awaad’s are especially fraught because differing diagnoses of the same patient are common in health care; it’s where the term second opinion comes from. Often, the only way a misdiagnosis is discovered is if a patient has another specialist check a doctor’s work. Even then, it’s not always clear whether a wrong diagnosis was intentional or not. As Louis Saccoccio, the head of the National Health Care Anti-Fraud Association, put it to me, “People rely so much on physicians’ professionalism that when that trust is violated, it’s a tough thing to catch.”...

    Saccoccio told me that while it’s hard to determine how common the intentional-misdiagnosis style of fraud is, the more typical variety is called “upcoding”: doing a cheaper procedure but billing for a more expensive one. (Awaad is accused of doing this, as well.)...

    Some lawyers argue that many of the doctors who get swept up in these kinds of cases are doing honest work: These doctors simply have a different opinion than another doctor who is later asked to review their diagnoses. Writing in The Wall Street Journal last year, the lawyers Kyle Clark and Andrew George pointed out that a decade ago, most health-care fraud centered on something the doctor failed to do, such as neglecting to treat a patient who was actually sick. Now prosecutors are bringing more and more so-called medical-necessity cases, which focus on a test or procedure doctors did do that they shouldn’t have. “Doctors can, and do, honestly disagree by wide margins,” Clark and George wrote. “Show two doctors the same image, and you may get wildly varying—yet highly confident—opinions of what it shows.”

    The most devious doctors, who will harm their patients to line their pockets, make headlines. But in a way, even honest doctors are incentivized to err on the side of excessive care. Most doctors work on a fee-for-service basis, meaning the more they bill insurance plans, the more they earn. Some states and hospitals are trying to avoid this situation by experimenting with paying doctors a fixed amount. But that, Sparrow said, creates the opposite problem: It means doctors are incentivized to do less. Ideally, in his view, there wouldn’t be incentives either way. “I don’t want a doctor who is richer for treating me more or richer for treating me less,” he said. “I want a doctor who is on a salary.”

  8. According to the class action lawsuit in Wayne County Circuit Court, Awaad advised hundreds of children they had epilepsy and needed to undergo a variety of unnecessary treatments and procedures, and many were prescribed strong anti-epileptic medicine with which they had negative side-effects.

    Specialists who have reviewed the cases have stated in sworn affidavits that they found some of Awaad's diagnoses and treatments to be dubious or unnecessary, according to the lawsuit.

    Awaad's case has received broad media coverage over the years:

    In February 2006, Shana Reese was high school cheerleader who loved shopping and roller-skating with friends. Headaches started to slow her down. After two EEGs, Awaad diagnosed her with epilepsy and told her she couldn't drive, shouldn't go outside and had to quit cheerleading. She dropped from the school honor roll and was barely passing. Eventually, Reese saw other doctors and they diagnosed her headaches as caused by allergies, according to an article in People magazine in 2010.

    Kevin Patelczyk, now 30, was about 16 when he went to Awaad for episodes that included passing out, shaking and breaking out in cold sweats. Awaad ran an EEG and told him he had epilepsy. Over time, Patelczyk of of Sterling Heights developed digestive problems and numbness and tingling in his fingers and toes. Depressed, he spent two weeks in a hospital psychiatric unit after taking an overdose of pills. He then went back to see Awaad, who told him he had a heart condition and discharged him as a patient, according to a 2014 report in the Detroit Free Press.

    Both are suing Awaad for false diagnosis and unnecessary treatment for epilepsy.

  9. Awaad's unusual journey from promising student to defendant began in medical school in Egypt in the 1970s, where at some point he decided he wanted to migrate to the U.S. to practice medicine.

    In 1994, he received his state medical license and completed a one-year residency at Detroit Medical Center's Children's Hospital of Michigan and later negotiated a lucrative multiyear contract at Oakwood Hospital. After leaving Detroit in 2007 for the Middle East while allegations of poor patient care were swirling, then returning in 2014, Awaad's movements have many people scratching and shaking their heads.

    Brian McKeen, managing partner of McKeen & Associates, is conducting the depositions of Awaad and is co-counsel to the families in the now 8-year-old class action lawsuit against Awaad.

    Veteran plaintiff attorney McKeen told Crain's that Awaad, Beaumont and Oakwood have not been especially forthcoming in helping him and families understand what happened to their misdiagnosed children. He also said nobody has clearly explained why Awaad returned to Detroit to take a six-figure salary first by Oakwood, and then by Beaumont, which restricts him from direct patient care.

    "This guy came to Oakwood (in 2005), bragged about a huge practice in epilepsy at Children's Hospital and laid out an unrealistic plan to generate revenue," McKeen said. "(Oakwood) put him in business with an incentive-laden contract tied to billing, and business shot through the roof."

    McKeen, who said more than 2,000 children were treated by Awaad during about a four-year period, is joined in the case by co-counsels who include Bruce Truex, Anthony Randazzo, Nate Finch, Nancy Savageau and David Dickinson. They represent 247 clients in the class action lawsuit.

    "Every kid who came through the door was given a series of EEG (electroencephalogram) tests and diagnoses everybody (98 percent) as having epilepsy whether they had it or not," said McKeen, noting that some children suffered from seizures, other lesser medical issues or were just sleep deprived.

    Yasser Awaad was born in Cairo, Egypt, in 1954. He graduated in 1978 from medical school at Al-Azhar University. He moved to the U.S., took required preresidency licensing tests, received his Michigan medical license in 1994, completed a one-year residency at DMC Children's Hospital and began private practice that included having medical staff privileges at Detroit Medical Center.

    In 2005, Oakwood Hospital in Dearborn hired Awaad, giving him a $250,000 base salary that swelled to more than $600,000 as he hit patient volume incentive targets, according to Awaad's depositions and McKeen.(continued)

  10. (continued)Awaad's contract rewarded him with 50 percent of medical billings once he got above a certain threshold, according to his deposition.

    The patients and money were rolling in until March 2007, when patients received a letter from Awaad saying he would no longer be practicing at Oakwood.

    Awaad said in a deposition that he then left Oakwood for a job in Saudi Arabia after the hospital system wanted to move him into a private practice model and he could not come to contract terms. It's unclear exactly why Awaad left Oakwood, although he gave several answers in his depositions.

    In one deposition this year, Awaad was asked if there was any disharmony or problems at Oakwood just before he left. Awaad answered, "No." McKeen asked him several times about any problems he was aware of and Awaad continued to respond in the negative.

    Under persistent questioning by McKeen, Awaad later acknowledged his office was raided by FBI agents, although he characterized it as a visit that his office manager handled. The FBI and other investigators seized boxes of patient files. Awaad also confirmed to McKeen that he filed a lawsuit against Oakwood for withholding $400,000 due him for bonus and salary payments.

    But he continued to deny there was any disharmony surrounding his employment at Oakwood.

    Awaad repeated several times in depositions that he only left Michigan and the U.S. because he could not reach agreement with Oakwood on a contract. He implied he wanted to stay in Detroit and actively sought a contract, but when none was forthcoming in 2007 he had to take the job offer in Saudi Arabia to practice pediatric neurology at King Fahad Medical Center...

    While Awaad was in Saudi Arabia, several things were happening back in Michigan.

    First, the class action lawsuit was filed in July 2008 against Awaad and included Oakwood, Great Lakes Pediatric Neurology and Oakwood Professional Billing.

    In 2009, a Michigan attorney general investigation into Medicaid fraud by Awaad resulted in Oakwood repaying the state $309,140 for inappropriate billing.

    In January 2012, the Michigan State Board of Medicine ordered Awaad to pay a $10,000 fine and serve up to three years of license restrictions for misdiagnosing epilepsy in four children and giving them anti-seizure drugs they didn't need. The fine was part of a consent agreement between Awaad, the Michigan Attorney General's Office and the state Board of Medicine.