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"I've been arrested for a lot of things," Stewart says, "everything from drinking in public to second-degree murder. I do have a past. I'm loud and crude. I'm not as debonair, and I don't have as much education as the Kalk family. But it doesn't necessarily make me a bad person. Nobody took advantage of poor Dr. Kalk. It was the other way around."
Despite the dumped medical records, the encounters with police and the allegations of professional misconduct, Kalk continued to practice medicine virtually unfettered.
By the time he left for Texas in March 2009, medical regulators had been investigating Kalk for nearly three years. Still, he was somehow able to obtain a new medical license in Illinois during this time, and even with all of his indiscretions, he remains a licensed physician in Illinois with a clean record.
"His case kind of dragged out over the course of time," says Michael Boeger, administrator of the Missouri Bureau of Narcotics and Dangerous Drugs (BNDD). "He was on probation, and we didn't have any more issues again. Next thing you know, I'm reading about him in the paper, and he's fleeing the state."
According to Creve Coeur police reports, a BNDD inspector was "thrown out of the office" when he asked to see Kalk's onsite pharmacy on December 19, 2006. A week later, Kalk summoned the inspector back, and he was cited for a half dozen record-keeping violations.
"Due to a lack of receipt records, inventories and dispensing records," the BNDD found, "it was not possible to conduct an audit to determine if any controlled substances were missing."
But before the BNDD could punish him for the infractions, Kalk bounced a check to renew his medical license, and he lost the right to prescribe painkillers and other controlled substances. Boeger says it is rare for a doctor to work under such circumstances. "It's a liability. No insurance company will work with them. No hospital will give them privileges."
Yet in November 2007, Kalk was granted an Illinois medical license and full drug clearance by the state's pharmacy board. Susan Hofer, a spokeswoman for the Illinois Division of Professional Regulation, says there was no way of knowing about Kalk's troubles in Missouri. "Until there's a final action taken, they don't notify the association [of state medical boards]."
Kalk also continued his affiliation with Missouri Baptist Medical Center until December 2007. Hospital spokeswoman Mary Beck declined an interview request and refused to specify why he was dismissed by the facility.
The Missouri Board of Registration for the Healing Arts was last to act. Kalk wasn't formally disciplined until December 2008, when the state charged him with six counts of misconduct, including sending threatening e-mails to a medical billing company manager and inappropriately touching a female patient.
"Several allegations and different accounts came to us at different times. When a new allegation of misconduct comes in, we go and investigate," says Tina Steinman, the agency's executive director, explaining the delay. "You only have one opportunity [to revoke the license]. We have to make sure we have all the evidence we need."
Kalk signed a settlement allowing him to "voluntarily surrender" his Missouri medical license rather than have it revoked, effective July 1, 2009. Susan Hofer says that distinction is what has allowed him to remain unscathed in Illinois.
"We frequently open an investigation and take action based on the actions of another state," Hofer says. "The issue with voluntary surrender is it doesn't trigger the same kind of urgency as a revoked or suspended license. It's not clear that it's a disciplinary issue."
Medical licensing experts say such oversights are common because each state's system is unique, many are underfunded, and there's often miscommunication between the bureaucracies.
"They don't have staff to do adequate monitoring, let alone speedy resolution of cases," says Tim Greaney, director of the Center for Health Law Studies at Saint Louis University. "Those delays can hurt the public. An eighteen-month investigation can really cause harm during the pending investigation."
Kenneth Vuylsteke, who chairs the medical legal committee for the city's bar association and represents patients in malpractice claims, believes Missouri's system is biased in favor of physicians.
"Their whole theory is, 'We have a lot invested in their training; with the doctors' education, they have so much to offer,'" he says. "Doctors are valuable commodities, but they're also in a position to cause great harm if they don't know what they're doing. I think the Board of Healing Arts in Missouri and in other states needs to take a second look at what they're doing and try to protect patients instead of the licenses of physicians."
"Missouri definitely has due process built in," counters Steinman. "It can be good, it can be bad — depending on what side you're on."
Dr. Paula Clayton, medical director of the American Foundation for Suicide Prevention, says mental illness is a widespread problem among doctors. "Ninety percent of people who die by suicide have mental disorders," she says. "The studies are unequivocal: Physicians have the highest suicide rate of any profession in the Western world."
Clayton attributes the deaths to the fact that doctors often refuse to seek treatment for their conditions, fearing that it will hurt their careers. Kalk, though, says he had no fear of repercussions. "It's not a question of concealing, it's a question of not realizing," he says. "It just took time for friends and family to convince me I was ill."
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