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If they grow old alone, without children to care for them, these women are especially vulnerable. Their lack of mobility makes it difficult to get medical help, run errands, and shop for food.
And, of course, they are easy marks for the most unscrupulous criminals. So susceptible are old people in general to predators that police departments create units to investigate and attempt to protect them from becoming victims, such as the elderly abuse unit within the Miami-Dade Police Department's Domestic Crimes Bureau.
As Lewis, Enright, and Drees grew older and more feeble, the world outside their doors must have seemed more strange and terrifying by the day. No wonder they rarely left their homes.
It was most likely reassuring, then, to receive visits from a kindly doctor. We're raised to trust our doctors. We have to, we put our health in their hands. In return, medical ethics guidelines require them to put the health of the patient ahead of financial concerns.
And that is where Dr. Brady is on shifting ground. If it's not an outright conflict of interest, it might very well give the appearance of one for the primary care physician to be the major beneficiary of a patient's will. It can call into question the motives of someone who is prescribing medication, and may potentially make decisions whether to prolong the life of someone who is old and infirm. Of course, that's if they know they've been included in the will.
Because Brady and his lawyer declined to answer any questions, his complicity remains unknown. Did Dr. Brady know he was a beneficiary of these former patients? Did he ask to become one? Did the women discuss the subject with him beforehand? If so, what did he tell them? Does he negotiate for a portion of the estate in lieu of doctor's fees?
Among medical ethicists there is consensus that if a patient informed a doctor he was going to be included as a beneficiary, the doctor should simply not accept.
"If a physician knew there was a chance he might be named in a patient's will, he would need to immediately take himself off the case as serving as the primary physician, in my opinion," says Dr. Karl Steinberg, a geriatrician and director of a hospice and nursing center in Oceanside, California, who is also a national legal consultant on medical issues. "Elderly patients may lack the capacity to make a fully informed decision, and they may be subject to undue influence."
He adds: "It's just not appropriate to accept money from a patient, other than a fee. There's just something yucky about it."
"It's a conflict of interest," says Kenneth Goodman, co-director of the University of Miami's ethics program, and director of its bioethics program. "We have pretty bright-line rules in the practice of medicine about relationships that we deem appropriate. The reasons for this are that patients are presumed at the outset to be vulnerable, maybe they're sick, maybe they're scared. So we put those barriers up to keep vulnerable people from being taken advantage of."
"The most obvious prohibition is having sex with a patient," he continues. "Another clear rule is that you don't borrow money from your patients, and you don't insinuate yourself into their wills. Any time you find yourself in a patient's wallet or checkbook for anything other than a fee, you've gone from practicing medicine to doing something altogether different."
And of course, both men wonder, did these women understand everything clearly in their later years?
Lorain Enright may have been old, but she was certainly not senile, according to her great niece, Patricia Westberry Ketzle. "My great aunt was very strong-willed, very in control of her mind, but she became feeble," Ketzle recalls. "We did try to take care of her, especially my father. And it was difficult because she insisted on living alone."
In 1987 Ketzle's mother died, and the family became distracted in the aftermath. That happened to be the year Brady came on the scene, although Ketzle doesn't remember how. "One time he just showed up at her home when she was particularly needy. At the time he seemed like a god-send, a knight in shining armor. He's a very personable man, and got very involved in her life."
She adds: "He did have a way with older women. She was very persuaded by him."
Indeed, a letter Ketzle's father, Paul Westberry Jr., sent to lawyers, contained in probate court files, helps document that. (Westberry declined to comment.)
"When Dr. Brady came on the scene in 1987, he relieved me of paying her bills. He also went to the grocery store for her. Of course, she signed her checks and she paid Dr. Brady," Westberry wrote. "Her mind was very good, but she did forget things."
Westberry referred to himself in the letter as "the closest thing to a son she had." He did plumbing, electrical work, and carpentry on the house she insisted on living in alone.
"My father served that woman her entire life. We loved her and we took care of her," Ketzle says. "But it was exhausting."