Nancy Kuzma picked a doctor from the phone book for a routine gynecological exam last summer. It turned into one of the strangest trips she's ever made to the doctor's office.
Ms. Kuzma made an appointment to get birth control pills but got an abortion. At least, that's what the doctor billed her for.
And she wasn't even pregnant. In fact, she opposes abortion.
She went to see Dr. Tati Okereke -- pronounced Tah-TEE oh-CARE-eh-kee -- because his High Street Medical Clinic was near where she worked as a cleaner.
Ms. Kuzma had not read a recent newspaper report announcing that state officials had revoked his medical license July 27, his second suspension in two years.
Even though The Buffalo News reported his revocation Aug. 3, Okereke still was practicing medicine in the second week of August because the state Board of Regents took a month to notify him his license was pulled again.
And Ms. Kuzma was not aware Okereke is awaiting judgment on additional charges from the state Health Department that could lead to permanent revocation of his license.
According to hearing transcripts on those charges obtained by The Buffalo News under the Freedom of Information law, the state alleges that Okereke:
Raped two patients and made sexual advances toward a third.
Drugged and then tried to have sex with his receptionist at an office Christmas party Dec. 24, 1988, at the Hyatt Regency Buffalo.
Dispensed narcotics to himself and failed to account for 1,400 pills of various controlled substances he obtained from a Long Island drug wholesaler.
Prescribed Valium and diet pills to a woman who weighed 112 pounds and was 5 feet 4 inches, and prescribed diet pills to another woman with a known history of drug abuse.
Lied on staff membership applications to Buffalo General Hospital, Children's Hospital and a Maryland hospital, after he was denied privileges at the two local hospitals.
Continued seeing patients after his license was suspended for three months in March 1988.
The state Health Department lawyer prosecuting Okereke said he should not be practicing medicine.
"It's hard to imagine a person less qualified in terms of moral character to hold a license to practice medicine than Dr. Okereke," Health Department attorney Paul R. White said during hearings by the state Board of Professional Medical Conduct that ended in last April.
Okereke, 50, a Nigerian-born physician who lives in Amherst, is a survivor of the state's cumbersome procedures to supervise physicians, a system criticized for protecting doctors at the expense of their patients.
Taking every review and appeal available, Okereke managed to delay serving his last suspension nearly seven years after the Health Department filed medical misconduct charges against him in 1981.
When he failed to pay $13,000 of his $15,000 fine, his license was revoked in July. He was still practicing, awaiting official notice of revocation, when Ms. Kuzma went to his office on Aug. 10.
Ms. Kuzma, 25, who lives in an apartment off Broadway on Buffalo's East Side, said her examination by Okereke was unlike any she had ever undergone.
"He told me there was going to be a small operative procedure for getting birth control pills," she said during an interview. "He said he had to start me bleeding."
Ms. Kuzma said Okereke injected her with a drug that his nurse told her was Demerol -- a powerful pain medication similar to morphine. He then withdrew two large vials of blood from her uterus, without explaining why. She was left to drive home still disoriented from the narcotic.
Two nights later, she went to a hospital emergency room with a fever and stomach cramps. She missed a week's work, and the absence caused her eventually to lose her job.
But the biggest shock came last week, when she called her insurance company to learn what Okereke did to justify a $300 bill.
Okereke billed the procedure as an abortion.
"It stunned me," Ms. Kuzma said. "I am totally against abortion."
Doctor is 'pathological liar'
Ms. Kuzma said she was not pregnant when Okereke examined her. She said he never performed any tests, asked any questions about pregnancy or abortion, or even took a medical history from her.
When initially reached by a Buffalo News reporter in August about the Kuzma case, Okereke declined to comment.
Reached again for comment Friday about Ms. Kuzma's complaints, Okereke denied that he had ever seen her.
"I don't have any such patient," he told The News.
But Ms. Kuzma produced a prescription that Okereke wrote for her and signed, as well as a letter from Blue Shield, informing her the health insurance carrier paid Okereke $299.64 of the $300 he billed after seeing Ms. Kuzma in August.
She also said Okereke's nurse at his Linwood Avenue office -- she was directed there from the High Street clinic -- told her Okereke would be examining her, and said Okereke introduced himself when he came into the examination room.
White, the prosecutor in the latest Health Department charges, charged that Okereke has lied on a number of occasions.
"Dr. Okereke is a pathological liar," White said during the hearings in April. "The guy is either incapable or unwilling to tell the truth."
In his defense at the hearings, Okereke said that he is a victim of racial prejudice, that other physicians are jealous of him because he has published international papers, and that the Health Department had teamed up with anti-abortionists in Buffalo to oppose him.
But one of Okereke's fiercest opponents has been Marilynn Buckham, an abortion rights advocate who serves as executive director of Buffalo GYN Womenservices. She feels he discredits pro-choice advocates and gives abortion foes an easy target.
She is among the critics of the way the state oversees physicians. And she believes the Okereke case and its numerous delays and reviews represents all that is wrong with the system, she says.
"This state is so screwed up in its monitoring of doctors," said Ms. Buckham, who as the former administrator of the Erie Medical Center hired Okereke when he came to Buffalo in 1973. She later fired him and reported him to the state for medical misconduct and testified against him.
State system widely faulted
Michael T. Kelly, special prosecutor for Medicaid fraud and patient abuse in Western New York, said he has been puzzled to see doctors he has convicted retain their license. He is not involved in the monitoring, but refers cases to the Health Department.
"We can convict a doctor of a felony, for stealing $100,000, and he still doesn't lose his license," Kelly said. "Or if he gets a two-year suspension, he gets all the time suspended. It always comes back, 'It doesn't go to his treatment of patients.' "
Public Citizen, an interest group founded by consumer advocate Ralph Nader, charged in July that the state Board of Regents is lax in disciplining "dangerous doctors."
"New York's medical discipline process is unwieldy, tragically so," Public Citizen said. "On average, complaints take two years to be resolved, and in some cases they have become jammed in the bureaucracy for a decade."
Even those involved say the system needs to be streamlined. It has too many layers that hurt both the patients and doctors awaiting a speedy decision, they say.
Gov. Cuomo favors a plan by Dr. David Axelrod, the state health commissioner, to eliminate the state Board of Regents as well as the health commissioner from the review process.
Axelrod wants all cases to be heard only by his department's Board of Professional Conduct. These are teams composed of two physicians and a lay member who conduct hearings.
"The problem here is not with us, it's with the Board of Regents," said Bill Fagel, a Health Department spokesman. "Dr. Axelrod feels, in a number of instances, the Board of Regents has watered down his recommendations to the point where they don't mean anything."
Suspension cut to 3 months
Fagel cited figures showing that the Regents reduced Axelrod's recommendations in 220 of the 470 cases heard against doctors from 1987 through 1989.
The state Board of Regents agrees with Axelrod. The system is too cumbersome. But it recommends removing the Health Department from the process and transferring the hearing to the Education Department, with the Regents still making the final decision.
The lengthy ordeal involving Okereke's medical misconduct charges in 1981 illustrates the critics' contention that the current system is unfair both to patients and doctors.
Ms. Buckham complained in 1980 to the state Health Department that Okereke was allegedly involved in a scheme to divert abortion patients from her clinic, where Okereke still worked, to his private office.
He first told patients at the Erie Medical Center, a private clinic, they were more than 12 weeks pregnant, she said, meaning they would have to have an abortion at a hospital. At the hospital, she said, Okereke told the patients he could perform the abortion at his private office.
The state Health Department's office of Professional Medical Conduct investigated the complaint and others and recommended charges to the department's Board of Professional Medical Conduct, a three-member panel composed of physicians and lay members.
Nine times, between Aug. 27, 1981, and Feb. 1, 1983, the board held hearings on the charges. Okereke and his attorney, Paul J. Cambria Jr., were present.
The board found Okereke guilty in March 1983 on three counts -- paying for referrals, not filing timely fetal death certificates, and advertising or soliciting not in the public interest.
Nearly three years later, on Jan. 3, 1986, Axelrod upheld the findings and a recommended sentence of a five-year suspension, a five-year probation and $30,000 fine. But he also said Okereke did not have to serve the five-year suspension.
Okereke's case then went to the state Board of Regents Review Committee. Cambria appeared on May 30, 1986, and argued on Okereke's behalf.
The Regents Review Committee issued its recommendations July 31, 1986. The five-year suspension was reduced to three years with three years' probation, and the fine was cut in half to $15,000, which it said was the maximum allowable.
The state Board of Regents then reviewed those recommendations and upheld the findings in October 1986. But the Regents called for three months of the three-year suspension to be served, meaning Okereke would be without his license for 90 days.
At that point, Okereke appealed to the courts. The Appellate Division of State Supreme Court and the state Appeals Court turned him down in November 1987.
Finally, on March 1, 1988, Okereke's three-month suspension began, almost seven years after the charges were first filed.
But Okereke's case does not end there. It is far more complicated.
Racial remark led to mistrial
While those charges were making their way through the system, Okereke was accused in 1982 of raping two patients and then bribing both so they wouldn't testify.
Represented by defense lawyer Robert M. Murphy, Okereke gained a mistrial in 1985 on the first rape because an alternative juror said she overheard two other jurors making a racial remark about Okereke. He was acquitted of both rapes in the second trial.
Okereke also was arrested at a December 1988 office Christmas party at the Hyatt Regency. Buffalo police accused him of drugging his receptionist, trying to have sex with her and fighting with police when he was arrested. A grand jury declined to indict him after learning the woman never filed a complaint.
Days after the grand jury's decision, the state Health Department filed its most recent 60 charges against him, including the three criminal accusations.
Because a lesser standard of proof is allowed in civil proceedings, Okereke could be found guilty even though he was acquitted in the criminal trial and the grand jury did not return an indictment.
And there is no statute of limitations. The charges against Okereke include a complaint by a woman who was 19 at the time Okereke saw her in 1973. She said he injected her with a drug and fondled her until she asked what he was doing.
"I guess I got braver as I got older, trying to stand up for (my) rights," she told the hearing officer about why she came forward so many years after the incident. "I'm hoping other people didn't get hurt the way I did."
Any guilty finding by the Board of Professional Medical Conduct in the current license proceedings could go through the various levels of review that took seven years to complete last time.
"I think it's so discouraging to see how the system really operates," Ms. Buckham said.
She said she vowed to fight Okereke's continued practice after patients came to her with complaints that he drugged them and sexually abused them during examinations.
"It's really unfortunate to women in the community that this guy was allowed to practice all these years," she said. "If he gets his license back, he'll just go back to the same thing."
The state Board of Regents said Friday that Okereke's license was revoked at least until next August for failing to pay his $15,000 fine. Even then, a spokeswoman said, he has to reapply to get his license back.
Okereke apparently feels he might be practicing medicine sooner.
When a female News reporter phoned last week for an appointment, Okereke said he wasn't currently seeing patients and referred her to another physician.
But he told her, "Call us back in March."