A doctor charged last month with murdering four people had a paper trail of professional troubles — including being kicked out of a Chicago residency program for "substandard" behavior — yet maintained a license to practice medicine in Illinois for a decade.
Documents the Tribune obtained from the University of Illinois at Chicago show that Dr. Anthony Garcia's supervisors in the pathology program were so concerned about his lengthy absences and failure to contact them that in 2004 they ended his contract.
It was the third residency program that Garcia did not complete, and he was later fired from a fourth after authorities in another state discovered he had lied about his residency record, according to records. Those failings raised enough red flags that authorities in at least three states moved to block his ability to practice medicine.
Yet Illinois — apparently unaware of his problems — continued to renew his permanent medical license, exposing what some experts have said are broad weaknesses in how doctors are tracked across the country.
"It is just a big loophole in general that nobody is adequately tracking these residency and resume issues," said Robert Oshel, a retired associate director for research and disputes with the National Practitioner Data Bank. "Everybody was sort of doing the minimum they needed to, and nobody was really looking for the long-run public interest."
Garcia had been living in Terre Haute, Ind., when he was arrested July 15 in southern Illinois and charged with four counts of first-degree murder.
Authorities have said the killings were revenge against the doctors who fired Garcia from his residency program in Nebraska before he moved to Illinois. One of the victims was the 11-year-old son of one of the doctors who fired him in 2001 from the pathology residency at Creighton University in Nebraska. The boy, Thomas Hunter, and his family's housekeeper, Shirlee Sherman, 57, were stabbed to death in 2008 by someone who broke into the Hunters' home.
Then in May, authorities allege, Garcia killed the other doctor he blamed for his undoing at Creighton, Roger Brumback, and his wife, Mary, both 65. Roger Brumback was fatally shot; his wife was stabbed to death, authorities have said.
One of Garcia's attorneys, Robert Motta, said Garcia plans to plead not guilty. "We totally and completely believe in our client's innocence," Motta said.
After learning of Garcia's arrest, Illinois regulators reviewed his 2003 medical license application — which was granted while he was still a UIC resident — and his 2005, 2008 and 2011 renewal forms. They found discrepancies and suspended his license.
Among other omissions, Garcia had not disclosed that he was suspended from a residency program in New York because of "unprofessional and inappropriate conduct" and subsequently resigned, according to the Illinois petition for his suspension. Garcia had also been fired from his residency at Creighton, failed to complete his program at UIC and then was not allowed to continue a fourth residency in Louisiana after lying on his medical license application, according to records.
"The department discovered significant discrepancies between what has been reported in the media about Dr. Garcia and the information he provided on his applications," said Sue Hofer, spokeswoman for the Illinois Department of Financial and Professional Regulation, which licenses doctors in Illinois.
States have varying requirements for granting a medical license. In Illinois, a doctor must pass a medical licensing exam and complete at least two years of postgraduate residency training, but not necessarily at one institution.
Before issuing a license, Illinois checks the National Practitioner Data Bank and the Federation of State Medical Boards for actions taken against a doctor's hospital privileges and medical license.
Those databases, however, may not catch resident warnings, terminations, nonrenewals and withdrawals, officials said. Residents are often considered trainees in education programs and are generally not subject to reportable clinical privileges actions, according to Martin Kramer, spokesman for the federal Health Resources and Services Administration, which maintains the National Practitioner Data Bank.
Garcia was not reported for the incidents in New York, Nebraska or Louisiana.
"This case of Dr. Garcia highlights all the reasons why the National Practitioner Data Bank should have enhanced legal authority to require all these residency programs to report," said Dr. Sidney Wolfe, Founder of Public Citizen's Health Research Group, a consumer and health advocacy organization. "Slipping through the cracks are people like Dr. Garcia."
Garcia's attorney acknowledges that his client had "some problems maintaining employment with different residences."
Records show that after graduating from medical school at the University of Utah in 1999, Garcia struggled to launch his career.
He began a family medicine residency in New York in 1999, but state investigators soon found his behavior "left serious doubt" about his ability to successfully practice medicine, according to documents. Those documents, however, did not go into details about his behavior. He was suspended from the residency, but then Garcia resigned from the program, according to records.
He transferred to a Creighton residency in 2000 but was subsequently fired when the school determined that he had "willfully" called a fellow resident's home while the resident was taking a high-stakes exam, according to records.
In 2001, Garcia transferred from Creighton to UIC's resident pathology program.
Although he officially parted ways with UIC in 2004, his last day of on-site work was in July 2003, several months after receiving his permanent license to practice medicine in Illinois. For many months, Garcia disappeared from the program, some of the time on sick leave, and UIC officials were unable to reach him, documents from UIC show.
His absences and behavior eventually led his supervisor to write him a letter in May 2004, explaining why his contract would not be renewed for the 2004-05 residency year.
"I have expressed concerns to you about your absences in terms of programmatic, educational, and patient care issues," Garcia's supervisor, Dr. Michele Raible, wrote in a letter obtained by the Tribune under the Freedom of Information Act. "Of greater concern to all of us, though, is that your professional behavior in dealing with your residency position and its associated responsibilities has been substandard over the past year."
The letter from Raible, who died of cancer in 2010, refers to a discussion in which Garcia told her that he was "ill." In later records, Garcia reported that he left "due to poor health/migraine headaches/depression," and Garcia's attorney said his client told him he was having "horrific migraines" while at UIC.
But UIC officials did not share Garcia's troubles with the Illinois Department of Financial and Professional Regulation. UIC spokeswoman Sherri McGinnis-Gonzalez said that because Garcia already had received his permanent license, the university had no power to report him.
"The university had no authority as his training program to request that his permanent license be canceled," she said.
But Hofer, with the state licensing agency, said UIC still could have reported problems related to Garcia's temporary medical license, which he was granted as a UIC resident. McGinnis-Gonzalez declined to comment about that possibility.
Although Garcia was able to keep his record hidden in Illinois, authorities in Indiana and Louisiana found out about his past. In Indiana, records show, officials moved to deny Garcia's application for a license last year after he eventually revealed his incomplete record at other residency programs, a fact he had initially failed to disclose.
Louisiana in 2008 discovered discrepancies on his application through a credentials verification process that is offered by the Federation of State Medical Boards. The profile revealed that Garcia had not reported what happened at Creighton and that he did not complete the UIC program, records show. Louisiana officials notified Garcia that they intended to recommend he be denied a license to practice medicine in the state. Garcia then withdrew his application, according to Louisiana officials.
Louisiana is one of 12 states that require all applicants to submit a so-called Federation Credentials Verification Service, or FCVS, profile, which independently confirms a physician's academic and disciplinary history and compares the findings with what was reported on the physician's application.
Illinois does not require it. Hofer said Illinois relies on physicians, particularly during renewal, to honestly answer questions about any adverse actions that have been taken against them or conditions they may have developed that could impede their ability to practice medicine. She said making the federation profile a requirement would require legislative approval.
"We are always seeking ways to improve our licensing process to ensure the safety of the public," Hofer said. "Requiring submissions of an FCVS profile is one of the options under consideration."
With an Illinois medical license, Garcia eventually returned to Chicago, where he worked in 2009 at Visiting Physicians on the Near Southwest Side, making house calls to elderly patients. His former boss described him as an ideal doctor who had no complaints from his patients. Garcia had no disciplinary issues in Illinois, according to Hofer.
Garcia was doing what he had wanted to do since his childhood, according to a brief essay and resume he included in his application to UIC in 2001. He said he was "hard working," enjoyed auto mechanics and piano, and had a "love of science and the human body."
"Since my childhood, I have pursued a life ambition to scientifically study the human body," he wrote. "I am glad I can fulfill my interest and help others, at the same time."