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.