Internist's Relapse Into Drug Use Undetected

Cheney Was Aware of His Doctor's Problem

For years after Vice President Cheney's personal internist, Gary Malakoff, had supposedly quit abusing prescription painkillers, the team of doctors monitoring his recovery remained oblivious to the fact that the high-profile doctor was still drug-dependent, according to legal papers and medical records obtained by The Washington Post.

Records show that treatment team members at George Washington University Medical Center, who conducted frequent medical and psychiatric examinations to watch for signs of relapse, may even have facilitated Malakoff's problem by their deferential treatment, raising questions about the suitability of having medical center doctors overseeing one of their own.

The psychiatrist and neurologist overseeing care for Malakoff -- then the director of the medical center's internal medicine division -- repeatedly prescribed the drugs the internist was known to have been abusing, medical charts show.

And when the neurologist, Perry Richardson, needed to document Malakoff's progress to the local medical society, he let Malakoff craft the letter, Richardson acknowledged in a deposition.

"I have no concerns about his thought processes or judgment," Malakoff wrote about himself for Richardson's signature. "I truly believe that he is stable enough to see and take care of patients as well as teach our medical students and residents."

The documents, along with interviews of doctors familiar with the case, paint a picture of an insular and ineffective system of oversight in which Malakoff's doctors accepted his assurances of well-being at face value while he continued to order thousands of dollars of drugs on the Internet, repeatedly crashed his car and managed to bamboozle scores of urine tests.

By doing so, the records show, Malakoff's physicians effectively, if unwittingly, protected him from further disciplinary action by the District's medical licensing board.

The Malakoff case also has spotlighted the role of the Medical Society of D.C., the nonprofit physician organization that monitored his treatment.

Peter J. Cohen, the physician who chairs the committee that watches over impaired doctors, said the medical society took immediate steps when it discovered this spring that Malakoff was still using drugs.

"When we found out about this, because we knew his history, we acted very quickly," Cohen said. "The first thing we did was notify the hospital, and he stopped practicing immediately. . . . We did not coddle him. We did not hide him."

It is not clear, however, why earlier periods of ongoing drug use by Malakoff were not picked up by drug tests demanded by the medical society. Malakoff "has had some relapses" during his nearly five years of oversight by the medical society, Cohen said.

One thing that became clear yesterday is that Cheney has known about Malakoff's problems for some time. Jonathan Reiner, director of GWU's cardiac catheterization laboratory, said in an interview that Cheney "has known for years" about Malakoff's drug dependence, although he would not be specific.

"Dr. Malakoff had frank discussions with the vice president for quite a period of time about this," Reiner said. "This was not just recent news. He has kept him apprised."

Reiner said he had "no concern" that Malakoff's problems affected Cheney's care, saying that Malakoff was "a member of a team of doctors" that made collective decisions.