On the surface, the tragedy of Stephen Ours' death by cancer at age 33 seemed softened by the circumstances: He died at his Leesburg home, with his wife and two young daughters around him and the hospitals he distrusted far away.
Yet nearly a year later, there is little prospect that the pain his family experienced will ease soon.
His death has become the focal point of a larger drama involving Virginia's effort to revoke the license of his Loudoun County doctor, a man whose espousal of unconventional treatments -- like coffee enemas and vitamin regimens -- already has resulted in his loss of local hospital privileges and seen him ostracized by the local medical community.
While no one can predict for certain when it comes to cancer, the simple statistical fact is, the doctors say, that Stephen Ours' cancer was treatable. Had he opted for conventional treatment, there is a good chance he would be alive today.
Around that one assumption -- with which his beseiged doctor agrees -- swirls a cloud of bitterness that has splintered the once-close Ours family. It has pitted Ours' mother, who urged her son to accept conventional treatment, against his wife, Karen, who says her husband made his choice and lived it courageously to the end.
It also threatens to make the proceeding brought by the Virginia State Board of Medicine against Dr. Thomas J. Roberts, Ours' doctor, a cause ce'le bre within the passionate corps of unconventional medicine believers. To them, Roberts is merely the latest victim of a conservative, self-interested medical community that fears change.
More important, they argue, it demonstrates that the medical establishment does not believe that it should be up to the individual to decide what type of medical treatment he or she wants.
"That was the way Steve chose to live," says Karen Ours simply. "And that was the way he chose to die."
In such a highly charged atmosphere, the protagonist seems out of place. Thin, red-haired, and above all soft-spoken, Roberts practices in a small office in an old, converted Leesburg residence. A 1960 graduate of the University of Virginia medical school, he has practiced medicine in such places as Alexandria and Afghanistan. He has been in Loudoun County since 1971.
In Roberts' practice, preventive care is emphasized, according to testimony given in State Board of Medicine administrative revocation hearings in Leesburg during the last month. Testimony shows that he favors treatments, such as those developed by Dr. Max Gerson during the 1930s and 1940s, in which enemas, vitamins, dietary regimens and intravenous injections of certain solutions are seen as aids in purging the body of impurities and in reversing degenerative diseases.
Seemingly just as important to his patients, however, is his low-key style and what his witnesses called respect for the individual's choices and needs. For that reason at least, his waiting room is rarely devoid of patients from all over Virginia.
"He treated mind, body and soul," said Karen Ours, who testified in Roberts' behalf, of his handling of her husband's case.
Roberts problems began in 1979 when, according to testimony, several fellow doctors at Loudoun Memorial Hospital, where Roberts had privileges, became alarmed at his practices. "Dr. Roberts . . . has demonstrated an apparent willingness to treat patients without understanding what he is doing," wrote Dr. Lawrence Cohen, a senior hospital staff member in a letter introduced into evidence. "Also in question is whether Dr. Roberts has adequate medical knowledge or has the ability to apply the requisite knowledge in a rational and justifiable manner to the patients . . . ," Cohen wrote.
Accordingly, Cohen urged the hospital's committee on standards of professional conduct to suspend Roberts' privileges at the hospital.
About that time, Roberts wrote a letter to the hospital in which he stated that the treatments he had been using could be called "experimental" since little, if any, research on them had been reported in conventional medical publications.
In testimony at the hearings last week, Roberts explained that he had written the letter only because he was desperately trying to stave off the loss of his hospital privileges. He said he merely hoped that a contrite letter might satisfy his accusers.
It did not. Not only were his privileges suspended, documents in evidence and testimony show, but the hospital's physicians decided that he could be reinstated only after he had "consulted" the chairman of the psychiatry department of either Fairfax or Winchester hospital and received a "favorable report." Furthermore, upon reinstatement, he had to agree to allow another member of the hospital staff to engage in "continuous consultation" on all his cases.
In most cases, the loss of hospital privileges might be expected to ruin a physician's practice. Not so with Roberts, who continued to receive new patients, one of whom was Stephen Ours, who came to Roberts in late 1980, complaining of recurring slight fevers.
Ours, who had been experiencing the fevers for years, had visited several other doctors, none of whom had been able to diagnose the cause, according to his wife's testimony.
"Steve . . . was tired of doctors. He felt like they didn't know what they were doing," she testified. "I had been to Dr. Roberts. I suggested he go to Dr. Roberts if he wasn't satisfied."
Karen Ours, who had become interested in unconventional medicine about 10 years earlier thanks to a sister who had worked in a health food store, testified that Roberts "told him Stephen Ours he wasn't going to stop until he found" the cause of his fevers.
On New Year's Day 1981, Roberts called with the test results, she recalled. It was cancer -- specifically, a malignant germ cell tumor known as a seminoma lodged deep in his chest. She testified that Roberts urged her husband to take radiation therapy because, statistically, such tumors had been shown to respond favorably to such treatment. It was a recommendation he was to continue to make during the next year, she told the hearing. But then, as he would later, Ours refused.
"Steve felt his relationship with God was number one," she testified. Later, in an interview, she explained that her husband viewed his illness as a test of his faith. "He saw that his cancer was a lot more than a disease," she said. "He believed that it was possible for the body to heal itself," and he could not sidestep the challenge.
Even though he rejected Roberts' recommendation, she testified, her husband continued to consult him. In the meantime, she told the hearing, completely on his own, he decided to combat the cancer by means of a special diet that was to be monitored by someone other than Roberts.
That was not what he told his mother, Eloise Ours, according to her testimony, and that contradiction has formed the core of the state's case against Roberts.
"He was going to Dr. Roberts and made it clear this was his doctor and he would do what Dr. Roberts told him to do," his mother testified. The diet, which consisted, for instance, of carrots, burdock roots, whole grains and collards, was being undertaken with Roberts' approval, she said. "When I asked Steve . . . does Dr. Roberts work with the other individual ? He said, 'Yes.' That was Steve's answer: 'Yes, they do work together.' "
That was particularly distressing to Eloise Ours, her testimony shows. "I'd say, 'How is it?' Well, all I ever got was , 'Supposedly it's working and the toxins are coming out through the knuckles.' This type of thing." Nonetheless, as the year passed, she watched him grow weaker: "He was thinner . . . . I was making shirts for him and I had to go to the boys' size shirt pattern instead of a larger 17 1/2 shirt which he had been wearing."
Roberts' role in the case history of Stephen Ours, though by far the most dramatic allegations he faces, is not the only one against which he is defending himself in the license revocation proceedings. The others, brought against him in May of this year, include one of working with a physician not licensed to practice in Virginia, plus eight others involving patients in which his treatment and care was allegedly either "grossly ignorant or careless" or showed a "lack of good medical judgment." Roberts maintains he provided proper care in all cases.
In one case, for instance, the board contends he administered a grapefruit juice enema to a terminally ill cancer patient "when you knew or should have known that such treatment could not halt the progress of the disease." Uncontradicted testimony in that case was that no such treatment was in fact ever administered.
In another instance, the board alleges that, among other things, he performed an exploratory operation on a patient apparently suffering from an intestinal hemorrhage and then concluded the operation without ever finding the site of the bleeding. Roberts testified that he did so because he feared the patient would "die on the table" if he proceeded further.
In all but one of the cases involving his treatment of patients, either the patients themselves or members of their families testified in his behalf, all attesting to their beliefs that Roberts provided good and satisfactory care. As for the charge involving the unlicensed doctor, Roberts testified that he allowed the man to work in his office only on the condition that he not practice medicine. It was his understanding, he testified, that the man was awaiting receipt of his license from the state board. A final determination in the matter will be made in November, according to Julia Krebs-Markrich, the assistant Virginia attorney general who argued the case for the medical board.
In the eyes of his flamboyant attorney, Louis Koutoulakos, it is a cut-and-dried case of prejudice against Roberts on the part of the local medical establishment.
"They're crucifying this man," Koutoulakos told the medical board's hearing administrator. Koutoulakos charged that there was never any interest on the part of local physicians who heard his appeal of the hospital's suspension of his privileges to examine Roberts' practices to see whether there might be some element of value in them. "The basic issue was: 'Convince us, but we don't want to be convinced,' " he argued.
To both Karen Ours and her mother-in-law, however, there is nothing in the debate that can offer them solace. "It has gone on for almost a year now," says Karen Ours. "I just want it to be over with."
As for Eloise Ours, Stephen's mother, the memory of her son's assurances in 1981 that he was improving brings only bitterness. "I asked him what the prognosis was ," she told the court at one point, "and he said, 'Well, everything will be fine by the end of the year.' "
So it was that, a few months later, Stephen Ours, one of four sons, died. The date: Dec. 31, 1981.