St. Elizabeths Hospital officials looked at the resume of Dr. Walter M. Presnell six years ago and liked what they saw: a seasoned, Harvard-trained professional. He got the job as a staff psychiatrist at the federal mental hospital in Southeast Washington, and now earns $64,764 a year.
But there are questions about Presnell's background that went unanswered on his job application. His employment also raises questions about hiring practices at St. Elizabeths that the hospital said last week it is moving to address.
Companies providing malpractice insurance to Presnell agreed last month to pay $225,000 to a former patient who had sued the doctor in a Boston court, claiming that he was sexually abused by Presnell in private therapy sessions throughout the 1970s.
Despite settlement of the case, Presnell denied, and continues to deny, the allegation.
In sworn depositions taken in connection with the lawsuit, two other former patients alleged that they had sexual contact with Presnell and a total of seven witnesses, including a woman who was 15 at the time, said he had offered them marijuana and/or alcohol in his office in Lynn, an industrial city near Boston. A second malpractice complaint by one of the former patients, Robert Scott Riley, is pending in Massachusetts.
Presnell, in a deposition, has denied ever having sex with a patient, and denied the allegations concerning alcohol and marijuana.
A review of Presnell's 31-year medical career, as outlined in court proceedings, also reveals five instances in which he allegedly was terminated or allowed to resign from training or staff positions.
According to sworn depositions, Presnell was dismissed from Stanford Medical School in 1956 after one year of a three-year residency, was asked to leave a Veterans Administration residency program in Boston in the mid-1950s, was dismissed from the private Baldpate Hospital in Boston in 1969, resigned from the College Mental Health Center in Boston in 1973 and resigned as a physician connected with the Massachusetts Rehabilitation Commission in the late 1970s.
In his deposition, Presnell denied having been fired or involuntarily terminated from any position. "Not that I know of, no," Presnell said in answer to an attorney's question.
St. Elizabeths officials, who said they had relied on Presnell to relate his work history, said they were not aware of the lawsuits or the alleged past dismissals.
A spokesman for the hospital said last week that Presnell has been relieved of his patient-care duties at St. Elizabeths at his request, pending the outcome of a review of his background begun by hospital officials following inquiries by The Washington Post.
"The matter will be looked at quite seriously by the appropriate medical committees," said Harold Thomas, a spokesman for St. Elizabeths. "Any decision the hospital reaches will have to have its basis in the personnel management system under which we operate."
Thomas also said that last week the hospital initiated a review of credentials and hiring policies for physicians and dentists, to be carried out by a personnel department task force "to see if there are any holes in the process."
Thomas said that Presnell's hiring appeared to have followed federal guidelines. A hospital official who asked not to be identified said he was not aware of any patient complaints involving Presnell.
Presnell declined to be interviewed, calling the inquiry into his background "just harassment" and terming Robert Tyler-Nelson, the ex-patient who filed the Boston lawsuit, "sick."
Anthony M. Doniger, the Boston attorney representing Presnell and the insurance companies involved, said Presnell's "version is that he denies absolutely those allegations. He says it absolutely didn't happen."
Presnell also denied the allegations under oath in a deposition taken by Doniger and Daniel Burnstein, Tyler-Nelson's lawyer, in August 1983. The doctor said that he considered sexual contact with a patient improper under any circumstances because: "You change the role of the therapist . . . . You confuse the patient."
A review of witnesses' sworn statements, given in connection with Tyler-Nelson's lawsuit, reveals the names of at least 14 psychiatrists who said that they were told or were said by others to have been told of allegedly improper dealings by Presnell over the years.
Of those only one, Dr. Charles Story, a Boston area psychiatrist who is deceased, was said to have tried to alert state officials to the alleged problem. A spokeswoman for the Massachusetts Board of Registration in Medicine said the agency had a record of only one complaint against Presnell, filed last year by Burnstein.
Burnstein said he believes the case shows the indifference of many in the medical profession to allegations of patient abuse.
"I found psychiatrists who knew about Presnell . . . going back 30 years," he said, "and they didn't give a toot until the patients spoke up."
Burnstein also has filed complaints against Presnell with medical authorities in Connecticut and Georgia. Officials in those states, as well as Massachusetts, declined to say whether they are acting on the complaints.
In January, Burnstein wrote to the inspector general of the U.S. Department of Health and Human Services, St. Elizabeths' parent agency. An HHS spokeswoman confirmed that allegations against Presnell have been received, and said the matter is under review. TV Show Triggered Call-
Tyler-Nelson, 40, said realization that sex with his psychiatrist was not therapeutic came to him by chance in December 1981, two years after Presnell moved from the Boston area to Washington.
"I was walking through the living room and 'The Phil Donahue Show' happened to be on television. There was a panel of women saying they had been sexually abused by their therapists. And one woman said that she had even defended her psychiatrist afterward," he said.
"I stopped in my tracks. I had just defended Dr. Presnell a week before to another psychiatrist."
At the end of the show, Tyler-Nelson said, an announcer gave the name of a woman for viewers to call if they believed they, too, had been victimized. Tyler-Nelson telephoned. He was put in touch with Burnstein.
The 1982 lawsuit, which according to Burnstein cost Tyler-Nelson and his wife, Jan, $10,000 in expenses, started with Burnstein running small ads in Boston area newspapers asking other patients who had patronized a psychiatrist at 41 Nahant St., Lynn, in the 1970s to come forward.
Slowly, Burnstein accumulated the list of those who alleged under oath that they had had experiences similar to Tyler-Nelson's.
According to Burnstein, Presnell's insurance companies first offered $35,000 to settle the case. As the sworn statements from alleged victims grew, the figure rose to $75,000, then $150,000 and finally $225,000 -- the maximum under Presnell's coverage, Burnstein said.
Burnstein, who took the case on a contingency basis, got one-third of the settlement. The rest was received by Tyler-Nelson, tax-free.
"I hate the money," Tyler-Nelson said in a recent interview. "It gives me a dirty feeling."
Tyler-Nelson said that he felt "anger and a moral obligation, both" toward seeing the lawsuit through. "It's another hell to have to relive the thing." 'Desperately Wanted Out'-
Tyler-Nelson had a menial job in a General Electric factory in Lynn when he began seeing Presnell, at $25 a session, in November 1970.
"My life existed between my factory job and a three-story tenement," he said. "I desperately wanted out of there."
His father was an alcoholic, "dominated by his mother . . . who had been, as it sounded, . . . somewhat promiscuous," Dr. Frederic E. Oder, Tyler-Nelson's current psychiatrist, said in a deposition.
Presnell said in his deposition that he diagnosed Tyler-Nelson as a "borderline personality" suffering from anxiety, depression and suicidal impulses. Oder says that, at the time, Tyler-Nelson was "engulfed with feelings of hopelessness and despair."
" Presnell said my problem was that I had no ego," Tyler-Nelson said. "That 'until we develop your ego, I'll become your ego. It may involve things you don't like.' "
According to Tyler-Nelson, Presnell talked about a personal theory of the "hierarchy of sexuality . . . that first one must experience homosexuality and then move on to heterosexuality. The highest stage, for a select few, was bisexuality."
In subsequent sworn statements, a number of other alleged victims said that Presnell had lectured them on the "hierarchy of sexuality."
According to Tyler-Nelson's account, he was persuaded to engage in homosexual activities with Presnell virtually from the first therapy session.
" This was a part of most every meeting that he had with Dr. Presnell," said Oder in his deposition. ". . . This was the treatment."
Asked by Doniger about his reaction to Tyler-Nelson's statements, Oder said that he "wasn't surprised because I had, in fact, had another patient who had had a similar experience with Dr. Presnell."
"Did you believe that patient?" Doniger asked.
"I did, and do," the doctor replied.
Oder said he had never reported Presnell to any medical authority.
"I think I concluded after talking with a number of people that this kind of abuse was so frequent that he Presnell had probably been reported a good many times," he said. " . . . And then, you see, that was tied in with what I had heard, that he had left the area for Washington and was no longer in practice."
Oder testified that Tyler-Nelson found Presnell to be "an extraordinary charismatic and captivating figure" and saw himself "as a supplicant who somehow miraculously had the attention of this wonderful figure bestowed upon him."
On one of his visits to Presnell's office, former congressional aide Killian Brady Jr. -- who was not one of the doctor's patients, but gave a deposition in Tyler-Nelson's lawsuit in which he alleged sexual contact with Presnell -- said Presnell cracked the door and showed him Tyler-Nelson in the waiting room.
" 'That's my friend Bouncing Bob,' I'll never forget the words 'Bouncing Bob' and 'I'm his daddy,' " Brady quoted Presnell in the deposition.
" ' . . . He's a patient and I can pull strings or control or do anything I want at any time with Bouncing Bob.' Those were his exact words he used." Doctor's Troubled Career
Walter Madison Presnell launched his career in medicine on June 7, 1954, the day he graduated from Meharry Medical College in Nashville, Tenn.
He spent the next year serving an internship at San Francisco County Hospital and then embarked, in July 1955, on what was supposed to be a three-year residency in psychiatry at Stanford University Hospital. It didn't work out.
"During his year with us," wrote his supervisor, Dr. Thomas A. Gonda in a Nov. 5, 1956 letter, "we found that Dr. Presnell was deficient in basic medical knowledge, tended to be unreliable and exhibited a degree of psychopathy which not only interfered with his learning but was markedly detrimental to his patients."
A Stanford residency review board, Gonda wrote, concluded that Presnell "lacked the aptitude for psychiatry" and ousted him from the program.
Enrolled in a residency program at a Veterans Administration hospital in the Jamaica Plain section of Boston, according to a former supervisor, Presnell again ran into difficulty.
Dr. Daniel M. Weiss, the supervisor, said in a deposition that while he only rarely recommended that a resident not be allowed to continue, he found Presnell "unable or unwilling to adhere to the rules and regulations and to follow the instructions -- there was always some reason why -- it just wasn't working out . . . . I recall stating at the time that if they kept him, I was leaving."
According to Weiss, Presnell left.
Presnell completed a year's residency at Worcester State Hospital in Massachusetts in 1957, stating on his St. Elizabeths application that he ranked in the top 2 percent of his class. The same year he started a two-year residency stint under Harvard Medical School, assigned to Boston City Hospital.
Presnell also opened his first office, in Brookline, Mass., and began seeing private patients.
Shortly afterward, in November 1960, Presnell started to work part time as a psychiatrist at the Massachusetts state prison at Concord. The position, which lasted until February 1963, put him in touch with the experiments of Harvard drug guru Timothy Leary.
Leary had permission from state prison officials to administer a hallucinogenic drug to inmate volunteers under Presnell's supervision. In his book "High Priest," Leary describes a meeting at his house in the early 1960s in which Presnell pledged qualified support for the project:
"I'm not the new Freud and I have no ambitions to play that game," the doctor reportedly said. "I'm a Negro from the South with a degree from a second-class medical school, with a wife and two kids whom I'm trying to support and educate in an insane society and I'll help you all the way to win, but I'm not going to lose with you."
Presnell eventually dropped out of the project because, he told Burnstein in his deposition, he "didn't think it was primarily scientific."
On Feb. 23, 1963, Presnell resigned from the prison job. Massachusetts corrections officials, citing the state's privacy law, declined to discuss Presnell's tenure there, or confirm that he had been an employe.
Dr. Weiss, the VA hospital supervisor, said in his deposition that he had been told by a prison official that Presnell had been caught in a motel room having sex with a male prison inmate.
Presnell spent nearly two years on the staff of Hawaii State Hospital. Then he returned to the East Coast and from Nov. 2, 1965, until mid-1968, he was on the staff of Undercliff State Hospital in Meriden, Conn.
After that he moved on to a private psychiatric facility, Baldpate Hospital, in Boston. A year later, in June 1969, he was dismissed from Baldpate, the hospital's chief of staff, Dr. Patrick J. Quirke, said in a deposition.
Quirke said that, in his absence, Presnell had permitted drug patients to leave the restricted sector of the hospital.
"When I came back from vacation," Quirke said, "I felt it was kind of a disaster. They the patients were sitting on the roofs strumming guitars. I'm sure they were smoking pot on the grounds. Presnell was entertaining them."
On another occasion, Quirke said, he had seen Presnell, dressed in red pajamas or a red suit, standing on his head on the lawn. Quirke also recalled seeing Presnell at a psychiatrists' meeting where Presnell was wearing a gown, blue contact lenses and a blond wig.
"He was quite the entertainer, like a Flip Wilson-type," Quirke said, "with an imaginary girlfriend and all. He was the life of the party at parties."
That same June, Presnell got part-time work at Danvers State Hospital in Danvers, Mass., and stayed five months. He resigned, citing an increase in his private practice. His office by now was at 41 Nahant St. in Lynn, where Tyler-Nelson would soon become a patient.
While Presnell devoted himself to his practice, two other associations with mental health agencies soured.
He resigned from a part-time post at the College Mental Health Center, located in Boston's Prudential Building. The center's director, Dr. Vernon Patch, said in a deposition that he confronted Presnell after hearing that Presnell had had a drink with a patient.
Meanwhile, Presnell had been accepting referrals from the Massachusetts Rehabilitation Commission office in Lynn. That relationship, too, was terminated.
A state official declined to discuss the incident, but a psychiatrist, Dr. John Weltner, a consultant to the agency director, said in a deposition that between three and six patients reported sexual advances or inappropriate genital examinations by Presnell during a six-month period.
"The clearest example that I can remember is his masturbating a male patient . . . in his office," Weltner said.
Confronted by the agency director, Weltner said, Presnell denied homosexually molesting the patient and declined to see any more "Mass Rehab" patients.
By 1979, Presnell, according to his deposition, was sufffering "burnout" and looking for a way out of Lynn. "I just knew that I had done enough private practice," he said.
On Oct. 9, 1979, he joined the staff of St. Elizabeths. Patient Attempted Suicide
Twice, according to his malpractice complaint, Robert Tyler-Nelson tried to kill himself -- once while under Presnell's care.
"I'm a survivor," he said, smiling, as he sat recently in Burnstein's Boston office. "I really am." He lives with his wife and her family in a small community north of Boston and aspires to be a writer.
Regarding Presnell, Tyler-Nelson said he finds it mildly amusing that in blue-collar, industrial Lynn, the psychiatrist used to walk the snow-covered streets wearing a big fur coat and a diamond earring. "That took guts."
What he finds less understandable, Tyler-Nelson said, is the way that the psychiatric community dealt with Presnell for more than 30 years.
"So many people knew, the doctors," he said, "and they didn't do a thing."