The Murder in Exam Room 15

He expected doctors to perform a miracle. When they couldn’t, he sought revenge at the Brigham. Are hospitals the new front line in the escalating battle between patients and healthcare?

brigham and women's hospital shooting

Illustration by Brian Stauffer

Stephen Pasceri was insistent. The 55-year-old accountant, clad in khakis and a snug sweater that hugged his belly, stood at the reception desk in the gleaming lobby of the Shapiro Cardiovascular Center at Brigham and Women’s Hospital on January 20, quietly demanding to see Dr. ­Michael Davidson. He conceded to the secretary that he didn’t have an appointment, but he had risen early in the sharp winter morning to make the hourlong drive from Millbury, and he wasn’t leaving until he met with the heart surgeon.

Possessed with superb technical skills, Davidson was a rising star, but it was his bedside manner that set him apart. Sometimes doctors don’t like to discuss their failures, but Davidson was known for spending hours talking to patients and their families regardless of whether a surgery ended flawlessly or something went wrong. Pasceri’s mother, ­Marguerite, had been ­Davidson’s ­patient in 2014 and had died recently of heart and lung complications at another hospital. So it wasn’t out of the ordinary when ­Davidson welcomed Pasceri into exam room 15, knowing full well that the domino effect of this unscheduled visit could delay a dozen other appointments and encroach on the precious ­evening hours that belonged to ­Davidson’s three young children and his wife, who was seven months’ pregnant with their fourth child, a girl.

As Davidson closed the door behind them, Pasceri peppered him with questions about a drug called amiodarone, which he was sure had killed his mother. This wasn’t foreign territory for Davidson—he understood the confusion that accompanies losing a loved one, and he wanted to help Pasceri find clarity and peace. Davidson explained that it was a commonly prescribed medication for ­patients suffering from an irregular heartbeat, and that if they walked upstairs to the cardiac unit, Pasceri would see that one-third of recovering patients were taking it. But Pasceri was persistent: The grieving son’s calm demeanor held steady as he challenged the doctor’s judgment in prescribing the medication. After 15 minutes and little progress, Davidson asked his physician’s assistant to leave the room and check on patients whose appointments were now running late.

For 20 more minutes, the two men continued to talk. No one outside the exam room heard a sound, until all at once two blasts from a .40-caliber pistol tore through the morning calm. Davidson burst from the room, clutching his left hip and back, yelling, “He’s shooting, he’s shooting!” He made it to the end of the hallway before collapsing on the carpet in front of a secure door. After more than eight hours of emergency surgery, Davidson would not survive. The moment shots rang out, a hospital worker in his cubicle pushed a panic button rigged to his desk and within seconds, security guards and Boston police officers on hospital detail swarmed the building. Thanks to a controversial change in procedure at the Brigham months earlier, instead of sounding a vague “Code Grey” warning, a woman’s voice came over the public address system: “A life-threatening situation now exists at Watkins Clinic B—Shapiro 2. All persons should immediately move away from that location if it is safe to do so. If it is not safe to move away, shelter in place immediately.”

brigham and women's hospital shooting

From left, hospital surveillance video of gunman Stephen Pasceri before he murdered Michael Davidson; memorial flowers placed outside the Brigham. / Photographs courtesy of Suffolk County District Attorney’s Office (surveillance video), by David L. Ryan/Boston Globe via Getty Images (employee).

Grief is often depicted as a phase of gentle contemplation from which one emerges wiser and comforted. But for a few, grief can be a wellspring of destructive ambition. Still standing in the exam room, Pasceri pushed the barrel of the gun against the roof of his mouth and pulled the trigger. In a final note to his family found on a USB drive after his death, Pasceri wrote that a lawsuit would not have sufficed. To escape the demons of his mother’s death and ease his pain, he needed to murder Davidson.

It wasn’t the first time a gunman with unmet expectations had sought revenge on a doctor, and chances are it won’t be the last.

 

Across the United States, hospital shootings are now a monthly occurrence. In the year leading up to Davidson’s murder, there were more than a dozen, claiming 15 lives, and the trend is clearly on the rise. Between 2000 and 2005, an average of nine hospital shootings ­occurred each year. Over the next five years, from 2006 to 2011, the average spiked to more than 16, resulting in 161 deaths, according to a recent article in the Journal of the American Medical Association.

While not all hospital shootings are aimed at doctors, many are. In 2009, a former ­patient murdered Edna Makabenta and killed himself in her Las Vegas office ­after reportedly filing a complaint against the doctor. In 2010, at Johns Hopkins Hospital in Baltimore, 50-year-old Warren Pardus shot a physician in the chest after being updated on the condition of his ailing mother. Pardus then entered his mother’s hospital room, shot her in the head, and killed himself.

Two years later, Jason Letts—­dissatisfied with the care his wife was receiving at a hospital in Birmingham, Alabama—opened fire on a cardiac unit, injuring three before police shot him dead. The following year, in 2013, urologist Ronald Franklin Gilbert was shot eight times in an exam room. The killer, who is awaiting trial in southern California, said he harbored deep resentment over a botched prostate surgery performed two decades earlier, though records later revealed that Gilbert most likely never operated on the assassin. And two weeks before Davidson’s death, Jerry Serrato gunned down psychologist Timothy Fjordbak at a Veteran Affairs clinic in El Paso, Texas, before killing himself. Serrato, a former soldier and ex-VA employee, had reportedly expressed anger over being ­denied a claim of post-traumatic stress, though it appears the doctor he targeted played no role in the decision.

In each shooting, the killer was driven to extremes by a perceived failure of the healthcare system—to sustain an ill mother, repair a damaged body part, or deliver a desired diagnosis. Each time, a doctor became the target of that discontent.

  • Mumbles

    I stopped reading this two paragraphs in when I realized where this was going – the saintly Doctor Davidson and the disgruntled irrational loser with the gall of questioning Dr Saint’s judgment. This is the second such piece in a matter of months – the Globe did a similar puff piece a few months ago.

    Neither this piece nor the Globe answer the ultimate question – was the doctor wrong in his care for his patient?

    I am sick of this doctor being beatified by the media. His wife – a plastic surgeon who makes bank exploiting the insecurities of upper middle class girls and women – actually accepts CHARITIBLE donations set up by the B&W community (why don’t they set up similar charities for children from Mission Hill?). Heaven forbid she live on less than seven figures in Wellesley.

    All this makes me think that the only thing that mattered to Saint Doctor was money.(It’s clearly very important to his wife.) He wasn’t exactly working at the free clinic, was he? And when money becomes a person’s main motivation, it clouds their judgment.

    This doctor was no selfless martyr and I am sick of everyone treating him like one.

  • http://explainingindia.blogspot.in/ Sachi Mohanty

    It seems obvious to a non-American like me that if guns weren’t so easily available, such mindless violence would become less commonplace.

    • Snake

      it seems obvious to me that you don’t understand how America works.

      • Jay Melo

        He knows that cowards will kill with the easiest available means.

        • Mumbles

          The easiest way to kill someone is by becoming doctors and performing malpractice when you decide your patient isn’t rich or important enough to care for, like this piece of garbage Davidson.

    • tony curti

      Except that gun violence is always most prevalent in the cities and states that have the most stringent gun control laws. BTW – Massachusetts is not all that easy a state to become a licensed handgun owner.

    • datroofhomez
  • Pablo

    Guns make killing easier, but why does one human being want to kill another should be the focus. We have all been reduced to some quantifiable value. The medical system is certainly at the top for treating people simply based on their predetermined value. I am not say the doctor deserved to be killed, I am simply not surprised.

    • Mumbles

      If we had a single payer system, the medical profession would attract people who really do care about helping people, regardless of their socioeconomic status. As it is now, the medical profession (really, “medical business” is a better term) is attracting people who are in it for the money (certainly there are doctors who aren’t selfish and are working in clinics or in impoverished areas – but B&W aint a free clinic.) And when making money becomes your raison d’etre, you lose interest in a patient once you’ve tapped out the income stream.

      If Davidson had just followed his bliss and gone into investment banking, three more people would be alive today.

      • Maine_Idea

        Lots of assumptions in your comment.
        The article said he was inspired to go into cardiac medicine from an early age.
        And Ms. Marvin’s dad (among more than 3 others) have been saved by his surgical intervention.
        Eat a Snickers, Mumbles. Just because you’re feeling grumpy, doesn’t mean you should take it out on the rest of the world.

        • Jason Darrah

          Mumbles has proven himself to be an insufferable tool in multiple threads. It is best to ignore him and hope he goes away so that the grownups can have a real conversation.

    • tony curti

      I met a physician who immigrated from China 30-40 yeas ago. He surprised when he told me that violence against MD’s for either real or perceived malpractice was not uncommon there.

  • steveyuhas

    There is a certain kind of selfishness in grief. We all experience grief and when we’re in the midst of it, we think we have it worse than anybody else ever has. Sure, there is probably a sliding scale of grief and ways people deal with it (or not) and this is obviously extreme, but it is how many people feel when they lose a loved one – somebody could have done more. Except, the sad truth is death is inevitable and it always comes too soon. how we deal with it is what matters and not allowing grief to overtake us is vital to surviving it.

    • Mumbles

      True. One detail not in this article, but in the Globe’s a few months ago, was that when Davidson heard that Pascheri was there to see him, he “joked”, ” He’s probably going to kill me.” That suggests a history between these men. Was Davidson dismissive or rude to Pascheri in the past?

      It would behoove doctors to be kind to the families of patients when they die. Even though there’s nothing left to bill, it’s just human decency.

      • Marguerite Joly

        Dr. Micheal Davidson could not have been kinder to the family! He only jeered, “watch him shoot me” in humor, nothing more.

        • Mumbles

          Ms Joly,

          My condolences to your family.

          I wish that Davidson had been the saintly wunderkind miracle worker his family and the B&W now try to paint him to be.

          • Marguerite Joly

            He was a miracle worker and if you had ever met him you would know this! He was very unlike any surgeon I have ever met and I have met a lot. He was not arrogant or unkind in any way and never made us feel like we were less than or he was better than. Please know he did nothing that could even be considered provoking in any way. It was the combination of my brothers grief and mental illness that are solely responsible for this horrific tragedy. Now we must all heal through whatever way we can. For me healing begins with the conversation about death and dying and how our society deals with it! Let us talk about that!

          • HoyesMiGente

            I agree. Especially doctors need to be trained, or at least be accompanied by a team that will help with the respectful and kind transition to death for the ill one and their family. But the arrogance still enrages me. They work for us.

          • Mumbles

            Agreed x 1000. Nurses too could use some training in interacting with patients and their families. No excuse for their uppity attitude given their general lack of intellect and status.

          • Maine_Idea

            Wow, Mumbles. Talk about painting with a broad brush. You project tremendous disrespect toward those providing patient care. Turn your insult around and try it on for size. Can it be that your own “uppity attitude given (your) general lack of intellect and status” rubs off on others? Society/families are also responsible for contemplating the inevitable.
            Medical personnel is there to tend the sick – not hold the family’s hand and/or mediate their dysfunction. That’s the plain truth. They have multiple patients needing care and limited time to tend them AND keep up with the documentation. Spending more time with you takes away from someone else.
            I am a frequent flyer in the healthcare system, due to multiple disabilities – with good and bad experiences. I note ironically when I hear others complain about costs, and in the next breath demand more services and a softer touch. I am grateful for every good outcome. Don’t forget that staff also mourns the bad outcomes and deaths of so many high-risk patients. Mutual respect is the best practice – and if it falls upon you to be the one who sets the example for others, then do so.
            As Gandhi said, “Be the change you want to see in the world.”
            And as my grand uncle used to say, “Quitcherbellyakin and do something about it.”

          • Mumbles

            Nurses are in general stupid and lazy. If they had any brains they wouldn’t be cleaning bedpans for a living. It is time that patients and their friends and families give back as good as they get from these sullen, obnoxius leeches.

          • Cdoring1

            You are a disgusting and pathetic excuse for a human to make such comments. Go work in a hospital or nursing home for a day and walk in these peoples shoes, you ignorant prick. My mother has been a nurse for 30 years and I work security in a hospital. It’s bitter and ignorant people like you I get the pleasure of manhandling out the doors or handing over to the police on a weekly basis. Be happy the internet provides the means for you to hide behind anonymity when you make such hostile and evil remarks. Here’s hoping karma puts you in your place someday.

          • Mumbles

            “Walk in their shoes.” More like, “sit on their big butts at the nurses station complaining about the patients and reading US Weekly.”

          • jenrn920

            Mumbles- I am a registered nurse. I have a Bachelors Degree in Science from an accredited university. I actually left my pre-med tract to pursue Nursing as I was drawn more to the aspect of patient care and that relationship. More to the point I directly worked with Dr. Davidson for over a year, taking care of his patients in the days immediately following these complicated surgeries. Your disrespect does not belong anywhere in these comments. You are uninformed and your opinion is offensive on many levels. I can personally vouch for this man who went above and beyond what was required of him every day; never having anything but a big smile on his face and a kind word for everyone. There are 2 families out there still reeling from this tragedy as well as the innumerable friends and family this man’s path crossed who do not care to read your ignorant comments. As far as what nurses do… I am on my feet for most of a 12 hour shift. I am constantly critically thinking, assessing and observing, making note of acute and often subtle changes in a patients status that prevent complications and emergencies. I am not ashamed to give a bedpan when needed as I am there to care for these people in their entirety. I am a caregiver, a provider, an educator, an ear to listen, a hand to hold, a protector, and the list goes on. I’ve also had the pleasure of caring for insulting and degrading people like you and I will continue to do so, with a smile on my face, just like Mike.

          • Mumbles

            Yeah, you’re so smart that it took you a month to respond. It’s almost cute how proud you are that you attended an “accredited university.” Wow, really raising the bar, “jenrn.” Here’s betting it ain’t Harvard or MIT.

            I wonder if you’re like any of the slobs on the ABC show about the emergency room – the nurse who was so ugly her patient told her to put some powder on. Or the nurse who condescendingly called the patient “honey”, only to be completely served by him. (In her defense, she’s probably never been called ” honey” – just “idiot” or “pig” – so maybe she didn’t understand that it was insulting. In any event, B&W’s nurses are really representing on that show – not well, but it representing. (Actually I think the heifer who called the patient “honey” was named Jen. Is that you?)

            As for beloved Dr Mike – he never did anything in his life for which he was not handsomely compensated. And now his plastic surgeon wife is taking time off in their Wellesley home from exploiting teenage girls’ insecurities to solicit salmon dinners on the Web for her kids. And you’re telling me these parasites care about something other than money?

          • Marguerite Joly

            I cannot imagine the bitterness inside you:(!

          • Mumbles

            And I can’t believe that you’re not bitter given what that reptile and that hospital did to your family.

          • Mumbles

            “I actually left my pre-med tract to pursue Nursing (sic) as I was drawn more to the aspect of patient care and that aspect.”

            Nice try. (Golf clap). So tell me, jenrn, what class did you fail at your “accredited university” (University of Phoenix?)? Was it pre-calculus, or chemistry?

          • Mumbles

            You’re so basic.

          • Maine_Idea

            1-Aides empty bedpans, not nurses
            2-Nursing today often requires a bachelor’s degree (and pays well)
            3-But if I were a nurse, I’d prefer bedpans over foul and entitled attitudes
            4-And if I were a patient, I’d appreciate ANYBODY willing to do the scut work
            5-You shall reap what you sow
            (Not a pretty picture)

          • Mumbles

            Disagree on the degree requirement. Some nurses receive their “degree” from the hospital they work at. In other words, they completed an apprenticeship. Good luck developing any critical thinking skills.

            Agree that they get paid well. Too well.

            The ultimate question: if these slobs are sooooo smart, why aren’t they doctors?

            And if they’re not cleaning bedpans what are these sloths doing?

          • gansett

            Nurses can no longer attain their degree from a hospital as they used to years ago. The majority of big name hospitals now require nurses to have a bachelors degree for employment. For someone who feels the need to generalize and insult one of the most mentally and physically demanding occupations that exists, it would make your stereotypical, hateful, ignorance slightly
            more tolerable if you did some fact checking first.

          • Mumbles

            “Mentally demanding”? Give me a break.

            Hospitals may not grant degrees anymore – but they did, and so there is a fair amount of these lazy old cows who barely have an education and probably haven’t read a book in 30 years.

            And even if nurses are getting degrees – they’re not getting them from Harvard or Yale or MIT. This is a profession for lower middle class trash for whom cramming their fat cans in a pair of scrubs is a step up on the socioeconomic ladder.

          • HoyesMiGente

            IDK about “uppity attitude” and “general lack of intellect and status”…there are some nurses like that, of course, but I’ve run into mostly good ones when I do run into them.

          • Mumbles

            You’re lucky.

          • http://carlyjaymetcalfe.com/ Carly-Jay Metcalfe

            We deal with dying terribly. Sending love to you and your family XO

        • HoyesMiGente

          Ms. Joly–I’m very sorry for your losses. And sorry that it happened like this. Your brothers actions reflect nothing on you and the rest of your family. Please accept my sincere condolences.

          • Marguerite Joly

            Thank you! The conversation appears to be going in a negative direction with people blaming, accussing and disrespecting each other. These are the exact reasons why nothing changes or things change so slowly a generation passes by! We must focus on what we can do now to implement positive change in our health care system. What are the problems? Many we know and can do something about right away. For instance, let us establish a protocol for end of life conversations long before the end of life. Teach that death does not cheat us of life but is a part of it. The more society accepts and learns to deal with loss or change the better it will be.

          • HoyesMiGente

            We do need change. Change happens far too slowly where it’s needed. Maybe we all need to put a concentrated effort, media and likewise, that death (end of life), needs to be talked about long before it happens. It’s almost a truism in this country that we prefer to live with our heads stuck in the sand. You are absolutely right. These discussions need to start happening now.

  • HoyesMiGente

    That line “demonization of physicians”, has already almost made me leave this article. That’s such a biased and inaccurate thing to say. Physicians are held to the higher standard, as they should be. We train far too many mediocre physicians, and those doctors ( and they are the majority), are the ones who have held back and continue to hold back the innovative gp medicine that should have been available 30 years ago. Blerg. Back to the article.

    • Ladonna5469
    • tony curti

      If we took more personal responsibility for taking care of ourselves we wouldn’t’ use half the health care we do.

      • HoyesMiGente

        Right. If it was less expensive and there weren’t already the barriers that exist (like your comment), we probably all would. Thanks.

        • tony curti

          Do I understand you correctly? My comment is a barrier to health care????

          • HoyesMiGente

            Your attitude is shitty. And attitudes like yours are no help. Your comment was made disparagingly, and out of some false sense of superiority. G’nite.

          • tony curti

            Your sense of self-righteousness is only matched by an incredible knack for pretense and presumption. My attitude is shitty because I don’t agree with you?? Who the fuck are you?? BTW – THIS remark is posted disparagingly; my first post in response to you was merely factual. You strike me as another in a long line of disgruntled, self-appointed know-it-alls who will ultimately have no impact on health care largely because I doubt you would have the nerve or ability to get inside the profession you pretend to have the knowledge/ability to “fix”. Just how many doctors do you have working for you?? I’ve only rarely encountered that degree of snide, narcissistic self-importance. If you don’t like or agree with your physician get another one.

          • comfylawn

            Tony, you are absolutely correct with your original comment.

  • Kevin Phelps

    No “anti-racists” say a 100% Black area needs more diversity.
    No “anti-racists” say a 100% Asian area needs more diversity.
    No “anti-racists” say a 100% Muslim area needs more diversity.

    According to “anti-racists”, they are already 100% diverse.

    They say ALL & ONLY White area need to be more diverse, and that White areas only stop needing to be more diverse when there are no White people left in them.

    Anti-racist is a codeword for anti-White.

  • tony curti

    I remember reading one account of this incident that included the perspective that not only was Pasceri grieving the loss of his mother, but he was also being beset by medical bills which insurance was not covering and which he could not afford to pay. IF that’s true – you have to wonder about a system that adds bankruptcy to grief of loss, when the only “Crime” that’s been committed is that someone got old or sick. I’m not attempting to validate Pasceri’s actions, just to get a better read of the whole situation.

    • Mumbles

      The Davidson family was certainly doing well off the health care system. The wife (a plastic surgeon) still will, as long as there are insecure teenage girls to exploit.

  • Saltbush Bill

    One has to wonder when things like this happen why there is such outrage towards a healthcare system that might actually work. Why won’t people at least have a sane rational debate on guns and also socialized medicine ? Just a sad situation with no winners and this will go on and on until people start to understand the reasons why.