Doctor's X-ray postings unsettling

OVERLAND PARK — U.S. Senate candidate Milton Wolf posted a collection of gruesome X-ray images of gunshot fatalities and medical injuries to his Facebook page and participated in online commentary layered with macabre jokes and descriptions of  carnage.

Wolf, a Johnson County radiologist anchoring a campaign for the Republican nomination with calls for federal heath care reform, said in an interview the medical images were legally uploaded to public social media sites and other online venues for educational purposes. They also served, he said, to demonstrate evil lurking in the world.

However, Wolf and others viewing these Facebook postings relentlessly poked fun at the dead or wounded. The gunshot victim, Wolf joked online, wasn't going to complain about the awkward positioning of his head for an X-ray. In a separate Facebook comment, Wolf wrote that an X-ray of a man decapitated by gunfire resembled a wounded alien in a “Terminator” film and that the image offered evidence people “find beauty in different things.”

Wolf declined in an interview with The Topeka Capital-Journal to clearly answer questions about whether he continued to place images of deceased people on the Internet. He asked to keep copies of the Facebook posts shown to him, but when denied, he walked away.

"I'm not going to play these kinds of gotcha games," he said.

An array of professionals involved in medical ethics who viewed the images or were provided a description of the materials made public by Wolf condemned his airing of the information outside confines of a doctor-to-doctor consultation or for the purpose of formal medical research or textbook instruction.

"The dignity and privacy of the individual should be protected,” said John Carney, president of the Center for Practical Bioethics in Kansas City, Mo. “It doesn't sound like they're being protected if they're, obviously, on Facebook.”

Carney said the summary of Wolf's postings provided to him would be widely viewed as “beyond alarming for a professional in the field of medicine.”

Truman Medical Centers in Kansas City, Mo., where Wolf said he obtained the decapitation X-ray, said in response to an inquiry Friday it wouldn’t have granted Wolf permission to use images of a shooting victim in this manner. Officials at Shawnee Mission Medical Center, linked to X-rays on the Internet depicting a person embedded with shotgun pellets and marked as property of TheWolfFile.com, responded to inquiries Friday by revealing Wolf had pledged to request removal of the X-rays from a California political website.

The Facebook site operated by Wolf appears to have been disabled prior to launching the campaign to oust U.S. Sen. Pat Roberts, R-Kan. It has been replaced by a Facebook site devoted to Wolf's senatorial campaign.

Leroy Towns, spokesman for Roberts, said revelations about Wolf's interaction on Facebook raised questions about the doctor's legal and professional responsibilities to maintain privacy of patient medical information. The disclosures also raise questions about Wolf's viability as a candidate, he said.

“For any doctor to make patient records public and then use the records for public discussion and entertainment is just unthinkable,” Towns said. “Allegations of such lack of judgment demand extensive scrutiny and investigation.”

On Saturday, Wolf released a statement alleging Roberts was launching a character attack against him.

“The attack will not only target me,” Wolf said, “but will, through its implications, cast a wider net to vilify all doctors.”

Wolf, who frequently mentions in campaign stops that he is a distant cousin to Democratic President Barack Obama, has been endorsed by groups aligned with tea party organizers. He authored a book, “First, Do No Harm: The President's Cousin Explains Why His Hippocratic Oath Requires Him to Oppose ObamaCare.”

He graduated from The University of Kansas School of Medicine, has been a licensed doctor in Kansas since 2004, and is employed at the Shawnee Mission division of Alliance Radiology. The Kansas Board of Healing Arts hasn't reported Wolf to have been the subject of sanctions related to private hospital privileges or through disciplinary action of the state agency.

In the interview Thursday in Johnson County, Wolf said he received permission from patients when required before making use of records or images. He claimed usage, including Facebook posts, that didn't reveal an individual's identity didn’t require prior authorization.

“It's an educational thing for people,” Wolf said. “I take my charge of being a doctor very seriously.”

On Jan. 25, 2010, Wolf uploaded to Facebook a high-resolution rendering of a deceased man shot in the temple. Wolf also posted an X-ray depicting that victim's fractured skull and a cluster of bullet fragments lodged throughout the brain.

Wolf launched a Facebook chat about the 3D image by explaining it was taken from a postmortem examination. A Facebook friend, Melissa Ring-Pessen, responded that she performed the scan on Jan. 22, 2010, and was admonished for improperly positioning the man's head.

“Seriously?” she wrote.

“Sheesh Melissa,” Wolf replied, “it's not like the patient was going to complain.”

In a Facebook discussion of an image of the person decapitated by gunfire, Wolf shared that the X-ray was among cherished artifacts from time spent working as a medical resident at Truman Medical Centers. The graphic image shows a skull broken apart like a smashed pumpkin. Chunks of skull remain attached by tissue with vertebra exposed at the neck.

“One of my all-time favorites," Wolf posted to the Facebook picture. "From my residency days there was a pretty active 'knife and gun club' at Truman Medical Center. What kind of gun blows somebody's head completely off? I've got to get one of those.”

Facebook friend Angie Rosini responded, “Ya know, the cool thing is, is that this dude walked away from this unscathed.”

Wolf: “It reminds (me) of the scene from 'Terminator 2' when they shoot the liquid metal terminator guy in the face at close range and it kind of splits him open temporarily almost like a flower blooming. We all find beauty in different things."

Shane Kovac, spokesman for Truman Medical Centers, said patient information could only be released from the medical facility with written consent of a patient.

“We can say that no one within Truman Medical Centers would have or could have given permission for a physician or anyone associated with the hospital to post an image, diagnostic or otherwise, to a personal social media page that includes patient information," he said.

Mallory Laur, marketing specialist at Shawnee Mission Medical Center, said the facility responded when informed X-rays associated with Shawnee Mission Medical Center of a gunshot victim were visible on the website, “Left Coast Rebel – Freedom, Abundance, Responsibility,” in conjunction with an interview of Wolf.

She suggested the X-rays on the political site weren’t a violation of federal medical privacy law.

“De-identified health care images are often used for education and other purposes,” Laur said. “While not a HIPAA violation, Dr. Wolf is in contact with the website on which this image was posted to have it removed.”

However, Wolf said in the interview there was merit to exposing the general population to the end result of violent acts.

“These are real consequences,” he said. “You know, there are real consequences to some of the evil out there in the world and some of the tragedies that are out there in the world. Do you think there would be so many of these tragedies if people saw the consequences of them?”

While discussing the Facebook posts, he also made reference to life and death pressures placed upon some medical professionals.

“It's difficult as a health care professional to have to deal with those every single day,” Wolf said.

Jerry Slaughter, executive director of the Kansas Medical Society, said it wasn’t the place of physicians, nurses and others providers at any level to reveal on Facebook or other public sites the result of criminal violence or accidental injury suffered by patients.

He said an assertion Facebook constituted legitimate educational outreach didn't ring true.

“If it's patient information, identifiable in any way, it's inappropriate,” Slaughter said. “Absent any legitimate educational purpose or context, this is not ethical behavior.”

Barbara Bollier, a Kansas House Republican and retired doctor who taught in a bioethics master’s program at Kansas City University of Medicine and Biosciences, said apparent transgressions by Wolf could be reported to the Kansas Board of Healing Arts as a potential violation of professional conduct by the radiologist.

“I am surprised,” she said. “I've never heard of another physician doing this.”