Rx for Plunder

These days, Zimmer laughs off the incident. "I learned you can't take a car waterskiing!" he says. Zimmer went into detox and now proudly states that he became the first doctor in Florida to lose his license and get it reinstated. He changed his specialty to psychiatry and specialized in addiction therapy, putting to good use his ability to empathize with recovering addicts.

Zimmer acknowledges his share of personal problems. Doctors, he notes, are not infallible creatures who breathe some rarefied air. When he came to Oakland Community Health Center, he was a dude in need of a job.

Still, he feels that every patient treated at Oakland deserved to be there. "My job at a PHP was to prevent further deterioration," he says. Despite all of the work that had been put into falsifying documents to make patients look as if they were improving, Medicare regulations do indeed state that PHPs are "reasonably expected to improve or maintain" the individual's condition to prevent relapse or hospitalization. Though with stays at Oakland limited to 30 or 45 days, he says, the program was often forced to discharge patients "before we could see if the meds were working."

He concedes that he signed freely on psychiatric evaluations, progress notes, and charts. He adds, though, that in today's health care environment, it's necessary to move paperwork expediently. Health care is based on trust, he says. "When a nurse tells you that a patient has a fever, you don't ask to see a picture of the thermometer with today's newspaper in the background."

Zimmer says he has no problem with rules that allow owners of CMHCs to operate without any medical education requirements. "What does admin have to do with clinical?" he says. Zimmer's the kind of guy who has "trouble counting change, but I can do calculus." He always stayed on the medical side — "far away from the cash register."

But when he heard what happened to Yvonne, he felt heartbroken. "She's good people."

Yvonne Howell's lawyer, Allan Kaiser, tall, lean and mustached, waved his hands and argued passionately in front of the jury.

Kaiser acknowledged that some documents from Oakland were back-dated — but Yvonne was just making sure paperwork was in order! Maybe a few patients were not quite qualified for PHP treatment — so why did the doctor admit them? Yeah, Yvonne gave boxes of diapers to ALF owners — she's a nice lady! She had no authority to sign checks and no control over bank accounts. She did not make an exorbitant profit. She owned a few scrappy properties, he pointed out, but no mansion.

But witness after witness took the stand with at least one point to make against Yvonne Howell. Prosecutors introduced more than a thousand exhibits. Of 168 patient files, they pointed out something fishy in 167.

Watching a long, complicated case about health care fraud was no fun for the jury. "If you're going to do jury duty," said one of two jurors who spoke about the case on the condition that their names not be used, "why do we have to have the most boring people on the planet? One morning on my way into court, I was making a left at a traffic light and [prosecutor Nicholson] was crossing the street. I thought, 'Should I accelerate?' He's so boring! I don't want to hear him today!"

The juror described Nicholson's fellow prosecutor on the case, Roger Stefin, as "very boring but not as boring as the other one." Asked to justify his boringness, Stefin said wryly, "Sometimes we have to bore them into a conviction."

Once her three codefendants had taken plea deals, Yvonne Howell stood alone, charged with 23 counts from the original 43-count indictment. After a three-week trial and three days of deliberations in May, a jury found her guilty on ten of those counts. The allegations involving the alteration of documents — she was clearly guilty of those, the juror said. "I don't get the feeling she did it maliciously, though. Nurses say what they say in order to get patients treated."

But conspiracy to pay kickbacks and launder money? Those were a technicality, the juror explained. Because of the way the jury instructions were worded, they felt they had to find Yvonne guilty on those two counts. Upon being dismissed, the juror ran from the courtroom to the parking garage, where, racked with stress for determining the fate of a fellow human being, she promptly threw up.

Three months later, Yvonne was back in court, sitting under fluorescent lights in her prison jumpsuit, her hands cuffed, her hair cropped short. Only three people came to her sentencing.

Kaiser argued that Yvonne should get less time than Bernard and Althea, the two most culpable defendants. Otherwise, "my client is being punished for exercising her constitutional right to go to trial!" he cried. "What did my client get out of all this?" Like everyone else, he tried foisting the blame upon Zimmer.

"Frankly," prosecutor Stefin said, "in hindsight, Zimmer should have been charged."

It was Yvonne's turn to speak. "I am 60 years of age," she began. "I have spent my life taking care of the mentally ill and the aged people in society — the forgotten ones. I have spent long hours trying to get assistance for the poor and needy." She sniffled. "I sat here and listened to the testimony of Mashama Brannigan. At no time did she say that I was like a mother to her. I listened to Tabatha Harrell. At no time did she say that I gave her shelter when she was homeless with a 10-year-old daughter. I listened to Neil Leder. At no time did he say that I helped him when his car broke, to fill his radiator, or when he had no shoes."