Charges That Pediatrician’s Office Diluted Vaccines Shock Town

SAN RAFAEL, Calif. — To his young patients and their parents, William Liebman was the sort of physician who inspired loyalty. Many likened him to an old-time country doctor, talked of his indulgent nature with children, his generosity with his time. Most everyone called him Dr. Bill.

Then came the shocker. Marin County prosecutors charged the balding, soft-spoken pediatrician with three felony counts, alleging that his office diluted vaccines meant to protect young patients against hepatitis, whooping cough and other illnesses. The motive, prosecutors surmised, was to hike profits.

Liebman has denied the accusations in what state medical officials say is the first such case against a California doctor. National experts say they have never heard of a pediatrician anywhere charged with watering down vaccines.

Parents in this affluent suburb just north of San Francisco have reacted with a mix of disbelief, outrage and fear.

On one side, more than 90 families have joined a class-action lawsuit against the 59-year-old doctor and his practice.

“It’s hard to believe anyone could do this, but then I look at the facts,” said Maria Storniolo, whose 4-year-old son, Adrian, recently flunked a test for two different immunizations that had been administered at Liebman’s office. “The facts are my son wasn’t immunized for two horrible diseases.”

The pediatrician also has drawn a flood of supporters who refuse to believe he took part in any scheme to water down medicine.

They have plastered the walls of his San Rafael office with laudatory letters, launched a defense fund and held a candlelight vigil, and they rallied with placards when Liebman appeared in court. More than 40 nurses signed a letter praising Liebman and sent it to the local newspaper.

The charges, supporters say, simply don’t fit the man. They contend that there is little monetary gain in diluting vaccines and note that public health officials have found no evidence of suspicious illness among Liebman’s patients.

“None of it makes sense,” said Linda Curry, a parent who helped organize the defense fund. “This is a man who has devoted his life to children, six days a week, evenings. Why would he jeopardize the health of his patients, these children he loves dearly?”

Liebman has stopped giving vaccinations under an agreement with the Medical Board of California, which is reviewing the allegations for possible discipline. The doctor continues to practice at his San Rafael office in an upscale shopping mall and at a smaller outpost up the freeway in Novato.

On a recent morning at his main office, a steady line of families came in for appointments. Children frolicked on the Berber carpet, eyed a collection of teddy bears on a shelf and romped through a plastic playhouse. Supporters say the doctor has lost about 10% of his patients in recent months.

Liebman and his lawyers declined to discuss the case. In a letter to patients after his arrest Thanksgiving week, Liebman denied adulterating vaccines and called the charges “false and outrageous.” If the medicines were diluted, he said, “someone else must have done this.”

Prosecutors in the Marin County district attorney’s office say as many as 2,500 children may have been affected.

Their probe began in May when a nurse at Liebman’s office contacted Clay Hoffman, a district attorney’s investigator.

The nurse told Hoffman she had been marking the level on half-empty vaccine vials, then would find the glass tubes mysteriously full the next day, according to an affidavit filed by prosecutors. The rubber stoppers bulged from extra air forced in, she said.

When the doctor left on military reserve duty last year, the office went through more hepatitis B serum in his two-week absence than it had in the proceeding three months, prosecutors said.

Another employee told the investigator that Liebman was “cheap,” and alleged that the doctor would break protocol by reusing urine cups and the oxygen hoses needed for a machine that helps asthma patients.

Investigators searched the doctor’s offices in June and seized 21 vials of vaccines. A federal lab found that nine had been adulterated, according to the affidavit.

During a three-month period last year, Liebman’s office ordered 10 doses of a vaccine that guards against diphtheria and several other illnesses, but billed patients or their insurers for 20 times that amount, prosecutors alleged. The doctor used 36 milliliters of hepatitis B vaccine over the same period, but billed for more than five times as much, the affidavit said.

Since the charges were filed Nov. 23, Marin County has been gripped by the case.

Letters have flooded the local newspaper and TV news has covered the case extensively. The case is a topic of cocktail party debate. Everyone seems to have an opinion about Dr. Bill.

The pediatrician has been part of this community’s fabric for more than two decades, a father of four who coached soccer and baseball and worked with numerous civic groups. His practice is a family effort; his wife helps manage the office and a daughter works there too.

Patricia Henle first heard about the charges on the radio the night before Thanksgiving as she drove to pick up her son, Wally, a Liebman patient.

“We flipped out,” said Henle, noting that her firefighter husband is exposed to people with an array of diseases. She quickly had her 2-year-old son tested and was dismayed to find he was unprotected against four diseases.

Then the mother switched gears. Henle, a San Francisco attorney who specializes in class-action lawsuits, sued Liebman and his medical practice. The lawsuit alleges that the doctor violated state business statutes, failing to provide a promised service by not properly immunizing the children in his care.

Even so, Henle said, “I really do hope it’s not him.”

The charges against Liebman have filled Susan Kelly with doubt. She knows it’s improbable, yet can’t help but wonder if the frequent colds plaguing her daughter, Rachel, 3, might have something to do with improper immunizations.

“He seemed like a little grandfatherly, Santa Claus kind of man,” Kelly said. “You believe in your doctor. That’s why this seems so cruel.”

Jennifer Harwood, whose son Zachery is approaching his second birthday, is putting the boy through another round of immunizations as a precaution. And she’s angry about it: “I don’t want my son to be going through this.”

Although public health officials recommended that Liebman’s patients consider getting vaccinated again, a county survey estimated that only about one in six took steps to do so.

Scores of families had their children tested, but most did not. The tests require drawing a considerable amount of blood. The results are also considered relatively unreliable, health professionals say. In some vaccinated patients, antibodies decline to undetectable levels, experts say, although the patients’ systems retain an “immunological memory” that protects against disease.

Dr. Peter H. Tom, a state medical board consultant, said in court papers that improper immunizations put children “at serious risk” and jeopardize the community at large. Even rare illnesses can strike unexpectedly if not held at bay. One in 20 Californians contract hepatitis B during their lifetime, and one in 50 of those die.

Acknowledging that doctors face growing financial pressures under the managed health care system, Liebman’s supporters reject the notion he would water down vaccines to enhance profits.

“It’s a very difficult time now in medicine, but to do this?” said Dr. Jan Alban, a San Francisco pediatrician who has known Liebman for years. “Why would a doctor like him threaten the life of a patient or be so cheap as to falsify drugs? I’ve never known him to be anything but a good doctor.”

Liebman returns to court April 24 for a preliminary hearing. He is charged with willful cruelty to a child, adulterating drugs with intent to defraud and sale of adulterated drugs. If convicted, he faces up to six years in prison.

Supporters say they will stick with the doctor to the end.

“None of this squares with me,” said Stephanie Lum, the mother of a 4-year-old girl. “To us, he’s like a Marcus Welby.”

Robert Reyff and his wife, Sydney, recalled when their 6-year-old daughter, Jennifer, was stung by bees during a weekend getaway at a lake.

Frantic, they called the doctor’s office expecting to talk to a nurse. “The next thing you know Dr. Bill was on the phone telling us what to look for,” said Reyff, an attorney. “What better service can you ask for?”

Reyff, who served as a prosecutor in San Francisco during the 1980s, figured Liebman can beat the charges.

“District attorneys can sometimes get it wrong,” he said. And until more proof emerges, “I’ve got Dr. Bill’s word. I have every reason to believe him.”