I am a member of both groups involved in the Medical Malpractice Crises, that is the Victims and the Providers. I understand the emotions and perceptions of both groups. It is from this vantage point as an “insider” that I offer these thoughts about a future direction in the search for safe health care. American physicians like to pride themselves as being practitioners of the world’s leading health care system. In many respects this is true. The discoveries of American medical researchers and clinical investigators have transformed medical care throughout the world.

We are at the threshold of an almost undreamed of understanding and ability to treat disease through breakthroughs in the Human Genome Project. And yet, there is a silent “cancer” eating away at the fabric of our health care system. Despite the successes of American Medicine, we rank only 37th in the world, according to the World Health Organization, in terms of bringing these successes to all of our citizens.
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Ralph H. Speken and Stephanie Z. Speken

Medical Chart

Each and every Victim could (and should be free) to tell their own story. Ours is just one. We were unique since we were able to pierce through the cover-up. The details of our case should prove instructive to those seeking solutions.

Medical Chart

in PDF format

Open a page with documents, click arrows to navigate to the next and the previous page. Jump straight to page by typing page number of the scanned document.

Medical Chart

Doctors' Notes

The Doctors’ Notes are presented in a series of scanned pages. Click arrows to navigate to the next and the previous page.
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Nursing Care

The chart released by the Hospital does not contain a Nursing Treatment Care Plan. It contains only 1 actual Narrative Nursing Note. Both are required by the various national and state hospital review organizations.
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Clicking on the dates below reveals the Doctors Orders and Treatment Response for the particular date. These are the orders for the medications administed, nursing procedures including restraints, laboratory studies, etc. There are separate documents showing the nurses’ implementation of the medication orders.
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Laboratory Data

The laboratory findings are displayed on 8 pages. It is significant that the positive urine Toxicology screen for Benzodiazepine taken in the Emergency Room is missing from the chart. The existence of this positive Toxicology was reported in both the transfer note of the intern on 8/26/93 as well as the psychiatric transfer note of Dr. Bongiovi on the same date.
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Ambulance Report

Seth had 2 ambulance rides. The first of these was the ride in the Emergency Medical Service bus that took him from our home to the Allen Pavilion. On the transfer sheet, there is no mention of Xanax. Both I and Seth’s mother were out, he was only with his then 10 year old sister. He had just hit his head on the floor, having fallen from the seizure. In his delirious, post-ictal state, the issue of the Xanax was erased from his mind.
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I hereby certify that I, Shirley H. Smith, M.D., City Medical Examiner I, have performed an autopsy on the body of Seth Speken on the 28th day of August, 1993 commencing at 9:00 am in the Manhattan Mortuary in the presence of Drs. Alandy and Leach.
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Our story timeline

This timeline provides a visual representation of events that helps you better understand the history and process of an event sequence. You can read the compact timeline without a lot of space between stories.
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Standard of Care

The treatment delivered by the unsupervised trainees at Columbia was one of light sedation and the heavy use of restraints. This cruel and continuous use of restraints to control agitation was a violation of the Law of New York State as well as the hospital’s own Restraint Protocol.

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The 2-page protocol seen by clicking below reveals the rules of The Presbyterian Hospital (including the Allen Pavilion) regarding the use of restraints. In their application of these restraints on Seth, the Hospital broke its own rules.

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the reader can review the New York State Law governing the use of restraints. This Law was broken in multiple ways. The relevant sections of New York State Mental Hygiene Law that were broken are as follows.

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...people who hear and read about it simply would not be ready to believe it


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  • Moral Justice

    Supreme Court, Departmental Disciplinary Committee, December 23, 2005, Paul J. Gurran, Chairman
  • Terminal Condition

    Donald L. Barlett and James B. Steele, in Critical Condition (Doubleday, 2004), focused their skills as investigative journalists
  • Crimes and Misdemeanors

    In December, 2001, we wrote a document questioning certain activities of Noah Berkowitz, M.D.
  • 36 Healthcare Fraud Cases

    The Columbia Presbyterian Division paid $480,000 in 2003 for improper billing as well as upcoding

Supplementary data

Clicks the Read More link to get more information

Columbia's Defense and Charge

H. Speken; and (2) compelling the plaintiff Ralph H. Speken to appear for an examination before trial with respect to those issues raised by the proposed counterclaim; and (3) compelling the plaintiff Ralph H. Speken to appear for a further examination before trial

Bill of Particulars

COLUMBIA PRESBYTERIAN MEDICAL CENTER, "JOHN DOE", and "JANE DOE", (true identities unknown, being doctors, nurses, residents, interns and other medical or technical personnel who rendered services to the decedent at the COLUMBIA PRESBYTERIAN MEDICAL CENTER)

Resume - Dr. Ralph H. Speken

NEW YORK CITY HUMAN RESOURCES ADMINISTRATION Psychiatric Attending Psychiatric consultation to an array of city agencies, in particular, The Protective Services Administration, offering protective services for adults in New York City

Unpublished Letter to NY Times

Sick people are at risk in hospitals due to inadequately supervised and monitored physican trainees. Seth's case is a tragic example of this. Due to fiscal constraints, it is now necessary to reduce the numbers of even this group of student doctors

Columbia Health Care Team

Following are links to the lists of physician trainees and Attending physicians who were supposed to be caring for our son Seth


Seth, whose Hebrew name was Shmuel, came from a long line of Rabbis on his father's side. His great grandfather, Shmuel Mordechai Berman, was the final arbiter (Chief Poskin) of Jewish issues in Denver, Colorado, until his death in 1947

Our Website, “A Death in the Hospital”, was first published on the Internet in late 1996. It continued to be served until July 8, 1999. We were then forced to remove the site because of a General Release we signed only under duress. After a long series of events we repudiated the invalid contract for silence and re-published our website. We both are in the medical field and have a duty to speak the truth.

“The Devil is in the Details” and the details of our case should prove instructive to those seeking solutions. We make no apologies for the amount of information on this site. The topic is complex. Each and every Victim could (and should be free) to tell their own story. Ours is just one. We were unique since we were able to pierce through the cover-up. The failure to deal responsibly with medical malpractice is a great national shame. It is symptomatic of a healthcare system that is fragmented and at risk of imploding. Safety will only come when we have well-regulated, fair, and universally available healthcare.

The Regulation of Medicine

Reflections of an Insider