South Dakota hid evidence in Brady Folkens' death

Here's is an update from Brady Folkens' mom:

Please share with everyone!!
H.L. Aanning MD LLC
Medical/Surgical Consultants
Member AMA and FACS
252 Gavins Point Road Yankton SD 57078
605-665-4660
laanning@gmail.com

29 April 2016
RE: Brady Folkens (died 21 December 2013)

To the South Dakota Board of Medical and Osteopathic Examiners:

I was asked by Dawn Folkens Van Ballegooyen to read over the medical records she received from Avera McKennon Hospital, and to let her know how and why her son, Brady Folkens, died on 21 December 2013 in the ICU at that facility.

After going over these medical records I have come to the conclusion that:
1. Dr. Raed Sulaiman omitted a crucial laboratory result in his Final Autopsy Report dictated 15 January 2014:
a. Dr. Sulaiman failed to include a negative IgM for parvovirus B19 (PVB19) that precluded Brady Folkens having an acute PVB19 infection.
b. Dr. Sulaiman did include a positive IgG and two positive PCR tests (myocardial and blood)—but all three are positive in over 50% of juveniles the same age as Brady Folkens (17 years) and only prove that Brady Folkens had a prior exposure to PVB19. Here is the detail of the Final Autopsy Report showing Dr. Sulaiman’s omission of the IgM for parvovirus B19:

c. Dr. Sulaiman concluded, as his final diagnosis/cause of death, that Brady Folkens died from lymphocytic myocarditis caused by acute PVB19 infection.
d. Lymphocytic myocarditis can also be caused by drug reactions, autoimmune disease, viral infections, or can be idiopathic.
e. Again, a negative IgM for PVB19 conclusively eliminated this virus as a cause of Brady Folkens death
i. I communicated with multiple experts on PVB19-induced lymphocytic myocarditis and they are all in agreement that a negative IgM virtually eliminates parvovirus PVB19 as a cause of Brady Folkens’ death.

2. This should have been a forensic autopsy as Brady Folkens suffered his three-day illness leading to his death while in custody of the SD Corrections Department. The following issues raise questions as to Dr. Sulaiman’s expertise and competence to perform a forensic autopsy:
a. Dr. Sulaiman is not certified by the American Board of Medical Specialties in any field of pathology—specifically: clinical, laboratory, or forensic—as no entry is found on the ABMS website.
i. The McKennon Hospital website describes Dr. Sulaiman as being board-certified—and since Dr. Sulaiman is an employee of the Hospital, and the Hospital has access to ABMS data, the website is misrepresenting Dr. Sulaiman as a board-certified pathologist.
b. Dr. Sulaiman dictates that “Autopsy Consent” was obtained from Dawn Folkens as shown in this detail:

But, in fact, Dr. Sulaiman never explained the autopsy (for restrictions) nor obtained consent from Dawn Folkens (who actually had a promise from Dr. Recalde that the autopsy would be done at Sanford).
i. Significantly, there is no consent form for the autopsy in Brady Folkens medical records, and Dawn Folkens never signed one.
c. The “Clinical History” in the Final Autopsy Report is grossly deficient in describing Brady Folkens medical history prior to his death—specifically the following crucial elements were omitted (although more or less present in all the dictations by the other physicians in the ICU during Brady Folkens terminal hours—especially Dr. Masannat’s):
i. Medications
ii. Allergies
iii. Past Medical History - surgical/medical
iv. Family History
v. Habits
vi. All this information was available from the chart—or even from his mother who lives in Brookings
d. In the microscopic examination of the myocardial tissue, Dr. Sulaiman dictates:

Repeating Dr. Sulaiman: “The findings are of lymphocytic myocarditis, suggestive of viral etiology.” But Dr. Sulaiman does not describe any findings that are “suggestive” of a viral etiology.
e. Pertinent pre-terminal diagnoses—liver failure/hepatitis with markedly elevated AST (877) and ALT (260)—were all ignored by Dr. Sulaiman in his Final Autopsy Report.
i. Dr. Sulaiman never discussed Brady Folkens obvious liver involvement in this disease process.

3. The IgM documentation on page 8 of the Final Autopsy Report is suspicious for an alteration which omits the “Interpretive Information” for IgM and, instead, the “Interpretive Information” for IgG (below the blue line) has been substituted for the IgM:

a. In spite of this substitution there is the remaining documentation of IgM level at 0.25—and which is considered negative by the outside laboratory that did the test.
b. And the negative IgM for PVB19, as well as all the other laboratory values and the Final Diagnoses, were distributed to all the other (three) physicians involved with Brady Folkens care the day he died:
i. Francisco H. Recalde MD
ii. Hesham M. Elgouhari MD
iii. Kelly G McCaul MD
c. So each of these three physicians (detail below) knew that the IgM for PVB19 was negative—as each received a copy of the Final Autopsy Report and

also have received the separate laboratory notifications, as the results from outside laboratories became available and were distributed to the physicians involved with Brady Folkens’ care.

4. Interestingly, Fares Y Masannat MD, the infectious disease specialist, was not documented as receiving a copy of this Final Autopsy Report, yet:
a. He was directly involved (hands-on) with Brady Folkens’ care.
b. His dictation reveals the most complete description of Brady Folkens’ medical history prior to his death.
c. Dr. Masannat’s name is all over Brady Folkens chart. His consultation was copied for all of the three physicians who also received a copy of the Final Autopsy Report by Dr. Sulaiman. Why was he not named as a recipient of this Final Autopsy Report?
d. Neither Dr. Elgouhari nor Dr. McCaul appear to have any dictations in Brady Folkens’ chart and appear to only have participated via phone calls—yet they all received their copies.
5. Michael Heisler MD, the eICU attending, also did not receive a copy of the Final Autopsy Report—why?

6. Dawn Folkens was returned custody of Brady Folkens while at the Custer Hospital. She was present in the ICU at McKennon Hospital when Brady Folkens suddenly died. Dr. Recalde, the attending, asked her if she wanted an autopsy. Yes, she replied, but not at this hospital and she indicated that she wanted an autopsy performed at another hospital—Sanford. Dr. Recalde told her he would take care of it.
a. Dawn Folkens only learned from the funeral home that Brady Folkens’ autopsy was completed.
b. Only much later did Dawn Folkens learn, via a telephone call from the coroner, Dr. Kenneth Snell, that the autopsy had been done at McKennon Hospital, after all, by Dr. Sulaiman.
c. Dawn Folkens never received a call or a copy of the Final Autopsy Report from Dr. Sulaiman, Dr. Recalde, or anyone else at McKennon Hospital.
d. And Dawn Folkens first saw the autopsy report when she asked for Brady Folkens’ complete medical records from McKennan.

7. After reading Dr. Sulaiman’s Final Autopsy Report, Dawn Folkens did a web search and learned of Dr. Stanley J. Radio, pathologist at UNMC in Omaha, and requested pertinent tissue samples be sent to him for evaluation:
a. Dr. Radio sent his final report to both Dr. Sulaiman and to Dawn Folkens.
b. Dr. Radio had previously published a study showing that PVB19 detected by PCR methods and serology (IgG) simply demonstrates the virus is an “innocent bystander” and not a cause of lymphocytic myocarditis:
i. Dr. Radio did not see the characteristic microscopic findings seen with an acute RVB19 infection in the cardiac tissue.
ii. An immunoperoxidase stain for PVB19 was negative.
iii. Dawn Folkens paid this bill out of her personal funds.
c. Dr. Sulaiman offered no statement(s) with regard to Dr. Radio’s negative findings and never changed his original Final Autopsy Report—even though Dr. Radio sent a copy of his negative results to him.
d. Dr. Radio’s published work casts strong doubt on whether the children in the study quoted by Dr. Sulaiman, in his Final Autopsy Report, likely designed to lend credence to his final diagnosis, actually really had an acute infection of PCB19. The study was retrospective and picked out children who had positive PCR values for PVB19—simply showing that they had previous exposure and not proof of acute infection as serological markers were not obtained and quantitative PCR values were not obtained. Here is how Dr. Sulaiman, disingenuously we believe, injected this retrospective study into his Final Autopsy Report:


i. Dr. Sulaiman cites this reference (whose methods for retrospectively selecting a cohort of patients is specious, as any pathologist should be aware of, but whose weakness would not be noted by most other physicians) to further buttress his false assertion that PVB19 killed Brady Folkens.

My conclusions are that:
1. Dr. Sulaiman,
a. by omitting the negative IgM for PVB19,
b. by suggesting the microscopic findings as “suggestive” of PVB19 infection when he doesn’t even describe what these findings are,
c. by not fully obtaining all of Brady Folkens’ pertinent medical history,
d. by citing a specious study of children by Molina to implicate PVB19 in this case,
e. by not furnishing copies of the Final Autopsy Report to Drs. Masannat and Heisler,
f. by not taking into consideration an independent and negative autopsy report by Dr. Radio,
g. and by falsely dictating that Dawn Folkens had consented to this autopsy with no restrictions,
has signed his name to a patently false and fraudulent Final Autopsy Report on Brady Folkens. We ask the SDBMOE to adjudicate this claim.

2. Dawn Folkens, Brady Folkens’ mother, and I are completely stupefied by Dr, Sulaiman’s signing of this false and fraudulent Final Autopsy Report and feel that Dr. Sulaiman owes Dawn Folkens an explanation(s) as to why he dictated and signed this contrived document. We feel it is unlikely that Dr. Sulaiman, a priori, would have produced this document without outside demands that forced him to acquiesce. And this external force must have been powerful enough for Dr. Sulaiman to risk his integrity as a physician licensed in the state of South Dakota.

3. Dr. Recalde received a copy of the Final Autopsy Report and we wonder why he did not correct the false diagnosis implicating PVB19 as Brady Folkens cause of death. Seems to us that, being aware of this Final Autopsy Report and its critical omission of a negative IgM for PCB19, Dr. Recalde, as Brady Folkens’ attending physician, was not an innocent bystander.

4. I believe Dr. Sulaiman owes Dawn Folkens an apology.

5. Dr. Sulaiman does not appear as certified in any field of pathology when we interrogated the ABMS website. Question: why would the state of South Dakota allow a non-certified pathologist do a forensic investigation of a youth who just died while in custody with the DOC? We ask the SDBMOE to adjudicate.

6. The death certificate was signed by the Minnehaha Coroner, Dr. Kenneth Snell, who documented that Brady Folkens died from “lymphocytic myocarditis associated with parvovirus B19” and “natural causes”. Dawn Folkens and I believe this is patently false and we ask that a new death certificate be filed not blaming the virus for Brady Folkens’ death.

7. Dawn Folkens and I ask that the state of South Dakota convene a forensic investigation to determine why Brady Folkens died while in custody of the South Dakota Department of Corrections, and why:
a. Dawn Folkens, when at the Custer Hospital and in the midst of Brady Folkens’ health crisis, was asked to resume custody of Brady Folkens by a DOC official.
b. Dr. Sulaiman did not obtain consent for autopsy when Dawn Folkens was now Brady Folkens’ custodian/mother with parental authority.
c. Dr. Recalde did not follow through with Dawn Folkens’ directive, as Brady Folkens’ mother, to have an autopsy performed at Sanford.
d. Why not one of the physicians at Avera McKennon Hospital, ever, contacted Brady Folkens’ mother, Dawn Folkens, to offer any update on Brady’s autopsy, explain why and how he died, or offer to send her this Final Autopsy Report.
e. Why not anyone connected with the SD Department of Corrections, ever, contacted or reached out to Brady Folkens’ mother to explain why and how he died while in state custody.

Dawn Folkens and I fully understand the SDBMOE has limited investigative powers/authority with regard to some of our questions and complaints. But we also know that the Attorney General’s Office, headed by Mr. Marty J, Jackley, is the legal arm of the SDBMOE, and we respectfully ask both to work in concert to adjudicate the issues we have raised concerning the death of Brady Folkens.

Sincerely yours,

Lars Aanning