Troubled resident's case left UW with quandary

Service at UW

A memorial service for Dr. Rodger Haggitt is scheduled for 4 to 6 p.m. tomorrow in Hogness Auditorium at the University of Washington Health and Sciences Center, 1959 N.E. Pacific St., Seattle.

DURING THE YEAR leading up to last week's fatal shootings at the University of Washington Medical Center, pathology-department officials struggled with the best way to deal with a difficult employee who ultimately turned a gun on his mentor and himself.

They had criticized his work, urged him to see a psychiatrist and fired him.

Still, Dr. Jian Chen told his bosses he was "in total control."

And, ultimately, he was the one who decided his life would end on the floor of an office at the University of Washington Medical Center, near the body of a man he idolized.

In a year, Chen went from a determined pathology resident to an outcast who called his bosses liars, denied he was failing and shopped for a gun as his last day of work approached.

University administrators tried to defuse Chen's anger by buying him time. Rather than force him to leave, they gave him at least three reprieves as they tried to nudge him into other jobs.

Chen, 42, shot himself to death last Wednesday, moments after killing his mentor, Dr. Rodger Haggitt, 57, an eminent pathologist.

The next day, medical-center officials said at a news conference that they had done everything possible to manage Chen's increasing anger and anxiety. They said they had no reason to think Chen posed a danger and had declined to force him into a psychiatric evaluation.

Subsequent interviews with Chen's colleagues and supervisors show that administrators struggled to control an increasingly volatile situation mired in ethics, legalities and good intentions.

The university is reviewing the events that led up to the shootings and may launch its own in-depth investigation, said Dr. John Coombs, associate dean of the School of Medicine.

The state Department of Labor and Industries is investigating the shootings to determine whether the university has systems in place to protect employees from workplace violence. UW police are called about once a month to meetings where employees are being disciplined by supervisors who fear them.

But Chen's year at the university shows that dealing with a troubled employee is sometimes less about a system than a series of agonizing choices.

July 1999

Chen's arrival in Seattle last July marked the seventh stop along a circuitous career path that began 17 years ago when he graduated from medical school in Shanghai. A native of China who became a naturalized U.S. citizen last year, he began practicing medicine under the supervision of doctors at a Shanghai hospital.

Two years into his medical residency, he abruptly switched to forensic science.

He moved through a succession of programs in Japan and Texas. By 1992 he was studying under world-class scientists at the John Jay College of Criminal Justice in New York City. Colleagues there said he was smart, even-tempered and obsessed with his work.

Working with professors and researchers at the New York City medical examiner's office, Chen wrote his master's thesis on a DNA collection method he developed that could make it easier to identify rapists. The work was published in the prestigious Journal of Forensic Sciences.

But Chen wanted to give medicine another try, so he took English classes and passed a medical exam necessary to restart his training.

In 1998, at age 40, he entered the first year of a four-year pathology residency at the University of Mississippi Health Sciences Center.

He lasted a year.

Doctors in Mississippi said Chen was smart and creative, with an intense work ethic. He also could be argumentative and intractable. His proposals for experiments were judged unworthy of funding by the pathology-department head.

"This guy was a lost soul, but he was lost for a long time," said Dr. Sherman Bloom, who headed the Mississippi pathology program when Chen studied there. "He worked very, very hard and attempted to see things in very imaginative terms. . . . But he didn't understand science well enough."

Despite his lackluster performance and what Bloom described as recurring conflicts with colleagues, Chen obtained a favorable recommendation for an open slot at the UW, which runs one of the more demanding pathology residencies in the country.

Dr. Steven Bigler, a Mississippi pathologist who previously studied at the UW, wrote the recommendation, according to two UW administrators. Contacted a day after the shooting last week, Bigler said he was so upset he couldn't talk. He has not responded to four additional requests for interviews.

Bloom said it is difficult to give a negative reference without risking a lawsuit. But he said doctors at Mississippi had no reason to think Chen was dangerous.

At least six UW administrators interviewed Chen before he was selected, said Dr. Rochelle Garcia, director of the UW's pathology residency program. Garcia started that job July 1, 1999, the same day Chen arrived.

During the interview, administrators were concerned about Chen's poor English skills, Garcia said. "They thought that this would be something he would be able to work through."

July through September

Within weeks of Chen's arrival, his lack of scientific expertise was apparent in his work, according to interviews with Garcia; her boss, Dr. John Gie napp, director of grad uate-medical-education assessment and development; and his boss, Coombs, associate vice president for medical affairs and associate dean of the School of Medicine.

Second-year residents are paid $37,000 a year and expected to carry a heavy workload. They study specimens taken from patients to determine a likely diagnosis of disease. They also must interpret tests for doctors who treat patients.

A residency in pathology, which can last up to five years, requires speed and accuracy under pressure. Residents sometimes must offer a quick diagnosis to a surgeon in midsurgery.

Coombs said Chen's diagnoses were reliable. But he was slow and continued to make basic mistakes, such as placing specimens in unlabeled jars.

If corrected, he would grow defiant. "He would say, `But I know what's in there,' " Garcia said.

His dictations were difficult to transcribe because of his limited English.

Chen's workload was cut by at least a third by September, just two months after he started.

November

In November, Garcia told him that he could finish the residency year, which ended July 1, but that he should begin looking for another residency immediately.

Chen had more than three months to prepare for the national resident-selection program, or "the match," held each March. If he wasn't selected, he then would have to contact individual schools to apply for positions that had not been filled, a process known as "the scramble."

"There was an assumption that Dr. Chen (would) be taking responsibility for his life," Coombs said. "If you're not a self-starter, you're going to have a rough time here."

Dismissing Chen in the middle of a residency would ruin his chances to practice medicine.

"Rochelle Garcia felt it would have been more helpful to carry him on at a reduced workload and the same salary," Gienapp said. "I think she felt it would have been cruel to do otherwise."

Because Chen's work performance posed no danger to patients, Gienapp said, he and other supervisors agreed to let him stay through the end of the residency year. Last week, after the killings, Gienapp questioned that decision.

"In hindsight, maybe we would have helped him more . . . if we just terminated him in December," Gienapp said. "At the time, it would have been hard, very, very hard. And who's to say the same thing wouldn't have happened?"

After being told his residency would not be renewed, Chen began writing e-mails to his supervisors, particularly Garcia and Haggitt, whom he admired as a mentor and father figure.

"In the beginning, the e-mails were more like, `Please give me another chance,' " Garcia said.

January through March

As the weeks passed, Chen's e-mails grew longer and more despondent and angry.

On Jan. 25, Chen wrote to Haggitt:

". . . This is the first time in my life I feel so powerless for my future and everything is out of my hand. The dream was built for so many years. I went through such hard pathway and invest all I have. When I almost can imagine its completion, it suddenly collapsed. Looking at the ruin and debris, I am totally lost."

Chen protested the department's decision to give him only six months' credit for his yearlong residency.

He complained he was being unfairly scrutinized at the UW and opted to spend time in the pathology department at Seattle's Harborview Medical Center, which is run under contract by the UW.

As the March "match" approached, Chen's e-mails to supervisors became demanding, "basically ordering us to call these programs," Garcia said. "He expected us to give him a spot. He couldn't seem to understand that it doesn't work that way."

Thinking the misunderstanding might be the result of language or cultural differences, Garcia asked a Chinese member of the Harborview staff to talk to Chen. But Chen continued to insist that doctors in the UW pathology department, especially Haggitt, should find him a new job.

"Jian had this view of Dr. Haggitt like he was this all-powerful being," Garcia said.

When Chen wasn't chosen in the March match, Garcia urged him to call other programs. She reviewed his application letters, correcting his grammar.

But Chen rarely made calls to follow up on his applications, Garcia said. He said he needed Haggitt, a renowned pathologist with international connections, to call for him.

"Now I think that he just really thought he would find some way of getting us to keep him," Garcia said.

April and May

Garcia had urged Chen to seek counseling in March, and she did so again in April. He declined both times, saying he didn't need it.

Meanwhile, his increasing antipathy toward Garcia and Haggitt made it harder to help him. "The more antagonistic he got, the less comfortable I got recommending him to anybody else," Garcia said.

And his e-mails continued, growing "more bizarre" and complaining that the situation was "suicide for his career," Garcia said.

He made no direct threats, to himself or others, in the e-mails, she said.

"What (the e-mails) do is . . . give this flavor of someone who feels really hopeless and isolated," Garcia said.

On May 21, Chen sent an e-mail to Bigler, his former colleague at the University of Mississippi. In it, he complained that Garcia and Haggitt were lying about him.

"When Dr. Haggitt explained the reason of kick me out to me, he said I had little improvement of English, and Dr. Garcia said dictation was still a problem," Chen wrote. "That time only one word appeared in my brain - liars - and I was shocked. I cannot believe they will lie to me face to face and eye to eye. In my rough life I deal with a lot of liars, this is not new to me but these I respect like God and trust so much lie to me is totally unexpected."

May 23

Five weeks and three days before Chen's scheduled last day at work, a colleague told Garcia that Chen was shopping for a gun. Garcia rushed the news up the chain of command to Gienapp and Coombs.

Coombs, who oversees about 3,000 medical students, fellows and residents, said he met with Gienapp immediately and at least three more times over the next several days.

Meanwhile, Gienapp asked Garcia to talk to Chen about the gun. When she said she was afraid to meet with Chen alone, Gienapp agreed to attend the meeting with her and asked for a UW police officer to be present to "keep the peace."

The meeting lasted 10 minutes.

"Some concern of mental health of resident," the officer noted in his report of the meeting. ". . . Resident has made no threats of any kind. Resident stated he was not going to hurt himself or others. Resident was obtaining gun-shop info to buy a firearm for self-protection."

After the meeting, UW police checked state firearm permits; those records take three weeks to post, and they showed Chen had not purchased a gun as of early May. They told UW officials they had no grounds to arrest Chen and, without a threat of violence, no grounds to order him held in a hospital for 72 hours to undergo a psychiatric evaluation.

The campus police had no further involvement with Chen, said UW police Capt. Randy Stegmeier, and did not check firearm permits again.

Garcia and Gienapp urged Chen during the meeting to see a psychiatrist at the medical center's emergency room. He refused, saying he was "in total control," Garcia said.

When Garcia asked about his interest in a gun, she said Chen told her: "I just wanted it for protection. That's my right as a citizen of the United States."

The UW supervisors consulted a lawyer in the state Attorney General's Office and were told they had no grounds to force Chen into counseling. Two psychiatrists and a psychologist at the medical center agreed with that assessment, Coombs said. The best the supervisors could do is recommend counseling.

However, under the law, Chen could have been ordered to have a psychological evaluation, a less stringent intervention than the 72-hour psychiatric hold. But Coombs, Gienapp and Garcia all said they feared the repercussions of such action.

"We talked about that," Gienapp said. "But the idea of a psychological evaluation is you get people in a position that psychological help would be valuable to them. The very idea that he was crazy - that was very demeaning to him and very offensive."

Four residents who worked with Chen began warning Garcia and Haggitt to be careful.

"I felt incredibly helpless," Garcia said. "I was very scared."

Late May

As Chen became more silent and withdrawn, administrators decided not to confront him.

"People are not predictable," Gie napp said. "We're dealing with a different culture, with a whole different idea of psychological health, issues of face and value, different traditions of suicide."

Chen had no family in Seattle and no known friends. A colleague at the UW called Bigler, Chen's colleague in Mississippi.

Bigler discovered Chen's May 21 e-mail, which he immediately forwarded to Garcia. Bigler also had several phone conversations with Chen and, according to Coombs, assured supervisors at the UW that he did not think Chen was capable of violence.

"Legally, we took every step that was in our legal power," Gienapp said. "The only other thing we could have done was terminate him on the spot and banish him from the building. . . . If I thought that was an absolutely foolproof answer, I would have done it."

Administrators also decided it would be impractical to post a police officer in the area or to screen thousands of employees and patients for weapons.

"We didn't have enough to get a restraining order," Garcia said. "But we could have said, `You're fired.' The fear was that if we fired him right then, he would kill himself."

Gienapp told Garcia to monitor the situation and notify him if anything changed.

Late May through mid-June

A fellow resident found a map to a gun shop on Chen's computer screen. Garcia considered calling it, asking the owner not to sell Chen a gun. But she decided that would be an invasion of Chen's privacy.

Instead, she sent Chen an e-mail, urging him not to buy a weapon. He e-mailed back that he wouldn't, then requested a meeting with Garcia. She told him she was too busy and arranged instead for him to meet Dr. Mary Bronner, another pathologist in the department.

Garcia heard yelling from that meeting and later learned that Chen denied he had performance problems and asked for another chance to prove himself.

Garcia, Haggitt and Bronner acquiesced, "hoping it would convince him that we didn't have it in for him," Garcia said.

But the problems persisted. The transcriber complained it took hours to decipher Chen's reports. His descriptions of samples were hard to understand. He brought Garcia slides without patients' names written on them.

The annual residents' dinner was scheduled for June 2. Garcia didn't want to tell Chen he had failed again until afterward.

"I was worried that he would show up at the dinner with a gun," she said.

On June 6, Garcia, Haggitt and others told Chen that his work had not improved and that he had to leave by month's end.

That evening, Chen went to Wade's Eastside Guns, where he test-fired a .357 Glock handgun recommended by the staff. Store owner Wade Gaughran said Chen asked questions that indicated he had researched weapons.

Chen bought the Glock for $479. He picked it up June 14, the day the mandatory waiting period expired.

Late June

Some people who worked near Chen locked their doors. Some left work early to avoid him. Residents urged Haggitt and Garcia to get him out of the department, even if it meant getting him placed with another program.

"People were walking on eggshells waiting for July to come," Garcia said.

On June 23, Chen re-sent many of his e-mails to Haggitt and Garcia.

"I have exhausted all the possibility to save my career," Chen wrote. He again asked he be given more than six months' credit for his year at the UW.

"If we had given him more credit, maybe he would have said `OK,' " Garcia said. "The problem was, it wouldn't have been ethical."

Through it all, Haggitt seemed concerned only that Chen might harm himself.

"I think he probably just didn't believe that someone would do such a terrible thing," Garcia said.

Last Wednesday, 3:45 p.m.

Chen walked into Haggitt's office. The door closed and locked behind him. People in neighboring offices heard raised voices, then five shots.

Twenty-five minutes later, police forced the door open.

They found Haggitt dead, four bullets in his torso. Chen was dead, too, a single bullet in his head.

Susan Kelleher's phone message number is 206-464-2508. Her e-mail address is skelleher@seattletimes.com.

Eli Sanders' phone message number is 206-748-5815. His e-mail address is esanders@seattletimes.com.