Patients revere him; the government wants to put him away

By Kristen Hinman Spring 2004 Part 1 From:
(Go to: Part 2)

RAFIL Dhafir became my grandmother’s oncologist on June 25, 2002.

He’d been practicing in Rome, N.Y., for 20 years. But my parents, familiar with most doctors in our town of 35,000, had never met him. That June, my grandmother – a brunette with a sprite’s step and pearly complexion – spoke of dizziness and an aching back. This was a woman who’d missed exactly one day of school growing up, who’d rarely fallen ill in her 79 years and had never been a complainer, despite gradually sinking into dementia. My mother swiftly escorted her to a nurse practitioner and froze when the nurse lifted Grandma’s dressing gown: raw, blistery mounds masked her breast. A subsequent bone scan unearthed a minefield of tumors: on her spine, hip, brain, throat, pelvis and knees. Eleven days later, my mother and grandmother sat heavy-hearted in Rafil Dhafir’s wood-paneled waiting room. He’s Iraqi, my mother wrote me in an e-mail after that first consultation. He’s a Muslim. He knows exactly what to say to Grandma.

Introducing the doctor’s heritage, religion and bedside manner in the same breath sounded strange. What I think my mother wanted to say was: Dr. Dhafir is different. Beloved and bemoaned for her obstinacy, my grandmother had been to exactly five doctor’s visits since 1976 prior to plodding into Dhafir’s office that summer. Two of the visits had taken place that year alone: Grandma had succumbed to a routine physical several months earlier. Then, on June 19, a surgeon had inspected the protruding tumor. “It really needs to come off,” the physician had announced. “Oh, no!” retorted my grandmother. “I’m not having surgery at my age!” She agreed nonetheless to see an oncologist.

The following Tuesday, Grandma sat before Dhafir like a schoolgirl with a secret crush. “I’m an old lady,” she said.

“You don’t look like an old lady,” the doctor replied. “You’re a beautiful woman!” Grandma was wooed and began prattling about her golf game.

“I need to look at your breast, Dorothy, both breasts. Is that OK?” Dhafir asked. “Oh,” she cooed, “whatever you want to do.” Then, after several minutes of study: “I need you to go for one more test,” the doctor said, “and the breast biopsy.” Grandma looked into Dhafir’s silvery eyes and replied: “I’ll do whatever you want me to do.” My mother (present at every doctor’s visit) was stunned.

Seven months later, Grandma had rebounded and was called the doctor’s “star patient.” A month following that, Dhafir landed in jail. He was arrested on charges of conspiracy for violating sanctions against Iraq, as well as money laundering, health care and tax fraud, tax evasion and making false statements. (He would be denied bail on four occasions.) Soon after, Grandma was dead.

RAFIL Dhafir was born in Baghdad on July 1, 1948, and raised a Sunni Muslim. He graduated from the University of Baghdad’s College of Medicine in 1971 and immigrated to Highland Park, Mich., in 1972. He met his wife, Priscilla, there. The couple never had children. I found this information on a website demanding the doctor’s freedom when I began my quest to understand the man who had given my grandmother the conviction that she could compete with cancer. My family and many others, not all patients, had believed in Rafil Dhafir. The government, however, held a different view. Was our faith misplaced?

I started from the beginning. What was it like for Dhafir to grow up in Iraq? Why did he become a doctor? Flee his country? Dozens of friends, fellow worshippers, patients and coworkers, I found, knew virtually nothing about Dhafir’s upbringing or early years in America, and the doctor’s wife was guarding her silence.

I learned that the University of Michigan certified him as a medical oncologist in 1978. A friend remembered that he’d savored his mother’s ghraiba, flour-stuffed cookies, but knew nothing more. I kept digging.

When Dhafir moved to Syracuse in 1980, he became a central figure in the area’s nascent Muslim community. The Islamic Society of Central New York, with its newly-built mosque, had no imam, or prayer minister, until the late 1980s. Dhafir, only about 5 feet 4 inches and with a hushed, humming voice, still managed to distinguish himself with immense intellect and presence. He often led the Friday services and discussion groups and taught Islamic studies classes in addition to overseeing daily operations as the emir, or elected president.

Peers were impressed by his expansive knowledge of the Koran, the prophets’ teachings and the four schools of Islamic thought; they admired the way he illuminated different scholarly points of view on a subject. He also exuded humility. He closed his classes with the disclaimer: If I shared anything that benefits you, give Allah credit, and if I uttered any falsity, Allah, forgive me. And as a speaker, Dhafir captivated, fellow worshippers said. His talks were often taped, copies distributed on the Internet.

Listeners said they felt God in his gaze. From his small, bearded face, his intensely piercing eyes seemed to engage every listener.

Not all Muslims are devout, but Dhafir seemed a paragon, friends told me. He said his salah, or prayers, five times daily, doing the early morning and evening versions at the mosque. He eschewed pork, tobacco and alcohol.

He made his hajj, a pilgrimage to Mecca, and fasted during Ramadan. And he submitted to Islam’s basic tenet, the idea that God is reality. Welcoming friends at the jail, Dhafir later radiated gratitude and optimism: smiling, asking after others, suggesting that all of God’s acts have meaning. A true believer, his fellow Muslims call him.

In the 1980s, they said, the Islamic Society drew most worshippers from local universities. Students, many international, flocked to 925 Comstock Ave., several blocks from Syracuse University, from as far as Rochester and Rensselaer. Dhafir frequently attended Syracuse University functions organized by Islamic students in addition to joining them for debates and discussions at the mosque. Algerians, Indians, Egyptians, the young Muslims came for religious guidance as well as homecoming, and Dhafir opened his own home and cavernous library to many. He also hosted a yearly Thanksgiving dinner, preparing and feeding sweet potatoes, turkey and a particularly tasty pumpkin pie to upwards of 30 guests.

The young men later approached Dhafir when they wanted to build mosques. He visited a Potsdam, N.Y., group several times in the mid- 1980s to advise them in raising the necessary $70,000. One of the Potsdam men said Dhafir would know the Islamic saying: He who builds a house of God gets a mansion in the hereafter. At the Syracuse mosque, Dhafir, along with two others, was considered an elder – someone community members turned to for advice or help resolving disputes. The doctor also poured money into local Islamic activities over the years. His mosque held a yearly fundraiser at which Dhafir personally pledged thousands of dollars – $10,000, on average, annually. In the late 1990s, he was its biggest donor, funding 10 percent of the operating budget, according to the then-president. Dhafir wanted every penny put to good use. To save money, he argued that worshippers should clean up after functions, for example, rather than hire a cleaning service.

When Dhafir saw a need, say for burial expenses for a recently-converted Muslim, he filled it. He and his wife also endowed scholarships for high-school seniors (at least $2,000 annually) and funded $3,000 hajjs for needy worshippers. (Five people made pilgrimages last year alone.)

Dhafir’s offerings fulfilled zakah, Islam’s fourth pillar: the poor and needy have a right to others’ wealth. Many facing dire financial straits went directly to the doctor. He helped worshippers pay school tuition, rent and medical and electric bills, and he leased several apartments cheaply to families, never raising the rent. He took blood pressure and assessed coughs, saving people trips to physicians. He even covered legal expenses for a worshipper whose son stood trial for killing a man. The mosque’s directors also approached Dhafir regularly for anonymous aid. Since the doctor’s arrest last spring, I was told, the mosque has been struggling.

“SO, how many times have you golfed since I saw you last, Dorothy?” Dr. Dhafir began Grandma’s second visit. My mother, while reassured by the doctor’s warmth, was anxious for his pending verdict. Moments later, she listened – Dorothy’s lungs and liver were invaded – and waited to hear the word, “hospice,” as in: a send-off with best wishes. But Dhafir had other plans. New chemotherapy treatments were emerging all the time, and there was no reason to give up. He told Grandma she could relax in one of his three small living rooms, chatting, reading and watching television while she got her chemo. “Oh,” my mother whimpered. “Can we do it soon? How much time does she have? I’ve got these two brothers that don’t live here … ” Dhafir cemented his gaze on my mother: “It

could be several months or several years. Only God knows.” Had she been seated in our Protestant sanctuary, my mother would have bowed her head.

And so the ritual began the following day. Greetings from the receptionist: My, don’t you look great, Dorothy. Walk back to get blood drawn for a white cell count, hop on the scale for a weight check. Grandma, 5 feet 7 inches, weighed 95 pounds that first day; she would need nutritional boosters. Into the den, with its cheery, floral wallpaper and leather recliners.

Patients’ grandchildren sometimes paraded in for picnic lunches. Often the doctor himself stepped in to say hello, touch a hand, tell a joke.

“They don’t make them like you anymore!” he’d nudge Grandma. The sickest patients went religiously for chemotherapy and injections, while those in remission observed twice-yearly or annual check-ups; the doctor was also known to see someone quarterly if that made her feel better.

Patients and their relatives could call Dhafir anytime with worries; and sometimes, such as when he didn’t like a person’s negative attitude, he called them.

In Rome and two other offices, Camden and Wampsville, where the doctor practiced oncology, internal medicine and hematology over the years, gifts arrived: a woman vacationing in Wisconsin sent a box of Limburger cheese, another delivered her trademark lemon meringue pie, and at Christmas, some brought cookies. These were meant as offerings of sorts for a man who helped weak patients down the hallway, charmed with compliments and gags, and made patients believe he had all the time they needed.

Some of the offerings may have doubled as reimbursements, too. Dhafir was known to waive copayments as well as work out personalized billing plans with his numerous needy clients throughout Rome, Camden and Wampsville (the latter two, rural areas). Give me $5 when you can, the doctor sometimes said to those without public or private insurance coverage. Yet, even some who could afford copayments, like my grandmother, never received bills for them.

The doctor was known never to give up on anybody. When he’d exhausted the treatments available to him, he phoned directors conducting clinical trials across the country looking for doctors who’d admit his patients.

And he read voraciously to keep up with the latest news. Mountains of medical journals and reports, about the only ornament in his office, piled up on his bookshelves and desk. One nurse practitioner often tidied up, to his dismay, when he traveled.

I found that few doctors wanted to talk about Dhafir. The medical staff president at Rome Hospital noted only Dhafir’s good standing. A radiation oncologist with whom he worked closely admired his sincere concern for his patients. To them, he walked on water, she told me. And they’re alive, or lived as long as they did, she said, because he was adept at gauging their tolerance for treatment. Another physician, a radiologist, found Dhafir arrogant and demanding. He insisted on being phoned immediately with X-ray readings, or complained that his hospital staff dues shouldn’t fund wine for quarterly meetings, the radiologist said.

Dhafir’s most recent employees said he was a wonderful boss. He set an upbeat, jovial tone, which they all believed was vital for cancer patients. He called in daily when traveling and always left his nurse practitioners with a phone number at which he could be reached. He returned from the Middle East with small gifts: dates, inlaid wooden boxes or multicoloured scarves, for instance. Did he have a temper?

Sometimes a call in Arabic came in which displeased him, an employee noted from his tone of voice. Or, if he got charged for a call he had never made, the phone company heard from him. He got angry, employees said, when serious mistakes were made and held group meetings to explain the problems but didn’t single people out. Overall, the doctor set high standards.

He didn’t tolerate wastefulness. And tardiness with paperwork was unacceptable; Dhafir’s nurse had to send her billing materials to the office manager by the end of every day.

The doctor, a nurse told me, seemed very conscientious about Medicare regulations, instructing the staff with painstaking care each time a new policy took effect.

Employees knew little about Dhafir’s personal life. They were aware of his religious habits, never disturbing him when he closed his door for salah. And they knew not to schedule lunches with pharmaceutical salespersons during Ramadan. Though they were friendly with the doctor’s wife, Priscilla, who took care of office billing, employees rarely saw pictures or heard stories of family. (The doctor has six siblings and extended family in New York, England and Iraq.) Dhafir offered no information unless asked. Religion was invariably the subject that inspired the most questions from those curious enough to inquire. A Methodist medical technician who worked with him for 13 years became so hooked on Islam from quizzing the doctor and borrowing spiritual tomes, that she became a Muslim herself three years after she met him. Dhafir recorded his salah and gave her the cassette tapes.

BY 2003, the doctor practiced solely in Rome, N.Y., an hour east of Syracuse. He had closed his Camden and Wampsville offices several years earlier. Just after 6 a.m. on Feb. 26, 2003, he left his cedar-shingled home and steered his Lexus down wooded Springview Drive onto N.Y. State Route 5. Within moments, according to press reports, a state trooper and federal investigators stopped and arrested him. At the same time, more than 100 troopers and federal agents reportedly arrested two others and interrogated more than 100 people in the area.

That’s strange, thought Shirley Fadel, as she turned into the office parking lot about 8 a.m. to face several black SUVs: Patients don’t usually beat me here. Dhafir’s receptionist, the first to open up every day, pulled into her usual spot, locked her car and walked toward the office door. A cascade of slamming car doors rippled behind her. Fadel turned and saw a pack of FBI and IRS officials facing her. Are you going to open the door? one asked. Fadel wanted to phone her boss. He’s in jail, the agent announced. Well, what if I don’t open the door? Fadel replied. We’re going to bust the door down, he said. Fadel said the agent had a warrant, but she was too discombobulated to look at it.

About 10 (and by the end of the day, dozens of) officials began overturning Dhafir’s office – emptying the doctor’s desk, confiscating patient files, garbage, floppy disks and the appointment book. Can’t I call the patients and tell them not to come? asked the receptionist. This won’t have any impact on the patients, an agent replied. How stupid, Fadel thought, and picked up the phone. When Patricia Marrello, the nurse practitioner, and Danya Wellmon, the medical technician, arrived, agents whisked them into rooms for questioning. Several patients – whom Fadel hadn’t reached in time – sat waiting for chemotherapy. Agents surrounded Kelly Tubbs, the doctor’s transcriptionist, when she jumped out of her car. Tubbs – an ovarian cancer survivor who seems to regard Dhafir as a father – was horrified. Did she know the login and password for the computers? an agent asked. As Tubbs turned one on, another agent rushed to her side, shouting: What are you doing? Don’t you know they can set this up so she can push one button and erase everything? Erase what? Tubbs thought. Our lab work?

The staff feared for the patients and fumed as it learned that the government had been observing Dhafir since 1999 – they would have known patients never received chemotherapy on Thursdays (and few even came to the office that

day), why not have raided then? Patients sitting at home were terrified, too. Images of Dhafir’s house being searched appeared on the television news as confused patients and their relatives erupted in anger and dissolved into tears. I was a basket case, one told me; I just thought, what are they doing? My mother, frantic, called the nurse at home that night.

The Department of Justice, my family learned, was accusing Dhafir of money laundering and conspiracy as the founder of an unofficial charity, Help the Needy. Dhafir started the organization after the first Gulf War, soliciting donations globally for food and medical supplies for Iraqis, his friends said. Prosecutors charge that Dhafir didn’t obtain the required license to send humanitarian aid to Iraq and therefore violated the economic sanctions placed on the country in 1990. In raiding his home and office, authorities said they also found evidence of income tax evasion and tax and Medicare fraud. They also claimed he lied to Medicare investigators. In all, the government would charge Dhafir with 50 criminal counts.

His wife, his accountant and three associates would eventually plead guilty to a handful of counts as well: lying, conspiracy, filing false documents and breaking the sanctions.

AMONTH before Dhafir’s arrest, he had pronounced Grandma his “star patient.” Her tumors had shrunk, she was progressing excellently, and she could graduate from chemotherapy to an injection treatment. She was due for one a week after the arrest and got it. But beyond that appointment, with the government holding onto her file, my mother worried, how long would it take to get a new physician? She believed Dhafir was irreplaceable: Dr. Dhafir, how could our government think this of you? For the next three weeks my mother hustled, endlessly phoning Dhafir’s office, other oncologists and lawyers before securing an appointment with a new doctor and a photocopy of Grandma’s medical history. (A prosecutor later told me that agents had planned the file hauloff for a Wednesday to minimize disruptions to care, since there were no treatments on Thursdays and Fridays; Dhafir’s lawyer had the files back by the weekend, so the government was not responsible for the hold-up, the prosecutor said. Dhafir’s lawyer wouldn’t comment.) My mother also spent hours consoling Ruth Waters, a breast cancer survivor and 20-year patient of Dhafir’s. Waters’ other friends badgered her: How could you trust a terrorist?

He was my lifeline; I have blind faith, Waters told me.

Waters agreed to be a character witness at the doctor’s first bail hearing in late February. An officer ushered Dhafir – in jail garb, with hands cuffed and ankles shackled – into the Syracuse courtroom. He lifted his hands to wave and smiled at the crowd. All I could think of was the Lord, Waters said, at the sight of Dhafir, with his bound limbs and gracious gestures. There wasn’t time for Waters to testify, but others did, including Sister Jeanne Karp, a Roman Catholic nun who’d been Dhafir’s nurse practitioner until 2002. Karp knew Dhafir better than most employees. For one, the two shared an office for most of the eight years they worked together. Dhafir’s lawyer asked Karp if she believed he’d leave the country if released on bail.

Do you mind if I ask him a question? Karp replied. The lawyer obliged. Would you flee the country? Karp eyed Dhafir. Suddenly stern and loud, he pronounced: Absolutely not. That’s my answer, Karp told the lawyer. Dr. Dhafir is a man of his word, she continued, his commitment to God and keeping his word is stronger than his commitment to any human being.

Karp stepped down.

The nun’s testimony wasn’t enough. Dhafir was denied bail three times in 2003. He stayed in a city jail until November, then was transferred to a county facility that requires inmates to undergo strip searches before seeing visitors face-to-face. Dhafir refuses these searches for religious reasons, so he must see visitors, including his lawyer, through a glass partition and speak via telephone. The attorney must press documents – thousands – against the window for Dhafir to review, making the preparation for his trial tedious. The doctor, I am told, has access to books, and he answers religious queries from local college students. My mother wondered: Does he read the obituaries?

IN 1999, officials at a local Fleet Bank alerted the IRS of suspicious activity: They had observed 100 checks, each one slightly less than $10,000, being shuttled from Help the Needy into a personal account. Upon receiving the tip, the government began monitoring Dhafir for nearly four years – intercepting e-mails, letters, faxes; eavesdropping on meetings and phone calls; probing through his bank records, even trash, local residents learned in the newspapers.

Prosecutors would not say whether the money raised by Help the Needy actually funded food and medicine or whether they believe it funded something else. Some people who donated to Help the Needy and were interrogated by federal officials think the doctor has been portrayed as a terrorist, based on questions they were asked and on media coverage. But prosecutors beg to differ. Michael Olmsted, a federal prosecutor, said that because the arrest came after Sept. 11 and just a few weeks prior to the war in Iraq, his office had made a point of emphasizing that Dhafir was not (and is still not) accused of terrorism.

After studying the court documents and speaking with prosecutors, it seemed to me that the sanctions-breaking argument against the doctor is solid. It was a well-known fact in the local Muslim community that Dhafir had been devoting abundant time and energy to Help the Needy, and that he had gotten many Islamic Society members to donate as well. The other elements of the case are confusing, however. These charges of tax evasion, tax and health care fraud: Are they the government’s add-ons, brought up in the absence of evidence of terrorism?

How are all of these charges interrelated?

Go to: Part 2