The Missouri Medical Diploma Mill

 

Part 2: “Bringing in a gusher”

In part one of this series, I shared how St. Louis Star and reporter Harry Thompson Brundidge infiltrated and exposed the operations of two Missouri medical diploma mills—the Kansas City College of Medicine and the St. Louis College of Physicians and Surgeons. Those two schools represented the tail end of a long period of sporadic medical diploma mill in America. Today’s blog post shares more of Brundidge’s look “behind the curtain” and how his story led investigators to medical licensing boards in Arkansas, Connecticut and Florida.

The story began in early August 1923 when Brundidge’s editor directed him to investigate medical diploma mill activity in the state. He gave his reporter one lead (Dr. Robert Adcox) and a direct order: Get yourself into “the [diploma] mill.”  Brundidge established a new identity as a St. Louis coal salesman, initiated contact with Adcox and soon found himself traveling to Kansas City where he met the self-proclaimed “brains” behind the operation, Dr. Ralph Voigt.

Harry’s first payment of $600 resulted in Adcox (pictured with Brundidge below)

adcox 1

securing a high school certificate for him complements of fellow conspirator William Sachs, the Director of Missouri Public Schools. This certificate and a bogus chiropractic degree served as the basis for advanced standing admission to the Kansas City College of Medicine. While waiting for these credentials, Harry received instruction from Dr. Voigt on an electro-therapy machine—an impressive looking but bogus diagnostic machine with numerous dials and flashing light switches. Voigt’s description of it as a “sucker machine” explained its primary purpose as a means for Harry to fleece unwary patients once they got him a medical license.

Adcox and Voigt then placed Harry in what they characterized as a “ringer class” at the Kansas City College—their reference to a group of sham students apparently mixed in with legitimate students attending the school.  Harry shared his nervousness about being placed in a room with legitimate medical students. Adcox and Voigt’s advice was simple: “Keep your mouth shut and your ears open.” This brought Harry into contact with another conspirator, Dr. Date R. Alexander, Dean of the Kansas City College.

Police raids and arrests of Drs. Adcox, Voigt, Alexander and Sachs in October 1923 secured a mountain of evidence, much of it leading directly to several licensing boards. The first of these was the Arkansas Eclectic Medical Board. Connections between this board and the Kansas City College had raised suspicions as early as 1917. The linkage grew more understandable once it became evident that the Chairman of the Arkansas Eclectic Board chair held a diploma from the Kansas City school.

The Arkansas board provided Kansas City graduates with their most direct route to medical licensure. The board examined 203 Kansas City ‘graduates’ between 1916 and 1924, licensing nearly 82% of these individuals. Amidst the publicity, the board proclaimed its innocence and offered to “throw open its books.” Amazingly, the Arkansas Eclectic Medical Board not only survived the 1923 scandal, it remained in statutory existence until 1955 when the state finally consolidated its separate medical, eclectic and homeopathic licensing boards. This inexplicable reprieve probably occurred because the board had virtually no one to license. Eclectic medical schools were already largely disappearing with them any graduates seeking a medical license.

The evidence acquired in Missouri tied directly to the Connecticut Eclectic Medical Board which presented the main conduit for licensing St. Louis College graduates. That board seemed to “open its doors” abruptly in 1921-22 as more than 140 graduates of substandard schools such as St. Louis College sought a medical license through that board. Political wrangling and closer investigation by a Connecticut grand jury left that state’s governor lamenting how the state had become a haven for unqualified doctors.

st louis

 

The grand jury heard insider testimony from Adcox and Sachs as well as a Connecticut licensee, George Sutcliffe, who had begun cooperating with state authorities began months earlier.

sutcliffe

These confessions implicated the Dean of the St. Louis College (Dr. Waldo Briggs) and an insider (“fixer”) at the Connecticut Eclectic Medical Board—probably board chairman, James Christian.  Adcox’s confession described how advance copies of exam questions, lax proctoring and informal oral exams moved St. Louis grads to a Connecticut license. The police raid of Adcox’s home secured more than a dozen sets of exam questions from the Connecticut board spanning several years. The pipeline into Connecticut proved so lucrative that the conspirators described it as “bringing in a gusher” from the oil fields. The corruption went so deep that even the pre-medical credentials of the board’s chairman were the forged handiwork of Dr. Sachs. The grand jury summarized the situation this way: The eclectic medical board had been a “willing part[y]to fraudulent conduct.”

The Star’s expose and the resulting investigation even reached a defunct medical board! In Florida, the eclectic medical board had links to the Missouri-based diploma activities. As a cooperating witness, Adcox, described how advance copies of exam questions, crib notes and cash payments secured licenses in that state. Little of this reached the newspapers in 1923 as widespread irregularities had already been uncovered leading to the dissolution of that board in 1921. Two members of the Florida Eclectic Board were convicted of felony mail fraud in transacting the medical diploma trade. The board’s former secretary waged a protracted legal battle that culminated in his conviction and five-year prison sentence in 1927.

Not all of the nefarious activity led to licensing boards situated outside Missouri. In the final installment of this series, we’ll double back to see how the scandal imploded the Missouri Board of Health.

Source:  This multi-part series is derived from my article “An Underworld in Education: The Demise of Missouri’s Medical Diploma Mills,” Social History of Medicine (ahead of print publication October 2018)

 

The views expressed are those of the author and do not necessarily reflect those of the Federation of State Medical Boards.

The Missouri Medical Diploma Mill

Part 1: “Harry, why don’t you become a doctor?”

Harry Thompson stepped out of his rented room in St. Louis on the morning of August 13, 1923, waved to the postman walking past and called out to him—“Can you tell me where the nearest doctor lives?” The postman offered a hurried, “Right there!” pointing several houses down the street toward a man watering plants on his front porch. Dr. Robert Adcox heard the exchange and looked up to see Thompson making his way toward him. After a brief discussion and despite some initial reluctance, Adcox agreed to treat Thompson’s sore throat.

After a follow-up visit and several increasingly friendly conversations, Dr. Adcox presented his young patient with an opportunity—“Harry, why don’t you become a doctor?” Thompson responded with a chuckling protest, citing the obstacles to such a career move, including his lack of a high school diploma. Adcox brushed aside such concerns. “Bunk, Harry, my boy! You wouldn’t have to go to school to become a doctor.” He then explained how a high school diploma could be obtained and all obstacles removed to securing a medical diploma and a license to practice. Skeptical but intrigued, Thompson pressed for details. A smiling Adcox said, “Harry, a good magician never reveals how he does his tricks…be ready to go to Kansas City with me tomorrow night…I’ll show you how it’s done.” Two months later, Harry Thompson (aka Harry T. Brundidge, reporter for the St. Louis Star newspaper) possessed a high school certificate, a medical diploma (backdated to 1916) and a medical license.

Figure 2 St. Louis Star front page

This episode became the opening salvo in Brundidge’s exposé series launched October 15, 1923. The full-story of the Brundidge’s investigation played out on the front page of the Star almost daily over six weeks. The Star related how medical diploma mill activities centered primarily around two Missouri schools (Kansas City College of Medicine and Surgery; St. Louis College of Physicians and Surgeons) served as a pipeline to licensure in several states. The Star also revealed how the main players in the Missouri-based diploma mills (Drs. Robert Adcox, Ralph Voight, Date R. Alexander, Waldo Briggs) were part of a loose national network of medical diploma mills that once touched all regions of the country.

The Star’s first headline, ‘Ring Selling Medical Diplomas throughout the U.S.’ triggered massive national interest, presenting a major embarrassment to medical education and licensing in the United States. That this story has been conveniently forgotten should not be surprising. Fallout from the scandal and its resulting investigations culminated in the dissolution of one medical licensing board (Connecticut), the reorganization of another (Missouri) and a fight for existence in a third (Arkansas). A fourth board (Florida) was spared this ignominy only because earlier malfeasance led that state’s governor to dissolve it before the Star’s story broke. The Star’s reporting brought America’s Class C medical schools outside the whispered circles of medical education and into a national spotlight. A few of these schools operated so far on the fringe of U.S. medical education as to be little more than diploma mills—either explicitly through their design or as once legitimate institutions that drifted into de facto diploma mill activity. These schools represented dying institutions; Harry Thompson Brundidge and the St. Louis Star eagerly helped  to hasten their demise.

Figure 1 harry thompson

The 1923 exposure of the medical diploma mills in Kansas City and St. Louis concluded a sordid chapter in American medical education that saw similar institutions dotting the landscape. Though the most notorious 19th century medical diploma mill (Eclectic Medical College of Pennsylvania) predated the post-Civil War rise of medical licensing laws, most of its rivals in the trade originated alongside the emerging medical legislation in the last quarter of the century. All regions of the country confronted medical diploma mill activity especially in the period before most medical boards had the authority to approve medical schools and thus restrict licensing to graduates of bona fide schools.

The west coast saw medical diploma mills in Washington and California. The Pacific College proved an especially persistent and egregious participant in the diploma trade drawing a protracted effort from the California medical board to force its closure.

New England witnessed its share in the illicit trade. Lax chartering laws in Massachusetts allowed medical diploma mills to flourish briefly in that state: Bellevue Medical College of Massachusetts, American University of Boston, Excelsior Medical College, Druidic University, etc. New Hampshire and Vermont authorities confronted medical diploma mills or fraudulent institutions functioned as well.

From the Atlantic to the Midwest, medical diploma mills operated at various times in the District of Columbia, Michigan, New Jersey, New York, Pennsylvania, Ohio and Wisconsin. Several of these operations originated with co-conspirators in John Buchanan’s Philadelphia diploma mill: Henry Stickney with New England University and Henry S. Thomas’ Detroit Eclectic Medical College. Others emerged from institutions originally founded with apparently legitimate purposes before lapsing into the diploma trade. This appears to have been the case with two similarly titled Cincinnati area schools: Physio-Medical College and the Physio-Eclectic Medical College. More than a dozen medical diploma mills plagued Illinois at various times especially the multiple ventures of Johann Malok in the1890s.

The problem persisted primarily because it represented a potentially lucrative business. The Wisconsin Eclectic Medical College’s owner was arrested in 1897 after lucrative sales earning tens of thousands of dollars. All of these schools were among the forty institutions identified as “fraudulent” by the AMA Council on Medical Education in its review of U.S. medical colleges published in 1918.

By 1923 the vast majority of these schools had closed or been publicly identified such that their graduates were nearly unlicenseable. Shutting down the remainder should have represented nothing more than a clean-up exercise. Not so!

I’ll continue the story in Part 2 and share how Harry Brundidge’s story implicated medical licensing boards in Arkansas, Connecticut and Florida.

 

The views expressed are those of the author and do not necessarily reflect those of the Federation of State Medical Boards.

Sources:

This multi-part series is derived from my article “An Underworld in Education: The Demise of Missouri’s Medical Diploma Mills,” Social History of Medicine (ahead of print publication October 2018)