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As Lawmakers Again Debate Medical Aid In Dying, Patients And Doctors Say It's Far From Simple

The California state border is less than 30 miles from Lynda Brooks-Bracey's home.

A 57-year-old Las Vegas resident diagnosed with pancreatic cancer, Brooks-Bracey receives much of her treatment in the neighboring state, which has more specialty care options than Nevada. Her doctors say the cancer is metastatic, so widespread that it's incurable.

Though she has access to treatment, therapies and medicine available to other cancer patients in California, as a Nevada resident, there's one option she doesn't have.

Medical aid in dying.

"It's a state line. It's a little border of earth to me," Brookes-Bracey said in an interview. "I cross that border, and all of a sudden, my choices are different."

California legalized medical aid in dying in 2016, allowing a physician to prescribe a lethal dose of medication for a terminally ill patient. It's a practice authorized in 10 states and Washington, D.C.

As Nevada lawmakers again consider legalizing medical aid in dying, Brooks-Bracey hopes the Legislature approves it as an option for patients like her.

"Even if [the bill] is passed tomorrow, it probably won't help me," she said. "But I pray and hope that it will help somebody down the road."

A Christian and self-described believer in God with four adult children, Brooks-Bracey is on palliative chemotherapy treatment, a type of care to ease symptoms and give a patient more time even if there is no cure for an illness. She's hoping chemotherapy can give her the time for a clinical trial to become available to help extend her life.

But when hospice care can give no relief from pain, and she's no longer herself, Brooks-Bracey said she would like access to the option to pass away on her own terms.

"[Hospice care providers] do a phenomenal job. But … they cannot do everything," she said. "They cannot guarantee a lack of suffering."

Lynda Brooks-Bracey (left) cuts up a watermelon while wearing her medical alert bracelet (right) inside her home in Las Vegas on Wednesday, March 29, 2023. (Daniel Clark/The Nevada Independent)

'Soul searching'

2023 marks the fifth legislative session where Nevada lawmakers have debated a measure to legalize life-ending medication for terminally ill patients. The issue is far from partisan and recent polling conducted by Susquehanna Polling & Research and sponsored by a pro-medical aid-in-dying organization indicates 82 percent of Nevada voters support legalizing the option.

The furthest a medical-aid-in-dying proposal advanced prior to the 2023 session was in 2017 when a bill sponsored by then-Sen. David Parks (D-Las Vegas) passed through the Senate on an 11-10 vote with two Democrats and all but one Republican opposed. 

Sen. Pete Goicoechea (R-Eureka) and Sen. Patricia Farley (I-Las Vegas) crossed party lines to pass the measure. In his floor remarks before the vote, Goicoechea said death is something everyone in his world deals with constantly: whether with an old dog, a good horse or a terminal animal. 

He referenced the novel Old Yeller, saying sometimes those choices are hard and said that over the years, a number of his constituents who were close friends ended their lives after receiving a terminal diagnosis.

"For the families who are impacted by that, this bill and death with dignity would, in some cases, give them an option beyond using a hose to the exhaust pipe or a gunshot," Goicoechea said. "Death with dignity is a far better option."

Though then-Sen. Ben Kieckhefer (R-Reno) had been a co-sponsor of similar legislation in the past, he cast a vote against it, saying he felt a "lack of clarity" around the bill, which brought up questions for him about humanity's divine spark and how people respect it. 

Despite the 2017 bill failing in the Assembly, those sentiments were echoed in later sessions.

"It has made me do some soul searching and actually maybe do some research in the Bible because this is a very tough conversation for us to be having," Assemblyman Gregory Hafen (R-Pahrump) said during a 2021 hearing on the measure.

(Top) Sen. Edgar Flores (D-Las Vegas) speaking with Dr. Johanna Koch, left, and Samantha Trad with Compassion & Choices Action Network, right, after a hearing on SB239 in the Senate Health and Human Services Committee in Carson City on March 14, 2023. (Bottom left) Flores speaking with, from right, Nevada Right to Life Executive Director Melissa Clement, Nevada Families for Freedom President Janine Hansen and other opponents of medical aid in dying legislation. (Bottom right) Flores preparing for the hearing. (David Calvert/The Nevada Independent)

That failed 2021 measure and the 2023 measure were sponsored by now-Sen. Edgar Flores (D-Las Vegas), who noted that he would have never expected to bring forward legislation legalizing end-of-life medication after growing up in a traditional Latino and Catholic household.

But after watching a family member suffer and pass away from a terminal illness, Flores said he wanted to give people facing a terminal diagnosis a choice about how to die.

"When you have a terminal illness, and you are suffering every single second, you're not choosing between life and death," Flores said during the 2023 bill's (SB239) first hearing in March. "You're simply choosing how it is that you want to die." 

The bill passed out of the Senate in a narrow 11-10 vote Wednesday, and now awaits a hearing in the second house.

A spokesperson for Gov. Joe Lombardo said the governor is aware of the legislation but did not comment on whether he supports it.

Members of the state Senate pass SB239 (11-10) on Wednesday, April 19, 2023, at the Legislature in Carson City. (David Calvert/The Nevada Independent)

Legalizing medical aid in dying

Under Nevada law, terminally ill patients can refuse resuscitation or treatment to keep them alive, but they are prohibited from actively taking drugs to end their lives. 

Medical professionals can also administer palliative sedation to terminally ill patients as a last-resort measure. Palliative sedation uses pain relievers and sedatives to alleviate suffering by making a patient calm, unaware or unconscious until they die from their illness. The process can occur in a hospital or home while a patient is in hospice. If palliative sedation takes place in an at-home setting while a patient is in hospice, families or loved ones often carefully manage the medication administration.

As proposed and amended, Nevada's medical-aid-in-dying legislation has safeguards stipulating a physician can only prescribe life-ending medication to a patient who:

Is at least 18 years of age

Has been confirmed to have a terminal condition by at least two practitioners

Has less than six months to live

Has made an informed and voluntary decision to end life

Has the mental capacity to make informed decisions (as determined by the provider or licensed mental health care professional)

Has the ability to self-ingest the medication

Is not requesting the medication because of coercion, deception or undue influence

The measure requires that patients requesting medication designed to end life must make two verbal requests, separated by a minimum 15-day waiting period. It also requires one written request signed by a witness who is unrelated to the patient, not entitled to any portion of the patient's estate, not an interpreter for the patient and not someone connected to a health care facility.

Once a patient submits the requests, a practitioner must take the following steps:

Inform the patient of the ability to revoke a request for medication at any time

Determine and verify the patient meets all requirements for making the request

Discuss diagnosis and prognosis as well as alternative options for care

Refer the patient to a consulting medical practitioner who can confirm the diagnosis, prognosis and competence of the patient and that the patient has not been coerced or unduly influenced (the patient must then return to their primary doctor for the prescription)

Instruct the patient not to self-administer the medication in public

The bill protects health providers from civil and criminal liabilities and states that they do not violate medical standards of care by assisting a patient in acquiring medication designed to end their life. 

It also clarifies that wills, contracts, insurance and other annuity policies are unaffected by a patient's decision to take life-ending medication. It also provides that no physicians or pharmacists are required to prescribe or fill a prescription for life-ending medication.

A death resulting from the self-administration of a medication designed to end a patient's life would not constitute suicide or homicide. Patients would have their terminal condition listed as the cause of death on their death certificate. 

'Playing God'

Though supporters have described the end-of-life option as "medical aid in dying," "death with dignity" and "physician aid in dying," Dr. T. Brian Callister, a professor of medicine at UNR's medical school and an internal medicine specialist and hospitalist, said those framings aren't accurate.

"I call it physician-assisted suicide, or doctor-assisted suicide," Callister said. "Words are important. And I believe [terms like 'medical aid in dying' is] candy coating physician-assisted killing."

An outspoken and long-time opponent of medical aid in dying, Callister has been in the medical industry for more than 35 years and is considered an expert in hospital care transitions and end-of-life care. He's traveled around the country testifying against medical-aid-in-dying legalization efforts and has focused on the need for better palliative end-of-life care and resources.

Callister, who is a parish deacon at the Lady of the Snows Catholic Church in Reno, also serves on a technical hospital patient harm panel through the Centers for Medicare and Medicaid Services and as the governor of Nevada for the American College of Physicians. He is the past president of the Nevada State Medical Association and the American College of Physicians Northern Nevada District. He said when he teaches about end-of-life care, he emphasizes the importance of keeping patients comfortable.

No doctor can accurately say when someone will die, he said. He added that doctors should do whatever they can to ensure a patient is comfortable and ease the pain of a terminal illness, but not end a life.

"Physicians shouldn't be playing God," Callister said. "I can give you a diagnosis. I don't know how long you're going to last. I'm going to say, who knows? Your Creator knows or nobody knows, however you want to believe it."

He also said when people discuss end-of-life care, they often reference horrifying experiences with death, which he said can be avoided by pain management and proper end-of-life care.

"I've seen more selfless loving, more healing of family relationships, more bonding and closeness of families and friends during a terminal illness than you see at any other stage of life," Callister said. "So as hard as it is, there are some incredible periods of growth and love, and relationships. And I think you risk losing a lot of that."

Many supporters of medical aid in dying disagree. Numerous testifiers during the bill hearing in March spoke to the horror of watching friends and loved ones struggle with cancer before dying.

Reno resident R.J. Erickson told lawmakers how his father died after being diagnosed with stage 4 lung cancer. His father, John Marshall Erickson, had advocated for medical aid in dying and wanted to die peacefully. He said his father received hospice care but experienced a "torturous" death.

"During this end-of-life journey I was personally responsible for mixing his methadone and morphine. I was slowly killing my father," Erickson said. "Over the five-day period, before he finally went into a medical or medicine-induced coma, there were episodes of hysteria, delusions … it was not what I was expecting to have happen."

R.J. Erickson testifies during public comment on SB239 in the Senate Health and Human Services Committee at the Legislature in Carson City on March 14, 2023. (David Calvert/The Nevada Independent)

Many who testify to the horrors of watching family members die from a terminal illness have had terrible experiences with death, Callister acknowledged, but said modern medical care should ensure that kind of situation should never happen. He said those patients probably needed better palliative or hospice care.

Along with inaccurate predictions surrounding life expectancy and the commitment doctors make to cause no harm, Callister said he worries the legislation will have the unintended consequence of reducing access to care, because insurance companies will always go for the cheapest option and could deny payments for potentially life-saving treatments.

The legislation will likely make it so insurance companies will offer this so-called medical treatment of death in lieu of life-saving treatments that the patient may prefer, Callister said. He added that insurance companies denied care and instead offered the end-of-life option when he sent one patient to California and one to Oregon.

Others have raised concerns that the legislation could potentially harm communities of color that experience systemic inequalities in the health care system and issues the measure could present to people with disabilities who have historically faced barriers to self-determination and bodily autonomy.

Disabilities advocate Deidre Hammon wrote in opposition testimony that the legislation presents a form of ableism (discrimination and prejudice against people with disabilities) stemming from a fear of becoming disabled and thus a burden on family members. She added that "talk of legalizing assisted suicide for terminally ill patients could be expanded to include people who simply have lifelong disabilities."

Proponents of the legislation argue that those types of concerns are addressed through the competency clause within the legislation and the requirement that patients make the request without any coercion and go through multiple hoops before receiving a prescription for life-ending medication.

Though students ask him what the correct dose of a type of pain drug is, Callister said the right amount is the one that works. Humans are adaptive creatures, he said, adding that pain medicines can be increased, there are regional nerve blockers doctors can employ, and there is no need for out-of-control pain.

As for the difference between a death via medical aid in dying and an overdose of pain meds, Callister said it comes down to intent. Suppose he or another medical professional gives a patient 10 milligrams of morphine and they die three hours earlier than they otherwise would have. In that case, Callister said that's ethically different from medical aid in dying.

"We don't know how much quality time we're gonna have," Callister said. "Let's try to maximize that. And when you get near the end, I will do everything under my power to keep you comfortable and help you have a peaceful passing."

Grappling with morality

Rabbi Benjamin Zober, one of the rabbis of Temple Sinai in Reno, said any conversation about death is often intertwined and heavily influenced by a person's religious background and beliefs.

"Our society is death averse," Zober said. "Religions often … end up taking a really hard line, whether we are active in a religion or not."

He said Judaism places a high premium on personhood and the self, noting that within the religion there is a core belief that all humans are created in a divine image with a sacred spark. While studying to be a rabbi, Zober said he went through a battery of mock interviews and question sessions where he was asked about morals, ethics and practices, solidifying his beliefs and teachings. 

But once he began working within communities, he said reality challenged his beliefs. For example, in Judaism, Zober said there are a set of rituals surrounding dying that he views as wonderful, but some families or individuals decline because that's not what they want.

"It doesn't pay to force someone into that mold because some book says so. The reality is that the person in front of us is different," he said. "Sometimes that means that we have to rethink things."

Other religious groups and organizations are explicitly opposed to medical aid in dying. 

A statement from the Nevada Catholic Conference, a Catholic advocacy group, framed medical aid in dying as assisted suicide and said that the issue should not be confused with ethical end-of-life choices such as palliative care or hospice care.

"The Church believes in the dignity of all human life, until the moment of natural death. This vision is predicated on the conviction that God alone is the Author of life, and the sole arbiter of death," the statement said.

A 2013 Pew Research report found that most major religious groups are generally opposed to medical aid in dying.

Zober said some interpretations of religious texts he's read indicate that if there is something like pain stemming from a terminal illness that diminishes a patient's ability to live in the image of God or severely threatens someone's divine spark, then something like medical aid in dying would not only "be permitted, but it would be praiseworthy." However, he said there have to be safeguards preventing abuse and careful consideration surrounding the matter.

"The problems with taking such a hard line about an issue, particularly one's end of life, is that it can be very alienating," he said. "If someone makes a decision and the people around them or the values of the people around them say, 'this is absolutely not acceptable' then there is no discussion … and possibly even no forgiveness. It puts that person in kind of an impossible situation."

'He begged us to help him die'

Based in the Lake Tahoe area, Dr. Johanna Koch is a board-certified family, hospice and palliative care physician who has practiced in Nevada for more than 35 years and as a hospice medical director for 20 years in the Silver State and neighboring California.

As a hospice physician, she has cared for approximately 3,000 patients with her teams and makes regular visits to check in on patients and assess their health. Though she works in both states, she said her patients face completely different options when it comes to end-of-life care.

Hospice can only do so much to mitigate pain and suffering, she said. At some point, patients feel as though the price of staying alive is too much — they face exhaustion, weariness, pain, nausea, weakness and other symptoms that are difficult to ameliorate.

"Sure, we can give you a pill that'll take their pain level down or manage their nausea, but that doesn't solve the bigger problem," she said. 

Dr. Johanna Koch, right, speaks with Sen. Robin Titus (R-Wellington), left, following a hearing of SB239 in the Senate Health and Human Services Committee at the Legislature in Carson City on March 14, 2023. (David Calvert/The Nevada Independent)

Though health care professionals will talk about how peaceful a hospice death can be, Koch said the reality is that waiting to die can be painful for patients and their loved ones.

She believes people who have unmitigated suffering and are at the end of their lives should have the right to choose how they die, whether that is through palliative sedation or medical aid in dying. Palliative sedation is often cast as a "natural death," Koch said, noting that she doesn't necessarily agree with that framing.

She said that if you are medicating somebody according to the law, all you're doing is sedating them enough that they don't wake up until they die. If a patient is well-hydrated and has a good fat mass on their body when that starts, they could live weeks. Their skin may start falling off and their body will start decomposing before their heart and lungs give out, she said.

"I'm not sure who judges the value of a natural death versus being empowered to have control over your own death," Koch said.

Koch said she doesn't discuss the option of medically assisted death with her patients unless they bring it up. She estimated she has prescribed the medication to fewer than 30 patients and said she has never moved forward on a patient's request for aid in dying who she felt was being coerced or acting impulsively.  

"I have to feel really good and clean about every prescription I write," she said. "[People requesting medical aid in dying] have done soul searching, they've done everything they needed to do to bring closure in their lives. … they've made amends, they're ready to go and it's just so clear."

When working with patients in California requesting medical aid in dying, she said she'll probe their intent, asking questions about whether they know what they're asking for, why they might want to end their own lives and the consequences of that decision.

Not having that option available in Nevada can lead to more agony for patients, Koch said.

"It also makes me worried that they may take things into their own hands," she said.

Dr. Johanna Koch, right, speaks with a hospice patient during a home care visit on April 12, 2023. (David Calvert/The Nevada Independent)

In all her years of practice, Koch has only had two patients commit suicide. She and her hospice team take precautions to prevent overdoses, including closely tracking medication use and ensuring there are mental health resources available to patients. 

Most of her patients in Nevada are unaware of the option of medical aid in dying because it's not legal in the state. But two years ago, Koch said she had a patient at Summit View Hospice in Reno with advanced cancer that no longer responded to treatment. 

He was suffering and the drugs needed to control his pain rendered him too sedated to function. She said he frequently expressed a desire to die.

"We provided spiritual, emotional and psychological support, frequent visits and aggressive symptom management," Koch said. "Despite this, he begged us to help him die."

She described how on a cold winter morning, her patient called the police and informed them there was a dead body in the garage. He then went into his garage, spread out a tarp, laid down and shot himself in the head.

"That broke my heart," she said.

Finding comfort

For some, the option to die on their own terms brings its own comfort.

In the past, Koch said she has prescribed end-of-life medication to a patient who was then willing to try a more aggressive form of chemotherapy because she knew she could opt out if the suffering became too much. The patient eventually did not take the medication.

(Left) Lynda Brooks-Bracey looks through a book her family created for her when she was diagnosed with cancer and (Right) poses for a portrait inside her home in Las Vegas on Wednesday, March 29, 2023. (Daniel Clark/The Nevada Independent)

For Brooks-Bracey, this isn't her first time facing death.

More than 20 years ago, her first husband died after he was diagnosed with leukemia. Brooks-Bracey said he received wonderful hospice care, but he still died in pain.

People don't talk about death and dying, and how it happens, she said.

"Most people do not pass away as we assume or hope that they do in the movies and in the fantasies that we see," Brooks-Bracey said. "It doesn't always happen that way. Even with the best intentions from doctors and hospice, they can still only do so much."

Roswell Park Has Paid $4.67 Million To Settle Discrimination Lawsuits, Faces More Complaints

Dr. Anne Grand'Maison said she was forced out at Roswell Park Comprehensive Cancer Center last year after raising concerns about patient safety and gender discrimination.

Dr. Jane Zhou said she was silenced by a male colleague during tumor boards – meetings in which doctors discuss complex cancer cases and decide treatment plans.

And Marsha Gayles, the only Black employee in Roswell Park's case management department, said she helped her department transition to remote work early in the Covid-19 pandemic but then was not allowed to work from home herself.

The three women are among 15 former employees who have filed lawsuits since 2015 that accuse Roswell Park of discrimination based on race, gender or disability, a review of state and federal court records found. Roswell Park has paid at least $4.67 million to settle six of those cases, according to public records. Of the remaining nine lawsuits, three former employees were unsuccessful in their legal cases, while six are ongoing, including Grand'Maison, Zhou and Gayles.

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"The court filings paint a picture of a pattern of retaliation and intimidation against those who have the courage to speak up," said Laura E. Edidin, an attorney at Wigdor, a New York City employment law firm that has represented five Roswell Park employees, including Grand'Maison. "That's a theme that has been sounded across numerous lawsuits."

The lawsuits, in part, prodded Roswell Park more than two years ago to hire an outside law firm to produce a report on the cancer center's policies regarding diversity and inclusion, as well as a review of past discrimination complaints. The cancer center has not publicly released the report, despite objections from several members of its board of directors – a situation that has gained attention from community leaders who want Roswell Park to confront its past.

In a statement, Roswell Park said its employees and management are dedicated to "creating diverse, equitable and inclusive communities both within and outside our center."

"We benefit from an incredibly diverse workforce at Roswell Park," the cancer center said. "Over the course of years we have shaped our policies and employee resources to meet the needs of team members reflecting every dimension of diversity."

A nurse and a call center employee are alleging racial discrimination in lawsuits against Roswell Park Cancer Institute. In one of the cases, both filed this week in U.S. District Court, the nurse also alleges the cancer center retaliated against her for reporting events she claimed posed a danger to a patient. The employees are represented by a New

The 15 employment discrimination lawsuits filed against Roswell Park since 2015 were more than the number lodged against other area health care institutions, a review of court records found. During the same eight-year period, six such lawsuits were filed against Kaleida Health and five against Catholic Health System – both larger than Roswell Park – and three against Erie County Medical Center Corp., similarly sized as Roswell Park at around 3,800 workers.

Roswell Park said the total claims since 2015 are comparable to other large regional employers. It argues an "accurate and complete review" would include state and federal cases, internal claims as well as those filed with the Equal Employment Opportunity Commission and the state Division of Human Rights. Unlike lawsuits, some of those complaints are not publicly available. 

Diversity data that Assembly Majority Leader Crystal Peoples-Stokes, D-Buffalo, requested from area health systems – and obtained by The Buffalo News – did show Roswell Park with a similar number of EEOC complaints in 2020 compared to some of its Western New York peers, though the cancer center had more lawsuits or settlements arising from those claims.

"Many large employers routinely settle all claims before they can be heard in court," Roswell Park said. "We have an obligation to challenge unwarranted claims because we feel strongly that we must advocate for the truth as a nonprofit public benefit corporation."

Roswell Park said the majority of claims and allegations The News identified originated before Candace Johnson took over as president and CEO in February 2015. 

Of the 15 lawsuits, four were filed by employees who joined Roswell Park in late 2016 or after, and seven other complaints detail at least some allegations after February 2015.

Investigative Post first reported on the number of lawsuits against Roswell Park since 2015.

Roswell Park said it has made major strides in its diversity, equity and inclusion efforts since Johnson took over. For example, the cancer center's minority hiring has grown significantly over the last decade and, in 2022, 32% of its new hires were Black, Hispanic, Indigenous or people of color. As of last year, 64% of Roswell Park's workforce identified as female.

Roswell Park also noted it has, over the last five years, built the largest center dedicated to Indigenous cancer research in the country, developed a lung cancer mobile screening unit to boost access for underserved communities and worked to train the future workforce through partnerships with Buffalo Public Schools and Howard University, a historically Black research university.

'We have changed over time' 

In a meeting with editors and reporters at The News in September, Johnson acknowledged that Roswell Park hasn't always been known for its diversity and inclusion efforts. When she joined the faculty in 2002, for instance, she said she didn't think Roswell Park was responsive to the community and thought of itself "as sort of an ivory tower of scientists and physicians."

Elena Pop was a doctor at Roswell Park Comprehensive Cancer Center. She is also the mother of twins and, in a new federal lawsuit, accuses her former bosses at Roswell of fostering a "culture of discrimination" against women. In her suit, the fifth discrimination complaint against Roswell in two years, Pop claims the cancer center ignored her internal complaints

"I think we have changed over time," Johnson said. "And I'd like to think a lot of that is me, because I'm different than the white men who have led us before."

The six settlement agreements Roswell has paid in recent years include $4 million to urologist Dr. Willie Underwood III, $425,000 to Dr. Elena Pop and $125,000 to registered nurse Terry Kearney, according to public records.

Underwood, who filed his lawsuit in 2015, claimed racial discrimination against the cancer center and his supervisor, Dr. James Mohler, who allegedly called him a "token Black."

Pop, in her 2019 lawsuit, claimed gender discrimination against the cancer center and two supervisors, including Mohler. And Kearney, whose 2017 suit states she was the center's only Black registered nurse, claimed a supervisor regularly chastised her but did not treat non-Black nurses the same way.

Grand'Maison's case, filed Jan. 31, is the most recent lawsuit, while Gayles' complaint was filed in October. Zhou filed her original complaint in 2019.

All three women spoke to The News recently, saying they brought concerns to top executives but nothing was done. Now, they are hoping to change Roswell Park's policies and procedures.

Dr. Anne Grand'Maison, who worked at Roswell Park from 2016 to 2022 as a medical oncologist trained in sarcoma, filed a lawsuit early this year against the cancer center and several of its top leaders, claiming that she was forced out after she raised concerns about patient safety and gender discrimination.

Libby March

"I hope for accountability," Grand'Maison said. "The only way is to tell the story, and I hope the public will react."

Roswell Park said it "takes prompt, appropriate and immediate action in all personnel matters," as outlined in its procedure for investigating reports of discrimination, harassment and retaliation – a procedure that was expanded in December.

Roswell Park said it does not comment on ongoing litigation and will defend itself in court.

'I just simply refused to be silent'

In 2016, fresh off a fellowship at top-ranked MD Anderson Cancer Center in Texas, Grand'Maison said she was excited to join Roswell Park as a sarcoma medical oncologist. It was close to her native Canada, and she also saw the chance to grow the cancer center's sarcoma clinic.

But during her five-plus years at Roswell Park, her lawsuit claims, she observed error-filled sarcoma pathology reports, doctors who were uneducated in the latest sarcoma research and senior doctors who refused to seek second opinions in difficult cases. She also encountered, the lawsuit states, a work environment that was hostile toward female doctors, especially from pathologist Dr. Carl Morrison during sarcoma tumor boards.

In a statement the day Grand'Maison's complaint was filed, Roswell Park denied the lawsuit's "unfounded claims" and said it is recognized by the Sarcoma Alliance for having the specialized expertise and resources for sarcoma patients. Further, in a response to the complaint, attorneys for Roswell Park claimed the cancer center gave Grand'Maison "every opportunity to learn, grow and succeed as a new staff physician," but she instead "focused on criticizing and belittling" colleagues, including Morrison. 

In January 2022, Grand'Maison told a clinical practice plan coordinator in an email that she planned to leave by May 1 of that year because her husband was relocating to Canada. 

They ended up not relocating, which the lawsuit claims Grand'Maison's husband – a fellow doctor who also had privileges at Roswell Park – made clear to the cancer center. Since her husband corrected the record and no one replied to her initial email, Grand'Maison did not send any follow-up emails.

Meanwhile, Grand'Maison kept raising concerns to executives, including in an email March 15.

On March 16, Grand'Maison received an email from the director of employee and labor relations, confirming her resignation.

Despite Grand'Maison's attempts to dispute the resignation, Chief Human Resources Officer Errol Douglas in April 2022 denied her request to rescind the resignation because, the lawsuit states, Roswell Park already had extended her probation period by a year for her "lack of collegial relationships with physicians/colleagues and staff."

Douglas said Roswell Park intended to terminate Grand'Maison but instead deemed the resignation "an acceptable way of ending the work relationship," the lawsuit claims.

Soon after Dr. Jane Zhou started working as a pathologist at Roswell Park in December 2016, she felt like her voice was being silenced.

In particular, Dr. Mihai Merzianu, who led head and neck pathology, hindered Zhou's ability to partake in the head and neck tumor board, according to an amended complaint Zhou filed against the cancer center in August and a recent interview in her attorney Lindy Korn's office. And when Zhou did speak up at tumor boards to share her expertise, Merzianu degraded and demeaned her, the lawsuit states.

Summarizing her interactions with Merzianu, Zhou put it this way: "He basically was saying, 'just shut up.' "

Roswell Park attorneys denied Zhou's allegations against Merzianu in court records, but noted human resources, after being contacted by Zhou in 2017, "worked to alleviate the disagreement between" Zhou and Merzianu.

During her Roswell Park tenure, Zhou experienced sleep deprivation, "debilitating anxiety" and heart palpitations, which resulted in her taking medical leave for a five-day stretch in February 2018.

By March 30, 2018, Zhou's employment was terminated.

Zhou was told she was being dismissed because she did not have backup coverage for her medical leave or on Feb. 14, 2018, when she left work 90 minutes early to get her car inspected, the lawsuit claims.

In their response to the complaint, Roswell Park attorneys said Zhou was "terminated for the unprofessional conduct of leaving work early without arranging for proper patient coverage."

Zhou, born and raised in China before coming to the United States in 1990, said she got into medicine to try to make a difference in society. It's why she underwent 16 years combined of medical school, residency and a fellowship at MD Anderson.

"My way of doing that is to be good at my job, to make sure I help the patients with my skills and expertise," Zhou said. "That's all I wanted, and that's why I spent 16 years to be good at something."

Near the end of March 2020, Marsha Gayles' supervisor tasked her with arranging remote work for the case management department.

By mid-April, after Gayles had received her laptop to work remotely, Gayles was informed that she would not be working remotely due to the "needs of the department," according to her lawsuit filed in October and a recent interview in the office of her attorney, Kevin P. Wicka.

Her supervisor further said that she was "not comfortable" with Gayles working and answering calls from home. 

Gayles was frustrated and in a bind, with her 10-year-old son's school shifted to remote instruction. And since her son had asthma, she was concerned about bringing Covid home. Meanwhile, she claims, other department assistants were allowed to work remotely.

Gayles burned through her paid leave time and then ran into unpaid leave. Around May 1, 2020, she worked in the office three days a week and was later advised she would have to return to the office full time.

Gayles reported complaints to human resources multiple times but was told it was up to her supervisor to approve or deny remote work, the complaint states.

Asked for a comment, Roswell Park said it accommodates remote and hybrid work requests through its policies. "During the Covid-19 pandemic, most clinical workers, including support staff working in clinical areas, worked onsite in order to provide clinical care to cancer patients," Roswell Park said.

In court papers, Roswell Park's attorneys deny Gayles' claims and argue a denial of a request to work remotely is not an adverse employment action.

Gayles submitted a resignation letter, detailing the discrimination she felt, to Douglas, the chief human resources officer, her supervisor, and Johnson on June 10, 2020.

Afterward, David Scott, then-director of diversity and inclusion, reached out. In a meeting with Scott on June 17, Gayles claims Scott told her that "there are difficult situations everywhere" and "it does not get better than Roswell."

Gayles worked her last day there on June 24, 2020, less than three years after she started as an executive assistant in its urology department.

Gayles hopes her story will instigate change.

"You walk in, you see this beautiful facility, everybody's walking around and moving," she said. "But it's almost like there's a looming tumor somewhere that's spreading and that is covered over with this imagery of, 'We're top notch, we're the oldest cancer center in the U.S.,' but where are the fruits?"

Jon Harris can be reached at 716-849-3482 or jharris@buffnews.Com. Follow him on Twitter at @ByJonHarris.

Must-read local business coverage that exposes the trends, connects the dots and contextualizes the impact to Buffalo's economy.

226 Negroes Perish In Fire

NATCHEZ, Miss. -- Authorities counted 226 known dead today in, a 15-minute fire that swept through the Rhythm club, Negro dance hall, Tuesday night and that some of the 40 who were seriously injured probably would die.

Corner R. F. Smith said 226 bodies, many of them burned so badly identification was impossible, had been taken to undertaking parlors and that the others still were at hospitals where they died.

Smith said many of the Negro patrons of the moss-festooned dance hall, which at one time had been a Negro church, came from Louisiana and it would be days before they could be identified.

"We will just line the bodies up and let their relatives pick them out," he said.

All bodies had been removed from the pile of ashes and twisted tin which had been the walls, floor, and roof of the Rhythm club, the "society" night club of Natchez's colored section.

The nature of the tragedy to this city's 8,000 Negroes, who comprise 60 per cent of the population, would be comparable to a disaster in a white community in which its leaders were decimated. Among the dead were a large number of Natchez's comparatively few educated Negroes physicians, lawyers teachers, social workers the leaders of the colored community.

The fire lasted only 15 minutes in which time the flimsy shack-like building was reduced to ashes.

The white people of Natchez protested today against the lone exit toward which nearly 500 screaming Negroes fought and clawed as the flames flashed through dried Spanish moss hanging from rafters and along the walls. They demanded a city ordinance requiring more exits in dance halls.

The Negroes had danced for hours to the syncopating swing music of Walter Barnes Negro orchestra out of Chicago. Then a spark was touched that turned the merrymaking into a rout of horrifying screams.

A trumpet note was heard occasionally through the din and flames as Barnes' orchestra tried to quiet the frenzy.

Julius Hawkins, 27-year-old Negro pressman of the Natchez Democrat who escaped from the inferno told of the fire:

"I've never seen anything! Like it before in all my life. I was standing near the door. It caught near me and spread all over the place. I turned, made a run for the door and got out with only a scratch.

"InsIde I could hear everybody trying to get out. They were crushing each other, many were stomped to death. Others were smothered and suffocated. All were crying, yelling-, fire burning them. It was a horrible sight; young girls, boys, all friends of mine, were in there. I hope I never see the like of it again. You can't imagine the sight. They were trapped like rats."

Charlie Hall, 32-year-old Negro truck driver, said:

"I jumped through one of the windows and saved myself. Many persons were under chairs and tables, all badly burned. They had sought shelter there, but it was not for long. Soon I could hear their cries. It was terrible."

Sam Serio, member of the Natchez fire department, said that when the truck arrived at the dance hall "bodies were stacked waist high all over the building."

"It was a veritable firetrap," Serio said. "There was no escape. They were burned to death or trampled under each other's feet. It was the worst sight I've seen in 30 years of fire fighting."

Barnes and five of his orchestra -including a girl singer were known dead. One was still miss-' ing by mid-morning. Four other members of the orchestra and Barnes brother, Allen manager of the band, escaped.

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