To one longtime patient, Dr. J. Paul Muizelaar is a "miracle worker," a "teddy bear" and a "loving, caring man who only wants to make things better for people."
To another patient, the UC Davis neurosurgeon is a "very grandiose" physician with a dismissive attitude and a "bizarre" bedside manner.
Colleagues also are divided. UC Davis refers to Muizelaar in a recent news release as an "internationally recognized expert," but a fellow UC Davis neurosurgeon who once worked for him then sued him describes him in court papers as "arrogant," "inept," "unethical" and prone to "behavioral outbursts" and "screaming tantrums."
Fifteen years after his arrival at UC Davis, the enigmatic physician now finds himself the focus of a university investigation into his experimental treatments of dying brain cancer patients.
A tall, imposing figure who, according to court records and colleagues, collects Maseratis and fine wine and rides his bike to work, Muizelaar was abruptly removed last month as chairman of the neurosurgery department, pending the outcome of the probe.
The widening controversy, first reported by The Bee last month, has drawn an unwelcome spotlight to the medical school and to Muizelaar and his colleague, Dr. Rudolph J. Schrot, who engaged in the experimental procedures.
"I think it's safe to say that controversy has surrounded Dr. Muizelaar since he got here," said Noel Ferris, a veteran Sacramento personal injury attorney who sued the UC regents for alleged malpractice in 1999 in a case involving one of Muizelaar's patients.
"I think he's more of a cowboy than other doctors," Ferris said. " And they (university officials) keep making exceptions for him."
Tumor treatment at issue
Muizelaar and Schrot are accused of opening the skulls of three patients with malignant brain tumors in 2010 and 2011 and intentionally introducing bacteria, theorizing that an infection could prolong their lives. Two of the patients developed sepsis and quickly died; a third lived for some months but also has died.
While the doctors obtained the patients' consent for the procedure, documents show, UC Davis officials maintain they proceeded without permission from the university or from the federal government, in violation of regulations that protect human research subjects.
Muizelaar, who talked with The Bee last month, did not respond to an interview request for this story.
Schrot recently responded to the Bee by email, stating that he has "full confidence in Dr. Muizelaar's ability to be the Chair" of the neurological surgery department.
Both doctors have blamed the controversy on a misunderstanding among parties, saying they believed at the time they were providing "innovative treatment" for desperately ill people and had gone through the proper channels.
University officials said Friday in a written statement that the current UC Davis investigation, led by the provost, "will move as quickly as circumstances allow."
Some patients back him
The stakes are high for both the doctors and the university, with reputations and research funding on the line. The nature of the doctors' work has led to ghoulish headlines around the country and vicious blog entries on the Internet prompting some patients to rally to their defense.
"How dare you people do this to this man?" asked 79-year-old Kathi Edward of Marysville, who became Muizelaar's patient in 2001 after developing severe spinal problems.
"Everybody but Dr. Muizelaar said I had two months to live," she said.
Still alive 11 years later, Edward said Muizelaar was so devoted to her recovery he would visit her daily in his scrubs, exhausted, and reassure her. She later thanked him by buying him an exotic piece of Steuben glass shaped like scales.
"I couldn't have gotten through it without Dr. Muizelaar," she said. "He radiates assurance that you don't need to worry. That he's there. That he's going to take care of everything.
Edward, along with other current and former patients, fired off letters and emails and phone calls to The Bee, lambasting the coverage and describing Muizelaar as a "caring professional" who is "compassionate and skilled," "kind and humble."
'He's very grandiose'
But other patients paint a different picture of the doctor.
Laura Hernandez, a former bank manager, said she consulted Muizelaar in 2006 for a slow-growing, non-cancerous tumor in her skull. She said she agreed to surgery after the neurosurgeon assured her the procedure was a "slam dunk" and she would be back to work in a few weeks.
Instead, she said, she became paralyzed on her left side and spent six months learning to walk again before returning to work.
"At my bedside, Dr. Muizelaar told me that he could not explain what had happened to me," said Hernandez, 58. "If he couldn't tell me why it happened, who could?"
Hernandez said Muizelaar later told her he had used a special skull procedure "he had lectured about" to reduce infection, but she got one anyway which, she said, led to five more surgeries. She said she now has lifelong injuries, including a debilitating foot drop which requires her to wear a brace.
"He's very grandiose. You could tell he thought a lot of himself," said Hernandez. She said she eventually abandoned UC Davis for treatment at Sutter.
Hernandez did not sue, explaining that it was "not in my nature."
But others have filed lawsuits against Muizelaar in state and federal courts, describing intense dissatisfaction with the surgeon and his unique, 15-year arrangement with UC Davis.
Special permit to practice
Muizelaar, 65, was born in the Netherlands and does not have a California medical license nor is he board-certified in the United States, the gold standard for medical specialists.
A doctor who is certified by the American Board of Neurological Surgery must complete an approved training program and evaluation process, designed to assess skills and experience.
Instead, Muizelaar was hired at UC Davis under a special program that allows foreign doctors who are "academically eminent" to practice medicine in California. The "special faculty permit" from the state medical board grants the physician all rights and privileges but only at a sponsoring California medical school and its formally affiliated hospitals.
Muizelaar told The Bee last month that he came to UC Davis in 1997 after three years at Wayne State University in Detroit, and the previous 13 years at the Medical College of Virginia in Richmond.
At the time, he said, UC Davis was one of the largest trauma centers in the country.
"I am well-known for treatment of brain injuries, so they thought it would be a good fit if I be head of the department," he said, describing himself as "world famous."
But some of Muizelaar's patients said they felt misled by the university about the extent of Muizelaar's credentials, especially because he was department chair.
"I had no idea that was probably one of the most shocking things of all," said Adrian Woodfork, 64.
Woodfork, a state worker, did not learn about the unusual licensure until months after Muizelaar had performed his back surgery in October 2007.
"It gave me goosebumps," he said. "As you're trying to assess who's qualified, you take credentials and all those things into consideration."
Woodfork said he learned about the licensing matter in March 2008, when The Bee published a story about a federal lawsuit filed against Muizelaar and the university by another neurosurgeon at UC Davis.
The 2008 lawsuit by Dr. Dongwoo John Chang, who has since left the medical school, accused Muizelaar and others of "attempting to destroy Dr. Chang's reputation" and driving him out after he complained about Muizelaar to higher-ups.
Besides the licensing issue, Chang cited Muizelaar's "excessive medical malpractice record," according to the lawsuit.
"Dr. Muizelaar has been the subject of multiple (in excess of 10) medical malpractice lawsuits and many other breaches of acceptable medical standards of care, (while) Dr. Chang has not been sued for malpractice in the same time periods," the lawsuit states.
Chang, who now practices in Illinois, dropped his lawsuit last year; he declined to comment for this story.
Multiple malpractice cases
Court documents show that Muizelaar has been named in 11 medical malpractice cases in state and federal courts since 1998. Of those, four settled with payments to plaintiffs for a total of more than $300,000. according to Bonnie Hyatt, spokeswoman for the UC Davis Health System. Six of the cases were closed with no payments and one remains open, she said.
In two other malpractice lawsuits, Muizelaar was the surgeon but was not specifically named as a defendant in the action. Payments to the plaintiffs in these cases totaled $600,000.
The Medical Board of California lists one of these as a 2003 arbitration award for $250,000 on Muizelaar's public licensing information.
The other lawsuit, brought by attorney Ferris, charged that a 43-year-old woman died while participating without her consent in a research study led by Muizelaar and another physician. The woman, who suffered a brain aneurysm, was successfully treated by Muizelaar but died in the experimental follow-up procedure by the other doctor.
Hyatt said Muizelaar's claim history is within national norms for a high-risk specialty.
A study published last year in the New England Journal of Medicine found that neurosurgeons were the most likely specialists to be sued, with 19.1 percent facing a claim each year. Neurosurgeons were followed by thoracic-cardiovascular surgeons (18.9 percent) and general surgeons (15.3 percent).
"Dr. Muizelaar's practice includes a high number of complex adult spine and trauma patients," Karen Finney, a UC Davis Health System spokeswoman, said in an email. "Additionally he does the majority of brain aneurysm surgeries."
The university's investigation is continuing.
Meanwhile, at least one former patient says the university's actions have done nothing to diminish her confidence in Muizelaar.
"They shouldn't be so quick to crucify," said Edward, who still thinks of the neurosurgeon as her "miracle worker."