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Dr Conti

The puzzling crime and untimely death of pediatrician Ralph Conti

PART ONE

One summer evening eight years ago, Nina and Lawrence Dibbs drove to Foothills Pediatrics on the Siena campus of St. Rose Dominican Hospital in Henderson. The couple, married nearly 30 years, was excited: They were going to visit someone who, they thought, could help slow the accelerating march of Nina’s progressive multiple sclerosis, which had recently begun to make her legs feel like two-ton dead weights.

The source of their hope was not a pediatrician, however; it was Alfred Sapse, owner of a business called StemCell Pharma, who was marketing and selling what he described as a revolutionary cure for several diseases, including MS. Nina’s aunt had discovered Sapse on the Internet. “Nina, you don’t have to go to Europe for the stem-cell treatment, after all!” she had shouted through the phone earlier that day. “They’re doing it right down the street from you!” Nina called Sapse, and he told her to come right over.

The reason she and her husband were going to a pediatrician’s office is that Sapse wasn’t licensed to practice medicine in Nevada — or anywhere in the U.S. Although he claimed to be the scientist behind the procedure Nina sought, he needed a licensed physician to actually perform it. Enter Ralph Conti, owner of Foothills Pediatrics and a phenomenally popular doctor throughout the valley, where he operated five other locations, in addition to the one in Henderson.

There, after the pediatrics practice had closed for the day, the Dibbses met Sapse, a gangly 80-year-old who sported a full head of white hair and glasses as thick as his Romanian accent. His pitch on the wonders of stem-cell implants gave Nina pause, making her think: “He’s a smooth little talker.” But it didn’t matter; she’d decided before the drive over that she was going to have the procedure done.

“Tell you what,” she recalls Sapse saying. “I can get you in right away. You just need to give me $5,000. I need two different checks, each for $2,500. I want you to meet Dr. Conti. He will be doing it. This is his office.” A rather short, dark-haired man with soft eyes and a friendly smile introduced himself, immediately putting the Dibbses at ease. Conti was the caring, reassuring counterweight to Sapse’s hard-sell.

When Nina and Lawrence returned the next day with their money, Conti and an assistant took them into an exam room. Nina lay on a table with Lawrence at her side, while the doctor cleaned an area on her abdomen, numbed it, made an incision about an inch long and inserted, into a tunnel-like opening he’d burrowed under the skin, a one-inch strip of tissue that resembled a small piece of linguine. The tissue had come from the placenta of a recently delivered newborn. Conti closed the incision and gave the Dibbses a prescription for antibiotics. The whole thing took about 15 minutes, Nina estimates.

Back in the reception area, Sapse gave the couple a bottle of Gerovital H3, a drug for Nina to take in order to activate the stem cells she now hosted. According to Sapse’s explanation, the cells would travel throughout her body, scouting out problems and correcting them with their superhero powers of differentiation and regeneration — the ability to mimic and multiply.

“I wanted to get the miracle!” Nina says now, widening her round brown eyes for emphasis. “I wanted to walk. Think about it: You’re in the prime of your life, and then, one day, you have to go in a wheelchair to leave the house. You’ll do anything.”

She and Lawrence were excited after the procedure. They got on the phone with members of their big, close family to share the experience. Their two daughters came over to see mom’s incision. Conti began dropping by on his way to work to check on Nina and change her bandage. The doctor would give her pep talks to keep her spirits high.

Within a month, though, Nina and Lawrence began to give up hope. Although her incision healed fine, Nina wasn’t feeling any positive effects on her MS. She contacted Sapse to see about getting a second procedure. He agreed, but said it would cost her another $5,000. Reluctant to pay a second time for something that might not work, the Dibbses declined. When Conti heard about the exchange, he offered to do a second implant free of charge. She accepted.

Conti Magazine CoverSapse and Conti’s stem-cell implant wasn’t the miracle Nina had hoped for. The second procedure was no more effective than the first. Today, despite trying many other treatments, she needs a walker to get around the house. But she’s determined not to let MS stop her from living her life. Sitting at the dining table of a spotless Anthem home, prettily dressed and coiffed, with a pot of spaghetti sauce simmering on the stove, she says, “I still do everything around here.”

Similar resolve drew more than 30 people — suffering from cerebral palsy, lupus, Parkinson’s and other debilitating diseases — from around the country to Las Vegas in 2006 for Sapse and Conti’s treatment. The pair’s services, in turn, would lead them to be investigated by the Food and Drug Administration, charged with criminal conspiracy and fraud by the U.S. Attorney and convicted by a local jury in November 2012. Sapse now sits in Terminal Island federal prison in San Pedro, California, serving a 17-and-a-half year sentence. Conti, however, died under murky circumstances shortly after the conviction, leaving behind a wife and young son.

Several people involved suggest Sapse got what he deserved (a few come right out and say it). But Conti … when it comes to him, most wonder what happened. In the space of a couple years, he went from celebrated local physician to criminal convict to decedent. How?

It’s more than just a mystery to be solved. Embedded in the story of Ralph Conti are questions of medical ethics and government regulation that will only get thornier and more numerous as stem cells make their way into the mainstream. In Turin, Italy, prosecutors are trying to stop a company called Stamina Foundation from offering its controversial stem cell therapy to patients, dozens of whom have taken to the streets in protest, swearing that their well-being depends on the very treatments regulators say could harm them. Back in the U.S., meanwhile, one need look no further than this year’s Oscars and their nod to the Dallas Buyers Club, about a 1980s black market for unapproved AIDS therapies, to find examples of FDA opposition to drugs that patients believe could save their lives. The Las Vegas stem-cell scheme illustrates how far dying people will go to find cures for their diseases, how vulnerable this makes them to exploitation and how slowly the bureaucracy moves that is supposed to protect them.

And yet, at the heart of this tangle of medical policy issues is the very human question of a beloved doctor’s motivation. “Dr. Conti had everything going for him,” Dibbs says. “He was a great doctor, he had a son, he had a wife, he had a great practice.”

Conti was 51 when he died. He had half his life in front of him, plenty of room for a comeback. One friend said Conti was a millionaire. Another described him as the rock star of pediatricians. Almost no one who knew him personally believes that his motivation could have been anything other than to help people.

Is it possible that, in delivering Sapse’s “miracle,” Conti was actually doing something good — or at least thought he was? And if not, then why did he do it?

 

Was it To help his patients?

Conti TrikeBarely touching her ice water, dark, sharp-eyed Isela Stellato looks out of place among the afternoon drinkers and gamblers haunting the Lodge at Tenaya off Ann Road and the 95. She’s asked to meet there because it’s down the street from the middle school where she teaches math, and her daughter, Tristan, is trying out for cheerleading while her mom reminisces about the family doctor.

As a 24-year-old, Stellato had been told she may never get pregnant, so when she did, years later, she was extra careful. She took a parenting class at the public library, and during a guest presentation, Ralph Conti impressed her with his knowledge and charisma. She and her husband picked him from a slate of interviewees, and the pediatrician saw all three of their children, all their lives, until he died two years ago. No one in the family was involved in the experimental implants or even knew about them until the trial, and they’ve been trying to put together the puzzle pieces of Conti’s downfall ever since.

“I have a master’s degree,” Stellato says. “Now, my husband and I are really healthy. We’re trying to go fast food-free and teach our children the difference between manmade food and natural food. In our education about nutrition, we’ve learned a lot.”

For instance, they’ve learned that third-party companies hired to certify the health and safety of the things we put into our bodies don’t always act in the public interest. Rather, sometimes, they are motivated by profit. “Our government doesn’t always do everything it can to protect us,” she says.

Plenty of people believe the FDA, like any bureaucracy, is inadequate and slow. Those who mistrust government agencies in general go further, asserting that the official arbiter of safe, effective medicine is in bed with big pharma, prone to scuttle any product that threatens the bottom lines of corporations such as Pfizer and GlaxoSmithKline. (The team that defended Conti in his criminal case espoused this theory.) Stellato is more measured, both recognizing the risks of Sapse and Conti’s stem-cell implant procedure and leaving the door open for a Robin Hood-like altruism.

“Maybe I rationalized it, because I cared for him, and he cared for my family, but I thought whatever he was doing, he was doing it to help people,” Stellato says.

This belief, widely held among Conti supporters, is understandable given his reputation. After graduating from Rutgers' Robert Wood Johnson Medical School in Piscataway, New Jersey, Conti did his internship and residencies at Stanford University School of Medicine in Palo Alto, Calif., and Kaiser Permanente Medical Center in San Francisco. He finished in 1990, then moved to Las Vegas to begin private practice. In 2000, he founded Foothills Pediatrics, a Henderson-based business that fanned across Las Vegas over the subsequent decade. By 2011, it operated six offices and employed eight physicians along with 50 other staff. That same year, Conti made Las Vegas Life magazine’s annual Top Docs list, an honor that had already landed him on the cover of the magazine in 2000.

At the heart of Conti’s success were his compassion for and skill in treating children. He was known for making house calls, leaving evening functions to attend to patients in need and even providing transportation to his clinics for children who lacked it. Tears in her eyes, Stellato recalls: “Yesterday, I had to take Tristan to Foothills, and it wasn’t Dr. Conti, and I got really emotional. You expect to hear the whistle. He would whistle all the time … and he would have these things in his pocket that had lights. He would pull them out and say, ‘Blow out the light,’ to the kids and when they blew, he would turn it out. Meanwhile, he would be listening to their heart or looking in their ears.” These qualities make his fans believe he did the experimental stem cell implants for the right reasons.

His patients were the reason Conti gave for getting involved with Sapse. During follow-up visits with Nina Dibbs, she says, he told her that he was hoping the treatment would help children, like those he saw in his practice, with debilitating diseases. Dibbs remembers him saying, “How are you feeling, Nina? Come on, we want this to work!”

 

Was it for the greater good?

StandSapse and Conti came together through a midwife named Lydi Owen, whom Conti described during trial testimony as “the grandmother of all midwives” and a personal friend of his. Owen learned of the two men’s shared interest in stem cells and introduced them in the summer of 2005. Over the next several months, they met frequently at the Starbucks inside Vons supermarket on Maryland Parkway and Twain Avenue. Conti described these meetings as mentoring affairs, in which Sapse would give him books and journal articles and drop knowledge picked up through his 50-year career in science and medicine.

“You know, it just got me excited about stem cells and regenerative medicine,” Conti would say on the stand. In other words, he didn’t perform the stem-cell implants just to help specific patients — very sick children — he also believed he was helping to advance the field of stem-cell study. When he talked to people about the procedure, he framed it in terms of “research.”

Stem cells do show great promise for treating diseases, due to their capacity to differentiate and regenerate. They start out unspecialized and can self-renew through cell division; under certain circumstances, they can also be induced to become specific cells with special functions.

Not all stem cells are created equal. A very young embryo contains the stem cells that will comprise the entire body, meaning they’re very versatile, or “potent” in industry lingo. Stem cells are found in some adult tissues, such as bone marrow, and researchers have figured out how to create others. But none is as potent as embryonic stem cells, dubbed “the gold standard” by Science’s Gretchen Vogel in 2008. Trouble is, harvesting embryonic stem cells entails destroying the embryo, and nobody wants to do that.

Placental stem cells offer one solution. The stem cells located in the layer called the amnion are relatively potent, and harvesting them doesn’t require sacrificing anything other than the placenta itself. In 2005, around the time Conti and Sapse were meeting at Starbucks, this news was making headlines in scientific journals.

Amniotic stem cells have some particular attributes that make them attractive to researchers, says developmental geneticist John Gearhart, who directs the University of Pennsylvania's Institute for Regenerative Medicine. They are less likely to be rejected by the body’s immune system as a foreign intruder, and there’s no question they circulate in the blood system. Some interesting findings have emerged from the exchange of stem cells between mother and baby, Gearhart says, giving the example of a mom with thyroid disease whose baby’s stem cells found their way to her thyroid and repaired damaged tissue.

But it’s a far cry from that, which has been demonstrated in carefully monitored circumstances, to taking one person’s placental stem cells, inserting them in someone else’s body and expecting them to repair any existing pathology in that body. Reacting to this idea, the premise of Sapse’s StemCell Pharma, Gearhart says, “Oh, boy. That’s far-fetched!”

There are still many dots to connect between what stem cells might be able to do, and what scientists can actually do with them now. As an example of the latter, consider results of two separate but similar studies published in scientific journals in April of this year. By devising a way to clone human embryos, the researchers moved the ball another yard closer to the goal of harvesting stem cells in a noncontroversial way and personalizing them to respond to specific pathologies in adult humans. For instance, a person with Type 1 diabetes might someday receive stem cells from one of these cloned embryos that could help his pancreas develop the insulin-producing cells it lacks.

StandThis is where the field of regenerative medicine is in 2014. Gearhart, who contributed to the pioneering work that paved the way for what’s happening today, says the bottom line is this: No stem cells, placental or otherwise, are used clinically in the United States yet; so, despite Conti's references to "research," they were highly unlikely to be in the clinical-trial phase eight years ago.

Besides, he adds, the FDA would never approve a study done the way Conti and Sapse operated. The agency requires researchers working with regulated items — including human cells, tissues and tissue-based products — to take certain steps that ensure public safety, and Sapse and Conti followed few, if any, of them.

For starters, the FDA wants to know where the regulated items come from. Sapse and Conti got their placentas from two sources. One was St. Rose Dominican’s labor and delivery department, where Conti said he would pick them up from new parents. (One such woman, Deanna Wise, told the Review-Journal in October 2011 that she had given the pediatrician permission to take hers, because he told her it was for research. Contacted for this story, the hospital confirmed that its policy at the time was not to release placentas to anyone other than the birth mothers, and that it had not released any to Conti.) The second source was Owen, who would save them after births in which she assisted.

As for the safety of the source tissue, placentas provided by Owen were from vaginal deliveries. This became a key point in the government’s criminal case against Sapse, since he told clients that only placentas from C-sections --— which didn’t pass through the birth canal, where they could pick up the mother’s pathogens — were safe and used in his procedure. And although Conti and Owen said they consulted charts and bloodwork to screen placenta donors, they didn't keep records of donations.

The FDA also monitors storage. To prepare their placentas for the implant procedure, Conti and Owen washed them in saline solution, separated the amnion and stored pieces of it in a hydrogen peroxide mixture. Gearhart finds the process counterintuitive: “We’ve done a lot of work with umbilical cord blood and placental tissue, and you do all you can to keep them in the purest state. You want them dense and concentrated … and hydrogen peroxide? What is that? That stuff is so toxic.”

Even assuming some stem cells survived the preparation, there’s the further problem of implanting them in humans. The FDA expects to see computer models and results of animal testing prior to clinical trials. Sapse could produce no such work. During the criminal trial, and in a letter to Desert Companion, he provided a lengthy curriculum vitae citing his medical education in Romania, academic fellowships in Europe and the U.S., and published papers and speaking engagements around the world … none of which appears to be preliminary work on the procedure in question. For that, he says, he relied on medical training he received in Eastern Europe and Russia in the 1960s, scientific literature on studies done by others and conference sessions. He had no wet lab, no way to conduct biological experiments himself.

Even if Sapse had done the proper build-up to a clinical trial, he didn’t do the paperwork required to document the experiment’s progress once it began. Patients of Sapse and Conti did report receiving post-procedure phone calls, and Conti followed up with Nina Dibbs at her home, but any notes they took weren’t stored or organized formally for future reference, such as in a database or spreadsheet. When investigators searched Sapse’s apartment, they were shocked to find he didn’t own a computer. Conti described himself, during trial, as being more or less computer illiterate in 2005, when his research into stem cells began.

Of course, if you believed the FDA had no authority over you or, worse yet, would use its power to hamper your work — work that stood to help millions of people around the world — then you probably wouldn’t follow its protocols anyway. During the criminal trial, the government fought back repeated efforts by Conti’s attorneys to introduce FDA politics as part of his defense. Sapse’s attorney recounted his client’s previous attempt to bring a beneficial drug to market, which was thwarted by the federal agency. And in a letter from prison, Sapse wrote:

“My dear Ms. Kyser, I would like to forewarn you that if you should decide to get deeper into the events mentioned above, you could very well be stepping into a mine field, and that may be made to intimidate you (sic). The purpose of all this intimidation … is to prevent the world at large to know that there is a drug to treat Alzheimer’s that might threaten some very large financial interests.”

The entire criminal stem-cell case, he later told me on the phone, was a “smoke screen” engineered by the government and big pharma to prevent him from marketing his latest discovery, a cure for Alzheimer’s, to the public.

Such conspiracy theories enrage Gearhart. A cancer survivor, he recalls overhearing fellow patients in treatment say things such as, “The government has the cure, you know. They just won’t give it to us.”

“Those arguments sell well to the public, because people want to believe someone’s making money or having their palms greased,” he says. “Drug companies don’t own the FDA. I know these people. I’ve worked with them for years. They’re there to make sure things are done in a way that is safe for patients.”

That, he says, is the ultimate goal of making researchers jump through so many hoops — to prevent someone like Sapse from profiting off a product that doesn’t work, and may even cause harm.

After receiving complaints about the implant procedure, the Nevada attorney general’s office determined Sapse wasn’t licensed to practice medicine in the state and kicked the case up the jurisdictional ladder. The FDA conducted its investigation and concluded: Apart from a handful of minor improvements that could mostly be chalked up to the placebo effect, Sapse’s procedure, performed by Conti, benefitted few people and actually gave several infections. Worse, the investigators found, Sapse and Conti deceived patients about the source of certain placental tissue, their chances of seeing results and other details.

That, in essence, was the crux of the U.S. Attorney’s case for conspiracy and fraud. In the end, it was less about using human tissue without FDA approval, and more about lying to desperate, dying people, promising them relief under false pretenses — and taking their money.

 

PART TWO

In 2012, federal judge Kent Dawson heard most of his cases in courtroom 6D, on the sixth floor of the Lloyd George building at the corner of Las Vegas Boulevard and Clark Avenue. There, the solemnity of the bar, prominently displayed government seal and bench set on a moderate overlook is offset by the warmth of cherry wood, azure carpet and a squareness to the 60-by-40-foot space that draws everyone close to the center.

On Tuesday, November 20, 2012, the four rows of benches on either side of a wide aisle at the back of courtroom 6D were packed. Supporters of Ralph Conti were there, alongside reporters and government suits. All were on the edge of their seats — today would be the day they’d hear from Conti himself. At around 10 minutes after 9 a.m., the doctor took the stand. For nearly five hours he answered questions asked by one of his two defense attorneys, Dennis Roberts. Things seemed to be going well; even looking back today, in the black-and-white of court transcripts, one can read Conti’s charm:

 

Roberts: Okay. What’s medicine like practiced every day?
Conti: It’s being in the moment. It’s knowing why the patient is there. Sometimes the --— the reason that they are there is not the stated complaint. Uh, they may be in for a stated complaint of a cough, “my child has a cough,” but really they want to talk about their breast cancer. Um, it’s — it’s making a bond with the child and making sure the mom understands or the dad understands why they are there: Um, how did my child get this? What does he have? How — how did it get it? How are we gonna treat it? And when should I call you back? If I can answer those four questions in a sick visit, I consider it an effective interaction.

 

Conti laid out the whole story for those in the courtroom to hear. He talked about how he’d been interested in stem-cell research before meeting Alfred Sapse, because he believed it could provide a cure for his cerebral palsy patients, kids who would never “ride a bicycle or throw a baseball or be fed through anything but a tube in (their) stomach.” He said he met Sapse through Lydi Owen, a respected midwife whose grandchildren he treated, and who knew the two shared an interest in stem-cell research. He spent months listening to the elderly scientist, reading books and articles Sapse gave him, and becoming more and more convinced of stem cells’ medical promise. He hid nothing about the procedure itself, explaining how he’d get the placentas when he was on call at St. Rose by asking shift nurses in the maternal child unit to let him know of scheduled C-sections for which he’d be assigned the babies. He’d fill out generic hospital permission forms for the parents to sign, and then take the placentas in sterile containers to his nearby office, where he’d prepare them with saline and hydrogen peroxide. He described how Owen taught him to separate the amnion from the rest of the placenta, like separating two pieces of wet Saran Wrap.

Conti also noted that he’d met with his business attorney in January or February 2006 to get an informed-consent release for the stem-cell procedure, which he began doing soon after. He said he asked all the patients he saw for the procedure to sign one, indicating that they knew it might or might not work. Sapse gave him patients’ medical records, he said, so he could familiarize himself with their conditions. He emphasized that some patients reported improvements in their conditions, such as the ability to urinate on their own, which kept him motivated. He recalled how, in July of that year, after 20 or so of the procedures had been done, St. Rose’s medical director, Stephen Jones, called him to his office and told him he’d have to complete a thick stack of paperwork if he wanted to continue taking the placentas. Conti handed the forms off to Sapse, but they began using placentas supplied by Owen instead. Around the same time, Conti said, an FDA officer paid him a three-day visit, asked lots of questions about the procedure and even dug through his files. The officer said he’d send an official warning, with which Conti would have 15 days to comply. But the notice didn’t come until Thanksgiving, Conti said — about four months and a dozen procedures later. He did only one more after that, well within the 15 days. Sapse, he added, claimed all along to be keeping records and taking care of FDA compliance. Once Conti saw FDA requirements hadn’t really been met, he refused to do any more procedures. (Sapse subsequently moved his business to Mexico, where a doctor named Omar Gonzales did some 100 more procedures.)

Throughout the morning and afternoon, Conti filled in this reasonable-sounding narrative with details. The defense produced exhibits to back up his story. Then, late in the afternoon, Assistant U.S. Attorney Crane Pomerantz began his cross-examination and the tide turned quickly. Conti’s confidence wavered, and contradictions in his story emerged. He had claimed to be in the top three of his class at Stanford, yet he was unclear on the basics of HIPAA (the Health Insurance Portability and Accountability Act), a well-known law for protecting patient privacy. He said he didn’t know what an affidavit was, yet he’d been through two bankruptcies by that time (a point to which we’ll return). He said his scientific knowledge was based on specific articles, yet in those articles, authors both followed the processes he ignored and noted that further lab work was needed before clinical trials could be undertaken. He said he had an ethical dilemma about doing the procedure after receiving the FDA warning, but did it anyway because the patients needed it; yet the consent form clearly indicated the procedure was elective.

Perhaps worse, certain omissions suggested someone who was either arrogant or careless. Conti admitted to not having consulted with any previous patients of Sapse’s, other scientists or fellow physicians about the procedure. He said he didn’t take so much as blood pressure or temperature from fragile patients with terminal illnesses, some of whom had traveled from as far away as the East Coast, before operating on them, because he could tell how people were doing by simply looking at them. And then there was this:

 

Pomerantz: You didn’t ask Mr. Sapse to see tissue-handling protocols?

Conti: Uh, I did not ask to see tissue-handling protocols. No. I —---------------------------- I mean, it was one of those procedures where you’re kind of makin’ it up as you go along. It’s a shot in the dark. Um, this was brand new stuff. I mean — and, you know, there weren’t many experts in stem cells.

 

Such a statement vexes the byzantine arguments that the prosecution and defense constructed through countless hours of research and thousands of pages of court documents. In the case file, one can read them duking it out over details such as the title Conti used to sign a confession-like affidavit, the difference between “amnion” and “placenta,” and what constitutes an expert witness. All this legal wrangling boiled down to determining whether Conti was trying to help people or deceive them, doing it for research or profit, and as an employee of StemCell Pharma or in cahoots with Sapse. If the subject in question is simply making it up as he goes along, then his intent seems up for grabs. And motive is key in a criminal act such as fraud: Did he mean to delude victims in order to profit?

In courtroom 6D that November 20, and almost every other day of the trial, were two men who were certain they had the answer to that question. Neither the former FDA agent sitting with the prosecution, nor the paralegal at the defense team’s table ever freely had their say at trial, but both believe they know why Conti did what he did.

 

Was it for the money?

Retired FDA criminal investigator Douglas Loveland asks me to hold a minute while his dog chases a deer in the back yard of his home outside Arlington, Virginia. When he comes back to the phone, he jumps right into the story.

Sapse came to Loveland’s attention when Loveland was still active in the FDA. Another agent, who had taken his class on medical research fraud, thought of him when Sapse’s case hit her desk. The regulatory side of the agency passes cases on to the criminal side when violators fail to comply after warnings. Loveland was in the division that investigates biological processes, and cases such as this were his specialty.

“It was a long investigation,” he says. “We opened it in October 2007, and Sapse wasn’t indicted until 2010. There were hundreds of patients all over the world we had to track down and interview. … Through Interpol, we went to where he got his degree in Romania and found he had a Ph.D. in public health. He wasn’t a medical doctor. But, as is often the case in medical fraud, he faked his credentials.” In Loveland’s opinion, the stem-cell procedure was just the latest in a long line of Sapse scams. “There’s newspaper reporting on him going all the way back to 1980,” he says.

He further dismisses the idea that there was any real scientific inquiry involved. “Some people blame the FDA for not allowing stem-cell technology to be used on patients, but the reality was, nobody had figured out what stem cells could actually do at that point,” he says. “I knew more about stem cells than Alfred Sapse did.”

How could a smart, successful guy like Ralph Conti fall for such a charlatan?

Two words, Loveland says: willing dupe. “Conti might be a great pediatrician, but in this case, he played a role that’s well-documented in criminal history. Con men pick people who are bright and have access to the flock of sheep they’re trying to shear. … Someone as warm and personable as Ralph Conti — I could see immediately why people liked and trusted him.”

Still, that explains Sapse’s motivation more than Conti’s. Pressed on that — and reminded of Conti’s own professed desire to help kids with cerebral palsy — Loveland says the doctor might have believed that at first, but after a while he had to have figured out the operation wasn’t legitimate. Then, Loveland believes, “he kept doing it for the money.”

During 2006, Conti made approximately $60,000 for doing the stem-cell implants. His salary from the pediatrics practice, he estimated at trial, was between $500,000 and $600,000. To many observers, it makes no sense that a man who had millions in assets would risk his reputation on a venture that earned him 10 percent of his annual income.

To Loveland, it makes perfect sense. That’s because Sapse paid Conti in cash, off the books, and, Loveland says, the pediatrician liked to gamble. This allegation came up during trial and, as with all the questions he was asked, Conti answered candidly: Yes, at one time, he’d had a $70,000 debt with a bookie. But that, he said, was in 2008, two years after his involvement with Sapse ended, and he paid it off in full before he was indicted in 2011.

As evidence of Conti’s dishonesty, Loveland points to a 2006 affidavit that Conti signed after the FDA investigator visited his office. In it, Conti says he was paid $200 or less per procedure. He later admitted it was closer to $2,000.

There were other signs that all was not well in Conti’s finances. In 2002, Foothills Pediatrics filed a Chapter 7 bankruptcy for debt relief; it didn’t close until 2007. Then again, in 2011, Foothills filed a Chapter 11 case to block former business partner Michael Rosenman’s efforts to collect $362,000 in a business dispute. Rosenman won a judgment first by an arbitrator, then by a bankruptcy judge, but not before garnishing Foothills’ insurance companies for his due. This case was winding down just as Conti was indicted on the criminal charges.

And then, there’s the question that Assistant U.S. Attorney Crane Pomerantz asked after the trial was all over: “Conti said he was never doing (the procedure) for the money. If that was the case, then why didn’t he do it for free?”

 

Was he simply naïve?

Larry Olstad prefers not to speak ill of a former client’s fellow defendant, but if Alfred Sapse did have criminal intentions, Olstad posits, then there’s no way Conti knew it.

For two men who plainly dislike each other, Loveland and Olstad, a key member of Conti’s legal defense team, have surprisingly similar theories as to why a successful pediatrician would get mixed up in a federal crime: because he was duped. But where Loveland sees a willing dupe — in it for the money — Olstad sees a well-meaning one, someone who assumed good faith on the part of others and was blinded to misdeeds by his determination to make a positive difference.

“Ralph had a quality of innocence about him,” Olstad says. “He went to private schools all his life. He came from money. … He was not streetwise.”

A former attorney, Olstad is now a Portland-based paralegal. Although he never spoke on record during the trial, Olstad is present throughout the transcripts. Dennis Roberts and Conti’s other defense attorney, Nancy Lord, consulted with Olstad frequently, repeatedly voicing concerns that the paralegal raised. At one point, during a heated exchange, Judge Dawson tells Roberts, “I can see that your paralegal is arguing with me through you, but the objection is sustained.”

Olstad’s passion is partly personality-driven. As he talks, he frequently raises his voice, chortles and scoffs. But in the Conti case, it was also a matter of affinity. The two had met through mutual friends at a Grateful Dead concert and quickly bonded. When Conti told Olstad about his legal troubles, his fellow Deadhead was glad to lend a hand. Olstad helped Conti assemble his legal team, then worked tirelessly on the pediatrician’s defense.

They made the case that Conti saw Sapse as a brilliant, if
eccentric, researcher. When the two met, Sapse showed Conti a photo of himself at a conference with famous scientists Jonas Salk and Linus Pauling. Sapse talked the language, so Conti never questioned his background. Doctors don’t go around asking other doctors to see their credentials, but even if Conti had, Sapse could have produced them, as he did during the trial, Olstad says.

He firmly believes Conti was interested in finding a cure for cerebral palsy in children. The doctor was tired, Olstad says, of seeing babies born limp and pale, and having to tell their mothers and fathers they were facing a lifetime of physical therapy and surgeries that could do no more than forestall the inevitable. It was traumatizing, he says, for someone as sensitive as his friend.

What’s more, according to Olstad, Conti was doing something completely within his professional purview. As the defense frequently asserted in its case, physicians have the right to experiment with therapies on their patients, and the FDA doesn’t have the right to regulate the practice of medicine. Indeed, the medical community has long grappled with the line between patient care and patient study, and some passages of the World Medical Association’s Declaration of Helsinki, the last word on ethical principals for medical research on human subjects, are open to interpretation:

Physicians must consider the ethical, legal and regulatory norms and standards for research involving human subjects in their own countries, as well as applicable international norms and standards. … Physicians who combine medical research with medical care should involve their patients in research only to the extent that this is justified by its potential preventive, diagnostic or therapeutic value and if the physician has good reason to believe that participation in the research study will not adversely affect the health of the patients who serve as research subjects.

Where would medicine be, Olstad adds, if doctors were constrained by a strict set of rules telling them they can only use certain devices and products in the prescribed ways? History is filled with examples of cures and treatments found through the creative or intuitive application of remedies. One technical term for this practice is off-label drug use. An accepted practice in U.S. medicine, it allows a licensed physician to prescribe medication for something other than its approved application. The problem is, the legal exception for off-label drug use applies to drugs and treatments that are already FDA-approved; stem cells were not. Nor had Sapse submitted an application for a new drug that would have started that ball rolling. And if he had, relevant American Medical Association guidelines would have exhorted him to carry out the research with the appropriate oversight and monitoring — in this case, by the FDA.

Those who claim FDA overreach into medicine frequently argue that state medical boards have the last word in governing doctors. In June 2008, Conti received his first warning from the Nevada State Board of Medical Examiners, which accused him of performing an “experimental procedure” involving the implantation of human tissue in 18 patients. An accompanying records request also alleged substandard care, based on his failure to examine the patients, take their medical histories or conduct follow-ups. Conti didn’t provide the records requested then, or after a formal complaint was filed in 2010. In 2011 he was fined nearly $8,000. His license was never suspended, and he continued practicing pediatric medicine until he died.

Olstad believes the federal government wanted to make an example of Conti, a high-profile physician who circumvented their authority. The feds' interest in keeping stem cells out of the hands of independent researchers has put us far behind other countries in the field, Olstad says, and Sapse knew this from his previous work in Europe.

He believes that by the time Conti was visited by the FDA, he was already invested in the stem-cell work, vulnerable to Sapse’s reassurance that he was handling matters “in Washington,” as he said. And a sense of being above reproach might have fed Conti’s offhanded dishonesty with the investigator about the amount of money he was paid for procedures and other details.

“He should have been more careful about what he was doing,” Olstad says. “He should have said, ‘You need to make an appointment with me if you want to talk,’ and his lawyer should have been there. The problem with being the best there is, is that you get impatient with the restrictions put on lesser beings, because they’re not as good as you are.”

When the FDA’s November warning came, Olstad says, Sapse prevailed on Conti to continue for the sake of the clients; that — not the money — was why the doctor did one last procedure before parting ways with Sapse for good.

 

PART THREE

The trial of Alfred Sapse and Ralph Conti lasted 15 days. The jury deliberated for three hours and 50 minutes before returning its verdict. Both men were found guilty of conspiracy. Five counts of mail and wire fraud had been dismissed, due to relevant victims dying in the interim; Conti and Sapse were found guilty of all the remaining counts in which each was charged, four for Conti, 18 for Sapse.

Throughout the trial, and in the months leading up to it, Conti had suffered from severe neck pain. He’d considered having surgery to fix the problem sooner, but decided to wait so his recovery wouldn’t interfere with his defense. Two weeks after his conviction, as he awaited sentencing, Conti got the surgery at Desert Springs Hospital. The surgery went fine. He awoke from anesthesia and spoke to his wife, Carol. She went home, where she later got the call that he’d died.

Carol Conti wouldn’t talk about her husband, but she allowed her attorney, Bruce Shapiro, to speak on her behalf. “She went through a tough time during the trial, during his death, after his death,” Shapiro says of his client. “Obviously, she was devastated after his death, but because of her son, she worked through it. She’s done an unbelievable job getting over it. I think she’s moved on.”

Carol Conti isn’t the only one keeping mum about Ralph Conti’s death. P. Michael Murphy, the Clark County coroner, denied both informal and formal requests to see his investigation, which is technically public record. He would only confirm that Conti was a 51-year-old Caucasian male and Henderson resident who died at 2:08 p.m. on December 16, 2012, at Desert Springs Hospital. (The hospital also declined to provide any further information.) The cause of death is undetermined. This, according to Murphy, rules out other official causes, such as accident and suicide.

Shapiro says Carol Conti naturally had questions that remain unanswered, but if the possibility of malpractice had existed, he believes she would have pursued it, and she didn’t.

Sapse is not so circumspect. In his letter to Desert Companion, he writes that Loveland’s “extreme measures to get the technology of the drug … pushed Dr. Conti into suicide.” On the phone, he reiterated his view that Conti somehow killed himself. Others involved hinted at the possibility without directly advancing the theory.

It’s difficult to imagine someone engineering his own death under the careful watch of a post-operative team, although a physician would certainly have a better chance of pulling it off than someone with no knowledge of medicine. The coroner did look for foul play, though, and found none, a fact revealed in a form that made its way into the criminal case file.

Further undermining the notion that Conti committed suicide, attorney Dennis Roberts filed a motion for a new trial on Conti’s behalf four days before he died. Olstad says his friend was looking forward to an appeal because he firmly believed his conviction would be overturned. Instead, it was expunged from his record. That’s what happens when someone dies before sentencing — almost as if he were innocent all along.

Throughout the trial, Isela Stellato continued to take her children to Conti, as did Shapiro and the Dibbs’ daughter, who’d been referred to the pediatrician by her mother a couple years after her two failed implant surgeries. They all believe the best way to determine Conti’s guilt or innocence is by looking at the rest of his life, which he devoted to taking care of others. From his very different perspective, Pomerantz agrees: Look at what the doctor did, he says, and judge for yourself.

Funeral services were held at St. Francis of Assisi Catholic Church in Henderson on December 21, 2012. Hundreds of people packed the church and stood outside, among them Nina Dibbs, who says it was a “beautiful service, just beautiful.” Expressions of grief poured onto the Facebook Page "Support Dr. Ralph Conti" from its 1,300 followers. Few spoke of the criminal trial; the day was for remembering better times. The Review-Journal ran Conti’s obituary with this request: “In lieu of flowers, please honor his passion for continued stem-cell research with a donation in his name.”


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