James Ellroy - The Best American Crime Writing 2005

When Arndt returned from New Orleans, Stephen Lipson asked his protege about his experience. Arndt told him it went great, neglecting to mention the federal law he had broken while he was there. On May 29,Alfredo Fuentes submitted a passport application under a false name, and Arndt filed a supporting affidavit. Fuentes had been Arndt's domestic partner for several years, and he had moved with Arndt from Massachusetts to New Orleans. But Fuentes was a Venezuelan who was in the States illegally. The fraudulent passport application, Arndt would say later, was their attempt to head off deportation.

Three months later, in the early morning hours, Fuentes was sitting on a bedroom couch talking to a man named Roger Volzer in Volzer's Provincetown home on Cape Cod. After Volzer got up to blow out some candles, Arndt, who had been staring at the men through a window, used his surgeon's hands to rip out a screen and climb into the house, according to the Provincetown police report. Volzer would tell police that Arndt punched him in the head, pushed him out of the bedroom, and then threw a chair at him. Arndt was charged with assault and battery, burglary, and malicious destruction of property.

Volzer eventually decided not to press charges in exchange for Arndt's agreeing to pay him $30,000 and to attend weekly anger-management counseling. Christopher Snow, Volzer's attorney, says Arndt's supporters lobbied his client, telling him a conviction could derail a promising medical career.

But if Arndt dodged a bullet, he hardly acted grateful during their meetings, says Snow. "In the 'if looks could kill' category, he was a murderer. He acted if the proceedings were an incredible invasion on his otherwise important life. He had absolute contempt for the fact that someone might have the audacity to hold him accountable for his bizarre and destructive behavior."

In the end, Snow has said,Arndt paid only $18,700 and failed to follow through on counseling.

In the fall of 1998, Arndt pleaded guilty to the misdemeanor passport violation in federal court in Louisiana. He was sentenced to three years' probation and fined $3,000. But because he had renewed his medical license a few months earlier, he would not have to report that conviction to Massachusetts authorities until his next renewal period two years later.

The fines and legal fees, meanwhile, were adding up. His breakup agreement with Goldfinger, the one that required Arndt to pay 9 percent of his income to his former partner, was slated to go into effect in 1998. So just when Arndt had finished up his lengthy medical training and was about to start making some real money- the 2002 median salary for spine surgeons was more than $545,000, according to the Medical Group Management Association-the financial vise was beginning to tighten.

Arndt argued in court filings that the Goldfinger agreement should be invalidated because he had signed it under duress. The case slogged through the courts and arbitration until a Superior Court judge upheld it in 2000. Goldfinger would never collect a dime.

Even with so many distractions, Arndt seemed able to wall off his personal problems from his professional work.

James A. Karlson, chief of orthopedics at Mount Auburn Hospital, had known Arndt since residency and practiced with him both at Harvard Vanguard and in their four-surgeon group practice. Arndt had privileges at most of Boston's top hospitals but began focusing his attention on Mount Auburn when the veteran spine surgeon there started to cut back. Karlson says there were a few low-level concerns about Arndt, such as tardiness, but no indication of his mounting personal problems. "He had certain problems that we didn't pick up on," Karlson says. "Should we have? 'Could we have?' is a better question."

The care of Raymond LaVallee-Davidson offered a few clues. In the summer of 2001, Arndt operated on his back at New England Baptist Hospital. LaVallee-Davidson says Arndt told him the surgery would take about eight hours. It took eighteen, and even after that, Arndt told him he had been unable to finish the job. Because

LaVallee-Davidson suffered serious complications, it wasn't until December that follow-up surgery was scheduled at Mount Auburn. Just after six o'clock on the morning of surgery, he was being prepped by hospital staff and about to be anesthetized. "I had asked them to hold off, because I had a few questions I wanted to ask Dr. Arndt before I went under," the forty-four-year-old recalls. Four and a half hours later, hospital staff told him they had been unable to locate Arndt, and so LaVallee-Davidson got dressed and made the four-hour drive back to his home in Skowhegan, Maine. Four days later, he says, he got a call from Arndt saying he had overslept. LaVallee-Davidson, who says that initially he found Arndt to be "probably one of the most compassionate people I have ever met," is now among Arndt's former patients suing him for malpractice.

Early on the morning of July 10, 2002, Charles Algeri, a former Waltham cabdriver with a history of back problems, arrived at Mount Auburn Hospital and was prepped for fusion surgery on his lumbar spine. Algeri says Arndt arrived late and unshaven, with dark circles under his eyes. "He said his car had been towed because he had parked in a bus stop," Algeri says.

Like most of the cases Arndt took on, the surgery for Algeri would be a complex, all-day affair. According to state investigative reports and interviews with some of the people involved, this is what happened: The first incision was made around 11:00 a.m. In the OR during the afternoon, Arndt twice asked the circulating nurse to call his office and ask if "Bob" had arrived. By the second call, the receptionist informed the nurse that "Bob" was Arndt's code name for his paycheck and told her to tell Arndt the check would be delivered to him there.

Just before 6:00 p.m., Leo Troy, one of Arndt's fellow orthopedic surgeons from their private practice, was passing by the front desk near the operating room when a secretary asked him if he could take the check to Arndt in the OR. Troy had a few minutes before he was scheduled to operate on another patient, so he had planned to look in on Arndt anyway. He went into the OR, handed Arndt the check, and then observed the surgery for a couple of minutes. Then, Arndt asked him if he would watch his patient for "about five minutes." At the time, Arndt was about seven hours into the surgery. Algeri was under anesthesia and had an open incision in his back. It's not unusual for surgeons doing long procedures like this one to step out to use the bathroom. Although he is not a spine surgeon, Troy says he had assisted Arndt before and was "qualified to close up the patient in an emergency." Arndt then turned to a salesman from a medical device supplier-sales reps often sit in on complex surgeries in case there are questions about the equipment-and said, "Let's go."

A few minutes later, a nurse walked into the OR and asked where Arndt was. Told he had stepped out for a few minutes, she said, "I bet he went to the bank." She had apparently overheard Arndt talking about it earlier. Troy and the rest of the OR staff were incredulous. They tried paging Arndt. Hospital administrators were notified. The decision was made to wait for Arndt to return and, if he didn't come in a timely manner, to try to find a spine surgeon from another hospital. Troy, who calls Arndt an excellent surgeon, says he never had any doubt that he would return.

And he did. Thirty-five minutes later. He admitted he had gone to the bank, and the OR staff said he seemed surprised that they would be upset with him. He finished the surgery about two hours later. Mount Auburn suspended Arndt's privileges the next day, and after an internal review process, the suspension was reported to the state medical licensing board.