NEW LONDON, N.H. — The voice sounded like a child crying. It seemed to follow Dr. Anna Konopka around, echoing through the rooms of her house, audible everywhere. She thought it might be coming from the neighbors’ — but no, it was clearly inside her own walls. “Mrs. Ghost,” she called it.

Of course, she didn’t tell anyone. They would think she was unstable. She was a primary care doctor, treating both children and adults. It wouldn’t do for people to hear that she was bothered by ghosts. But finally, one night around midnight, as she was getting ready for bed — there it was, in her room, a few feet away, sobbing. “I said, ‘All right, what do you want from me? I will … pray for you for three days. Let me know if it is enough,’” Konopka recalled. “And she stopped crying. She never followed me again.”

Konopka takes that same in-your-face approach to everything. As a high schooler in 1940s Poland, when all her classmates dug out their rattiest, most proletarian clothes for the Communist Party meeting, she wore her fur coat. More recently, when she heard that doctors at the local hospital had lodged an official complaint about her, she drove over to find out their motives herself. And in early November, after she voluntarily gave up her license so that the New Hampshire Board of Medicine wouldn’t suspend it, she went to court so she could get it back.

She is 84, and has become a symbol — if an eccentric one — for a kind of physician autonomy that is almost extinct in our era of highly regulated medical care. She works alone in a cottage next door to her house, with no receptionist, no practice administrator, no nurses, no N.P.s, no P.A.s, no hospital affiliations. She has a computer in her kitchen, but she doesn’t use it much. She keeps her files in a cabinet in her office, page upon handwritten page of careful, old-world lettering. She does not take insurance, instead charging patients $50 cash for each office visit.

Against her will, though, she has also become the face of a related debate about how best to ensure that older doctors are providing the most up-to-date care. “This is one of the big questions in the field of medical education: What should we be requiring of older doctors in terms of demonstrating the maintenance of the skill required to practice medicine?” said Dr. Anupam Jena, a health economist at Harvard and a physician at Massachusetts General Hospital.

Like drivers, doctors can be a menace at any age. Some might be the best practitioners around at 75, while others might be malpractice magnets before they’re 40. Yet many bristle at any talk of increased oversight — and Konopka is even more defiant than most.

“You are with the system, or you are out of the system,” she said. “It’s like communism: If you are out of the system you are treated as an enemy. … I am practicing traditional medical arts. They manage the patient and I treat the patient. I’m not going to compromise.”

Dr. Anna Konopka
The entrance to the cottage that serves as Konopka’s three-room office. Cheryl Senter for STAT

To see Konopka, you drive past a trout-filled lake, along a country road, until you see a mailbox with a little sign that reads “A. M. Konopka, M.D.” Her black labradoodle greets you in the yard with growls, and then nuzzles you with his head.

Inside, the place feels at once quaint and cosmopolitan, like a professor’s mountain retreat. When she reaches for the otoscope or stethoscope in her examining room, Konopka looks out at raspberry canes and black currant branches giving way to forest. The air smells distinctly of tongue depressors. In her consultation room, your eye is drawn to a book called “Urine Under the Microscope,” and to a toy piano, bright as a Froot Loop, resting on the “Physicians’ Desk Reference,” its binding a deep, serious blue. The walls are filled with Polish paraphernalia, Catholic imagery, and, most prominently, medical degrees and certificates in frames.

Those documents of competency weren’t easy for Konopka to get. When she was born, in 1933, her father was a judge in the small city of Rzeszow, about 60 miles from Ukraine in one direction and Slovakia in the other. But by the time she was graduating high school, her family had moved to Krakow, the country was aligned with the Soviet Union, and her family had lost almost everything except their reputation as members of the gentry.

“They wanted to recruit me for the Communist Party. I told them that I am not interested because my moral standards and their moral standards — they are two different standards,” she said. “Therefore they put me on the blacklist.”

Dr. Anna Konopka
A photo of Konopka taken when she first arrived to the United States from Krakow, Poland. Cheryl Senter for STAT
Dr. Anna Konopka
Konopka laughs after playing a tune on her piano at home in New London. Cheryl Senter for STAT

No Polish medical school would accept her after that. But her dressmaker made a prediction: Don’t be upset, she said. If you wait long enough, you’ll get in.

Konopka smiles at the memory. It was a good prediction, she said. She waited three years, cleaning out laboratories, practicing piano. Then, after Joseph Stalin died in 1953, the Polish government became a little more forgiving — an extension of the Khrushchev Thaw — and Konopka started medical school. “My professor from internal medicine was always telling us, ‘You have to know medicine to take care of people in jungle or desert,’” she said. “I can really take care of any sickness.”

“This is one of the big questions in the field of medical education: What should we be requiring of older doctors … to practice medicine?”

Dr. Anupam Jena, Massachusetts General Hospital

Then, when she came to the United States in 1961, she had to prove her competency again, writing exams, doing residencies and internships, getting licensed in two different states.

The paperwork was a pain, and some of the hospitals that employed her were in rough parts of New York, but practice-wise, she doesn’t remember any problems. She saw patients at St. Catherine’s Hospital in Brooklyn, and Misericordia Hospital in the Bronx, and Jersey City Medical Center, in New Jersey, to name a few. Eventually, she moved to New Hampshire, where the mountain climate reminded her of home. She worked part-time for the Department of Corrections, and examined families in the green-shuttered office next to her house.

Dr. Anna Konopka
Konopka takes a call at her kitchen table. Cheryl Senter for STAT

The complaints, she said, began three years ago: complaints about her prescribing practices, about how and when she referred patients, about her diagnoses. She said they came from other local providers.

The one case that has been made public came to a head in September 2014. A 7-year-old patient Konopka had been treating for years allegedly came in with a heartbeat that was too fast and strangely patterned. According to documents from the New Hampshire Board of Medicine, the doctor suspected this was a side effect of an asthma medication she’d prescribed, so she changed the prescription. But the board claims that she failed to do certain follow-up tests or refer the child to a cardiologist — and that she had not attempted to treat the patient with an inhaled steroid.

She rejects the idea that she has done anything wrong. “I treated the patient here in my office and in three days the child was jumping around and was healthy,” she said, quivering. “Therefore, how they can criticize me? I know medicine, I know pharmacology, I know everything. I have been treating people for over 55 years the same way and nobody died from respiratory problems or cardiac problems of any age.”

The board disagreed, and tried to arrange a hearing in 2016. It was rescheduled twice. Finally, this past May, Konopka consented to 14 hours of continuing medical education about asthma, pharmacology, and cardiology, in addition to the minimum required to renew a physician’s license.

But then Konopka was informed that the board had enough concerning evidence about her abilities as a physician to enact an emergency suspension of her license on Sept. 13. Instead of losing her ability to see patients — at least temporarily — within days, she decided to voluntarily surrender her license, which would give her about a month to wrap up her practice.

Now, she is trying to get her license back. She wants to figure out who is bringing what she calls this “fake charge” against her, and what their true motive is. She wonders if it has to do with her anti-abortion picketing in front of Planned Parenthood, or her lack of electronic records, or the fact that she registered for but does not use the state’s Prescription Drug Monitoring Program, which is a way to curb opioid abuse. She also believes that the local hospital has been trying to steal her patients for years.

Or, she went on, it might be her age that led to the board’s disciplinary actions. “They got the idea that I am old enough to be forced to retire,” she said. “But I don’t want to retire. It doesn’t matter my chronological age: I can work right now for another 10 years.”

“I don’t want to retire. It doesn’t matter my chronological age: I can work right now for another 10 years.”

Dr. Anna Konopka

There has been plenty of controversy about how to keep doctors plugged in to the latest debates and constant updates in medical knowledge. In 2015, for instance, physicians revolted against the American Board of Internal Medicine’s proposal for more stringent mid-career testing, complaining it was burdensome, expensive, and irrelevant to patient care. That’s still a point of contention — especially for those who might be nearing the age of retirement.

“There is no point in designing an intervention that is cumbersome to physicians if we have no proof that it improves their outcomes,” said Jena, of Mass. General. “These things are big enough and important enough for patients that we should be trying to generate high-quality evidence.”

Jena has done research looking at how the age of a treating physician in hospitals correlates to inpatient outcomes. His team found that older internists tend to have higher mortality among their patients. But that finding does not tell you anything about a particular physician; it just shows that doctors and their employers as a whole need to consider how to keep practitioners sharp and up to date.

In Konopka’s case, it’s hard to know how seriously to take her conjectures about why her competency is being questioned. The medical board declined to comment beyond the documents that have been made public.

“Sometimes, as in any other industry, decisions about physician termination are made in good faith, and sometimes physicians have brought and won lawsuits for antitrust violation, breach of contract, or if you’re dealing with a state agency, a failure of due process,” said Judith Feinberg Albright, a health care attorney who has no involvement in the Konopka case. She added that it might be harder and costlier for a physician in solo practice to engage in corrective action than it would be if he or she had the support of administrators and partners.

Some of Konopka’s patients — whose phone numbers she provided to STAT — have not yet taken on other primary care providers, hoping that she will get her license back. Cheryl Hodgdon, a 56-year-old dog trainer from Croydon has not had such a strong attachment to a physician since she stopped being treated by the doctor who delivered her. She had an appointment with Konopka once a month. “She believes, like a lot of old doctors from Europe, that the less medication you take, the better. I love that about her,” said Hodgdon.

Hodgdon also loved the recipe for a honey-and-garlic elixir that Konopka gave her for a cold last winter. She loves that Konopka always picks up her phone, no matter what. She loves that Konopka will send patients to get Olbas Herbal Remedies from the pharmacy. And she agrees with Konopka that American-trained doctors might not want that kind of practitioner in the area.

As Hodgdon put it, “She’s different. She’s on her own. She’s not controlled by any hospital; she can talk to you for as long as you need her to.”

Dr. Anna Konopka
Tools of the trade and porcelain keepsakes in Konopka’s examination room. Cheryl Senter for STAT

The wooden chair in Konopka’s consultation room used to be reserved for patients. Now, it is often occupied by journalists. They come with recording devices and cameras and computers, snapping pictures, asking for documents.

But she said that her patients, too, are calling and visiting and writing letters. “It is of course very painful because the patients are coming to my office, and calling over the phone, and crying, and waiting for me, and I cannot do anything about it,” she said. “I cannot refer to any doctors because they don’t want them.”

That was the argument she made in Merrimack County Superior Court in Concord, N.H., three weeks ago. She was asking for an emergency injunction to get her license back, because her patients have too many “multiple chronic problems” for the “ACA system” to handle. She added that they cannot afford care from anyone in the area but her. The judge said he would take the matter under advisement.

Dr. Anna Konopka
Konopka speaks in her own defense during the Nov. 3, 2017, court hearing seeking an injunction to get back her medical license. Geoff Forester/The Concord Monitor via AP

“I am in limbo,” she said the following week. For a while after she lost her license, she was still taking her three customary swims every day, driving to Lake Sunapee or Pleasant Lake, doing a quarter-mile at a time. But she did her last laps of the season on Oct. 23, when the water temperature, she said, was 61 degrees. She still takes her dog out to wooded back roads every day. She has knee problems, so she can’t walk him anymore, but she lets him out of the car and motors very slowly through the autumn trees, with the dog padding dutifully behind.

She refuses to just retire, though, or to wait passively for a verdict. A few weeks after her temporary hearing, she’d had no news, and she was preparing for a confrontation, as she had with her ghost.

“Friday I am planning to go to the superior court,” she said. “I have some kind of project.” She wouldn’t give any details on what she was hoping to do. “I am keeping quiet. If you are in war, you have to be careful about your enemies. I am in a war with the people from the system, therefore I have to be careful with what I am doing — I don’t want them to come with a counterattack.”

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  • There are a lot of issues with the healthcare system in this country, but, in this case, these issues are being used as a smoke screen. The care this physician provided was “problematic” on a number of fronts. As suggested by VTDoc, the full story is not being told here.

    • Most of the commenters here seem to have fastened onto the emotional aspects of the narrative and are either ignoring the facts or have dismissed them as unproven or unimportant. Maybe it’s a sign of the times we live in; I don’t know.

      This story could just as easily have been spun a different way: “Amid mounting allegations of unsafe care, NH Medical Practice Board suspends license of 85-year-old doctor.” Would there have been a different response? This situation could not have just sprung up overnight. Five allegations (that we know of) against one doctor in a town of 4,000 is a lot. I’m pretty sure this story is just the tip of the iceberg.

  • We need more doctors like her. If complaints come from patients, take them seriously. If from other doctors, not so much. I can’t tell you how many times I’ve had unintentional but serious harm from doctors practicing guidelines, from FDA approved medications, and FDA approved dental and medical devices. They are generally fine for acute and commonly recognized infectious diseases. I’ll take a skilled and respected complementary, functional and/or integrative physician and a biologic dentist for chronic and unexplained health conditions any day. They work to get to the bottom of them and correct underlying problems and imbalances.

  • The law in both NH and VT (and all NE states now) is that, if one prescribes controlled substances like oxycodone, it is required that the practitioner check the Prescription monitoring system to make sure the patient in question is not getting prescriptions from multiple providers. Dr Konopka does not. She also has been demonstrated to have a “liberal” approach to prescribing these drugs in that she is not careful about what she prescribes or to whom. She has a reputation for being “an easy touch”. The current draconian attitudes and practices around opioid medications are troubling and problematic. At the same time, it is practices like Dr Konopka’s that have helped fuel the problem in the first place. That is the part of the story that she doesn’t recognize nor do the journalists who carry her torch dig up.

    • You know this about Dr. Konopka, how? Her patients are local people who have been going to her for many years. One of her patients stated that she is a doctor who tends not to prescribe medications, but prefers to have the body heal itself. She has not fueled the Opioid problems. She has done nothing wrong, other than continue to practice (until she was stopped). Let her practice!

    • I have discovered a number of my patients getting prescriptions from her as well as me, and when I called her on it she was oblivious.
      Since she has stopped prescribing other doctors have been inundated with patients on high doses of opioids who should not be.
      One should know whereof one speaks before mounting one’s high horse….

    • Can you reference the data that you are referring to – Objective evidence that this physician is inappropriately “liberal” in prescribing opioid medications? I am a strong advocate of electronic health records and clinical data integration. But I wonder if there is truth to allegations that she inappropriately prescribes opioid medications, or if those allegations are just part of an attack by competitors who work with larger practices and the region’s medical center.

  • Terrific article. The proof is in the pudding. Dr. Konopka did no harm and has done a lot of good. That is the essence of practining good medicine. The medical board should apply the rule to itself and back off.

  • I was with her until I got to the quote about how she’d never had a patient die from respiratory or cardiac problems. That was a huge red flag. The statement alone means she either a) has never had a patient with serious respiratory or cardiac problems and thus would not be able to recognize them b) is a liar or c) has had plenty of patients with serious respiratory and cardiac problems but has not recognized them and did not follow up on the outcomes/did not treat the patients and they presented to the emergency room in critical condition where they were treated. Furthermore using “no patients have died from this in my care” as a defense shows a gross misunderstanding of medicine and how it’s practiced. Anyone who works in medicine knows that patients die sometimes, that sometimes providers do everything they can and patients die anyways. It’s an expected reality when it comes to medicine not a defense for poor practice.

  • Healthcare needs more Doctors like Dr. K Who are able to spend enough time with their patients to provide proper treatment at a reasonable cost, whose goal is to minimize not maximize the amount of medications prescribed and who has knowledge of basic herbal remedies that can be more effective than medications. I haven’t seen the study but I’m sure it exists that correlates increasing prescriptions with decreasing time with patients.

  • There seems to be nothing wrong with the Md’s approach to medicine, she is practicing medicine how it use to be done before technology took over. Most dysfunction in the body can be rooted out by physical assessment of the patient and listening to the patient’s tell you how they are feeling within their own body. She is also cost conscious which in today’s medical model of for profit and not for patient health is unsettling to the hospital’s bottom line, their profit margin.

    Sounds to me like they are using her age to criminalize her because she is practicing medicine as it was meant to be done. It would be interesting to hear how this woman’s case pans out.

  • While reading this article and considering whether I would trust this doctor to give good care I came to the paragraph with the chilling bit of information that she pickets against abortion in front of Planned Parenthood. Any doctor who tries to bully and intimidate women seeking abortions has her own religious agenda in mind to the detriment of the health of her female patients.
    That and the fact that she refuses to use electronic records sealed the question for me.
    This woman is not qualified to provide adequate medical care.

    • Being morally opposed to abortion is not mutually exclusive to being able to provide medical diagnosis and treatment. Unless of course you were going to her for an abortion. Which you wouldn’t.

    • Being against abortion, or having a moral opinion on anything, is not a “religious agenda”. Valuing human life at a different point of development than that at which you value human life is a personal value which a doctor or any human is entitled to hold, as are religious beliefs.

      Considering the slowdown that is bound to ensue if net neutrality is extinguished as planned, she may well be ahead of the game by refusing to use electronic records.

      Her ability, as reported, to assess and treat patients based on their symptoms exceeds the level of competence of more recent medical school graduates. I’m not sure how that constitutes a lack of qualification in your eyes. It sounds more like you don’t like her because she has opinions which differ from yours.

    • My opinions on the issue of Choice is different than Dr. K’s. However, I would love to have her as my doctor. I have had doctors who have been pro and anti choice. That matters not, to me. Are they good, thinking physicians? That’s what matters to me.

    • It’s not because she is anti choice that I see a problem. It’s because she actively seeks to intimidate women seeking abortions and shut down clinics that offer them.
      I think a woman seeking help from her who discovered she was pregnant and didn’t want to be would not receive good care from this doctor. I believe the doctor would abuse her power to prevent her patient from getting an abortion.

  • What’s painful about this story is how little the physicians castigating Dr Konopka know about the art of healing. My city (Chicago) has dozens of so-called ‘alternative practitioners’ and their patients generally do quite well. Virtually all of these patients have a PCP whom they’ll use in a pinch. Chicago also has mega medical centers, like Northwestern, in which patients undergo vast amounts of often inappropriate diagnostic tests and procedures, are flipped from specialist to specialist, and emerge from a veritable rabbit hole of health care with physician induced PTSD, swallowing a platterful of dubiously effective meds and financially impoverished to boot.

  • A doctor told me that she was having to carry 3,000 patients in order to satisfy the powers that be which meant very fast appointments. She said that was not what she had gone into medicine for so she changed to a different platform.

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