October 5, 2008 - When Ron Wolff, a disabled Army veteran, walked into the examining room at the VA Hospital in Miami three years ago, he says he found it unsettling that nurse practitioner Andres Irizarry began talking about how he enjoyed going to sadomasochism conventions.

As he later stated in sworn testimony, Wolff says the nurse ordered him to drop his pants and began fondling him in a way that felt distinctly sexual, not medical.

Robert Pelier, Irizarry's attorney, says Wolff's accusation is "absolutely untrue."

For almost three years, Wolff tried to complain about the incident, first to the U.S. Department of Veterans Affairs, then to the Florida Department of Health.

His case is another example of how the healthcare system, particularly in Florida, seems sometimes to move extremely slowly in investigating its professionals.

A spokeswoman for the state Health Department told The Miami Herald that investigators "must follow due process against a practitioner." The system is designed to protect doctors' reputations until disciplinary action is taken.

In April, Public Citizen reported Florida ranked No. 31 among the states for serious actions per 1,000 physicians.

Fourteen months ago, The Miami Herald reported that a hospital had removed heart surgeon Alex Zakharia from its staff after "numerous patient deaths" and that Zakharia had admitted he suffered from worsening memory loss. The surgeon's disciplinary case is still slowly moving through the state system. He retains a clear/active license.

In the VA case, attorney Pelier said his client didn't want to talk to The Herald, but had cooperated fully with the investigation and had an excellent job record at the VA. Pelier said the VA has told him of no other accusations.

However, a VA investigation, which began more than two years after Wolff first complained, found that at least two other patients and an intern had made similar complaints about Irizarry, going back to the early 1990s.

The VA now says it was a mistake that The Miami Herald obtained the VA investigative report. Written in July, the report concluded there had been "a long-standing pattern of inappropriate behavior to vulnerable individuals by Mr. Andres Irizarry dating back to at least 1991." It recommended the hospital consider some kind of disciplinary action.

Wolff obtained that report from the VA after repeated requests, and he gave a copy to The Herald.

Susan Ward, spokeswoman for the Miami VA, said: "The investigation is still ongoing," and that's why it hadn't been shown to Irizarry's lawyer.

The spokeswoman said Irizarry continues to be employed by the hospital, but he "has been taken out of patient care while the administration is looking at the recommendations the panel made. Appropriate steps were taken."

"Why didn't the VA do anything before?" asks Tonia Werner, a forensic psychiatrist at the University of Florida who specializes in legal issues involving behavior, including sexual abuse. "Why are there four reports and he's still there?"

Irizarry retains a clear/active license in Florida as an advanced nurse practitioner.

Wolff says he complained to the state several months ago but an investigator didn't see him until Wednesday.

Raised in Iowa, Wolff joined the Army when he was 17. He has been in the VA system for years, with a life-threatening illness that he asks not be revealed, plus high blood pressure, diabetes, heart arrhythmia and anxiety and panic disorders.

Completely disabled because of his medical conditions, he gets $1,502 a month from the VA and Social Security. He receives all his care and medications from the VA without charge.

In December 2005, after moving here from San Diego, Wolff went to the Miami Veterans' Administration Hospital, where he was seen by Irizarry. As he later testified under oath: "The first step to this physical examination was laying on my back on the examination table and lowering my jeans . . . . and my underwear, and him touching my penis. And it went on for a while. . . .

"By the time it was over, any ambiguity as to what was going on had left my mind that this was not a physical examination, that it was something else."

In an interview, Wolff said: "It seemed to go on forever. I was afraid to say anything. I was out of my meds. I needed my meds. It was like a life-or-death situation."

Werner, the UF psychiatrist, says many patients are reluctant to report inappropriate behavior by healthcare professionals. 'The biggest factor is people's trust in healthcare in general. `Do what the doctor says.' And that same thing would apply to an advanced nurse practitioner."

Saying he hated to return to the Miami VA Hospital, Wolff moved back to San Diego. He says a friend urged him to complain. 'He told me: `If this happened to you, maybe it has happened to other people, and that there was a responsibility to speak up.' "

Wolff says he saw a VA patient advocate in San Diego. He later testified: "He told me that I needed to understand the consequences of going forward with a complaint of this nature. And the consequences could possibly be that it's going to be he said/he said, and you won't get anywhere. . . . And the consequences might be that your benefits will be jeopardized."

Cindy Butler, a VA spokeswoman in San Diego, says the Patient Advocate's program "has no record of ever seeing" Wolff.

Wolff decided not to pursue his complaint, but in July 2007, he responded to a mail survey sent out by University of Miami President Donna Shalala and former U.S. Sen. Bob Dole, who had been appointed by President Bush to look into the VA system after a scathing Washington Post series on wretched conditions at the Walter Reed Army Medical Center.

Wolff detailed what happened in Miami and at the Patient Advocate's office in San Diego. He then got a call from two California VA administrators who questioned him about the patient advocate but not about the Miami incident.

One California supervisor called him back and said she had counseled the Patient Advocate employee who talked to Wolff and told him his behavior was not appropriate, Wolff says. But, he says, the supervisors showed no interest in the nurse practitioner's behavior.

Last year, having run up huge credit card debts, Wolff moved back to South Florida, where he believes he can live more cheaply. He eventually filed for bankruptcy, listing $400,000 in debts. He reported that he gets $1,500 monthly in disability benefits, which doesn't cover his $1,900 monthly expenses, most of which go for a one-bedroom condominium unit in Miami Beach.

In November, Wolff complained to the VA inspector general in an e-mail: "I am more than willing to be polygraphed about any of these issues. . . . I believe the VA should compensate me for this misconduct."

VA records show the complaint was forwarded to the Miami hospital three months later. Another three months went by before the Miami VA contacted him. In June, he testified before a three-member Administrative Investigative Board. In July, the board issued a six-page memo.

The copy sent to Wolff is redacted, with the names of other patients and employees blacked out. It reports that a person Irizarry worked with from 1991 to 1994 "felt sexually pressured by Mr. Irizarry on two occasions." Someone complained to the chief of psychology but "no appropriate action was taken," the report states.

Sometime "prior to 2006," another patient made a complaint about "inappropriate touching during a physical exam." Irizarry was given "verbal counseling" about such behavior, the report said.

A third patient, who saw Irizarry at the Oakland Park VA clinic four times, complained that he was "feeling sexually pressured" by the nurse practitioner during medical examinations.

Werner, the UF psychiatrist, says that, given how reluctant patients are to come forward, "It's possible there are many more victims out there."

The board recommended that "Irizarry be referred to Human Resources for appropriate disciplinary action. Should the Miami Healthcare System continue to employ Mr. Irizarry, he will . . . . have no patient contact."

Three months later, the VA is still deciding what to do with him.

On Tuesday, a week after The Herald asked the VA about the case, Wolff said he was visited by two investigators from the VA's Office of Inspector General Criminal Investigations Division.

Now 60, Wolff remains upset about the slowness of the investigation. 'The VA has become as much a part of the problem as the incident itself. . . . There are signs all over VA hospitals -- `We Put Patients First' -- but I didn't see anything like that."