Shortly after 6 p.m. on March 8, 2008, Manchester police received an anonymous tip that medical records had been dumped in a trash bin behind Lafayette Center, a nondescript strip mall straddling the suburbs of Ballwin and Manchester. When an officer arrived at the scene, he discovered nearly 500 white binders spilling out of three Dumpsters. The files contained the test results, Social Security numbers and other personal information for 466 patients of Dr. Alexander T. Kalk.
Police attempted to phone Kalk at his office on Old Ballas Road in Creve Coeur. When no one answered, officers searched the building and found no sign of trouble — and no trace of Kalk.
Many of the patient records were printed on letterhead from Missouri Baptist Medical Center. A general practitioner with a specialty in internal medicine, Kalk began an affiliation with the hospital in 2004, and many of his 2,000 patients had been referred to him through the facility.
When police contacted the hospital, Dr. John Krettek, vice president of medical affairs and chief medical officer, told them Kalk hadn't been on staff there for several months after being "forced to leave due to numerous complaints of misconduct." The hospital, according to police reports, agreed to store the records temporarily "to protect the interests of the patients" and await the arrival of federal investigators from the Department of Health and Human Services, which had been notified of a potential violation of patient privacy law.
In the meantime, Manchester authorities continued their search for the missing doctor. They spoke to his wife, who told them that they were in the midst of a bitter divorce. She said she and her children had been "hiding from her husband for several months because she fears for their safety," according to police reports.
She also stated that Kalk was suffering from a variety of mental disorders and "in the process of closing his medical practice due to his own personal and medical problems." The doctor, she further explained, had been staying with friends recently but "might be homeless."
Kalk's employees were equally baffled by their boss' mysterious disappearance. Yoshiko Lesinski, an office clerk, reported to work as usual, only to find that she and a half dozen coworkers had been locked out. She waited outside for a couple hours before giving up and returning home. "He didn't tell anyone he was leaving," Lesinski recalls in a recent interview. "I didn't know what happened. I just figured he didn't make it to office, but he just never returned."
Inexplicably, Kalk, in April 2008, a month after trashing his patients' charts, somehow managed to open a new practice less than half a mile away from his old one. It lasted only a few months.
Kalk was more than $1 million in debt, with his medical license in jeopardy, when he abruptly left the state in March of this year. He did not surface again until June 21, when he was arrested by Clayton police on suspicion of forging checks belonging to his estranged business partner.
Today, the 39-year-old Kalk lives with his older sister in Austin, Texas, where, he says, he's undergoing treatment for an undisclosed mental ailment. "It's a story of sadness and psychiatric problems," Kalk said of his struggles in a telephone interview last month. "I can only say I'm sorry for the things that happened when I was sick."
The first time authorities sensed something seriously amiss with Dr. Kalk came on December 12, 2006, when two of his employees notified Creve Coeur detective Paul Hornung that their paychecks bounced.
Recalling the case last month, the detective said he smelled trouble when he phoned Kalk about the charges. "He called back and left a voice mail that was just incomprehensible," Hornung says. "It was way out there. That was the first clue that I was dealing with somebody who wasn't all there. The more I learned about it, the worse it got."
Hornung then followed up with the disgruntled workers, who, along with complaining about the bad checks — totaling around $1,500 — proceeded to hurl dozens of other accusations at Kalk. In his police report, Hornung wrote that the two employees had recently quit their jobs because they "felt the doctor had either 'lost his mind' or 'was using drugs, which made him weirder than usual.'"
They also claimed Kalk was living in his medical office, "no longer showering or using personal hygiene," and that a "sub-contractor" made daily visits to the office to apply "make-up to Dr. Kalk's face, to hide bags due to lack of sleep."
Because of the peculiar behavior, Kalk's entire eighteen-person office staff — save for one person — had quit over the previous two weeks. Hornung questioned the lone remaining worker, who admitted Kalk "had been acting a little weird lately," but did not "feel that [Kalk] was a threat to himself or others."
When Hornung finally spoke to Kalk about the allegations, the doctor was furious. "Dr. Kalk was extremely offended that I would call a doctor as important as him, or that I would worry for his safety," he stated in his report. "Dr. Kalk showed no levels of comprehension [about] his entire office staff quitting on him. He believed all of them should work for free to show their dedication to the best doctor in the country and to care more about him than other materialistic things."
Later in his conversation with the physician, which Hornung described as "a continuous ramble," Kalk admitted that he didn't have the funds to cover the payroll checks. As for the criminal charges, Hornung noted, Kalk "instructed me on how to handle the investigation: his way, or not at all."
Three days later, on December 15, 2006, Hornung phoned the Missouri Board of Registration for the Healing Arts and the Bureau of Narcotics and Dangerous Drugs — the two state agencies that regulate physicians — to alert them to Kalk's agitated state. Within a week, both agencies began their own inquiries. When Kalk paid his debt to his employees on December 18, the bad-check charges were dropped, and Hornung closed the case.
"Legally, it had to be [the] end of my involvement," says Hornung, adding that he wished he could have helped Kalk seek treatment. "That's honestly why I did what I did. "
Growing up, Kalk led what one family friend calls a charmed life. "He was athletic, he was good-looking, very smart," Rob Zaleski remembers. "He was one of these kids who seemed to have it all."
The youngest of five children, Kalk was raised in Chicago's Hyde Park neighborhood. He went to the same University of Chicago private schools that President Obama's daughters would later attend. In high school he was editor of the school newspaper and captain of the basketball team. Even then, says his sister Debby Kalk, her brother was interested in medicine. "He worked in labs at a local university. He had a relationship there."
After high school, Kalk moved on to Tufts University in Massachusetts, studied biology and graduated cum laude. At Tufts University School of Medicine, he earned a spot in the Alpha Omega Alpha Honor Medical Society. He completed residencies in the surgery department at the University of California-San Diego School of Medicine and in the family medicine branch of Kaiser Permanente in San Diego.
During this time, Kalk's father suffered congestive heart failure. Despite working a busy schedule, Kalk insisted he be moved to San Diego so he could care for him. "His dad really went downhill in those last few years," Zaleski says. "He was not in a good way. [Alex] is a workaholic, but he devoted all of his free time to caring for his father."
Later, Kalk fell in love with a Missouri native, and the couple was married in St. Louis County in June 1997. In 2002 the couple moved to St. Louis. She wanted to be closer to her family, while he longed to start his own private medical practice.
"He disliked working for an HMO because he generally saw about 40 patients a day and got to spend limited time with each one," sister Samara Kalk writes in an e-mail. "Working for himself in St. Louis, he spent large amounts of time with each patient and answered their questions and responded to their problems by phone and e-mail without billing them for it. He is a very caring doctor."
For two years Kalk worked in the urgent care unit at St. Anthony's Medical Center. In late 2004 he began an affiliation with Missouri Baptist and opened his own office.
By 2005, according to divorce files, Kalk's marriage began to crumble. The couple separated in December 2005, and a month later, his wife filed for divorce.
"He was just in shock. He could not believe that this was happening to him," says older sister Debby. "It sent him careening off."
Julie Kalk, Dr. Kalk's ex-wife, declined an interview request for this story. Her maiden name, which she adopted after the divorce, is being withheld. Her Clayton attorney, Lisa Moore, did not respond to several requests for comment.
Thousands of pages of court filings from the lengthy divorce proceedings — in which Kalk represented himself, though he had no legal training — reveal a dispute that turned hostile as the estranged couple bickered over custody of their two young daughters. Kalk's actions, meanwhile — both in and out of the courtroom — became increasingly bizarre.
"Although the Court understands the stress of a divorce proceeding can cause individuals to become anxious and upset and act in ways that are not normal for them," a judge wrote in November 2007, "[Kalk's] behaviors have been so far outside anything this Court has ever seen that his actions are not explained simply by the stress of divorce."
On October 27, 2007, security guards at the Saint Louis Galleria noticed what appeared to be a man wandering the lower level of the mall clad in a wedding dress, veil, light-blue Crocs and a blond wig. It was Alex Kalk.
When asked to leave, Kalk became "loud and abusive," the guards informed Richmond Heights police. Later, after his arrest for disorderly conduct, he told police he was going to a wedding in costume and was at the mall to get his makeup done.
"It should be noted," the police report states, "Kalk was already wearing makeup."
"There are things I did due to a psychiatric condition," Kalk says regretfully of the incident. "It's certainly not typical of my life's behavior."
More than anything, adds Kalk, it was the sheer enmity of the divorce that launched his downward spiral.
Kalk was restricted to supervised visits with his children at the St. Louis County courthouse. According to court files, the same month Kalk was arrested at the Galleria, visits were suspended because of his "repeated verbal threats, hostility and aggressive behavior" toward courthouse staff.
Earlier in 2007 a judge ordered Kalk to be escorted around the building by a security guard at all times after he got into a heated argument outside the courtroom with his wife's attorney.
"The way I fought was a stupid way of fighting," Kalk says. "I was rebellious, and I defied authority and thought that somehow that would work. It was really a psychiatric problem that didn't allow me to see I was humiliating myself and everyone else."
On June 17, 2008, St. Louis County Circuit Court Judge Larry Kendrick ruled against Kalk. The doctor was granted monthly one-hour supervised visits with his children and ordered to pay more than $94,000 in total child support, despite his claims throughout the proceedings that he was penniless.
The decision sent Kalk into a rage, prompting him to fire off a blistering three-page letter to Kendrick, calling him "a disgrace to the memory of [his] mother" with "the morals of a Nazi." Using a black marker, he scribbled insults directed at the judge on several printouts of Wikipedia entries, including the ones for "tyrant," "fraud" and "alcoholic." Kalk then submitted them as court documents. Kendrick declined comment for this story.
Aside from the occasional bounced check and unpredictable behavior, some former employees and patients say Kalk's work was largely unaffected by the chaos in his life.
"We all did notice, but personally, to me, it never interfered with the work atmosphere," says Irma Osmancevic, who spent a year as Kalk's secretary. "I can't say anything but good things about him, because that's how it really was."
Patients say he was generous with his time and concerned with their troubles, both medical and personal. "As we knew him, he was so smart, so sharp," says Donna Etling. "I cannot believe he's doing all these things. He must have two sides. He was so kind, polite and helpful, and willing to go out of his way to find information. He gave us all the time in the world. This other side of him, I did not see."
Occasionally, though, Kalk's patients noticed something was awry. "I went to him one time and he tried to get me to buy my medication from him in cash," recalls Janie Richie. "When I didn't, he got really kind of hateful. After that, I never went back."
Court documents reveal that Kalk was in dire financial straits. A detailed income report he submitted to the court during the divorce shows his practice lost more than $90,000 in 2006. One of his biggest expenses, $56,000, was advertising.
Kalk frequently paid to appear in local publications, particularly Riverfront Times. Beyond promoting his business, many of the ads refer facetiously to his personal turmoil. In the September 7, 2006, edition of Riverfront Times, Kalk published a spoof of the Bobby Darin song "Mack the Knife," which ends with the line, "Look out ... old Kalky's back!!"
Another ad, from the October 19, 2006, edition of Riverfront Times, is designed to look like a strip-club promotion. It refers to his medical office as "Club 711 West," and the text over his picture beckons patients to "Come Party with One of the Smartest Doctors on the West Side, 7 Days a Week."
"You could probably say [my illness started] about the time I started running the ads in the RFT," Kalk says. "That was clearly abnormal."
In July 2007 RFT slapped him with a cease-and-desist order after he repeatedly plastered newsstands with magnets bearing the portrait of Che Guevara and the tag line: "A Revolutionary Doctor: alexanderKALKM.D."
In 2007 and 2008 collection agencies and medical-billing companies hounded him about his credit-card debt and unpaid bills. The state Department of Labor and Industrial Relations contacted him several times regarding back pay he owed to his employees, and the Internal Revenue Service garnished his wages after he failed to pay his taxes.
"Because I was ill, I was becoming less organized at collecting money from insurance companies," Kalk explains. "I'd also taken on too much responsibility of leases of medical equipment. The overhead for medical equipment costs was too high. It reached a point with zero money. No money at all."
Kalk filed for bankruptcy on April 15, 2009, claiming more than $1.1 million in liabilities and just $300 in total assets, in the form of a used TV set.
Jim Stewart arrived at Kalk's office on Old Ballas Road as a new patient on a fall day in 2006. He was 47 years old with dark gray hair slicked back across his head. He suffered from cerebral palsy and other ailments and was earning a living chauffeuring prostitutes.
"A girl would do out calls, and I would take them to the calls and wait and take them back. If they flipped a light or called, I'd go in and get them," Stewart recalled last month at his squalid Brentwood apartment, where he lives with his ailing mother and two cats. "I met Alex through a stripper and a hooker that I knew. I needed a doctor; I was sick. She said, 'He's great, he's one of my clients.'"
Asked if Stewart is telling the truth, Kalk hesitates before saying, "I don't want to say. I don't know. I guess so, yes, he's a driver."
Kalk and Stewart quickly forged a friendship that extended well beyond normal doctor-patient boundaries. On September 28, 2006, Kalk says he crashed his Honda Accord and couldn't remember where he left the vehicle. He then reported the car stolen and asked Stewart to try to locate it for him.
"I had NyQuil, and I was driving with a 102-degree fever," Kalk recounts. "Instead of staying home and not working, I tried to drive to work. I basically had a problem where I hit tires against curb and left it at a gas station. Then the car got towed away. Jim was able to find the car."
Kalk celebrated the incident by placing an ad in Riverfront Times in October 2006. The poster for the movie Dude, Where's My Car? was altered to include his and Stewart's faces over those of the actors.
In January 2007 Stewart was arrested in Granite City, Illinois, for assaulting his brother with pepper spray. Kalk brought Stewart a prescription drug, the painkiller oxycodone, to the jail and helped bail him out. "It's not typical for a doctor to bail people out of jail," Kalk concedes. "My illness had me thinking that was the right thing to do, that he'd be suffering without medication in jail."
In September 2007, a year after they met, Stewart and Kalk decided to go into business together and registered a corporation called Metropolitan Physicians Group with the Missouri Secretary of State. Stewart was listed as the chief officer and says he bankrolled Kalk's move to a new office on Studt Avenue in Creve Coeur with more than $40,000 in personal loans. He refuses to specify where the money came from.
"I'm connected to certain things I can't discuss," Stewart says cryptically. "Alex knew where I got the money. It was something I had put away for years. I thought it was a good, legitimate investment. A doctor's office, if things are run right, makes money."
Says Kalk: "There was a short period of months where we worked together in practice. I would see patients, and he helped with billing and collections."
The partnership soon soured. The final straw, Stewart says, came when he learned that Kalk had set up a separate company — seven months earlier, in February 2007 — called Project Change Lives with a man named John Tiller.
"It was an idea to have a help group for people who were having trouble with addictions," Kalk explains. "We were never able to get it off the ground. It never took in any money."
Tiller was only a few years removed from setting up a company called "The Civil Rights Defense Legal Team," which swindled prison inmates and their families by charging them for fraudulent legal advice (see "Serial Tiller," Bruce Rushton, July 24, 2002). Kalk says Tiller's parents were among his patients and he wasn't familiar with his business partner's shady past, which includes 27 felony convictions.
"I knew people in prison who Tiller scammed money off of," Stewart says. "When I heard [Alex] was associating with him I said, 'No way.' I made him dissolve the company."
According to Secretary of State records, Project Change Lives was formally disbanded in November 2007. Tiller could not be reached for comment.
Kalk and Stewart's partnership lasted until March 2008, when Kalk trashed his patients' medical charts in Manchester. Stewart provided Manchester and Creve Coeur police reports to Riverfront Times.
"We had 2,000-some patients," Stewart says. "They only found 466 records. What happened to the other 1,500? What if that was your Social Security number and D.O.B. and all your personal information floating around out there?"
Last month Stewart set up a website, www.mpg2009.org, ostensibly to expose Kalk and notify former patients about their missing records. Stewart also uses the site to publish sensational tales about Kalk's alleged exploits with prostitutes and strippers.
"After everything I've done for this guy, to screw me over the way he did, there is no way in hell I'm going to sit back and let him get away with it," Stewart says. "He'll go to the next person and do the same thing."
Kalk insists Stewart is a deranged, disreputable ex-con out to "torch the ashes of my life." "It's not against the law for people to go to east-side clubs. This guy happened to be a friend who knew my personal life," Kalk says. "When I met him I didn't know his whole past. He was just a guy who was offering help to me when I was pretty alone and needed some help."
Stewart admits his criminal record is lengthy. He claims — and Kalk believes him — to be the son of a Mafia hit man who worked for St. Louis' Giordano crime family. At his Brentwood apartment, Stewart goes so far as to describe how, at the age of nineteen, he shot his father to death in a domestic dispute after his dad supposedly came after him with a knife. Stewart says it was self-defense, and the jury acquitted him.
"I've been arrested for a lot of things," Stewart says, "everything from drinking in public to second-degree murder. I do have a past. I'm loud and crude. I'm not as debonair, and I don't have as much education as the Kalk family. But it doesn't necessarily make me a bad person. Nobody took advantage of poor Dr. Kalk. It was the other way around."
Despite the dumped medical records, the encounters with police and the allegations of professional misconduct, Kalk continued to practice medicine virtually unfettered.
By the time he left for Texas in March 2009, medical regulators had been investigating Kalk for nearly three years. Still, he was somehow able to obtain a new medical license in Illinois during this time, and even with all of his indiscretions, he remains a licensed physician in Illinois with a clean record.
"His case kind of dragged out over the course of time," says Michael Boeger, administrator of the Missouri Bureau of Narcotics and Dangerous Drugs (BNDD). "He was on probation, and we didn't have any more issues again. Next thing you know, I'm reading about him in the paper, and he's fleeing the state."
According to Creve Coeur police reports, a BNDD inspector was "thrown out of the office" when he asked to see Kalk's onsite pharmacy on December 19, 2006. A week later, Kalk summoned the inspector back, and he was cited for a half dozen record-keeping violations.
"Due to a lack of receipt records, inventories and dispensing records," the BNDD found, "it was not possible to conduct an audit to determine if any controlled substances were missing."
But before the BNDD could punish him for the infractions, Kalk bounced a check to renew his medical license, and he lost the right to prescribe painkillers and other controlled substances. Boeger says it is rare for a doctor to work under such circumstances. "It's a liability. No insurance company will work with them. No hospital will give them privileges."
Yet in November 2007, Kalk was granted an Illinois medical license and full drug clearance by the state's pharmacy board. Susan Hofer, a spokeswoman for the Illinois Division of Professional Regulation, says there was no way of knowing about Kalk's troubles in Missouri. "Until there's a final action taken, they don't notify the association [of state medical boards]."
Kalk also continued his affiliation with Missouri Baptist Medical Center until December 2007. Hospital spokeswoman Mary Beck declined an interview request and refused to specify why he was dismissed by the facility.
The Missouri Board of Registration for the Healing Arts was last to act. Kalk wasn't formally disciplined until December 2008, when the state charged him with six counts of misconduct, including sending threatening e-mails to a medical billing company manager and inappropriately touching a female patient.
"Several allegations and different accounts came to us at different times. When a new allegation of misconduct comes in, we go and investigate," says Tina Steinman, the agency's executive director, explaining the delay. "You only have one opportunity [to revoke the license]. We have to make sure we have all the evidence we need."
Kalk signed a settlement allowing him to "voluntarily surrender" his Missouri medical license rather than have it revoked, effective July 1, 2009. Susan Hofer says that distinction is what has allowed him to remain unscathed in Illinois.
"We frequently open an investigation and take action based on the actions of another state," Hofer says. "The issue with voluntary surrender is it doesn't trigger the same kind of urgency as a revoked or suspended license. It's not clear that it's a disciplinary issue."
Medical licensing experts say such oversights are common because each state's system is unique, many are underfunded, and there's often miscommunication between the bureaucracies.
"They don't have staff to do adequate monitoring, let alone speedy resolution of cases," says Tim Greaney, director of the Center for Health Law Studies at Saint Louis University. "Those delays can hurt the public. An eighteen-month investigation can really cause harm during the pending investigation."
Kenneth Vuylsteke, who chairs the medical legal committee for the city's bar association and represents patients in malpractice claims, believes Missouri's system is biased in favor of physicians.
"Their whole theory is, 'We have a lot invested in their training; with the doctors' education, they have so much to offer,'" he says. "Doctors are valuable commodities, but they're also in a position to cause great harm if they don't know what they're doing. I think the Board of Healing Arts in Missouri and in other states needs to take a second look at what they're doing and try to protect patients instead of the licenses of physicians."
"Missouri definitely has due process built in," counters Steinman. "It can be good, it can be bad — depending on what side you're on."
Dr. Paula Clayton, medical director of the American Foundation for Suicide Prevention, says mental illness is a widespread problem among doctors. "Ninety percent of people who die by suicide have mental disorders," she says. "The studies are unequivocal: Physicians have the highest suicide rate of any profession in the Western world."
Clayton attributes the deaths to the fact that doctors often refuse to seek treatment for their conditions, fearing that it will hurt their careers. Kalk, though, says he had no fear of repercussions. "It's not a question of concealing, it's a question of not realizing," he says. "It just took time for friends and family to convince me I was ill."
Kalk declines to reveal his diagnosis, but Bruce Harry, an associate professor of clinical psychiatry at the University of Missouri, says he displays virtually all the symptoms of bipolar disorder.
Also called manic-depressive disorder, the illness causes extreme mood swings, reckless spending, severe insomnia and a tendency to "do things that many around them would regard as morally objectionable." "It's often tragic," Harry says. "It can be very disruptive, not just to an individual's life, but to everybody around them."
It's not surprising, Harry adds, that Kalk refused treatment for so long. "The highs from the manic part of manic-depressive sometimes feel so great it's hard to give that up, especially for someone who's down and out or hard on their luck. They feel like they are literally on top of the world."
But when his family finally came to his rescue, they were shocked at what they found. "He was not functioning," Debby Kalk says. "The bottom line is, when he came to Austin he was practically comatose."
Now Kalk believes his disease is "in remission," and on May 31, 2009, he applied for a Texas medical license. It can take up to a year to process the applications, says Jill Wiggins, a spokeswoman for the Texas Medical Board. Wiggins adds that Kalk's mental condition does not necessarily preclude him from getting the license.
"I do love medicine and helping people," Kalk says. "I just need assistance and ongoing support to make sure I don't make mistakes again."
He may not get that second chance. A Manchester police report indicates he is still under investigation by the Department of Health and Human Services for disposing of his patients' medical records. A spokesman for the department declined to confirm or deny any details about the case.
There's also a forgery case pending in Clayton. Pressing those charges is Kalk's nemesis, Jim Stewart. Stewart claims he can prove Kalk forged his signature on several thousand dollars worth of personal checks. "I'm not being vindictive," Stewart says of the charges. "I just want my money back."
Clayton police declined to comment. Records show a warrant was issued for Kalk's arrest on June 1, and he was picked up on June 21 when he returned to St. Louis for his monthly visit with his daughters. If charged and convicted, Kalk faces up to seven years in prison and a $5,000 fine.
"It's unfounded; it's completely untrue," Kalk says of Stewart's allegation. "I know how dangerous he can be, so I'd never think of crossing him. I'd never steal money from him or checks from him. I think he would kill me."
Says Stewart: "I don't have much of a social life. The friends I got I can count on one hand and with fingers left over," he says. "I really liked Alex. If it had been anyone else, they'd be dead."