On a Saturday morning in April, with spring flowers blooming outside her Helena home, Theresa Cardiello paged through the stack of medical records on her dining room table. They were flecked with orange and pink sticky notes bearing scribbled stars and question marks — her annotated attempts to make sense of the unimaginable.
Her late husband had been dead for 19 years. Theresa requested his case file from the local hospital in January, after ProPublica caused by a high-profile oncologist who had practiced in Helena for 24 years. Theresa wanted to understand if her longtime partner had suffered from something more than a rare blood disorder and a fatal case of pneumonia.
For years, her family had grieved the death, at age 46, of Frank Cardiello, a nurse and father of four. His adult daughter, Rachel, a singer-songwriter, on a 2013 album.
“Sometimes I still get that old pit in my stomach, when I think about how you’re never gonna see who I’ve been growing up to be,” one verse goes.
The family had never probed the practices of Cardiello’s doctor, Thomas C. Weiner, even after St. Peter’s Health fired him in 2020 and publicly referenced “proof that patients were harmed.” The ProPublica story launched the family into a painful reexamination of Cardiello’s treatment.
Theresa spent months waiting for the hospital to send the 20-year-old medical records, craving the information while fearing what she might learn. She tried to process her anxieties in a local writing group.
“Is this the right time,” she wrote in one exercise, “to open my deceased husband’s casket?”
‘WHAT IS THE AVENUE?’
After reading reporting by ProPublica and ԹϺ, some local families and patients have begun digging into their experiences with Weiner.
Their search for answers isn’t necessarily aimed at legal action, according to those who spoke to MTFP. Some are simply seeking clarity and closure about their relatives’ care.
But for those who are looking for legal recourse, Montana law and the medical malpractice system create sometimes impassable hurdles. The state generally bars the consideration of lawsuits related to medical incidents that happened more than two years prior. And a statutory cap on certain types of monetary damages can make it hard for injured parties to find an attorney willing to take their case.
Until and unless a case reaches court, much of the malpractice process is shrouded in confidentiality and is not accessible for public scrutiny.
Aside from litigation, few options exist for former patients or their families to seek accountability.
St. Peter’s medical records and internal reviews obtained and published by ProPublica describe Weiner treating patients for cancer they did not have, overprescribing pain medications, and making end-of-life decisions without consent from patients or their families. Those allegations underpinned St. Peter’s decision to terminate Weiner’s employment and privileges, according to the hospital’s internal assessments and public statements.
Weiner, who has maintained that he never harmed patients, challenged his dismissal in state court, ultimately losing his final appeal in February. He has also denied wrongdoing in an ongoing federal lawsuit accusing him of defrauding Medicare and other public health insurance programs. St. Peter’s agreed to a nearly $11 million legal settlement in 2024 over related claims. Weiner’s medical license was renewed by the state Board of Medical Examiners in March.
Weiner did not respond to an emailed request for comment about former patients and families questioning their care.
St. Peter’s spokesperson Andrea Groom did not say how many former Weiner patients and families have requested medical records since ProPublica’s investigation was published in December, but confirmed the hospital has “experienced an increase” in records requests since Weiner was fired in 2020.
Groom directed patients questioning Weiner’s care to bring concerns to the hospital’s . That team investigates patient complaints, Groom said, typically aiming to resolve them in seven days.
“Any patient or designated family member with questions or concerns about their care [is] encouraged to work through our established process with the St. Peter’s Health quality team,” Groom said.
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‘Eat What You Kill’
Hailed as a savior upon his arrival in Helena, Dr. Thomas C. Weiner became a favorite of patients and his hospital’s highest earner. As the myth surrounding the high-profile oncologist grew, so did the trail of patient harm and suspicious deaths.
Among the families seeking answers are the daughters of Lisa Peña, a 55-year-old woman who died within a week of being diagnosed with a rare blood disorder in 2012. Peña’s rapid decline and death left her family in shock, but they didn’t begin digging into their own questions until reading ProPublica’s investigation. They were disturbed by the reporting, they said, particularly the allegations about Weiner making unilateral end-of-life care decisions. More than 12 years after their mother’s death, Ashley Peña-Larson, the youngest daughter, decided to request her medical records.
“I just want to see,” Ashley recalled telling her sisters. “It’s like that gut feeling that you’ve always had but you just never did anything about, and then you kind of kick yourself because you didn’t do it.”
The records, which the family shared with MTFP, are highly technical and thin on explanation about Peña’s worsening condition. But their review caught a detail that worried them: A “Do Not Resuscitate” label had been added to Peña’s chart at least a day before the family was consulted about her end-of-life options. The family said Peña was unresponsive at the time and couldn’t have deliberated about that status. No earlier DNR directive attributed to their mother was in the records reviewed by MTFP.
“There was never an explanation. It was just like, oh, well, now she’s in the ER, she’s asleep and we’re never going to see her. She’s never waking up,” Annaliese recalled. “None of it really made sense to me.”
After spending months reviewing the records, the siblings say they now have more questions than answers, and no clear path to resolving them.
“Really, what is the avenue?” Ashley said in a March interview. “What is the avenue that a family can even take?”
THE ROAD TO COURT
The primary route for resolving allegations of improper medical care is a legal malpractice claim. As part of those cases, attorneys for both sides may hire third-party experts to assess evidence and provide opinions and analysis. Doctors and hospital staff may be questioned under oath. The case may be heard by a jury and can lead to financial judgments for a plaintiff’s economic losses — including medical bills and lost earnings — as well as pain and suffering and, in rare situations, punitive damages linked to findings of fraud or malice.
Montana state law establishes a two-year limit after alleged patient harm in which a medical malpractice case can be filed. That window can remain open for up to five years if an injury isn’t discovered immediately.
That restriction is in line with malpractice laws in many states. But it creates steep obstacles for former patients and families who only recently began investigating cases from years ago.
At least some parties have brought claims against Weiner before the statute of limitations ran out. Lawyers with St. Peter’s told MTFP the hospital is aware of at least nine malpractice complaints related to Weiner during his more than two decades of employment.
Nearly all of those complaints unfolded outside of a court’s purview, leaving them hidden from public view.
Before a malpractice claim can be brought to court, Montana law requires that it first be filed with the Montana Medical Legal Panel, a confidential industry-run group created by the state Legislature in 1977 with the stated purpose of weeding out frivolous malpractice claims. The organization is operated by the Montana Medical Association, an advocacy and lobbying group for physicians and certain other providers.
For every case it considers, the MMLP convenes a new panel, typically made up of six attorneys and health care representatives, including experts from the same field as the provider being challenged. State law gives the panel broad privacy protections, shielding evidence, decisions and other MMLP records from public disclosure.
The panel is tasked with making a nonbinding determination about a case’s merit. Parties can reach a pre-lawsuit settlement at any point in the MMLP process. If that doesn’t happen, and regardless of MMLP’s determination, a claimant can advance their case to state district court, where allegations against a doctor and the doctor’s defense become public.
Groom, the St. Peter’s spokesperson, declined to say how many of the nine cases involving Weiner ended in a settlement at the MMLP stage, or how many implicated the hospital in their allegations.
One medical malpractice case involving Weiner became public after it was filed in Helena district court in 2021 by the widow of Scot Warwick, a former Weiner patient who died the year prior. Internal medical reviews and court filings asserted that Warwick died not from cancer, which was never confirmed through diagnostic testing, but from toxicity related to chemotherapy treatments Weiner had prescribed for 11 years. In interviews with ProPublica, Weiner maintained that Warwick did have cancer, despite an autopsy and other tests failing to identify it.
Lisa Warwick first filed her case at the MMLP, as the law directs. In an April interview with MTFP, Lisa said she had never heard medical experts analyze a course of treatment in such detail.
“Being a patient, you don’t hear the discussions going on between physicians. At all,” Lisa said. “You don’t have a clue. And unless you had a copy of your medical records, you have no clue that there even was a question.”
Lisa said her attorneys told her the panel almost always finds in favor of the doctor under scrutiny. She hoped the medical experts and lawyers would be willing to consider her family’s evidence.
“I wanted to get a fair shake at it,” Lisa said. “It’s not a panel of my peers. It’s a panel of their peers.”
Lisa declined to comment on how the panel voted, citing advice from her attorney. After the MMLP case was resolved, she proceeded to sue Weiner and St. Peter’s. “Our mindset was, ‘We’re going,’” Lisa said. “This was about bringing forth and bringing to light what was actually happening in that hospital.”
“It’s not a panel of my peers. It’s a panel of their peers.”
Lisa Warwick, widow of Scot Warwick
The case was settled in 2022. Lisa declined to disclose the amount of the settlement, citing the terms of the agreement.
That same year, another former Weiner patient, Carolyn Miller, filed a malpractice lawsuit against St. Peter’s Medical Group, the hospital’s provider network. That filing — which has not been previously reported — made public Miller’s accusations that the oncologist had prescribed unnecessary chemotherapy treatments to her for roughly nine years.
Reached by phone, both Miller and her attorney declined to be interviewed about the case.
Court filings describe Miller having a swollen lymph node with cancerous cells removed by a different doctor in 2008, when she was 47. She proceeded to see Weiner for more testing and evaluation.
That year, court filings allege, Weiner told Miller she had an advanced case of non-Hodgkin lymphoma, despite scans showing no indication of persisting cancer. Nevertheless, Miller said, the oncologist recommended she continue with regular “maintenance” treatments of the cancer drug Rituxan every six months to keep the cancer from advancing.
The lawsuit described Miller continuing that regimen at Weiner’s direction until 2017, when her insurance company said it would no longer cover the treatments. Court filings say Miller continued to see Weiner as her primary care provider until 2020, an arrangement she said began at his recommendation shortly after she first saw him for cancer care.
Miller’s lawsuit said that after Weiner was fired, St. Peter’s sent her a letter describing concerns about his treatment protocols and inviting her to meet with a new oncologist. That doctor informed her she’d had “an indolent form of non-Hodgkin’s lymphoma, low grade, stage I, at the initial work up of her disease” but that later assessments had been “negative for evidence of new, ongoing, or recurrent cancer,” according to excerpts of Miller’s medical records presented in court filings.
Stunned, Miller sought a second opinion from an oncologist in Bozeman. The lawsuit described that doctor as reaching the same conclusion: no evidence of ongoing cancer.
St. Peter’s Medical Group responded with court filings denying the allegations and claiming that many of Miller’s arguments were based on “a subjective and incomplete summarization of the plaintiff’s medical records.”
Regardless, court records show that the medical group and Miller agreed to resolve the case after more than a year of litigation. Details about that resolution, including any reference to a financial settlement, are not part of the public record.
A HEARING THAT NEVER HAPPENED
Montana attorneys who represent plaintiffs in medical malpractice claims describe such cases as remarkably difficult and expensive to litigate, let alone win.
Successful cases can recoup medical costs and win monetary judgments for an injured person’s lost earning potential. But that type of damage may not amount to much for low-income or elderly patients, creating high stakes for other types of claims to pay out.
State law has long , the non-economic category of damages. Unless an attorney is confident a case will be settled for significantly more than the pain-and-suffering cap, they may decline to represent a plaintiff.
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Since at least April 2021, the Montana medical licensing board has had evidence, including thousands of pages of patient files and medical reviews, that Dr. Thomas C. Weiner, a popular Helena oncologist, had hurt and potentially killed patients, ProPublica and ԹϺ have learned. Yet in that time, the board renewed his medical license — twice.
“It’s going to cost $100,000 to prosecute a case that, on its best day, is going to be worth $250,000,” said John Heenan, a Billings attorney who has brought medical malpractice cases. “In practice, a lot of people don’t get representation.”
A Republican-backed bill signed by Gov. Greg Gianforte this session raises the cap to $500,000 by 2029, and sets up a 2% increase every year after. For now, many plaintiffs’ attorneys cite the cap as a deterrent to medical malpractice cases.
Without an attorney, claimants can represent themselves at an MMLP hearing. Hospitals, insurance companies and doctors are typically represented by defense attorneys who often practice exclusively in malpractice.
One claimant who challenged Weiner’s care without an attorney saw her case dismissed by the MMLP with no hearing at all.
“In practice, a lot of people don’t get representation.”
Billings attorney John Heenan
Marilyn Ketchum began compiling information about Weiner’s care months after learning that he had been fired by St. Peter’s. She requested and obtained the medical records of her late husband, Shawn Ketchum, from which she learned that his end-of-life status had been listed as “Do Not Resuscitate,” a directive the couple had told hospital staff he did not want just weeks before his 2016 death.
According to copies of Ketchum’s medical records shared with MTFP, Weiner repeated the DNR status over the phone to emergency department staff on the night he died. Marilyn and other family members did not arrive at the hospital in time to say goodbye.
When she first considered filing a claim alleging that Weiner had asserted an incorrect end-of-life status, Marilyn said, she could not find an attorney willing to take her case. She decided to proceed at the MMLP without counsel in early 2022.
For months, the parties waited for MMLP staff to find doctors and lawyers willing to sit on a panel about the case. Both sides filed briefs with the MMLP. Marilyn argued that her case was within the state-mandated deadline because she had not learned of the apparent harm until receiving Shawn’s records. The defense attorneys disagreed and asked the MMLP to dismiss the case.
Jamie Bonilla, a paralegal who worked as a claims specialist for the MMLP at the time, was tasked with shepherding Marilyn’s case to a hearing. In a February interview with MTFP, she described pushing for the statute of limitations question to be put to a panel.
Bonilla said the organization’s legal staff and its director, Jean Branscum, considered Marilyn’s claim to be beyond the two-year window. They were leaning away from convening a panel at all, Bonilla said, even as she kept trying to recruit panelists.
Branscum declined to discuss Marilyn’s case with MTFP, citing state law about MMLP confidentiality. Describing the organization’s processes generally during an April interview, she said that as the group’s director she could dismiss a case if it’s beyond the statute of limitations and a panel hasn’t yet been convened. But, she said, such situations are exceedingly rare.
Bonilla said she eventually quit in frustration over how Marilyn’s case was handled.
“Marilyn Ketchum was not treated fairly,” Bonilla told MTFP. “I’m angry about it. I don’t know her. She wasn’t the easiest claimant to deal with. But she was not being treated fairly and that’s just a fact.”
“[S]he was not being treated fairly and that’s just a fact.”
Former Montana Medical Legal Panel paralegal Jamie Bonilla
Weeks after Bonilla left her position, Marilyn’s case was dismissed. According to Marilyn, the organization never told her that her case had been determined to be beyond the statute of limitations — only that the MMLP was unable to convene a panel to hear the complaint. Branscum did not comment on why the case was closed.
Branscum said the panel often hears claims from people who are representing themselves without an attorney. She said the MMLP has talked about — but not pursued — a way for those claimants to access affordable or free legal representation. Ultimately, she noted, MMLP operations are largely paid for by fees from doctors and other members of the Montana Medical Association.
CHECKING THE RECORD
Since receiving Frank Cardiello’s medical records, Theresa and other family members have been measuring the hospital’s documented version of events against their own memories — and weighing whether they have evidence for a legal complaint.
Weiner had diagnosed Cardiello with aplastic anemia, a blood disorder, in October 2005, after he’d come to the hospital with unexplained bruising and fatigue. In the medical file shared with MTFP, Weiner noted that he and Cardiello had several long discussions about treatment options, including a bone marrow transplant or medication. The oncologist wrote that Cardiello was “getting advice from all sides,” including from family members, about whether to transfer his care to a major medical center. The doctor wrote that his patient was “not sure what he was supposed to do.”
Ultimately, the two decided to pursue a course of medications and transfusions in Helena to try to increase Cardiello’s blood cell and platelet counts. But by January, the oncologist said that Cardiello’s condition had not improved and that he was still dependent on transfusions. At that time, Weiner described Cardiello as “not inclined to do a transplant.” The next month, they decided to continue a medication regimen that included a high dose of Cytoxan, also known as cyclophosphamide, an immunosuppressive chemotherapy drug.
Theresa and two of Cardiello’s brothers still aren’t sure if a bone marrow transplant was ever a viable option. In their recollection, several family members were tested, but none emerged as a high-quality candidate. Cardiello’s medical records don’t reflect the outcome of those tests, and Weiner’s notes continued to reference the possibility of a transplant as late as February.
Just over a month after starting on the Cytoxan, Cardiello was readmitted to the hospital with pneumonia and a fever. He died there 18 days later.
For Theresa and other family members, that last stretch in the hospital was a confusing blur. Theresa remembers Cardiello deciding with family members that he should try to recover on a ventilator for a short amount of time and informing Weiner of that decision. Nothing in the medical file reflects that conversation.
Weiner’s last note in the file is dated April 11, almost two weeks after Cardiello’s death. He described the patient’s weeks-long deterioration in broad strokes, referencing rounds of antibiotics and transfusions. In Weiner’s accounting, Cardiello had opted against intubation.
“For some time, his oxygenation again continued to worsen. We discussed code status, and he went back and forth, but eventually DID NOT WANT TO BE INTUBATED,” Weiner’s note read, with the capitalized letters in bold. “And despite again all of the antibiotics, his respirations steadily progressed, and he expired on 3/30/06 with his family in attendance.”
In April, Theresa maintained that Cardiello would never have chosen not to be intubated. She expressed alarm at not seeing any record of the family’s wishes in the medical record.
“It’s what’s not there that’s important,” she said.
The copy of the medical file reviewed by the family and MTFP also did not include any reference to Cardiello’s medication dosage during his final hospital stay. Theresa and other family members described concern about that absence, given St. Peter’s accounts of Weiner overprescribing medications. They recalled Cardiello receiving a steady supply of morphine, sometimes drifting in and out of consciousness.
Theresa said that when she pressed St. Peter’s about the lack of medication documentation, records staff told her the hospital had handed over everything it had regarding Cardiello’s treatment.
Groom declined to comment on the Cardiello family’s specific circumstances, citing St. Peter’s policy. But she said the hospital’s record-keeping system has changed over recent decades, and records might be stored in various databases, on microfilm or in paper form, depending on when the patient received care.
“St. Peter’s policy is to maintain a patient’s legal medical record for 10 years past the date of death,” Groom said. “After that time, any portion of the medical record may be destroyed in accordance with state and federal medical record retention regulations.”
AN ONGOING INVESTIGATION
In early April, Marilyn Ketchum sent a two-paragraph email to the Helena Police Department asking to file a criminal complaint related to her late husband’s death. An agent with the Montana Department of Justice called her back within hours.
The criminal inquiry sparked by ProPublica’s reporting was first reported by ProPublica and MTFP in March. A spokesperson for the state attorney general’s office, which oversees the state DOJ, did not respond to a request for comment about the nature of the investigation or its timeline.
Cases that are beyond the statute of limitations for civil medical malpractice claims could still be relevant in a criminal inquiry, depending on the investigation’s scope.
Last month, the Cardiello family contacted a Montana law firm to ask about pursuing a malpractice claim related to Frank Cardiello’s end-of-life care. A paralegal there told Theresa the firm didn’t see an avenue for a civil case, citing the state’s statute of limitations.
The Cardiello family also contacted the Montana Department of Justice with their concerns. Theresa said she has not yet received a response, but that it felt good to flag her case for authorities.
Even if both civil and criminal inquiries are closed off to the family, Theresa said she’s found some relief from simply digging into the records of Cardiello’s care, processing what she’s found and speaking about her family’s experiences.
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Anthony Olson was told that he’d die without treatment, and to ignore a negative biopsy. He’s one of many patients who may have received harmful or unnecessary treatments from Montana oncologist Dr. Thomas C. Weiner, according to court records.
“I’m not really looking for financial compensation so much as for the truth to be told,” Theresa said.
One other source of consolation, she said, has been hearing that other families and former patients have initiated their own searches for answers. Staff at St. Peter’s told her they had seen a wave of medical records requests from other former Weiner patients. The law firm staff also told her they’d been fielding more questions from former patients.
“That made me think that people are speaking out,” Theresa said.
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