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121-494: Debora Green ( née Jones ; born February 28, 1951) is an American physician who pleaded no contest to setting a 1995 fire that burned down her family's home and killed two of her children, and to poisoning her husband with ricin with the intention of causing his death. The case was sensational, and covered heavily by news media, especially in the Kansas – Missouri area, where the crimes occurred. Though Green has petitioned for

242-454: A medical school attached to a university . In the US, medical school consists of four years. Hence, gaining a basic medical education may typically take eight years, depending on jurisdiction and university. Following completion of entry-level training, newly graduated medical practitioners are often required to undertake a period of supervised practice before their licensure , or registration ,

363-545: A European Certificate of Internal Medicine (ECIM) to facilitate the free movement of medical professionals with the EU are currently underway. The internal medicine specialist is recognized in every country in the European Union and typically requires five years of multi-disciplinary post-graduate education. The specialty of internal medicine is seen as providing care in a wide variety of conditions involving every organ system and

484-650: A career, she opted to attend medical school after graduating in 1972, believing the market was flooded with engineers. She attended the University of Kansas School of Medicine from 1972 to her graduation in 1975. Green chose emergency medicine as her initial specialty and undertook a residency in the Truman Medical Center Emergency Room after her graduation from medical school. Throughout her undergraduate and medical school attendance, she dated Duane M. J. Green, an engineer. The couple married while she

605-524: A compulsory subspecialty training (including acute internal medicine or a dual subspecialty including internal medicine). This latter stage of training is achieved through competition rather than just by yearly progress as the first years of postgraduate training. In the US, three organizations are responsible for the certification of trained internists (i.e., doctors who have completed an accredited residency training program) in terms of their knowledge, skills, and attitudes that are essential for patient care:

726-408: A confrontation. Farrar was convinced that Green was continuing to drink heavily while she should have been caring for the children, and he told Green that he knew she had poisoned him and that Social Services might be called to protect the children if she failed to get her life in order. After the last call between Green and Farrar, Farrar watched television alone in his apartment until about 12:30, when

847-519: A divorce. Green responded hysterically and told the children that their father was leaving them. Green was especially upset that a broken home might later disqualify the children from debutante events such as the Belles of the American Royal . Despite the impending divorce, Farrar initially declined to move out of the family home. He was concerned that Green, who had never been a heavy drinker of alcohol,

968-468: A holistic approach to care for the entire family unit. Internists also receive substantial training in various recognized subspecialties within the field and are experienced in both inpatient and outpatient settings. On the other hand, family medicine physicians receive education covering a wide range of conditions and typically train in an outpatient setting with less exposure to hospital settings. The historical roots of internal medicine can be traced back to

1089-444: A neighbor's phone call alerted him to the fire. During his police interview after the fire, Farrar's red eyes and trembling voice were apparent to detectives. He stated that Green had been "very concerned about money" in the context of their impending divorce, and that she may have set fire to the house to garner an insurance payout, but that she had never given any indication of intending to harm her children. After his interview with

1210-577: A new trial twice in recent years, her requests have not been successful. Green married Michael Farrar in 1979 while practicing as an emergency physician . The marriage was tumultuous, and Farrar filed for divorce in July 1995. Between August and September 1995, Farrar repeatedly fell violently ill, and despite numerous hospitalizations his doctors could not pinpoint the source of his illness. Green's emotional stability deteriorated and she began to drink heavily, even while supervising her children. On October 24, 1995,

1331-772: A period of decline, was reemphasised by the Royal College of Physicians of London report from the Future Hospital Commission (2013). The European Board of Internal Medicine (EBIM) was formed as a collaborative effort between the European Union of Medical Specialists (UEMS) - Internal Medicine Section and the European Federation of Internal Medicine (EFIM) to provide guidance on standardizing training and practice of internal medicine throughout Europe. The EBIM published training requirements in 2016 for postgraduate education in internal medicine, and efforts to create

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1452-503: A photo line-up as the buyer. Register tapes in the store's records showed that a purchase price corresponding to ten packets of castor beans had been rung up on either September 20 or 22. No records were found in any Earl May store of earlier such purchases that would have corresponded to Farrar first having become ill earlier in the year. Farrar underwent surgery in November 1995 to treat an aneurism that his doctors believed had been caused by

1573-412: A poison served to him in his food by Green. Upon her arrest on November 22, 1995, Green was charged with two counts of first-degree murder , two counts of attempted first-degree murder, and one count of aggravated arson. She was held on $ 3,000,000 bail —the highest ever required by Johnson County, Kansas —and maintained her innocence throughout pre-trial motions and a show cause hearing . However, when

1694-1081: A private school in Kansas City. Green was reportedly a good mother who wanted the best for her children and encouraged them in their activities of choice. Though she attempted to resume her medical career after her last maternity leave, her practice faltered and her chronic pain increased. In 1992, she gave up her practice and became a homemaker, working part-time from the family's house on medical peer reviews and Medicaid processing. Medical professionals who worked with her during this time described her as being distant and cold towards her patients and displaying obsessive behavior towards her husband. Farrar later alleged that Green had been self-medicating with sedatives and narcotics to treat pain from infections and injuries periodically throughout their marriage. He recounted several episodes to author Ann Rule in which he had confronted Green with issues regarding her demeanor, handwriting, and speech patterns that indicated drug intoxication, and said that Green had agreed to stop using

1815-504: A rage, she sometimes harmed herself or broke things, and rarely gave any thought to whether she was in private or in public during these episodes. By the early 1990s, Farrar worked long hours away from the home to avoid arguments and what he perceived as his wife's shortcomings as a homemaker. When the couple fought, Green responded by treating the children, especially Tim, as small adults and telling them about what their father had done wrong. Swayed by their mother's opinions about their father,

1936-464: A room in a local hotel. Ellen Ryan, Green's divorce lawyer, found her there later in the day in a distraught state. She repeatedly asked Ryan whether her children had died, chanted rhythmically about their deaths, and seemed unable to care for herself. Green was transported to a local hospital for treatment but remained emotionally unstable, suffering from insomnia and appearing to Ryan to be unable to take care of day-to-day life, even after her release from

2057-424: A student in his twenties completing his last year of medical school. Farrar was struck by Green's intelligence and vitality, though he was embarrassed by her habit of explosively losing her temper at minor slights. In contrast, Green felt that Farrar was a stable, dependable presence. The couple were married on May 26, 1979. When Farrar was accepted for an internal medicine residency at the University of Cincinnati ,

2178-431: A week-long vacation to recover some strength after restarting his job post-hospital. He had spent the afternoon with Margaret Hacker and then picked up Tim and Kelly for Tim's hockey game. After dropping the children back off with their mother at about 8:45, he had dinner with Hacker, leaving her around 11:15 in the evening. Throughout the evening on October 23, a series of phone calls between Green and Farrar escalated into

2299-721: Is also required. Internists may practice in Canada as generalists in Internal Medicine or serve in one of seventeen subspecialty areas. Internists may work in many settings including outpatient clinics, inpatient wards, critical care units, and emergency departments. The currently recognized subspecialties include the following: Medicine is mainly focused on the art of diagnosis and treatment with medication . The diagnostic process involves gathering data, generating one or more diagnostic hypotheses, and iteratively testing these potential diagnoses against dynamic disease profiles to determine

2420-456: Is an important part of most post-graduate education programs, and many licensed physicians continue to be involved in research activities after completing post-graduate training. Inherent in any medical profession are legal and ethical considerations. Specific laws vary by jurisdiction and may or may not be congruent with ethical considerations. Thus, a strong ethical foundation is paramount to any medical profession. Medical ethics guidelines in

2541-628: Is distinguished from family medicine in that the latter provides a broader model of care the includes both surgery and obstetrics in both adults and children. Accreditation for medical education and training programs in Australia is provided by the Australian Medical Council (AMC) and the Medical Council of New Zealeand (MCNZ). The Medical Board of Australia (MBA) is the registering body for Australian doctors and provides information to

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2662-427: Is granted, typically one or two years. This period may be referred to as " internship ", "conditional registration", or " foundation programme ". Then, doctors may follow specialty training in internal medicine if they wish, typically being selected to training programs through competition. In North America, this period of postgraduate training is referred to as residency training , followed by an optional fellowship if

2783-469: Is monitored and accredited by the independent General Medical Council (which also maintains the specialist register). Doctors who have completed medical school spend two years in foundation training completing a basic postgraduate curriculum. After two years of Core Medical Training (CT1/CT2), or three years of Internal Medicine Training (IMT1/IMT2/IMT3) as of 2019, since and attaining the Membership of

2904-402: Is not accepted as good practice with few exceptions. These exceptions include cross-coverage within a practice and certain public health urgent or emergent issues. The ethics of telemedicine including questions on its impact to diagnosis, physician-patient relationship, and continuity of care have been raised. However, with appropriate use and specific guidelines, risks may be minimized and

3025-542: Is recognized as a specialty within clinical pharmacy and veterinary medicine . The term internal medicine in English has its etymology in the 19th-century German term Innere Medizin . Originally, internal medicine focused on determining the underlying "internal" or pathological causes of symptoms and syndromes through a combination of medical tests and bedside clinical examination of patients. This approach differed from earlier generations of physicians, such as

3146-564: Is solely focused on adults and does not typically include surgery , obstetrics , or pediatrics . According to the American College of Physicians , internists are defined as "physicians who specialize in the prevention, detection, and treatment of illnesses in adults." While there may be some overlap in the patient population served by both internal medicine and family medicine physicians, internists primarily focus on adult care with an emphasis on diagnosis, whereas family medicine incorporates

3267-503: Is the name given to a person upon birth. The term may be applied to the surname , the given name , or the entire name. Where births are required to be officially registered, the entire name entered onto a birth certificate or birth register may by that fact alone become the person's legal name . The assumption in the Western world is often that the name from birth (or perhaps from baptism or brit milah ) will persist to adulthood in

3388-461: Is the masculine form. The term née , having feminine grammatical gender , can be used to denote a woman's surname at birth that has been replaced or changed. In most English-speaking cultures, it is specifically applied to a woman's maiden name after her surname has changed due to marriage. The term né can be used to denote a man's surname at birth that has subsequently been replaced or changed. The diacritic mark (the acute accent ) over

3509-747: The American Board of Internal Medicine , the American Osteopathic Board of Internal Medicine and the Board of Certification in Internal Medicine . In the UK, the General Medical Council oversees licensing and certification of internal medicine physicians. The Royal Australasian College of Physicians confers fellowship to internists (and sub-specialists) in Australia. The Medical Council of Canada oversees licensing of internists in Canada. In

3630-619: The Australian Health Practitioner Regulation Agency (AHPRA). Medical graduates apply for provisional registration in order to complete intern training. Those completing an accredited internship program are then eligible to apply for general registration. Once the candidate completes the required basic and advanced post-graduate training and a written and clinical examination, the Royal Australasian College of Physicians confers designation Fellow of

3751-546: The Ayurvedic anthologies of Charaka . Internal medicine specialists, also referred to as general internal medicine specialists or general medicine physicians in Commonwealth countries, are specialized physicians trained to manage complex or multisystem disease conditions that single-organ specialists may not be equipped to handle. They are often called upon to address undifferentiated presentations that do not fit neatly within

Debora Green - Misplaced Pages Continue

3872-664: The Olathe, Kansas , Earl May store in Green's address book. The detectives contacted nearby Earl May stores to find if any employees remembered selling castor beans, which are out of season in the fall. A clerk in Missouri recalled that in September a woman had ordered ten packets of the out-of-season seeds and explained that she needed them for schoolwork. The clerk gave a description of the buyer that corresponded to Green, and tentatively identified her in

3993-456: The e is considered significant to its spelling, and ultimately its meaning, but is sometimes omitted. According to Oxford University 's Dictionary of Modern English Usage , the terms are typically placed after the current surname (e.g., " Margaret Thatcher , née Roberts" or " Bill Clinton , né Blythe"). Since they are terms adopted into English (from French), they do not have to be italicized , but they often are. In Polish tradition ,

4114-471: The specificity and sensitivity of a particular test. An important part of this process is knowledge of the various ways that a disease can present in a patient.  This knowledge is gathered and shared to add to the database of disease profiles used by physicians. This is especially important in rare diseases. Communication is a vital part of the diagnostic process. The Internist uses both synchronous and asynchronous communication with other members of

4235-556: The 17th-century English physician Thomas Sydenham , known as the father of English medicine or "the English Hippocrates ." Sydenham developed the field of nosology (the study of diseases) through a clinical approach that involved diagnosing and managing diseases based on careful bedside observation of the natural history of disease and their treatment. Sydenham emphasized understanding the internal mechanisms and causes of symptoms rather than dissecting cadavers and scrutinizing

4356-607: The 19th century. During this time, internal medicine emerged as a field that integrated the clinical approach with the use of investigations. Many American physicians of the early 20th century studied medicine in Germany and introduced this medical field to the United States, adopting the name "internal medicine" in imitation of the existing German term. Internal medicine has historical roots in ancient India and ancient China . The earliest texts about internal medicine can be found in

4477-479: The Farrar family home, occupied by Green and the couple's three children — Timothy (age 13), Kate (age 10), and Kelly (age 6) — caught fire. Debora Green and Kate escaped without harm. Despite the efforts of firefighters, Timothy and Kelly died in the blaze. Investigation showed that trails of accelerant in the house led back to Green's bedroom, and that the source of Michael Farrar's intractable illness had been ricin ,

4598-799: The Royal Australasian College of Physicians (FRACP). Basic training consists of three years of full-time equivalent (FTE) training (including intern year) and advanced training consists of 3–4 years, depending on specialty. The fields of specialty practice are approved by the Council of Australian Governments (COAG) and managed by the MBA. The following is a list of currently recognized specialist physicians. After completing medical school, internists in Canada require an additional four years of training. Internists desiring to subspecialize are required to complete two additional years of training that may begin after

4719-490: The Royal College of Physicians , physicians commit to one of the medical specialties: Many training programmes provide dual accreditation with general (internal) medicine and are involved in the general care to hospitalised patients. These are acute medicine, cardiology, Clinical Pharmacology and Therapeutics, endocrinology and diabetes mellitus, gastroenterology, infectious diseases, renal medicine, respiratory medicine and often, rheumatology. The role of general medicine, after

4840-456: The US, two organizations are responsible for certification of subspecialists within the field: the American Board of Internal Medicine and the American Osteopathic Board of Internal Medicine . Physicians (not only internists) who successfully pass board exams receive "board certified" status. The following are the subspecialties recognized by the American Board of Internal Medicine . The American College of Osteopathic Internists recognizes

4961-455: The Western world typically follow four principles including beneficence , non-maleficence , patient autonomy, and justice . These principles underlie the patient-physician relationship and the obligation to put the welfare and interests of the patient above their own. The relationship is built upon the physician obligations of competency, respect for the patient, and appropriate referrals while

Debora Green - Misplaced Pages Continue

5082-449: The apparent poisoning of Michael Farrar may have been linked to the case, but officials declined to name the person suspected in either the arson or the poisoning. Green was arrested on November 22 in Kansas City, Missouri, shortly after dropping off her daughter for ballet practice. Though Green's attorneys had requested that if arrested, Green be allowed to turn herself in voluntarily, the police and district attorney felt that her behavior

5203-429: The basement level of the home, which contained the furnaces, had not been a point of origin, though two small orphan fires unconnected to the main burning had occurred in that area. Pour patterns were found on the ground and second floors, indicating that a flammable liquid had been poured there and covered many areas of the ground floor, blocked off the stairway from the second floor to the ground floor, and covered much of

5324-443: The benefits including increased access to care may be realized. Ethical considerations in financial include accurate billing practices and clearly defined financial relationships.  Physicians have both a professional duty and obligation under the justice principle to ensure that patients are provided the same care regardless of status or ability to pay.  However, informal copayment forgiveness may have legal ramifications and

5445-822: The best course of action for the patient. Data may be gathered directly from the patient in medical history-taking and physical examination . Previous medical records including laboratory findings, imaging, and clinical notes from other physicians is also an important source of information; however, it is vital to talk to and examine the patient to find out what the patient is currently experiencing to make an accurate diagnosis. Internists often can perform and interpret diagnostic tests like EKGs and ultrasound imaging (Point-of-care Ultrasound – PoCUS). Internists who pursue sub-specialties have additional diagnostic tools, including those listed below. Other tests are ordered, and patients are also referred to specialists for further evaluation.  The effectiveness and efficiency of

5566-461: The break-up of their marriage. Under cross-examination by Green's counsel, he admitted that both he and Green had contributed to the problems in the couple's marriage and that his relationship with his son had been so adversarial that they had sometimes come to blows. Witnesses called by the State supported Farrar's and the prosecutors' earlier claims that police had been called to the home a month before

5687-485: The burglar alarm, but when she tried to shut off the alarm at the control panel in her bedroom and it continued sounding, she opened her bedroom door and found smoke in the hallway. She exited the house using a deck that connected to her first-floor bedroom. While standing on the deck, she heard her son Tim on the home's intercom system, calling to ask her what he should do. "He used to be my thirteen-year-old", Green explained to police, and said that she had told him to stay in

5808-424: The children began to resent and disobey Farrar, to the point where Timothy and Farrar had physical altercations. In January 1994, Farrar asked Green for a divorce. Although she believed Farrar was having affairs outside the marriage, she later claimed to have been taken by surprise by his desire to end the marriage and responded to his asking for a divorce explosively, shouting and throwing things. Farrar moved out of

5929-435: The children had had good relationships with her, but that she was angry at her father for upsetting her mother by leaving. Pressed, she acknowledged that her mother had begun to drink large quantities of alcohol. She denied that she had ever seen matches in the house and expressed surprise that Tim had not escaped by the same route she had, which was via a bedroom window onto the roof. The Eastern Kansas Multi-Agency Task Force

6050-482: The children's deaths, and demanding to be allowed to see Farrar and the remains of the family's house. Though Green stressed to police that she wanted to be the one to "tell my husband our babies are dead," her request was not granted. Green was released from the police station in the early morning of October 24 after questioning. With the family home burned down, she had nowhere to stay. Farrar refused to let her stay in his apartment, but gave her some cash, and she rented

6171-431: The children, who had found their mother unresponsive. Green had disappeared from the home by the time Farrar arrived there, and though he eventually discovered that she had been hiding in the basement while he searched for her, she claimed at the time to have been wandering the town, hoping to be hit by a car. Farrar moved out of the family home in early autumn due to concerns about his personal safety. On October 24, during

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6292-413: The complexity involved in explaining the treatment of diseases that are not localized to a single organ, there has been some confusion surrounding the meaning of internal medicine and the role of an "internist". Although internists may serve as primary care physicians , they are not synonymous with " family physicians ", "family practitioners", " general practitioners ", or "GPs". The training of internists

6413-457: The cooking in the household. Michael Farrar underwent surgery in December 1995 to treat an abscess in his brain caused by the poisoning. Fearful that Farrar would not survive the proceedings, and knowing that his testimony was key to their case, prosecutors videotaped his testimony beforehand. The surgery was successful, and Farrar testified in person and recounted Green's problems with alcohol and

6534-589: The couple moved to Ohio . Green went into practice at Jewish Hospital as an emergency physician, but grew dissatisfied and eventually switched specialties. She began a second residency in internal medicine, joining Farrar's program. By the early 1980s, the Farrars were living in Cincinnati, Ohio . During this time Green developed a number of medical issues, including surgery on an infected wrist, cerebellar migraines , and insomnia . The Farrars' first child, Timothy Scott,

6655-415: The defense's own investigators verified the strength of forensic evidence against Green, she agreed to an Alford plea to all charges. On May 30, 1996, she was sentenced to two concurrent forty-year prison sentences. Green has petitioned for a new trial twice since her conviction. Her first request, which she eventually withdrew, was based on a claim of having been rendered incompetent for plea bargaining by

6776-449: The disease and are based on the likelihood that someone with the disease has a particular symptom.  A list of potential diagnoses is termed the "differential diagnosis" for the patient and is typically ordered from most likely to least likely, with special attention given to those conditions that have dire consequences for the patient if they were missed. Epidemiology and endemic conditions are also considered in creating and evaluating

6897-455: The doctor felt her demeanor was not unusual for someone going through a bitter divorce and noted that Green professed no desire to hurt herself or others when the doctor interviewed her privately. However, when Farrar came into view in the hospital, Green's demeanor changed. According to the doctor, Green spat at him, called him obscene names, and stated that "You're going to get these kids over our dead bodies". Though Green, with some persuasion by

7018-690: The doctor, initially agreed to a voluntary commitment, she shortly thereafter left the ER without informing anyone. She was found hours later, apparently having decided to walk home from the hospital, and brought back to the hospital. There, she agreed again to a voluntary commitment to the Menninger Clinic in Topeka, Kansas . While in the hospital for treatment, Green was diagnosed with "major bipolar depression with suicidal impulses" and placed on Prozac , Tranxene , and Klonopin . She returned home after four days in

7139-481: The early morning of October 24, he had found Kate Farrar to be "very frantic" with worry over her siblings, but that Debora Green had showed little, if any, emotion or concern. The defense argued that the psychiatric medications Green had been taking since her September hospitalization could cause blunted affect , which could have led police and fire personnel to erroneously report that Green had been unemotional. Birth name#Maiden and married names A birth name

7260-567: The early morning, Farrar received a phone call at his apartment from a neighbor who shouted that his house—meaning the Farrar–Green family home in Prairie Village—was on fire. Farrar immediately drove there. A 9-1-1 call placed from the house at 12:20 a.m. alerted police dispatchers to possible trouble, though the caller did not speak before hanging up. A police cruiser found the house on fire. Fire trucks were dispatched at 12:27 to what

7381-587: The family had a normal day before the fire. The children went to school and performed their chores before attending various after-school activities—Kate went to her dance class, Tim to a hockey game. Farrar had taken Tim and Kelly to the hockey game, while Green took Kate to ballet lessons. The family regrouped around 9 p.m. when Tim and Kelly were dropped back at the Prairie Village house for dinner. Green told police that she had one or two drinks after dinner and went to her bedroom, leaving it only to speak to Tim in

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7502-470: The family home, though the two remained in contact and informally shared custody of the children. With the pressure of living together removed, they attempted reconciliation, and decided that a larger house would ease some of the disorganization that had affected their marriage. In May, after four months of separation, they put in a bid on a six-bedroom home in Prairie Village, Kansas , but backed out before

7623-519: The fire to any number of people and the investigation continued with no public statement about suspects. When alerted to the possibility of Michael Farrar having been poisoned in the months before the fire, detectives investigated the origin of the castor beans that had led to police investigating the September domestic dispute. The label on the seed packets identified them as a product of the Earl May chain of stores. An officer found contact information for

7744-411: The fire was a result of arson, the investigators on October 26 called in a second area task force, this one focused on homicide investigation. On October 27, the district attorney for Johnson County was informed that the investigation was now criminal. In seeking to find who had set fire to the Farrar–Green home, investigators looked first for physical evidence of fire-setting upon those who had been in

7865-446: The fire, that Green's behavior had been cause for concern at the time, and that Farrar had turned in to police at that time seed packets containing castor beans. The Earl May store clerk who had identified Green as the purchaser of multiple packets of castor bean seeds testified to that effect. Medical evidence was presented that Farrar's illness had not fit neatly within the parameters of any known disease, but that its presentation matched

7986-603: The following subspecialties: In the United Kingdom, the three medical Royal Colleges (the Royal College of Physicians of London, the Royal College of Physicians of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow ) are responsible for setting curricula and training programmes through the Joint Royal Colleges Postgraduate Training Board (JRCPTB), although the process

8107-521: The garage roof, Green had been "terribly upset" and called to Kate to jump into her arms. Though Green missed catching her daughter when she did jump, Kate was not hurt. When the two ran into Farrar minutes later, Kate said that Farrar had been accusatory toward Green and Green had been crying and worried about her missing children. According to Kate, Farrar had moved out of the family home and spurned Green's desire for an amicable separation. Kate stressed that she loved and respected her mother and that all of

8228-405: The gastrointestinal illness itself. Though Farrar's illness was severe and possibly life-threatening, he eventually recovered and was released from the hospital on August 25. That night, however, shortly after eating a dinner that Green had served him, Farrar again suffered vomiting and diarrhea and had to be hospitalized. A third bout of symptoms struck on September 4, days after he was released from

8349-457: The hallway on the second floor. The pour patterns stopped at the door of the house's master bedroom, but had soaked into carpeting in the hallway leading to the children's bedrooms. Investigators could not determine the precise liquid used as an accelerant, though they proved that a can of gasoline the family kept in a shed had not been used. The amount of accelerant used was identified as between 3 and 10 US gallons (11 and 38 L). Concluding that

8470-622: The highest bail ever asked for in Johnson County. A pretrial show cause hearing in the Green case began in January 1996, with Green represented by Dennis Moore and Kevin Moriarty . Green's defense claimed that the fire in the family home had been set not by Debora Green, but by her son, Tim Farrar, who had once been caught by local police setting off Molotov cocktails . The defense also attempted to attribute Farrar's poisoning to Tim, who did much of

8591-418: The home for the missing children, but the building was so consumed by flames that they could only access a small portion of the ground level before the structure became unsafe. By the time the fire was under control, the house was almost totally destroyed, leaving behind only the garage and some front stonework. The fire had spread rapidly, and although high winds contributed to the intensity, authorities deemed

8712-411: The home. Green initially reacted with sadness that quickly changed to anger. She shouted at detectives, claiming that firefighters had not done enough to save the children. Where previously she had been cooperative and friendly with the detectives interviewing her, she now began to attack them verbally, calling investigators and their methods "pathetic", alleging that they had withheld from her knowledge of

8833-533: The hospital for the second time. Basing their conclusions on the likelihood that his illness was related to the Peru trip, doctors narrowed down the possible causes for Farrar's gastrointestinal issues to a handful, though none fitted his symptoms perfectly: typhoid fever , tropical sprue , or gluten-sensitive enteropathy . Farrar had noticed that each time he returned home from the hospital, he became ill again almost immediately, and he speculated that it may have been due to

8954-457: The hospital. Police interviewed Farrar at 6:20 a.m, informing him immediately that the bodies of Tim and Kelly had been recovered. He told police about the deterioration of his marriage and health over the past six months. In August 1995, Farrar had fallen ill with nausea, vomiting, and diarrhea. He initially assumed it was a residual effect of the traveler's diarrhea many people on the Peru trip had contracted while there. Though he recovered from

9075-407: The hospital. Farrar, who had researched castor beans in the interim and came to the conclusion that Green had poisoned his food with the ricin that could be derived from the beans, moved out immediately upon Green's return home. Farrar said that the day of the fire, about a month after Farrar's last release from the hospital, he had taken the day off from work—the first day of what he intended to be

9196-409: The house and her belongings. In her purse, he discovered seed packets labeled as castor beans , a copy of a supposedly anonymous letter that had been sent to Farrar urging him to not divorce Green, and empty vials of potassium chloride . He removed all three items from her purse and hid them. The next day, he asked Green—who had no interest in gardening that he knew of—what she had intended to do with

9317-452: The house and wait for firefighters to rescue him. She had then knocked on a neighbor's door to ask them to call 9-1-1. When she returned to the house, she found Kate, who had climbed through her second-floor bedroom window, on the roof of the home's garage. Green called to Kate to jump, and Kate landed safely on the ground in front of Green. Detectives noted that during her interview Green did not appear to be or have been crying, and her manner

9438-499: The house was repairable and the couple's home insurance paid out on the damage and lost property, the couple decided to move on, and Green and the children moved into the apartment in which Farrar had been living during the separation while the purchase of the Prairie Village home was re-negotiated. The couple put extra effort into avoiding the issues that had caused strife before their separation: Despite being an indifferent cook and housekeeper, Green tried to focus on cooking and keeping

9559-442: The house. They suspected that because of the use of accelerant, the fire may have flashed over at the point of ignition and singed or burned the setter. Accordingly, they tested clothing worn by both Farrar and Green that night and took samples of the hair of both. Neither Green's nor Farrar's clothing showed evidence of having been in contact with accelerant; Farrar's hair showed no singeing, but Green's—which had been cut twice between

9680-563: The incorporation of scientific principles into medical practice in the 1800s, while family medicine emerged as part of the primary care movement in the 1960s. The training and career pathways for internists vary considerably across different countries. Many programs require previous undergraduate education prior to medical school admission. This " pre-medical " education is typically four or five years in length. Graduate medical education programs vary in length by country. Medical education programs are tertiary -level courses , undertaken at

9801-411: The initial bout of symptoms, he relapsed about a week later, and on August 18 Farrar was hospitalized with severe dehydration and high fever. In the hospital, he developed sepsis . Doctors identified Streptococcus viridans , which had probably leaked through damaged digestive tissue as a result of Farrar's severe diarrhea, as the source of the sepsis; however, they could not pinpoint the root cause of

9922-411: The internal workings of the body. In the 17th century, there was a shift towards anatomical pathology and laboratory studies, and Giovanni Battista Morgagni , an Italian anatomist of the 18th century, is considered the father of anatomical pathology. Laboratory investigations gained increasing significance, with contributions from physicians like German physician and bacteriologist Robert Koch in

10043-477: The internist decides to train in a subspecialty. In most countries, residency training for internal medicine lasts three years and centers on secondary and tertiary levels of health care , as opposed to primary health care . In Commonwealth countries, trainees are often called senior house officers for four years after the completion of their medical degree (foundation and core years). After this period, they are able to advance to registrar grade when they undergo

10164-433: The kitchen some time between ten and eleven in the evening, shortly before he went to bed. Kelly and Kate had gone to bed earlier, each taking one of the family's two dogs with them. Green said that she had fallen asleep around eleven-thirty. At some point before falling asleep, she recalled, she had spoken to Farrar, who had phoned asking which member of the household had paged him. She told police that she and Farrar were in

10285-574: The last year of his cardiology fellowship. Later Green and Farrar both joined established medical practices in the Kansas City, Missouri , area. After a year, Green started her own private practice, which prospered until she became pregnant and took time off work for another maternity leave. The couple's third child, Kelly Christine, was born on December 13, 1988. As the Farrar children grew older, they were enrolled in The Pembroke Hill School ,

10406-418: The list of diagnoses. The list is dynamic and changes as the physician obtains additional information that makes a condition more ("rule-in") or less ("rule-out") likely based on the disease profile.  The list is used to determine what information will be acquired next, including which diagnostic test or imaging modality to order.  The selection of tests is also based on the physician's knowledge of

10527-439: The medical care team, including other internists, radiologists, specialists, and laboratory technicians.  Tools to evaluate teamwork exist and have been employed in multiple settings. Communication to the patient is also important to ensure there is informed consent and shared decision-making throughout the diagnostic process. Treatment modalities generally include both pharmacological and non-pharmacological, depending on

10648-478: The medications each time he confronted her. The Farrar children were all engaged in activities outside the home. Timothy played both soccer and ice hockey , while Kate was a ballerina with the State Ballet of Missouri by the age of ten. During this time, Farrar worked long hours and Green accompanied the children to their activities, though perception of her by other parents at the activities varied—some felt she

10769-456: The new house cleaner, while Farrar vowed to curtail his work hours so that he could spend more time with the family. The improvements lasted mere months, however, and by the end of 1994, both Green and Farrar had fallen back to their old habits and the marriage was again floundering. Fearful of another confrontation with Green, and looking forward to a trip to Peru the family had planned for June 1995, Farrar nevertheless decided to wait until after

10890-405: The normal course of affairs—either throughout life or until marriage. Some reasons for changes of a person's name include middle names , diminutive forms, changes relating to parental status (due to one's parents' divorce or adoption by different parents), and gender transition . The French and English-adopted née is the feminine past participle of naître , which means "to be born". Né

11011-415: The patient requirements include decision-making and provides or withdraws consent for any treatment plan.  Good communication is key to a strong relationship but has ethical considerations as well, including proper use of electronic communication and clear documentation. Providing treatment including prescribing medications based on remote information gathering without a proper established relationship

11132-423: The poisoning. Before the surgery, he submitted blood samples to Johnson County's crime lab to be tested for ricin antibodies . Media reports in the first week of November 1995 suggested the investigation had narrowed the field of suspects, first to those intimately familiar with the house, and later to one person. Based on the trajectory of the police investigation, news reports in the following days speculated that

11253-430: The police's presence against them and gave them no resistance, she denied being suicidal and called Farrar a series of obscenities. Farrar showed police the seed packets and other items he had found in her purse the day before, and the police transported Green to a nearby emergency room . The physician who attended her there found Green to be smelling strongly of alcohol, but not visibly drunk. Though Green appeared unkempt,

11374-435: The police, Farrar immediately filed for divorce from Green and for custody of Kate, who had been taken in by his parents while Green and Farrar dealt with the police. A court later awarded temporary custody of Kate to Farrar's parents, due to Green's instability and Kate's professed anger with her father. Green was allowed supervised access during this period, while Farrar's visits were not required to be supervised. Kate Farrar

11495-535: The primary diagnosis. Additional treatment options include referral to specialist care including physical therapy and rehabilitation.   Treatment recommendations differ in the acute inpatient and outpatient settings. Continuity of care and long-term follow-up is crucial in successful patient outcomes. Aside from diagnosing and treating acute conditions, the Internist may also assess disease risk and recommend preventive screening and intervention.  Some of

11616-401: The process of divorce, though she did not know how far along they were, and that although the children were very upset at the prospect, she herself was not and was looking forward to being able to rebuild her life. Green was awakened some time after midnight by the sound of the home's built-in fire alarm system. She initially assumed that the sound was a false alarm caused by her dogs triggering

11737-756: The providing professional courtesy may have negatively impact care. Physicians must disclose all possible conflicts of interest including financial relationships, investments, research and referral relationships, and any other instances that may subjugate or give the appearance of subjugating patient care to self-interest. Other foundational ethical considerations include privacy, confidentiality, accurate and complete medical records, electronic health records , disclosure, and informed decision-making and consent. Electronic health records have been shown to improve patient care but have risks including data breaches and inappropriate and/or unauthorized disclosure of protected health information. Withholding information from

11858-410: The psychiatric medications she was taking at the time of her hearings; her second, which was denied by a judge, claimed that the evidence used to convict her of arson had been rendered obsolete by scientific advances. Green was the second of two daughters of Joan and Bob Jones of Havana, Illinois . She showed early intellectual promise, and is reported to have taught herself to read and write before she

11979-412: The sale went through. Farrar later said that he had "backed down" in the face of his ongoing worries about the state of his marriage and the couple's debt load. Shortly after the Prairie Village home purchase fell through, however, the couple's Missouri home caught fire while the family was out. Insurance investigators later determined that the fire was caused by an electrical short in a power cord. Though

12100-686: The scope of a single-organ specialty, such as shortness of breath, fatigue, weight loss, chest pain, confusion, or alterations in conscious state. They may manage serious acute illnesses that affect multiple organ systems concurrently within a single patient, as well as the management of multiple chronic diseases in a single patient. While many internal medicine physicians choose to subspecialize in specific organ systems , general internal medicine specialists do not necessarily possess any lesser expertise than single-organ specialists. Rather, they are specifically trained to care for patients with multiple simultaneous problems or complex comorbidities. Due to

12221-458: The seeds. Though she initially claimed that she was going to plant them, when pressed she said that she intended to use them to commit suicide. Green's drinking was especially heavy that day, and as her behavior grew stranger, Farrar contacted the police for assistance in placing Green into psychiatric care. Police who responded to the home described Farrar and the children as "shaken" and Green's behavior as "bizarre". Though Green did not seem to hold

12342-459: The specialist referral process is an area of potential improvement. Determining which pieces of information are most important to the next phase of the diagnostic process is of vital importance. It is during this stage that clinical bias like anchoring or premature closure may be introduced. Once key findings are determined, they are compared to profiles of possible diseases.  These profiles include findings that are typically associated with

12463-604: The speed with which the house had become fully involved suspicious enough to bring in arson investigators . The bodies of Tim and Kelly were not recovered until the following morning, when the house had cooled enough to permit safe searching. Kelly had perished in her bed, most likely of smoke inhalation . Tim's body was found on the ground floor, near the kitchen. Investigators at first assumed he had died trying to escape, but later determined that he had perished in or near his bedroom, most likely of smoke inhalation and heat, and that his body had fallen through burned flooring to where it

12584-520: The stress of his dissolving marriage or the change from a bland hospital diet to a normal home one. When Farrar's girlfriend, Margaret Hacker, told him she suspected Green was poisoning him, he initially wrote off the idea as ridiculous. Though Green was caring for Farrar in the family home while he recovered from his repeated bouts of illness, she was also continuing to drink heavily and, increasingly often, claiming to be contemplating suicide or to want Margaret Hacker dead. In late September, Farrar searched

12705-415: The symptoms of ricin poisoning. An FBI criminologist provided testimony that he had tested for ricin antibodies in Farrar's blood approximately two months after Farrar's last acute symptoms, and found antibodies there in such large amounts that he could confidently state that Farrar had been subjected to repeated exposures to ricin. A police officer testified that as the first responder to the fire scene in

12826-750: The term z domu (literally meaning "of the house", de domo in Latin ) may be used, with rare exceptions, meaning the same as née . Internal medicine In the United States and Commonwealth nations, there is often confusion between internal medicine and family medicine , with people mistakenly considering them equivalent. Internists primarily work in hospitals, as their patients are frequently seriously ill or require extensive medical tests . Internists often have subspecialty interests in diseases affecting particular organs or organ systems. The certification process and available subspecialties may vary across different countries. Additionally, internal medicine

12947-561: The third year of internist training. The Royal College of Physicians and Surgeons of Canada (RCPSC) is a national non-profit agency that oversees and accredits medical education in Canada. A full medical license in Internal Medicine in Canada requires a medical degree, a license from the Medical Council of Canada , completion of the required post-graduate education, and certification from the RCPSC. Any additional requirements from separate medical regulatory authorities in each province or territory

13068-607: The time of the fire and the time the police took hair samples from her—showed "significant singeing". Detectives recalled that Green had denied ever having been in close proximity to flames; she had reported leaving the house after seeing smoke and not coming into contact with the fire either on the deck outside her bedroom or in the process of coaxing Kate off the garage roof. Neighbors of the family reported that when Green had come to their door to ask them to call for help, her hair had been wet. Though their suspicions pointed to Debora Green, investigators continued to receive tips attributing

13189-608: The tools available to the Internist include genetic evaluation. Internists also routinely provide pre-operative medical evaluations including individualized assessment and communication of operative risk. Training the next generation of internists is an important part of the profession.  As mentioned above, post-graduate medical education is provided by licensed physicians as part of accredited education programs that are usually affiliated with teaching hospitals. Studies show that there are no differences in patient outcomes in teaching versus non-teaching facilities. Medical research

13310-477: The trip to raise the issue of a divorce again. During their trip to Peru in June 1995, sponsored by The Pembroke Hill School, Farrar met and befriended Margaret Hacker, whose children also attended the school. Hacker was a registered nurse married to an anesthesiologist , and also unhappy with her marriage. The two began an affair shortly after both families returned from Peru. In late July, Farrar again asked Green for

13431-450: Was "talkative, even cheerful". She repeatedly referred to Tim and Kelly Farrar in the past tense, and referred to all of her children by their ages rather than their names. Her accounts of times from the previous evening varied, and she seemed uncertain what time she had done things like gone to bed. At 5:30 a.m., a detective arrived from the fire scene to advise those at the police station that Tim and Kelly Farrar had been found dead in

13552-406: Was a supportive mother, while others believed she drove her children too hard and put down their efforts too often. Farrar admitted that the marriage was never ideal. He later said that neither one had expressed their love to each other, even at the early stages of marriage. Farrar recounted that Green seemed to lack the coping skills most adults bring to bear in challenging times; when she went into

13673-454: Was born on January 20, 1982. After a six-week maternity leave , Green returned to her fellowship in hematology and oncology at the University of Cincinnati. On December 27, 1984, a second child, Kate, was born. Green again returned to her studies after maternity leave, and by 1985 had completed her fellowship. She went into private practice in hematology and oncology while Farrar finished

13794-531: Was called to conduct an arson investigation on the Prairie Village house on October 24. Staffed by fire investigators and search teams from throughout the area, they focused on determining the origin and cause of the fire, searching through debris for usable evidence and interviewing witnesses. A dog trained to detect the scent of fire accelerants was brought in to assist in searching the house. The investigators ruled out common causes of accidental fires, including electrical panels and furnaces. They determined that

13915-489: Was classed as a "two-alarm" fire. The first firefighters on the scene reported that Green and her ten-year-old daughter Kate were safely outside the house by the time they had arrived. Both were in their nightclothes. Kate begged firefighters to help her brother and sister, six-year-old Kelly and thirteen-year-old Timothy, who were still inside. Green stood next to her daughter, and was reported to have been "very calm, very cool". At least two firefighters attempted to search inside

14036-417: Was discovered. The surviving members of the Farrar–Green family were taken from the fire scene to police headquarters for questioning. Detectives were sent to the house to begin an investigation. Local Prairie Village detectives separated Green, Farrar, and their daughter Kate (who was accompanied by Farrar's parents) and began to question Green. According to video of the police interview, Green reported that

14157-450: Was interviewed by investigators on October 26. She stated that on the night in question she had woken up to find the fire already burning. Seeing smoke seeping into her room, she opened the bedroom door and called to her brother, then closed the door and placed the hang-up 9-1-1 call that alerted police. She then crawled out of her bedroom window to escape the fire. Kate reported to police that when she called to her mother after escaping onto

14278-532: Was studying at the University of Kansas. The couple lived together in Independence, Missouri , while Debora finished her residency, but by 1978 they had separated and then divorced. Debora cited basic incompatibility as the reason for the divorce—"[...W]e had absolutely no common interests", she was later quoted as saying—but the divorce was friendly. During the period the Greens were separated, Debora met Michael Farrar,

14399-415: Was suddenly consuming large quantities of it while supervising the children. Though Green continued her routine of ferrying the children to after-school activities, she would spend her evenings drinking at home, sometimes to the point of unconsciousness and nearly always until she lost what inhibitions she had left about her language in front of the children. On one occasion, Farrar was called home from work by

14520-483: Was three years old. Green participated in a number of school activities at the two high schools she attended and was a National Merit Scholar and co-valedictorian of her high school class. Those who knew her at the time later described her as "[fitting] right in" and someone who was "going to be successful". Green attended the University of Illinois from the fall of 1969, where she took a major in chemistry . Though she had intended to pursue chemical engineering as

14641-528: Was too unpredictable, and chose to arrest her without warning. Green was charged with two counts of first-degree murder, two counts of attempted first-degree murder, and one count of aggravated arson. In a subsequent press conference, District Attorney Paul J. Morrison cited a "domestic situation" as the motive for Green's alleged crimes. Green was initially held in a Missouri jail, then extradited to Johnson County Adult Detention Center in Kansas, on $ 3,000,000 bond ,

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