NEW YORK - So was he fat or svelte or maybe a tad chubby? Was it really a slip on the ice or could it have been something else - even, dare it be said, something he ate?
Now there are confidential documents passed to the media, still more dueling authorities, not to mention the ticklish matter of the mayor and the doctor's widow and the promised steak dinner.
Oh, the mess goes on and on like a seven-course meal.
Dr. Robert Atkins, the diet doctor who popularized the notion that dieters could eat fat and lose weight, has been dead for nearly a year, after the 72-year-old fell on some ice and hit his head. Yet indecorous questions about his health and, yes, his weight persist, and the mayor, who hasn't even been on the diet, can't seem to stay out of it.
The latest twist is the publication in The Wall Street Journal yesterday of details from Atkins' confidential medical report. The report concludes that Atkins had a history of heart attack and congestive heart failure and notes that he weighed a chunky 258 pounds at his death.
The release of the report by New York City officials outraged the Atkins people. It also annoyed Mayor Michael R. Bloomberg, already on delicate ground in Atkins matters.
"What happened is we made a mistake," said Ellen Borakove, spokeswoman for the city medical examiner's office. Late last year, the office received a request for Atkins' medical report from Dr. Richard Fleming of the Fleming Heart and Health Institute in Omaha, Neb. On Dec. 22, a member of the records staff mistakenly mailed it out.
While cause and manner of death are public information, medical reports are not. They are to be shared only with the next of kin or anyone authorized by the next of kin, a physician or medical facility that treated the deceased or any state or federal facility that legitimately needs it.
So it was fine to tell the world that the cause of death was "blunt impact injury of head with epidural hematoma" because Atkins "fell from upright position," but that's it.
Fleming was not a treating physician, and, according to Borakove, did not say that he was. A critic of the Atkins diet, he passed the report on to a group he was acquainted with, the Physicians Committee for Responsible Medicine, which promotes a vegetarian diet and denounces the Atkins plan.
The Physicians Committee gave the report to The Journal. Borakove said that a television station in New York apparently also has a copy, because the station called her last week. (The Physicians Committee furnished a copy yesterday to the Times.)
The medical report was an external examination of the body that concluded that Atkins had a history of heart attack, congestive heart failure and hypertension. Because Atkins' wife objected to an autopsy, Borakove said, none was performed.
Responses to the medical report's release came quickly from Atkins' supporters. Dr. Stuart Trager, chairman of the Atkins Physicians Council, said the story in the Journal "was based on incomplete personal medical records that were illegally delivered to the newspaper in violation of federal law."
He said that Atkins did not have a history of heart attack, nor was he obese. He said that Atkins weighed 195 pounds the day after he entered the hospital following his fall, and that he gained 63 pounds from fluid retention during the nine days he was in a coma before he died. "Friends say he was nearly unrecognizable," he said.
Trager said that Atkins did have cardiomyopathy, a heart muscle disease that was probably caused by a virus and not by what he ate. While Atkins had a cardiac arrest the year before his death, Trager said he was unaware that he had had any history of heart attack.
"Old age was not particularly kind to him," he said. "This cardiomyopathy was a real bugger. But the physicians who were treating him had no reason to think it was diet-related."
Veronica Atkins, Atkins' widow, issued a statement yesterday expressing her horror at "unscrupulous individuals" who "continue to twist and pervert the truth." She went on to say, "I have been assured by my husband's physicians that my husband's health problems late in life were completely unrelated to his diet or any diet."
Dr. Neal Barnard, president of the Physicians Committee for Responsible Medicine, made it clear that it was not Atkins' health alone that interested him. "I'm concerned about the Atkins machine trying to play the card that Atkins was healthy and thin into old age," he said. In his view, the Atkins diet "was and is an imminent public health threat."
Dr. John McDougall, a member of the Physicians Committee and an internist who had debated Atkins, said there was no doubt that Atkins had lost weight after his cardiac arrest, but before that was a different story. "I knew the man," he said. "He was grossly overweight. I thought he was 40 to 60 pounds overweight when I saw him, and I'm being kind."
As for the buildup of fluids in his final days, he said, "I never heard of anyone gaining 60 pounds of fluid in nine days." He said he suspected that Atkins was unable to follow his own diet. McDougall agreed that the diet produced weight loss but said he considered it extremely unhealthy and hard to follow. "I call it the make-yourself-sick diet," he said.
The mayor entered the Atkins controversy during a recent pasta dinner with firefighters, when he expressed skepticism that Atkins had died from a fall (there has been speculation that a heart attack caused the fall) and described him as "fat," remarks picked up by NY1 News.
Veronica Atkins demanded an apology, and after first refusing to do so, the mayor issued one through his press secretary. He also invited Veronica Atkins to a steak dinner, no potatoes.
Yesterday the mayor condemned the latest twist, saying that there were "absolutely no circumstances that private medical documents should be put out in contravention of the law." The medical examiner's office sent a letter to Nebraska health authorities complaining about Fleming's action.
And how about the mayor's steak, no potatoes meal with Veronica Atkins? "I did have something arranged and she had to cancel for family reasons and I don't know what she wants to do after that," Bloomberg said.