Respectful Insolence

I just found out via one of the mailing lists I’m on of a very disturbing case in Kermit, Texas. Two nurses who were dismayed and disturbed by a physician peddling all manner of herbal supplements reported him to the authorities. Now, they are facing jail:

In a stunning display of good ol’ boy idiocy and abuse of prosecutorial discretion, two West Texas nurses have been fired from their jobs and indicted with a third-degree felony carrying potential penalties of two-to-ten years’ imprisonment and a maximum fine of $10,000. Why? Because they exercised a basic tenet of the nurse’s Code of Ethics — the duty to advocate for the health and safety of their patients.

The nurses, in their 50s and both members of the American Nurses Association/Texas Nurses Association, reported concerns about a doctor practicing at Winkler County Memorial Hospital in Kermit. They were unamused by his improperly encouraging patients in the hospital emergency department and in the rural health clinic to buy his own herbal “medicines,” and they thought it improper for him to take hospital supplies to perform a procedure at a patient’s home rather than in the hospital. (The doctor did not succeed, as reportedly he was stopped by the hospital chief of staff.)

How can this be? This is how:

The nurses Vicki Galle, RN, and Anne Mitchell, RN, say they were just trying to protect patients when they anonymously reported their concerns April 7 to the Texas Medical Board (TMB). The RNs believed a physician wasn’t living up to ethical practice standards at the 15-bed county hospital where they worked.

The report indicated Rolando Arafiles, MD, one of three physicians on contract with the hospital, improperly encouraged patients at the Winkler County Memorial Hospital emergency department and the county’s rural health clinic to buy herbal supplements from him.

However, because the two nurses worked for a county hospital – and included medical record numbers of the patients in their letter to the TMB in April – the county attorney’s office indicted them on “misuse of official information” – a third-degree felony that carries potential penalties of 2-10 years’ imprisonment and a maximum fine of $10,000. Additionally, the prosecution asserts the nurses used patient records as part of the evidence they offered to the TMB to “harass or annoy” Arafiles.


Part of what’s so disturbing about this is that complaints to the medical board are supposed to be confidential. Indeed, this sort of retaliation is exactly why such complaints are confidential. Why do I say “retaliation”? Well, certainly there is the suspicious timing of how they were arrested:

Mitchell and Galle, both long-time nurses at the facility, were fired from their positions and were subsequently arrested June 12, just 5 days past the 60-day window that could have been part of the defense to prove retaliation. The two nurses are free on bond of $5,000 each.

Gee, you don’t think that timing was intentional, do you? If that’s not enough, take a look at this account:

The nurses went up their chain of command with their complaints. They got nowhere with their 25-bed rural hospital. So they anonymously turned the doctor into the Texas Medical Board using six medical record numbers of the involved hospital patients .

When the medical board notified the physician that he was under investigation for mistreatment and poor quality of care, he filed a harassment complaint with the Winkler County Sheriff’s Department.

To find out who made the anonymous complaint, the sheriff left no stone unturned. He interviewed all of the patients whose medical record case numbers were listed in the report and asked the hospital to identify who would have had access to the patient records in question.

At some point, the sheriff obtained a copy of the anonymous complaint and used the description of a “female over 50″ to narrow the potential complainants to the two nurses. He then got a search warrant to seize their work computers and found a copy of the letter to the medical board on one of them.

So let’s get this straight. Two nurses, alarmed that a physician was inappropriately peddling herbal remedies that he sells to patients in the emergency room of a small rural hospital in the middle of Bufu, Texas, try to report him through the chain of command. From here on out, I’m going to try to read between the lines a bit, but I bet my speculation is not too far from the truth. My guess is that Dr. Arafiles is probably either popular or desperately needed in Kermit–or both–and that he’s well-connected in the town. Well, actually, that last part is almost certainly true, as apparently Dr. Arafiles is buddies with the Sheriff (Robert Roberts) and–who knows?–probably Winkler County Attorney Scott Tidwell as well for all we know. The Sheriff, tipped off by his buddy that someone at the hospital was complaining about his questionable choice of venue to peddle his herbal woo, went after Mitchell and Galle as though they had gone on a four county shooting spree and and then, after he figured out who they were, threw the book at them, even though they had no justification in doing so:

The Texas Medical Board sent a letter to the attorneys stating that it is improper to criminally prosecute people for raising complaints with the board; that the complaints were confidential and not subject to subpoena; that the board is exempt from federal HIPAA law; and that, on the contrary, the board depends on reporting from health care professionals to carry out its duty of protecting the public from improper practitioners.

Excerpts from this letter include:

  • Information provided by an individual to the board… is information used by the Board in its governmental capacity as a state agency…Information provided triggering  a  complaint or furthering and investigation by the Board is information provided for a governmental purpose – the regulation of the practice of medicine.
  • …under federal law, the TMB is exempt from the [HIPAA] requirements; therefore, the provision of medical documentation with patient names on them to the Board is not a violation of [HIPAA].

And it’s true. In order to encourage whistleblowing and minimize the chances of retaliation, HIPAA rules don’t apply to complaints to state medical boards. Regardless of the merit of Mitchell and Galle’s complaint, they were well within their rights to report Dr Arafiles to the Texas Medical Board. It doesn’t matter whether they had first gone through the chain of command or not, regardless of what hospital flunkies or apologists for the sheriff say.

This case is bad. Real bad. Nurses and other health care professionals are reluctant enough as it is to report a bad doctor or a doctor peddling dubious therapies as it is. What makes this case particularly outrageous is not only because it appears to be a horrible abuse of power by Sheriff Roberts, but, even worse, it sends the clear and unmistakable message to nurses in Texas: Don’t get out of line or the medical powers that be will make you pay. They will find out who you are, no matter what it takes to do so, and then they will do everything in their power to retaliate. They’ll even try to throw you in jail if they can figure out a rationale to do so, legal or not. It’s hard enough to go against a doctor as it is, particularly in small towns, where doctors are often considered pillars of the community, making it hard enough to risk the disapproval that would be likely to be directed at any whistleblower. Without legal protections against prosecution for reporting a doctor to the board, confidentiality means nothing if there is someone in a position of power who is determined enough to shred the confidentiality of the complaint (like a county sheriff) and apparently ready to abuse his power to retaliate against the nurses making the complaints.

Even though I’m a bit late to the game, it disgusted me to read about this case. If we are to protect the public from physician misconduct, be it quackery, breaches of ethics, inappropriate sexual behavior, fraud, or whatever, there must be protections for the complainants against retaliation by hospitals or whomever. Quite correctly, the Texas Nurse’s Association is fully backing Mitchell and Galle, and Mitchell and Galle are also filing a civil lawsuit in federal court against the hospital (Winkler County Memorial Hospital), the county attorney, and the sheriff. The complaint alleges:

Specifically, Winkler County had a policy to prohibit any adverse report without first getting the approval of the Board of Control of Winkler County Memorial Hospital and the Medical Staff. This discouraged employees from publicly reporting matters of public concern regarding patient safety and patients’ health and welfare as to how they were being treated that would cast Winkler County or Winkler County Memorial Hospital or Rolando G. Arafiles, Jr. in a negative light.

This sort of miscarriage of justice should not be allowed to stand. The Texas Nurses Association has set up a legal defense fund for these nurses, and I urger you all to contribute. I have. I also encourage you to write polite letters of protest to the Winkler County District Attorney’s Office. It is a travesty that this retaliation against nurses just trying to do their duty for their patients has been allowed to continue this long and this far. We should do whatever we can to make sure that this pure power play to put a couple of uppity nurses back in their place does not stand.

Comments

  1. #1 LW
    September 18, 2009

    Thank you, Orac, for bringing this to our attention.

    Your link to the legal defense fund isn’t quite right. You can get to the defense fund by going to http://www.texasnurses.org/ and clicking on “contribute now” under “Winkler County Update”.

  2. #2 RevRonRants
    September 18, 2009

    Allow me to add my thanks, Orac. I am taking the liberty of sending a link to this post to the office of the Texas Attorney General, because I believe this retaliatory action deserves to be handled as a criminal case, as well as civil. For another physician to stand alongside the nurses is, I feel, quite significant (not to mention, unusual).

  3. #3 Reality Rounds
    September 18, 2009

    Thank you, Thank you, Thank you, for writing this. I am a nurse, and you are right that the hospital culture makes it very difficult for nurses, or anyone (even other doctors) to report questionable behavior of a physician. To arrest two nurses for attempting to protect their patients? Disgusting. I hope they win that civil lawsuit.

  4. #4 daedalus2u
    September 18, 2009

    As I understand it, giving the patient ID numbers to the sheriff is a HIPAA violation and the sheriff disclosing the information he got from the TMB is also a HIPAA violation. Since it was done under false pretenses and to use the health information for personal advantage and gain, the penalty is more severe, up to $250,000 fine and up to 10 years in prison.

    This goes far beyond a HIPAA violation. The sheriff gave perjured testimony in the grand jury and in the affidavit to get the search warrant. He should go to prison for a long time.

  5. #5 rrt
    September 18, 2009

    Uppity women are my favorite kind, and I smell a big, fat settlement for two of ‘em.

  6. #6 RevRonRants
    September 18, 2009

    Years ago, when I was a medical corpsman working a dirty ortho ward at a naval hospital, I walked into a patient’s room just as an ensign nurse was preparing to inject a syringe of Keflin in a patient’s IV. I noticed that she was about to inject the antibiotic directly into the IV stream, rather than into the bottle, and suggested that she reconsider (injecting such a massive dose of Keflin directly into the bloodstream would have had some “untoward” effects, as you know). She reminded me of my enlisted rank and told me to get on with my own duties, then proceeded according to her original intent. I restated my concerns, at which point, she ordered me to leave the room. I ended up physically taking the syringe away from her, whereupon she stormed out and promptly placed me on report for “assaulting” her.

    When I came before the ward medical officer for my pre-mast (a prelude to a court-martial), I explained the circumstances to him, noting that had she proceeded as she intended, she might well have killed the patient. He didn’t say anything… just stared at me. I was excused, and the charges were ultimately dropped, and replaced with a commendation. The nurse didn’t fare quite as well.

    I was fortunate that the WMO was more motivated toward patient well-being than he was toward circling the wagons. I’d like to believe that such an attitude is universal, but situations such as Orac described in this post indicate that it is not.

  7. #7 LovleAnjel
    September 18, 2009

    From what I hear on the intertoobs, the Sheriff is invested in the doc’s herbal scam.

  8. #8 selfification
    September 18, 2009

    Off topic — Orac, why is SBM returning a 404? Trouble with the hosting service?

  9. #9 peter
    September 18, 2009

    “Uppity women are my favorite kind, and I smell a big, fat settlement for two of ‘em. ”

    And what does this idiotoic comment mean?

  10. #10 Interrobang
    September 18, 2009

    selfification — I didn’t get a 404, I got an “Account Suspended” notice.

    Did someone forget to update their credit card info, or does SBM have a zealous hosting company that acts on complaints from angry quacks regardless of the evidence?

  11. #11 Tsu Dho Nimh
    September 18, 2009

    This is not his first run-in with the Texas Medical Board. Sorry for the all caps, that’s the way the site shows it.

    Action Date: 04/13/2007
    Description: ON APRIL 13, 2007, THE BOARD AND DR. ARAFILES ENTERED INTO AN AGREED ORDER REQUIRING THAT HE COMPLETE ADDITIONAL CONTINUING MEDICAL EDUCATION IN THE AREAS OF ETHICS, MEDICAL RECORDS AND TREATMENT OF OBESITY; PROHIBITING HIM FROM SUPERVISING PHYSICIAN ASSISTANTS OR ADVANCED NURSE PRACTITIONERS; AND ASSESSING AN ADMINISTRATIVE PENALTY OF $1,000. THE ACTION WAS BASED ON ALLEGATIONS THAT DR. ARAFILES FAILED TO ADEQUATELY SUPERVISE A PHYSICIAN ASSISTANT AND FAILED TO MAKE AN INDEPENDENT MEDICAL PROFESSIONAL DECISION ABOUT THE PROTOCOL DEVELOPED BY THE OWNER OF THE CLINIC.

  12. #12 Steven Novella
    September 18, 2009

    SBM is temporarily down because of high traffic. We are looking into the cause as it may be malicious. Sorry for any inconvenience, and thanks for asking.

  13. #13 Todd W.
    September 18, 2009

    Good luck! I hope the issue is resolved soon. On a related note, the past several days I’ve had issues loading the page, getting an “Error loading database” message and sometimes slow response to loading pages when they did come up.

  14. #14 Catharine
    September 18, 2009

    Why am I not surprised? Because I have had an Attending (not just any Attending, but the chief of our division) tell me to falsify data before? Because I have been a patient in a Doc-in-a-box where I was given an IM antibiotic injection, plus several prescriptions to fill (which, for some reason, HAD to be filled in their office, which doesn’t accept insurance for medication) for a simple case of sinusitis? Because when I approached a Fellow with some ethical concerns regarding the treatment of a patient he said, “I’m a physician. I write the orders. You’re just a nurse. It doesn’t matter what you think.” Being a nurse is nothing short of humiliating. Physicians would do well to remember that we are not their handmaidens, that we have our own professional standards, code of ethics, etc., that the difference between physicians and nurses is not one of intelligence but of education and training. We do have different roles and each is worthy of respect. I look forward to the day when nurses realize our power and value, hold massive strikes, and demand fair treatment.

  15. #15 Dr. Dredd
    September 18, 2009

    daedalus2u says: “As I understand it, giving the patient ID numbers to the sheriff is a HIPAA violation.”

    ————————————————–
    I think the nurses sent the medical info to the Medical Board, not the sheriff. But more importantly…

    It is NOT a HIPAA violation. HIPAA states:

    “PUBLIC HEALTH.–Nothing in this part shall be construed to invalidate or limit the authority, power, or procedures established under any law providing for the reporting of disease or injury, child abuse, birth, or death, public health surveillance, or public health investigation or intervention.

    “STATE REGULATORY REPORTING.–Nothing in this part shall limit the ability of a State to require a health plan to report, or to provide access to, information for management audits, financial audits, program monitoring and evaluation, facility licensure or certification, or individual licensure or certification.

    So, HIPAA violation may be an excuse that the DA wants to try, but it doesn’t hold water. Unless state law somehow limits the use of medical info for this reason (which I doubt), this case should be thrown out and the attorney sanctioned.

  16. #16 bob
    September 18, 2009

    Hate to sound paranoid, but is this related to that Mabus guy? PZ has a post up about him being worse than usual lately, I noticed the comments were messed up here last night, and now you’re saying SBM is being targeted. Did he decide medical doctors are part of TEH CONSPIRACY, too?

  17. #17 Militant Agnostic
    September 18, 2009

    Does anybody know if Dr. Arafiles is part of an MLM (Multi Level Marketing) supplement marketing scheme?

  18. #18 Joseph
    September 18, 2009

    I think the nurses sent the medical info to the Medical Board, not the sheriff.

    What daedalus2u is referring to is that, according to media reports, the Sheriff uncovered the identity of the nurses by contacting the patients. It appears that Dr. Arafiles gave patient numbers/names to the Sheriff (apparently a friend of Dr. Arafiles, and possibly a business partner.) Is that a HIPAA violation?

  19. #19 Todd W.
    September 18, 2009

    @Dr. Dredd

    daedalus2u wasn’t referring to the nurses providing the board with the numbers.

    As I understand it, giving the patient ID numbers to the sheriff is a HIPAA violation and the sheriff disclosing the information he got from the TMB is also a HIPAA violation.

    So it was possibly the sheriff and hospital staff involved in helping him that could be guilty of HIPAA violations.

  20. #20 Karl Withakay
    September 18, 2009

    RE: the SBM site- I have been informed that Steven Novella handles the technical stuff for SBM, and that Orac’s alter ego has dispatched an email to Steven, and was going to follow up with a phone call if he didn’t hear back soon.

  21. #21 Karl Withakay
    September 18, 2009

    ..Always hit the refresh before commenting on a page you loaded earlier in the day. :)

    @bob, I noticed some formatting weirdness in the comments section of one of PZ’s posts also.

    In regards to the subject of the post, when will people learn the lessons of Watergate, that the cover up is often what really gets you into trouble?

  22. #22 David C. Brayton
    September 18, 2009

    This guy was recommending that his pts buy herbs from his own company? If that is the case, it seems like a straight forward violation of the federal Stark law (which prohibits self-referrals).

  23. #23 Chris Noble
    September 18, 2009

    Sounds like a case for the Semmelweis Society International

    At least it would have been before it was taken over by delusional HIV Deniers

  24. #24 Elaine
    September 18, 2009

    Check out this doctor’s amazon reviews:
    http://www.amazon.com/gp/cdp/member-reviews/A3QSNZYM2TZ9CD

  25. #25 Joseph C.
    September 18, 2009

    Hahaha. This guy is such a dirt bag.

    I guess that he found that “Face-to-Face” sales book he reviewed on Amazon useful in hectoring his poor ER patients into buying his herbal woo concoctions.

  26. #26 Dr. Mary Johnson
    September 18, 2009

    Orac, very respectfully, I am a Board-certified Pediatrician who has been jumping up and down in the blogosphere since 2005 trying to get someone to care that a “non-profit” hospital in my own hometown professionally raped/robbed/left me for dead – because one night in 1998 (while still in public service with the NHSC), I answered a phone call from some terrified nursery nurses in the middle of the night, and intervened in a neonatal case being badly botched by someone else (a local FP who fancied himself a Neonatology expert because he taught NRP).

    By ALL accounts, I saved the child’s life.

    In doing so, and reporting the case to hospital peer review, I defied hospital executives who had previously threatened with with termination if I complained any more about some of the CRAP that was going on at the hospital (for instance, our Chief of Obstetrics at the time was having an extramarital affair with an LDRP nurse, got her pregnant, and aborted the baby in their apartment).

    I was fired – my contract breeched – my practice destroyed. After I sued, I was counter-sued for “libel” because I reported everything that happened to Clinton’s DHHS Secretary, Donna Shalala, the NC Medical Board and JCAHO (all PROFOUNDLY WORTHLESS in terms of physician advocacy or institutional oversight).

    In the process, documents I authored for the purpose of peer and medical board review were plundered by the idiots running the hospital – soley for the purpose of somehow proving me “disruptive”. Privacy, confidentiality and privilege meant nothing to these morons. It was all and only about destroying me.

    The cases were settled in my favor (after three years of legal hell), but afterwards I discovered I had been swindled to the tune of hundreds of thousands of dollars by perjury, contempt and fraud.

    Six YEARS ago, I reported these INYOURFACE crimes to the N.C. & U.S. Attorneys General. I have the goods on these crooked executives, yet NOTHING has been done.

    The local press is totally in the pocket of the hospital.

    When I listen to the Obamanation prattle on about healthcare “reform”, I want to SCREAM!

    DOCTORS (AND NURSES) WHO BLOW THE WHISTLE ARE DOGMEAT. What happened to these nurses does not surprise me and is nothing new.

  27. #27 J Todd DeShong
    September 18, 2009

    Being a Texan I feel I can say that Texas law enforcement badly needs to realize that it is time to join the 21st century and stop the wild west strong arm law tactics! I’ll never forget coming back to TX for a visit (after fleeing when Governor Ann Richards lost to George W. Bush…need I say more?) and seeing a sign on a door to a local restaurant stating: “Please do not bring concealed weapons into this establishment”. I thought it must be a joke, but my friends said, “No, Governor Bush repealed a 120 year old Concealed Weapons Law!”
    Now that I am a part of a great medical establishment in Texas, I must applaud the medical board on this one and state that not everything in Texas is crazy. Here in the Baylor Health Care System, we have a program that openly asks employees to stop any caregiver, no matter how far “above” you if you see that caregiver putting the patient at risk in any way, shape or form!
    JTD

  28. #28 Comrade PhysioProf
    September 19, 2009

    Robert Roberts

    What kind of fucked up imbecile named “Roberts” names their motherfucking kid “Robert”?

  29. #29 Marcus Ranum
    September 19, 2009

    What kind of fucked up imbecile named “Roberts” names their motherfucking kid “Robert”?

    Beats naming the kid “oral” or “anal” huh?

  30. #30 Robster, FCD
    September 20, 2009

    Mary, When you use a term like “the Obamanation,” you destroy your credibility completely and utterly.

  31. #31 Dr. T
    September 20, 2009

    “The Texas Nurses Association has set up a legal defense fund for these nurses, and I urger you all to contribute.”

    I’d rather contribute to the “Shoot Dr. Arafiles and Save Lives” fund.

  32. #32 Dr. T
    September 20, 2009

    “The Texas Nurses Association has set up a legal defense fund for these nurses, and I urger you all to contribute.”

    I’d rather contribute to the “Shoot Dr. Arafiles and Save Lives” fund.

  33. #33 Dr. Mary Johnson
    September 20, 2009

    Robster, respectfully, it’s a rather common term in the spheres where I blog, and I don’t drink the Deep Blue Koolaid.

    If that’s all you got out of my comment, then you’re not the audience I’m looking for.

    Speaking of destroying credibility, are you going to catch the POTUS on Letterman tomorrow night?

    Be there or be square.

    Heavy sigh.

  34. #34 Douglas McClean
    September 20, 2009

    Mary Johnson,
    I think the reason Robster suggested that your comment was destructive of credibility was that it was as complete a non sequitur as I recall ever having seen anywhere.

    Would you consider explaining what in holy fuck either President Obama or health insurance reform have to do with your (troubling) story?

  35. #35 Dr. Mary Johnson
    September 21, 2009

    Thanks Douglas, I’m happy to do that. I’d appreciate it, though, if you’d keep a check on the “holy fucks”.

    (At least you do think it’s “troubling” – that’s something.)

    Some us drank the public-service and “non-proftits are only there to serve” Koolaid when we were very young (I came to my hometown in 1995). I bought every empty promise and every noble lie and worked my ass off for three years only to see everything I ever wanted destroyed in the blink of an eye – all because I did the right thing by a dying infant (and let’s be clear, she was dying) being mis-manged by someone else – and I refused to cover it up.

    (I was finishing up a Federal NHSC obligation when this happened – we’ll get to that in a minute.)

    I started my adventure in Hillary’s “village”. North Carolina, for all of its reputation as a rabid red state, has actually been run by Democrats for the last gadzillion years. I’ve been stomped by all the noble Dems – from Jim Hunt to Mike Sleazely to Bev Perdue (aka Governor Dumpling).

    Current AG, Roy Cooper, has been less-than-worhtless. It’s all about who you are or who you know.

    OBTW, I’m sure you’ve heard of my ex-Senator, John Edwards – he who was going to be “the most accessible Senator ever”.

    (I’m gonna have to pause to throw up.)

    For all of the Dems noble talk about public service, and giving back to the community (in this sad case, my hometown), and (let’s not forget) “hope” and “change”, none of them could ever seem to lift a finger to push back some of the slime & GOB corruption that enveloped me/my case and do something to help.

    Now Sleazely and Edwards are looking at grand jury investigations and criminal indictments. I was begging for help from liars and crooks! I might as well live in Louisiana – or Chicago.

    On the Federal level (and opposite side of the aisle), I never held much against GW, because he never rode in on his white horse and told me he was going to save healthcare. That, and he had bigger things to worry about.

    And now we have President Obama – rolling out even more of the tired, worn-out notions that government (the same government that could not enforce its own contracts or protects its own people by making a few simple phone calls in my case very early on – the same government that has no clue what effective oversight is – the same government that was asleep at the wheel as billions of Federal dollars were wasted in North Carolina alone) will ride in and save us.

    Obama has even appointed an “NHSC success story” from Louisiana as Surgeon General.

    Just don’t glance down North Carolina way. You might see the “NHSC dismal failure” he & his admninistration do not want to admit exists.

    And let’s not forget as we reform things that the First Lady just happens to be one of those 317,000/year hospital executives well-versed in the art of the dump:

    http://drjshousecalls.blogspot.com/2009/09/on-michelle-obamas-bondage-belt.html

    The White House knows I’m here in the blogosphere. Someone there has been all over my blog. But my story does not fit the agenda.

    Ditto for JCAHO and the AMA . . . as useless as tits on a boar-hog when it comes to physician advocacy and patient safety.

    The agenda is, of course, total government take-over & control of the healthcare machine – sans whistleblower protection – sans tort reform – sans any real/effective oversight (especially of “non-profits”). But hey, let’s give it MORE to do. Doctors can be indentured servants. And while we’re at it, let’s let the newspapers re-organize into “non-profits” – or better yet, nationalize them too!

    The more the damned merrier!

    As for my “credibility”, you might wanna step over to my place and check this post out:

    http://drjshousecalls.blogspot.com/2008/08/well-now-i-guess-i-dont-have-to-sue.html

    Or this one:

    http://drjshousecalls.blogspot.com/2009/04/part-three-disruptive-decision-faux.html

    You might find those “troubling” too.

    Sorry, if I sound testy. But the VERY LAST thing you can attack is my credibility.

  36. #36 Orac
    September 21, 2009

    I still don’t see what any of this has to do with President Obama’s health care reform initiative. Your links are tenuous at best.

  37. #37 Calli Arcale
    September 21, 2009

    Okay, Dr Johnson, so your “Obamanation” comment has zero relevance to your troubling account of protectionism among your professional colleagues.

    The same has happened at for-profit institutions. I think it’s fairly safe to say that whether an institution is for-profit or non-profit has little relationship to whether or not the professional environment is hostile.

    There was a disturbing whistleblower story here in Minnesota recently. It wasn’t a doctor getting fired, but a gal was having problems getting an insurer to pay per contract. Last year, when the same thing happened, she asked her supervisor what to do and was told to report them to the relevant state authorities, which she did. The problem was quickly resolved, and her bosses praised her. This year, the situation occurred again, and after trying for seven months to get the insurer to cut the check, she report them to the authorities. The authorities investigated, the insurer paid up, and she thought all was settled. Wrong. She was fired for stepping outside the chain of command, and creating an embarassing situation for the insurer, with whom her office (a private corporation consisting of a group of private dental and medical practices) wishes to maintain a good relationship. She worked out a settlement out of court with her former employer, but when she went to apply for unemployment benefits, was shocked when she was turned down — her employer said she had been fired for misconduct. She appealed, and the court ruled *against* her, saying she didn’t get whistleblower protections merely because she failed to cite a specific statute violated by her employer — despite the fact that her employer did in fact violate state statute in firing her. Basically, she lost on a technicality.

    The bottom line is that protectionism runs deep in a lot of hospitals and medical practices, whether private or public, profit or non-profit. It’s a disturbing thing, but fearmongering about change certainly isn’t going to help. There have been many attempts to improve the situation over my lifetime; most have been discarded on the basis of being imperfect, which is frustrating partly because perfection is impossible but mostly because the imperfect fixes would be better than what we have now.

  38. #38 Dr. Mary Johnson
    September 21, 2009

    Orac, very respectfully (and thank you for the forum), President Obama’s “healthcare initiative” relies on the same old tired, worn-out “government-as-Daddy” concepts that have utterly FAILED me personally (as a public servant and medical whistle-blower) for eleven years.

    They failed my patients – and their parents – too. But nevermind about that.

    I have lots of links at Housecalls – about the joke that is medical peer review (courtesy of HCQIA), or the bigger one that is HIPAA (because institutions use confidentiality and privacy laws to hide medical badness instead of fix it). Both of these sweeping Federal laws were legislated in broad stokes – with little forsight as to the ugly unintended consequences (EXACTLY the way the new laws are being drafted now).

    They’re VERY imperfect (Calli) – and they’re very imperfect because no one could look beyond the next sound-bite or election. That’s part of the reason these nurses Orac is so concerned about here are legally hosed.

    Doctors & nurses can be utterly destroyed for doing the right thing – labeled “disruptive” – BECAUSE of bad laws like HCQIA and HIPAA – and sucky doctor/patient advocacy on the part of AMA and JCAHO. Occasionally you see a post like Orac’s in the medical blogosphere bemoaning the fact, but what has really been done to “reform” it?

    I ask you, what is being offered to fix this – right now – in Obama’s grand plan? Cuz it’s been eleven years and I’m kinda tired of waiting.

    A big phat nothing. You cannot fix anything if you do not first acknowledge that the problem exists. Oh, and it might help to sit down and iron out some details. Obama, like so many before him, has not done that. So again, my story/the links I provided are hardly “irrelevant” or “tenuous”. Understanding what happened in my case (and so many like it), and why it happened, are a huge of the KEY to fixing this mess.

    I will submit that doctors are NOT going to get any support for malpractice tort reform in ANY reform package until we can convince the public that we doctors (and our hosptials – “non-profit” and otherwise) can effectively and fairly police our own.

    But hey, tell me one more time that I’m “irrelevant” or that I have “no credibility”.

    Obama is not the first to tout programs like the NHSC (National Health Service Corps) as a solution to physician shortages (it was a big theme in the Kerry-Edwards campaign) – never mind that these programs usually serve as revolving doors for doctors just trying to get out of debt or work out their VISAS (by offering service to the sticks). The treatment I got in my own hometown as I completed such an obligation (and the so-called “protection” offered by DHHS to one of its own) is hardly “tenuous” or “irrelevant” IF YOUR OFFERING/ENDORSING MORE OF THE SAME.

    A patient-dumping scheme in Chicago, conceptualized by Obama’s wife (a very-well-paid hosptial executive) is hardly “irrelevant” to the President’s notions of reform (all about re-distributing RESPONSIBILITY and wealth).

    Nobody is talking about all of the suits in the middle – between the doctor and the patient – sucking the life out of medicine and the dollars off the top.

    Of course, no one is talking about some of the real reasons we’re in this mess – which is all about a sense of entitlement on the part of an entire citizen class (paid for by another) that our current system is voraciously feeding – with no limitations or boundaries set.

    That’s what so many of the folks at the tea parties are mad about. But nevermind. Calling them names and telling them their concerns/experiences are irrelevant will win them over.

    Here’s another thought (having been dissed/ignored by a local press totally in a local hosptial’s pocket for eleven years), a national press that’s totally gaga over Obama and/or in his administration’s pocket (especially if it can retreat to the “non-profit” sector – which, in reality, suffers next-to-no oversight) is hardly “irrelvant” to how we get to that reform.

    I ask you, might the President have better spent his time yesterday reaching accross the aisle to those who oppose him (for good reason) – as opposed to mugging it up for the cameras?

    I for one, would like to see this very imperial President actually govern as opposed to pontificate & scold. If he wants my support, he needs to do something that changes my mind.

    And OBTW, Medical Boards that tell doctor they must do their “duty” and blow the whistle . . . but then turn their backs on those who do . . . need a good legal wallup upside the head. I may have to resort to that shortly with the NCMB. Only time will tell. Let’s just say I’m thisclose to throwing up my hands and hiring a lawyer again – something that, if the system worked AT ALL, I should not have to do.

    The point kind of is that I am sick and tired of the flowery rhetoric . . . be it from Hillary . . . or John-Boy . . . or Hunt/Sleazely/Perdue . . . or Obama . . . if there is nothing behind it.

    I want to see them back up what have so far been empty words.

    That’s not “fear-mongering” it’s fact.

  39. #39 KATHY CARR
    September 21, 2009

    I WANT TO REPORT THE WORST DOCTOR I OR MY MOTHER HAS EVER VISITED. HER NAME IS DR. BEVERLY JORDAN IN ENTERPRISE, AL. I FEEL VERY DEEPLY THAT SHE NEEDS HER LICIENCE TAKEN AWAY BEFORE SHE IS ABLE TO KILL SOMEONE!!!!!! MY MOTHER HAS BEEN GOING TO THIS SO CALLED DOCTOR FOR 3 YEARS. MY MOTHER IS 69 YRS OLD CAN NOT SEE SO I HAVE TO DRIVE HER TO HER APPTS. AND BE IN THERE TO HELP HER OUT. THIS DOCTOR WAS ALSO MY DOCTOR, BUT I REQUESTED TO GET MY RECORDS IN ORDER TO FIND ANOTHER DOCTOR BECUASE THIS DOCTOR IS THE REASON I HAD TO HAVE BACK SURGERY.. MY SURGEON IS THE ONE THAT RECOMMENED THAT I GET RID OF HER. MY MOTHER BEING HER AGE WAS AFFRIAD TO CHANGE BECAUSE SHE IS AFFRAID OF CHANGE. THIS STUPID DOCTOR FOUND OUT I WAS CHANGING DOCTORS AND THREW MY MOTHER OUT OF HER PRACTICE..SHE IS NOT THE ONLY DOCTOR IN THIS PRACTICE BUT BECUASE SHE THREW HER OUT SHE WAS TOLD BY TAMMY THE OFFICE MANAGER THAT THE OTHER DOCTORS WERE NOT ABLE TO SEE HER EITHER. THIS SO CALLED DOCTOR JORDAN GAVE MY MOTHER ENOUGH MEDS FOR THREE MONTHS WHICH WAS FINE THAT WOULD GIVE US TIME TO FIND HER ANOTHER DOCTOR..WELL IT HAS NOT BEEN A MONTH AND THE MEDICINES MY MOTHER HAS TO TAKE KEEP HER LIFE LIVABLE. WELL WHEN MY MOTHER CALLED TO GET HER REFILLS SHE WAS TOLD THAT THIS DOCTOR BEVERLY JORDAN OF ENTERPRISE, AL HAD CANCELLED ALL HER PRESCRIPTIONS!!! PLEASE I BEG OF SOMEONE TO FIND A WAY TO TAKE THIS WOMANS LISINCE AWAY FROM HER. SHE DOES NOT DESERVE TO BE WORKING ON ANIMALS!!!!!!!!! SINCE ALL OF THIS WE HAVE FOUND OUT FROM SEVERAL AND I MEAN SEVERAL PEOPLE THAT IF THEY HAD NOT LEFT HER THEY WOULD BE DEAD..IT IS ONLY A MATTER OF TIME BEFORE SHE DOES KILL SOMEONE……..I HOPE SOMEONE WITH SOME KIND OF PULL READS THIS AND LOOKS INTO HER BACKGROUND AND WHAT SHE IS DOING TO PEOPLE NOW BEFORE IT IS TO LATE.

  40. #40 Jay K.
    September 21, 2009

    Ah, Mary read Ayn Rand. Good for her. When will she be “going Galt?” I hope soon.

  41. #41 Dr. Mary Johnson
    September 22, 2009

    Jay, I’ve never read Ayn Rand in any depth. I’ve heard the name bantered about as some kind of insult amongst the more politically liberal set in my own neck of the blogosphere (apparently there’s a book out there that we more conservative types are all supposed to have read).

    I don’t know much about “going Galt” either – but from what little I’ve read on that subject, it may not be a bad idea.

    My wings (the right and the left) are broken. I’ve voted Republican most of my life, but I’ve been an Independent for almost a decade (because for all that the yahoos running the state of North Carolina are beyond-corrupt-soon-to-be-indicted Democrats, the good-ole-boys running my county . . . the people I first turned to for help . . . were Republicans).

    Corruption is corruption. Greed is greed. Ineptitude and sloth are ineptitude and sloth – ESPECIALLY in government medicine.

    What the hell is “reform” if it’s not going to work for the doctors & nurses – the people actually studying and training and working like dogs (as the lawyers hover) to provide the care? I’d like to get beyond left and right – or Dems and Republicans – and talk about what reform really should be – beyond just filling hands that are sticking out.

    Obama has been showcasing all manner of victimized citizen in his campaign for universal coverage. I haven’t seen him showcase any physicians burned by the system.

    That might be embarrassing.

    To me, the term “Obamanation” (the term that seems to have so many people here literally spitting on their keyboards) does not just refer to the man, but all of those who blindly follow him and his (not new or unique) ideas.

    I hesitated commenting here at all. I’m pretty sick and tired of getting beat up for telling the truth – being told I have no credibility after spending YEARS of my life being the only credible/truthful person in a room. The system is broken. But “the fix” Axelrod & company want to impose is no fix at all.

    Orac, if you are really concerned about this case (the nurses) . . . Douglas, if you find my situation “troublesome” . . . well tell me, HOW is this going to be fixed/addressed in “reform”?

    KevinMD had a post up yesterday that had me spitting on my keyboard:

    http://www.kevinmd.com/blog/2009/09/health-care-reform-protests-fears-beliefs-exploited.html

    After I let loose, one commenter NAILED it:

    “This article – and many like it simply state – we need reform so let’s support this reform because we surely need reform and therefore, let’s get behind and support the reform that the President says we need. Healthcare reform should be about the details and making them economically viable. We do not need another failed program, ie, war on poverty, Amtrak, Fannie + Freddie, etc.”

    I’m here in the blogosphere, signing my own name, throwing the medical tea, taking all kinds of crap from people (“colleagues”) who have little clue/real understanding of the extra-special hell I and others like me have been through.

    I’ve been to Obama’s Mountaintop (it’s where Hillary’s village was) and I was thrown over the side.

    And one more thing . . .

    . . . keep hurling the smug insults & character slurs . . . belittling anyone and everyone who might not slurp up the deep Blue Koolaid as it is currently being served.

    That will really get you somewhere.

  42. #42 Orac
    September 22, 2009

    Orac, if you are really concerned about this case (the nurses) . . .
    Douglas, if you find my situation “troublesome” . . . well tell me, HOW
    is this going to be fixed/addressed in “reform”?

    It’s not, because that’s not the purpose of health care reform, and it’s a straw man argument to imply that it is and attack it for not dealing with your situation. The purpose of reform is to try to decrease the number of uninsured to as close to zero as possible and to try to rein in costs and improve care. We can argue whether the current proposals can achieve those aims, but it’s silly to attack them for something they were never meant to do.

    That’s because it is not the federal government that licenses physicians and health care professionals, and that will not change under anything that comes out of Congress. It is the state that licenses physicians, etc. Consequently, it is the 50 states that would need to reform.

    Your whole “Obamanation” bit is nothing more than a red herring. You don’t like government; you don’t like Obama; you detest his politics; so you attack him and blame his ideas for your situation when they are not at fault. In other words, you’re attacking the wrong target.

  43. #43 dmcclean.myopenid.com
    September 22, 2009

    Orac said exactly what I was about to say, only more eloquently.

  44. #44 Dr. Mary Johnson
    September 23, 2009

    Orac, again respectfully (and your eloquence aside), you’ve missed a fairly big point.

    In my case, we’re not talking about licensing or even privileging. My license/privileges NEVER came under attack . . . for all that the North Carolina Medical Board cannot be bothered to defend the duties it requires.

    I’m well aware that the Federal government does not license physicians (and, in the wake of Katrina, we could debate all day long about why it might be a good idea to have a more nationalized system of physician oversight & discipline . . . in which doctors who have screwed up in one state could not hop over the line and practice unrestricted in another . . . and in which doctors could be more effectively mobilized in national disasters).

    I was fired (by a tax-exempt “NON-PROFIT” charged with the public good) . . . for facing down threats and saving a baby’s life and reporting another MD to peer review . . . while I was in FEDERAL SERVICE.

    Afterwards, I was black-balled locally, and had to hit the road as a Locums to make ends meet.

    When this incident happened I was literally days away from completing a National Health Service Corps (NHSC) obligation – the SAME program that paid for the medical education of Obama’s new Surgeon General . . . the same program he now touts (like John Edwards and John Kerry before him) as a wonderful way to improve access to underserved areas.

    The DIFFERENCE is that, in my case, every (government) contract was breached (by the “non-profit” hospital), every medical ethical/moral canon was violtated, and pretty much every rule of law was broken (from violating the confidentiality of peer review to in-you-face perjury), yet the Federal government (supposedly my protection and shield) did not lift a finger to put an end to it.

    In the beginning, it would have only taken two or three phone calls on the part of the Feds (in this case, Clinton’s Secretary Shalala) to STOP what was going on and salvage my practice (in my own hometown). Now it’s just a damned mess.

    That was bad enough. But here’s the real kicker about the Federal government’s fundamental inability to adequately oversee anything: I WAS SUED FOR “LIBEL” (ultimately unsuccessfully – spending my own money to defend it – money I did not have) for providing requested feedback to the NHSC!?! The irony is that I used what was supposed to be a confidential forum to do it (in other words, I did not publicly broadcast anything)!?!

    It’s actually not so very different from the HELL these nurses are being put through for trying to stop a quack.

    For my effort & trouble, I got ZERO help from the government I served honorably and well. ZIP. NADDA.

    But hey, Obama says let’s give our ineffectual Federal government MORE to manage and oversee! Yippee!

    You’re damned straight I’ve got no use for that kind of reasoning – and I will vigorously oppose it.

    Orac, you were all concerned about these nurses – in Texas – a state that’s considered backwards and ignorant by the liberal elite because it’s where GWB hails from – but the TRUTH is that medical whistle-blowers have been pulverized and ignored by both politcal parties – there is no aisle. The actions never match the rhetoric.

    And I’ve been listening a long time – since my stint in Hillary’s “village”.

    I think my aim is spot on. Former Senator John Edwards . . . the liar that I desparately (and now ironically) appealed to for help in combatting “non-profit” perjury/contempt/fraud . . . would be U.S. Attorney General now (horrors!) had he not been caught with his zipper down. So don’t tell me that the President isn’t a politics-as-usual kind of guy.

    Speaking of credibility, REFORM CAN BE WHATEVER WE MAKE IT. Not to include peer review & tort reform and whistle-blower protection in current “reform” measures – not to demand more accountablity from “non-profits” – is just STUPID AND IRRESPONSIBLE if we really want to improve care and access – and decrease cost.

    I used the word Obamanation in my original comment – which is exactly what my story is (just like these nurses) . . . a medico-legal abominiation . . . to emphazize that what we are getting here (so far) is no change at all. It’s just more of the same on a grander, more expensive scale than anything we’ve ever seen. We are selling our children’s futures down the toilet.

    Yet all you can do is spit and sneer and tell me that eleven years of my life lost to inneptitude and sloth on the part of the Federal government (and in my case, largely at the hands of “progressive” Democrats) is “irrelevant” and “tenuous” and a “red herring”.

    I’m sorry if this is too much insolence for your taste, but you’re just wrong. I know that a lot of folks here are scared of you and you don’t hear it much. But you’re just dead wrong.

    And I am going to keep being insolent.

  45. #45 Happy Hospitalist
    September 28, 2009

    unbelievable. A disgrace to the medical and law professions.

  46. #46 Needs to be Anonymous
    September 30, 2009

    Using HIPAA as a punishment device for whistleblowers is a major tactic, at least in Pittsburgh. There were stories in the paper about a whistleblower who won her case for wrongful discharge for HIPAA reasons. And a bunch of whissltblowers being shut down for the same reason but lacked the legal representation to get a fair treatment. There were docs involved as well, but who knows what happened there??

    The most astounding story was about crushing Dr. Starzl’s revealing findings on the rate of complications in the liver transplant service was double what the chief doc was reporting.

    Apparently, Dr. Starzl was banned from stepping in his own Transplant department because they accused Dr. Starzl of being a HIPAA violator for trying to tell the real story.

    Astounding, but later the senior medical person said it was the right thing to do.

    There is nothing in HIPAA that protects against using the HIPAA to bash whistleblowers and penalize “unnecessary secrecy” as much as “inappropriate disclosure.” The lack of balance in the law can be very effectivly used in a completely legal way to silence anyone who cant fight back against an army of hospital lawyers.

    Someone needs to do something about this, and the Starzl case seemed to be the biggest example. Did that ever get looked at by anyone??

  47. #47 liz wetzel
    February 7, 2010

    The woman is not even a real nurse, she is an admin nurse, those who type and checks medicare eligibility.

    The rubber suture was a temporary fix. THe doctor is US licensed, had previously practiced in other US hospitals, FOR YEARS.

    People are calling him now a quack because of the ramblings of a typist nurse who writes ghost letters so someone who worked all his life be deduced to a ‘quack’.

    She wants someone to lose his license, something the guy worked for all his life. Now that she was outed, she is now playing hero – claiming she just wants to save the world.

    How can you be a hero if you are out to destroy someone’s reputation and livelihood?

    The guy has saved lots of lives, hasnt lost one. Yet the woman is out to destroy him. Now is that heroism to you?

  48. #48 Orac
    February 7, 2010

    Gee, Liz, you wouldn’t happen to know Dr. Arafiles, would you?

    And, yes, I do consider these nurses to be heroes, and if he has done what these nurses reported him for he does deserve some sort of sanction, possibly even the loss of his medical license.

    Stay tuned. Liz. I’ve written a followup post to this one that will post overnight. If this one pissed you off, tomorrow’s post will really get your blood pressure to skyrocket!

  49. #49 liz wetzel
    February 7, 2010

    Why shouldnt I post the same post when its the same news everywhere?

    You should know that the Japanese auto industry donates to racist websites like amren and the like, to continue disparaging Koreans and Filipinos.

    The Koreans have publicly complained about them for turning the korean women to comfort women.

    My great grandfather was WW2 veteran who was amputated by a Japanese bayonet. He was thought to be dead, a philippine native dragged his body underneath their nipa hut basement, was healed and fed by the Filipino. I wouldnt be here if not for that filipino.

    The Filipinos have been an US ally for decades now. So if youre being paid by the Japanese, you should be ashamed. That is Judas gold.

  50. #50 Chris
    February 7, 2010

    Huh? Who said you couldn’t post anything? What is the stuff about the Philippines about? This is Texas, where Spanish surnames have been common since before Texas was a republic.

  51. #51 micah
    February 9, 2010

    This Liz person sounds like she has some kind of personal knowledge of Mrs. Mitchell. You must be one of those ignorant people that give us “west-texans” a bad name. WTF? Wake up! If you look at the facts, you’ll see that Dr. Arafiles’ license is REVOKED in the state of New York. He also practices under a limited license in Texas. I’m from the area too, and I know that several other nurses raised questions and concerns about this “quack” for months to the Hospital Administration. And nothing, I repeat, NOTHING was done about it. They’d rather do nothing and risk patient safety then hire a better doctor with an untarnished record. Open your eyes: Dr. Arafiles, the sheriff, the hospital administrator, and the county attorney are all in on this. They don’t want to get rid of their “golden boy” who probably hooks them all up with prescription meds.
    I’m not saying that Dr. Arafiles hasn’t done some great things and saved lives….that’s what doctors do, it’s their job. But the question is: How many times can he get away with un-ethical practices, that can potentially put a patient in danger? Liz: Did you forget about the patient that ended up dead after your “golden boy” kept her in an emergency room in Kermit for too long, instead of rushing her to Odessa, Lubbock, Midland, or even Andrews (all of which are better equipped to handle such cases)? I guess that’s one of those facts that’s easy to overlook…..just like the herbal med peddaling, taking supplies from the clinic to perform procedures at a patient’s home, and prescribing dangerouse weight-loss drugs (speed) when unnecessary. The list goes on……
    No matter what kind of nurse Mrs. Mitchell was, she was obligated to report this dangerous doctor. And if he’s done nothing wrong, what’s he so upset about? People have the right to make legitimate complaints using the proper lines of communication. This is what Mrs. Mitchell did. Another question: Why the heck did they drop the charges on Mrs. Galle? Oh yeah…because they don’t have a case! Both nurses were involved in the “anonymous complaint” yet only one nurse is going to trial. If anything, these people are out to get Mrs. Mitchell and ruin her good name. I can’t wait for her to be acquitted. Then she’s going to win her civil case, and shove this crap up Winkler County’s ass!

  52. #52 Composer99
    March 30, 2011

    … and I think it’s time for comments to get closed on this thread.

  53. #53 Narad
    March 30, 2011

    Wait, I want to hear more about this chicken.

  54. Orac, again respectfully (and your eloquence aside), you’ve missed a fairly big point.

    In my case, we’re not talking about licensing or even privileging. My license/privileges NEVER came under attack . . . for all that the North Carolina Medical Board cannot be bothered to defend the duties it requires.

    I’m well aware that the Federal government does not license physicians (and, in the wake of Katrina, we could debate all day long about why it might be a good idea to have a more nationalized system of physician oversight & discipline . . . in which doctors who have screwed up in one state could not hop over the line and practice unrestricted in another . . . and in which doctors could be more effectively mobilized in national disasters).

    I was fired (by a tax-exempt “NON-PROFIT” charged with the public good) . . . for facing down threats and saving a baby’s life and reporting another MD to peer review . . . while I was in FEDERAL SERVICE.

    Afterwards, I was black-balled locally, and had to hit the road as a Locums to make ends meet.

    When this incident happened I was literally days away from completing a National Health Service Corps (NHSC) obligation – the SAME program that paid for the medical education of Obama’s new Surgeon General . . . the same program he now touts (like John Edwards and John Kerry before him) as a wonderful way to improve access to underserved areas.

    The DIFFERENCE is that, in my case, every (government) contract was breached (by the “non-profit” hospital), every medical ethical/moral canon was violtated, and pretty much every rule of law was broken (from violating the confidentiality of peer review to in-you-face perjury), yet the Federal government (supposedly my protection and shield) did not lift a finger to put an end to it.

    In the beginning, it would have only taken two or three phone calls on the part of the Feds (in this case, Clinton’s Secretary Shalala) to STOP what was going on and salvage my practice (in my own hometown). Now it’s just a damned mess.

    That was bad enough. But here’s the real kicker about the Federal government’s fundamental inability to adequately oversee anything: I WAS SUED FOR “LIBEL” (ultimately unsuccessfully – spending my own money to defend it – money I did not have) for providing requested feedback to the NHSC!?! The irony is that I used what was supposed to be a confidential forum to do it (in other words, I did not publicly broadcast anything)!?!

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