High Fines and Misdemeanors Needed to Strengthen Healthcare Reforms

A series of events continuing to unfold in a rural Texas county underscore the fact that the national healthcare reform debate has little to do with health care and even less to do with reform.

Unless you have more than a passing interest in healthcare waste, fraud, and abuse, you probably missed the acquittal of a hospital administrator charged with a felony for doing her job. This case is another example that proves my belief that state and federal agencies need to enforce existing rules and regulations instead of being saddled with sweeping legislation that will not guarantee your healthcare providers take care of you.

On Feb. 11, a state court jury in Andrews, Texas, took less than an hour to acquit Anne Mitchell of felony charges that she misused official information when she reported improper medical practices performed by a physician at Winkler County Memorial Hospital, a 19-bed facility in Kermit. The county prosecutor in January dismissed similar charges against Vickilyn Galle, another hospital administrator.

The following comes from published reports, state court records, and a federal lawsuit filed by the women against various hospital and county officials.

Mitchell and Galle, registered nurses, worked at the hospital for 25 and 24 years, respectively. Mitchell served as compliance officer, utilization review back-up, and co-medical staff coordinator. Galle was head of quality improvement and utilization management and was the other co-medical staff coordinator. The credentialing of all hospital physicians and the review of patient quality issues were among Mitchell’s responsibilities.

Mitchell was in her position in April 2008 when the hospital, contrary to its bylaws, hired Rolando Arafiles, Jr., MD, who, at the time, was under a three-year restriction from the Texas Medical Board, which kept him from supervising or delegating prescriptive authority to a physician assistant or advance practice nurse, or to supervise a surgical assistant.

A year later, after the hospital’s board ignored reports by Mitchell and Galle regarding medical-related incidents involving Arafiles and five patients, the women filed an anonymous complaint with the TMB, as required by law and hospital accreditation rules. Mitchell and Galle alleged Arafiles performed improper medical procedures and was using herbal medicines not dispensed by the hospital’s pharmacy.

The TMB sent Arafiles a letter, as required, telling him about the complaint, which he turned over to his friend, patient, and alleged partner in an herbal supplement business, Winkler County Sheriff Robert Roberts, Jr. The high sheriff started an investigation, but not into the doctor’s questionable medical practices. No, the high sheriff took it upon himself to find out who ratted out the good doctor. In doing so, the women and the TMB, thinking the high sheriff was conducting a legitimate probe into the allegations, fessed up to the women’s identities.

One thing led to another which led to the eventual indictments and arrests of the women in June 2009 for obtaining and disseminating confidential patient information, a third-degree felony carrying jail time of up to ten years and a fine of up to $10,000. The high sheriff was the only witness to testify before the grand jury.

By the way, the hospital canned the women just before the indictments.

The jury foreman said the six men and six women didn’t know why Mitchell was arrested. The high sheriff chalked up the acquittal to a good spin by the defense.

Three months after the indictments, the U.S. Department of Health and Human Services Center for Medicare and Medicaid Services conducted an investigation, what CMS calls a survey. CMS found the hospital medical staff violated the facility’s by-laws by approving Arafiles for active status privileges while he was under the three-year Texas Medical Board restriction.

CMS determined the hospital failed to prevent Arafiles from performing a non-emergency room procedure in the ER, a procedure Arafiles botched, requiring a referral to a plastic surgeon in another city. CMS also found that Arafiles used oxygenated olive oil, an herbal creme he carried in his car, on a patient, not once, but three times.

And CMS said the hospital improperly fired the women who were doing their jobs as required.

Hospital honchos responded to each finding by saying, in effect, it happened as described, that they were really, really sorry about it, and that they promise to try to not let it happen again, really.

In some Texas towns, running a red light can cost you $75. In Texas, it seems, a hospital can hire a physician in trouble with the state, allow improper medical procedures, and punish employees for following the law in the protection of patients without having to pay anything except an apology. If Congress really wanted healthcare reform, it would give CMS the authority to punish with high fines and misdemeanors slimy hospital administrators and physicians who consider quality patient care an inconvenience.