Texas Medical Board Files Complaint Against Physician Involved in Whistleblower Case

I’ve written before about the case of Anne Mitchell and Vicki Galle, RN’s who lost their jobs at Winkler County Memorial Hospital in Kermit, Texas after reporting concers to the Texas Medical Board about Rolando Arafiles, Jr, MD, one of the physcians on the medical staff.   What happened next  created a national firestorm, and is almost too strange to be believed.

Now, Medscape Today reports that the Texas Medical Board has filed a formal complaint against Dr. Arafiles. 

The Texas Medical Board (TMB) has charged a family physician at the center of a nationally publicized whistle-blower caseinvolving 2 nurses with poor medical judgment, nontherapeutic prescribing, failure to maintain adequate records, overbilling, witness intimidation, and other violations.

The charges follow a report that the 2 nurses — Anne Mitchell, RN, and Vickilyn Galle, RN — made anonymously to the TMB last year about patient care rendered by Rolando Arafiles, Jr, MD, at Winkler County Memorial Hospital in Kermit, Texas, where the 2 nurses and Dr. Arafiles worked.

Read the rest at Medscape Today – free registration required:

Ordered by an LIP? The Hospital Dilemma.

Prior to providing care, treatment, and services, the hospital obtains or renews orders (verbal or written) from a licensed independent practitioner.

Sounds like a no-brainer right?  How difficult can it be for hospitals to comply with such a simple standard?

Turns out, pretty difficult. 

Nearly every hospital struggles to comply with at least one aspect of that simple-sounding CMS/Joint Commission requirement in today’s highly-mobile society. 

Each day around the country, patient’s show up at hospitals wth orders for various laboratory or radiology studies.  If the physician or advanced practice nurse practices at the hospital, there’s no question that he or she is a licensed independent practitioner; the records are right there, usually available with just a few keystrokes.

But what if the doctor or APN practices at a hospital across town, or across the country?  Patient’s often travel with prescriptions in hand, or may contact their health care provider back home regarding a flare-up of some chronic condition.  Studies are ordered, and results need to be sent to the ordering practitioner. 

How does the hospital performing the study verify that the orders originated with a licensed, independent practitioner?  Before the lab work, radiology exam, or other outpatient study can be completed, someone at the hospital must obtain an address, verify the license of the ordering practitioner in the state in which they practice, and record that information in the hospital data system.  In large cities or popular tourist areas, that scenerio can be repeated many times each day. 

Some health systems have hired dedicated empoyee(s) to handle this responsibility, others pass the job on to staff in Patient Admissions or Registration, usually with the Medical Staff Office as a back-up resource if questions or problems arise.  Because the verification must take place pror to the provision of services, meeting this standard in a timely fashion can prove quite challenging. 

The complete standard is referenced below: 

Standard PC.02.01.03

The hospital provides care, treatment, and services as ordered or prescribed, and in accordance with law and regulation.

Elements of Performance for PC.02.01.03

1. For hospitals that use Joint Commission accreditation for deemed status purposes: Prior to providing care, treatment, and services, the hospital obtains or renews orders (verbal or written) from a licensed independent practitioner in accordance with professional standards of practice and law and regulation.

Reference Cop:  42 CFR 482.12(c) Governing Body

The Patient in the Mirror

They say doctors make the worst patients, but I do not agree. The worst patients are abusive or rude; I am merely neglectful. I do not go to doctors or have a personal physician. I don’t need one: I run six miles a day and don’t smoke, drink or eat red meat — I am ridiculously healthy.

The first thing I do is convince myself it isn’t a lump. Not difficult, as I’ve felt plenty of lumps, and mine does not fit the category…

Read the rest of Ellen D. Feld, M.D.’s journey from physician to patient, from the New York Times.

Clinical Setting No Excuse For Hostile Work Environment

After resigning her position, a female physician in North Carolina brought a claim of sexual harassment against her former employer, the physician-owner of a medical clinic.  Initially the court ruled against her claim, stating that it was “not uncommon in a medical setting to use off-color jokes to “ease the tension.”

The 4th U.S. Circuit Court of Appeals reversed the lower court’s decision, refusing to accept the argument that because a medical setting deals with human anatomy on a regular basis, it is somehow “liberated from professional norms.”

Read the case summary at Employment Law Matters – EEOC v. Fairbrook Medical Clinic, P.A., 4th Circ., No. 09-1610, June 18, 2010.

Surgical Fire – A Daughter’s Response

One woman’s courageous response to a devastating sentinel event:

My mother was critically burned during surgery in December 2002 when a topical solution was not allowed to dry before the doctor used a cauterizing tool.

The entire experience was awful, but the worst realization for me was that nobody would listen. No one apologized, no one showed much emotion at all. All I heard was “mistakes happen.” I tried to find out where I could report the event, but discovered that often, I simply wasn’t believed.

Before she died, my mother asked me to make sure that something like this never happens to another human being.

Cathy Reuter Lake
Founder, SurgicalFire.org

Joint Commission Releases Partial 2011 Pre-Pub Standards

The Joint Commission has released partial pre-publication standards updates for 2011, which will remain available on their web site until October 1, 2010.   

The currently available pre-pubs include:  

  • Hospital and Critical Access Hospital Standards – Language for the long-awaited MS.01.01.01 regarding Bylaws requirements - Effective March 31, 2011
  •  Hospital StandardsPatient Centered Communication, which sets requirements for interpreters and translators for non-English speaking patients, as well as effective communication methods for patients with vision, speech, hearing, or cogitive impairments. – Effective January 1, 2011
  •  Behavioral Health Standards – Revisions to the Care, Treatment and Services Chapter - Effective January 1, 2011