Anne Mitchell, a nurse whose job it was to assure a high quality of care at a hospital, wound up at risk of serving ten years in prison just for doing her job. A doctor under fire for repeated mistakes put her in that peril as a ploy to save his own career. She blew the whistle on that doctor, a physician at her small West Texas community hospital. A nightmarish cascade of events ensued that enraged nursing organizations in Texas and across the country and drew national media attention.
Originally a nurse by education and profession, Ms. Mitchell had served as a hospital compliance officer at Winkler County Hospital in Kermit. Her job was to make sure that the hospital followed all the rules: federal, state, and local laws and the medical staff bylaws. She is an intense, diminutive, blue-eyed blonde woman with a thick West Texas accent. She is forceful and self-assured.
She recommended that Dr. Rolando Arafiles not be allowed on staff because the bylaws excluded a doctor with a license restricted by the Texas Medical Board. The license restriction had come as the result of a state medical board investigation into the poor care he had rendered at a weight loss clinic. The hospital administrator (CEO) overruled her and allowed the doctor on staff. Once he got on staff and began making frequent blunders, Ms. Mitchell feared for the safety of the members of her community. She reported several mistakes Arafiles had made at her hospital to the Texas Medical Board.
Here’s where things got unusually nasty. Things happened that I never saw in five years as a hospital chief of staff and governing board member in Florida. The Texas Medical Board intake people promised Anne anonymity, but the local sheriff, a good buddy and business partner of the doctor’s, obtained the file from the board under the subterfuge that he was also investigating Dr. Arafiles. Anne Mitchell’s name came with the file which the sheriff then handed to Arafiles’ lawyer. The lawyer was also the local prosecutor and he brought criminal charges against Anne Mitchell and tried her for “misuse of information”– a totally trumped up charge– in February, 2010. The best legal defense can be a good offense, and this appears to be the tactic employed on Arafiles’ behalf, but it is seldom used in such an extreme manner.
At trial, Anne Mitchell’s lawyer elicited examples of the doctor’s care from several witnesses. (He had folksy nicknames for all the patients he describes such as “Appendix Boy”, “Ms. Turkey Toe”, and “Finger Bumper”). Without explanation the doctor sent a ten-year-old boy home from the emergency room with definite bedside and X-ray findings of appendicitis. The boy’s family was astute enough to take him to another hospital over fifty miles away where he was successfully separated from his red hot appendix. Three other cases, a skin graft done badly, a bizarre management of a toe fracture and an unconventional handling of an injured finger, were also presented to the jury.
Dr. Arafiles has a commanding presence: athletically built, well dressed, every inch the professional. But when Anne’s lawyer got him on the stand, he sounded like the typical excuse making, insight lacking doctor who hurt patients that I dealt with at my hospitals. Anne’s lawyer elicited a claim from the doctor, under oath, that all the charges against him, past and present, had been due to the envy of his competitors, who resented his outstanding clinical skills and enormous income. During another part of his testimony, several onlookers gasped as Arafiles stated that diabetes does not make it more likely that a post-operative infection will occur. (One of the effects of diabetes is to depress immunity to bacteria, making infections, including post-operative ones, more likely.)
The jury required an hour of deliberation and one ballot to exonerate Ms. Mitchell. They questioned why she had ever been arrested.
In the aftermath, Ms. Mitchell successfully sued all the people–the sheriff, the doctor, the prosecutor and the CEO of the hospital– who had put her at risk of losing her liberty. She got the equivalent of perhaps a few years salary. She became the toast of the nursing profession in the state of Texas, receiving awards and making many appearances before nurses’ groups. In February of 2011, the Texas Medical Board gave the doctor little more than a slap on the wrist. He had to pay a fine of five thousand dollars, take some courses and have a monitor for a few months. The doctor is still practicing and Anne Mitchell is out of a job. Below is the decree by the Texas Board of Medicine. Please let me know your reaction to this post. I’m happy to try and answer any questions you may have.
ON FEBRUARY 4, 2011, THE BOARD AND ROLANDO GERMAN ARAFILES JR., M.D., ENTERED INTO A MEDIATED AGREED ORDER PUBLICLY REPRIMANDING DR. ARAFILES AND REQUIRING HIM TO COMPLETE WITHIN ONE YEAR THE CLINICAL COMPETENCY ASSESSMENT AT TEXAS A&M’S KNOWLEDGE, SKILLS, TRAINING, ASSESSMENT AND RESEARCH (KSTAR) PROGRAM AND COMPLETE ANY AND ALL RETRAINING AND REMEDIAL MEASURES RECOMMENDED; HAVE A PHYSICIAN MONITOR HIS PRACTICE FOR 12 MONITORING CYCLES; WITHIN ONE YEAR AND WITHIN THREE ATTEMPTS PASS THE MEDICAL JURISPRUDENCE EXAM; COMPLETE WITHIN ONE YEAR 16 HOURS OF CME INCLUDING EIGHT HOURS IN MEDICAL RECORD-KEEPING AND EIGHT HOURS IN TREATING THYROID DISEASE; AND PAY AN ADMINISTRATIVE PENALTY OF $5,000 WITHIN 90 DAYS. THE BOARD FOUND DR. ARAFILES PROVIDED FALSE INFORMATION TO THE BOARD; FAILED TO MAINTAIN CONFIDENTIALITY OF A PATIENT; ATTEMPTED TO CONTACT A COMPLAINANT OR WITNESS REGARDING AN INVESTIGATION BY THE BOARD; ADMINISTERED A DRUG OR TREATMENT THAT WAS NONTHERAPEUTIC IN NATURE; AND FAILED TO TREAT A PATIENT ACCORDING TO THE GENERALLY ACCEPTED STANDARD OF CARE.