On Trial for Reporting Incompetence

In Texas, one of the most disturbing trials I can remember is unfolding. Nurse Anne Mitchell is facing a felony prosecution for "misuse of official information" for writing a letter to the state medical board complaining of misconduct by Dr. Rolando Arafiles. In the letter she cited six examples of misconduct, identifying them by file number rather than patient's name. The NY Times:

Mrs. Mitchell counters that as an administrative nurse, she had a professional obligation to protect patients from what she saw as a pattern of improper prescribing and surgical procedures — including a failed skin graft that Dr. Arafiles performed in the emergency room, without surgical privileges. He also sutured a rubber tip to a patient’s crushed finger for protection, an unconventional remedy that was later flagged as inappropriate by the Texas Department of State Health Services.

And Ms. Mitchell is not the only one to have complained about Dr. Arafiles:

The hospital administrator, Stan Wiley, said in an interview that Dr. Arafiles had been reprimanded on several occasions for improprieties in writing prescriptions and performing surgery and had agreed to make changes. Mr. Wiley, who said it was difficult to recruit physicians to remote West Texas, said he knew when he hired Dr. Arafiles that he had a restriction on his license stemming from his supervision of a weight-loss clinic.

In a surprise inspection last September, state investigators found several violations by Dr. Arafiles and concluded that the hospital had discriminated against the nurses by firing them for “reporting in good faith.”

If you know anything about American medicine, you know how rare it is for a doctor to be cited for any sort of violation, so to me this record suggests this Dr. Arafiles is very bad indeed. But it seems that Dr. Arafiles has the right friends:

When the medical board notified Dr. Arafiles of the anonymous complaint, he protested to his friend, the Winkler County sheriff, that he was being harassed. The sheriff, an admiring patient who credits the doctor with saving him after a heart attack, obtained a search warrant to seize the two nurses’ work computers and found the letter.

Like any good bully, he has responded by accusing his accusers of "harassing" him:

“I’ve been brutalized and abused,” he said. “I’m the victim in this case, and that is all I can say.”

The rank injustice of this makes me sick, and it is terrible policy as well. The main obstacle to any real reform of malpractice laws in America is that, in practice, we have no other way of weeding out bad doctors. This case shows why. Nobody within the hospital will complain about bad doctors because, first, nothing serious ever happens to the doctors -- Arafiles got a "reprimand" and "agreed to make changes" -- and second, because terrible things do sometimes happen to the people who complain. Texas like most states has laws that require medical professionals to report misconduct, but look what they are doing to a brave nurse who actually did so. So incompetent doctors go on practicing until they have been sued so many times that they can't get malpractice insurance, and everybody loses.