There’s a disturbing case in Texas, involving two whistle-blowing nurses who reported a physician to the Texas Medical Board (TMB).
Apparently, they took offense at the physician who was peddling herbal medications in the emergency room, among other deeds. Unable to convince hospital administration to discipline him, they reported him to the Board.
And here’s where it gets disturbing.
Angered by the action, the physician then filed a criminal complaint, alleging harassment. According to hospitalist Chris Rangel, who covered the case, “the two nurses were indicted for misusing privately protected patient information for a non-governmental and nefarious reason (to harm a private citizen),” which is considered “a third-degree felony that carries potential penalties of 2 to 10 years’ imprisonment and a maximum fine of $10,000.”
Once they were identified, they had very little legal protection, and now both nurses face a real possibility of jail time. They are currently free on bond.
Dr. Rangel and David Gorski, who blogged about the case over at Better Health, both come down hard on the TMB. Indeed, Dr. Rangel writes, “the so-called anonymity provided by the TMB in the complaint process is largely an illusion and a pathetically weak substitute for real and effective legal protections. In reality, as this case shows, accusers can be easily tracked down and made to suffer.”
Dr. Gorski is no kinder: “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.”
A tragic case, and hopefully the impetus for some reforms within the Board.
Related posts:
- Does consensual doctor-patient sex actually harm the public?
- The Texas stampede of physicians
- Should a doctor be board-certified?
- Tort reform working in Texas
- The overzealous Texas Board of Medicine
- Texas malpractice reforms are working too well
- Tort reform in Texas: Working better than expected
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If the judge has any sense he’ll throw out the case against these nurses.
I’m a cardiothoracic ICU nurse in Florida, and I think it’s asinine that these nurses are being hauled up on charges for doing their job…which is to act as the patient’s advocate. It was absolutely appropriate for these people to question a doctor who was attempting to sell herbal remedies in a hospital ED for personal gain. Patients are in an extremely vulnerable position when they’re in the hospital or ED. This doctor appears to have been using his position as a doctor and the patient’s medical crisis to profit personally, which I believe is unethical. These nurses sould be applauded for bringing to light a situation in which a fellow medical professional was taking advantage of the patients in his care.
Mary apparently is under the impression that the President (this one, but not the last one) can snap his fingers and make laws by himself. Of course the last one chose to violate the constitution and used signing statements to pick and choose which laws he’s signed he’d enforce. But since President Obama remains faithful to the Constitution he swore to uphold, he’s being condemned?
This case isn’t about the President or how you don’t like him. It is about the Texas medical board, how it protects doctors at the expense of patients, and how willing it is to violate privacy themselves to allow doctors to prosecute their accusers.
And as for Dan, you still don’t seem to grasp the difference between voluntarily choosing a doctor and having one assigned without any opportunity for choice as in the ER. An ER doctor selling snake oil to his patients has them at a serious disadvantage. He has far more control of the situation than a patient who has gone to get their eyes checked. If that patient feels its a hard sell, they can walk out and go to a different doctor. An ER patient is risking his life to do that. Apples and Oranges.
And as for tort reform in Texas, there are actually fewer OB/Gyn practitioners in rural areas. Only increases are in urban centers. The only people to benefit form this are the doctors who can err at will with little cost to themselves.
Once upon a time, physicians compounded and sold nearly all the medicines that they recommended to their patients. Some worried about the conflict of interest involved in both recommending and selling the medications. Meanwhile the number of medicines increased and the complexities of obtaining them, compounding them, and storing them became more and more of a challenge so that it became more common for physicians to “outsource” this ancient art of theirs to a new profession. The selling of pharmaceuticals directly to patients has never been removed completely from the scope of medical practice and it supported by law in all but a few states. Herbs have always and still constitute a part of the medical pharmaceutical armamentarium.
Oddly, Texas is one of the few states that severely restricts this ancient privilege of physicians with respect to prescription drugs. There is a valid question as to whether this is an anticompetitive antitrust violation. But what does all that have to do with non-prescription remedies?
I accept that this behavior on the face of it may seem cheesy. Cheesy however is not synonymous with unethical. It seems to me that whether or not it is unethical towards patients depends on whether he was advising and then attempting to sell remedies for the purpose of profiting himself without regard to harm to or lack of benefit to patients. If the remedies recommended were those that in his best professional judgement are those that were most likely to benefit the patients, the fact that he was to further profit by their sale does not make their sale automatically unethical. It does raise the question of his objectivity however.
It of course also raises questions of objectivity when I pay my dentist 70$ for an exam and he recommends $10,000 of gold onlays to be done by him, or when one pays a cardiologist for a consultation and the consultation result is a recommendation for $12,000 of further studies and tests–to be carried out by the cardiologist on equipment owned by him, or one is sent to an MRI scanner owned by the neurologist who declares it’s necessity. . . and on and on. Medicine is rife with conflicts of interest which is why character is a valid criterion for the profession.
Other ethical issues might of course be raised by the specific circumstance of the context of the care–the ER. Was he an employee and therefore not fully the owner of his own time while in the ER or was he billing the patients? Was the crises of emergency situations used to excessively influence vulnerable patients to agree to expenditures unrelated to resolution of their emergency? We all know that not everyone in the ER is having an emergency and that, regardless of what brought people in, advice regarding non-emergency and chronic care issues is often sought. We all also know that an incredible percentage of the prescriptions given are never filled. Can’t one argue that it is better for the patient to leave with the necessary remedies in hand?
Another question to be considered is this: Where does the notion that physicians should never sell medications (prescription or otherwise) fit in with the growing phenomenon of pharmacies themselves hiring limited license practitioners as employees to provide urgent care services on their own premises, where almost without exception the recommended remedies will then be sold?
The potential conflict of interest in pharmacy clinics is much greater, at least in theory for two reasons:
1. The ratio of pharmaceutical sale income to practitioner fee income, and therefore the pressure to bend objectivity, is potentially much greater. Physicians who sell pharmaceutical typically find them a small addition to their bottom line. For pharmacies, it is the anticipated added traffic to the pharmacy that is at the heart of the business model of clinics.
2. The non-physician practitioners hired to work in these clinics are from newly defined professions that do not have 2500 years of ethical tradition of independent objectivity bearing on them and in their relatively brief history have largely functioned as employees with duties to an employer–which is now the pharmaceutical company itself.
I bring up these questions which are not central to the main issues above because they are pertinent to some of the discussion and bear consideration. It is of some concern that the original blog labeled the behavior “inappropriate” but doesn’t demonstrate with details nor cite a final finding by the medical board. I think that judgement is prematurely echoed above. However horrified we are by what happened to the nurses, we ought to not pre-judge the original question of the ethics of his practice–a judgement which requires far more specific information than we now have.
Doc Stone, be it “cheesy” or unethical, going after the nurses for reporting a legitimate concern about this doctor to the TMB is fundamentally WRONG on so many levels.
Lmaris, it would seem to me that President Obama was under the mistaken impression that he could just snap his fingers and make the entire medical system bend/jump to do his bidding. If memory serves, he was going to ram reform down our throats this past summer (the Dems were acting like a bunch of sailors drunk with new power) – but some folks concerned about Constitutional checks and balances stopped him.
The Texas Medical Board is not the only medical board in the country with big problems in terms of doing right by medical whistle-blowers. I met with the President and lead attorney of the N.C. Medical Board back in June to discuss my case – a case that they freely admitted had fallen through some BIG cracks. It’s been several months, and I’ve not heard ONE WORD out of the Board or the NC/US AG’s office (calls were supposed to be made on my behalf). I’m so disgusted, I’m ready to sue the Board, JCAHO and NC/USDHHS.
If I am forced to file that lawsuit, I can guarantee you, it will be a thing of beauty.
And/so I know EXACTLY how these nurses (totally abandoned to the good-ole-boy wolves) feel.
This case – in which two nurses were fired and are being maliciously prosecuted (a crime in and of itself) for doing their duty . . . and mine – in which a Pediatrician in public/Federal (key word: FEDERAL) service was fired and maliciously battered in civil court for doing hers . . . could VERY EASILY be dealt with by the powers-that-be in the state and US Attorney General’s offices.
But cases like mine/like that of these nurses are not important enough to pursue. Incredibly, when I met with an investigator from the IRS, this is actually what I was told.
Here’s an example of what might happen if someone in the Obama adminsitration snapped those fingers: If they did not “pony up” and do the right thing by the professionals they retaliated against, the hospitals involved could lose their Certificates of Needs and their funding for various projects – even their “non-profit” status. In my case, the executives involved could be prosecuted for FEDERAL crimes (i.e. brazenly lying about the “confidentiality” of their “non-profit” books and salaries).
In other words, MUCH PRESSURE could be brought to bear against those who would retaliate against medical whistle-blowers IF the govennment (and assorted regulatory bodies) would acknowledge that the problem of retaliation exists. Maybe it would take more than a “snap” of Obama’s fingers, but it could be done a whole lot more easily than some of the other things he’s trying to ram down our throats
And it would send a very clear message that retaliation against medical whistle-blowers is not something that is going to be tolerated by the “hope and change” crowd.
HCQIA (peer reveiw) needs to be fixed. HIPPA needs to be fixed. Medical Boards should be advocates for the profession – in addition to providing discipline. DHHS needs to protect its own. JCAHO needs to wake up and stop dumping on “disruptive” doctors and nurses and start looking at the things going on that might be making them “disruptive” (like bad/corrupt administrators).
But these things have not been fixed. Bad laws are made by politicians with no clue, and good people are left to swing in the wind – because the politicians won’t take your calls if your case demonstrates a problem with their law. Since you’re not the one swinging, I totally understand why you don’t get why I’m a little put out by the abject hypocrisy I’ve witnessed on the part of the do-gooding Democratic party (both in Raleigh and Washington) my entire professional life.
Apparently now, after years of hard work trying to keep my head above water (all the while being stomped on & ignored by the likes of Hunt/Easley/Perdue/Clinton/Edwards/Perdue – because I’m just not “right people”), I’m just a warm body to see the masses of people Obama & company want to add to the Federal entitlement roles.
Speaking of the Constitution, personal property rights, and the re-distribution of “wealth” . . . as doctor (especially one in primary care) I apparently have no rights or dreams of my own. The fruits of my labor belong to someone else. I am “a dime a dozen”.
I’ve got news for the President and his team (you’re right, of course – I do not like them – mostly because of their ignorance and their arrogance): Ignoring the problems that good doctors and nurses have faced down in the current way-beyond-messed-up system is not a good formula upon which to base their precious “reform”.
Eric Holder (in the US Attorney’s office) would much rather spend his time ensuring the rights of the terrorists at Gitmo . . . making sure they have nice linens and TV’s and reading materials . . . than doing what is necessary to help productive, law-abiding citizens who have been screwed over by warped interpretations of Federal contracts and laws.
I don’t want to hear about GW (and yes, I agree, his Justice Department could have done something to help me and didn’t). You see, GW is back in Texas now. I want to know what this President – the one who made all the promises – is going to do besides posture and preen for the cameras – accepting awards he in NO WAY has earned.
Where is the ACLU?
You’re kidding right?
The ACLU is where is ALWAYS is when it comes to protecting the civil rights of doctors and nurses.
Under the table.
Might as well be JCAHO or the AMA.
I’m a nurse at this hospital. I can assure you there is FAR MORE to this story than has been released! These nurses are NOT supported by their fellow coworkers. They’re an embarrassment to our hospital and to the nursing profession. We hope they finally get put in their place. The solicitation of outside support is only going by what information they have been provided, which is one-sided and mis-leading!!!!Time will tell and the truth will come out!Don’t be so quick to jump to their defence until the end!
Florence (as in Nightinggale?), perhaps you’d like to sign your real and/or last name as you fling the mud? Have you ever heard of the concept of “due process”?
For you’ve essentially made yourself an accuser with this classic “insider”/”trust me because I know more than the rest of you” comment. You’re “safe” because there’s no way the nurses, while under indictment, can counter your slur right now.
Been there done that.
I’ll be the first to acknowledge that,case there is probably a much more complicated back-story here – to which the general public is not privy. “Whistle-blower” cases are generally very convoluted.
Several issues roll into one story: (1) the doctor’s behavior – and whether it merited discipline or not, (2) the motivation & clincial/personal credibility of the nurses who reported him (i.e. was it in good or bad faith?), (3) the behavior of hospital adminstration in the matter (were they trying to cover up . . . for the doctor . . . or even for the nurses?), (4) the policies of the TMB towards medical whistle-blowers, and (5) the (fairly incomprehensible) actions of the law enforcement & prosecutors.
Whether their co-workers at the hospital “support” these women for reporting this doctor, I would suggest that prosecuting the nurses on a legally bogus charge is NOT the way to “put them in their place”.
Your comment here – which you represent to the sentiment of a number of people at the hospital (a hospital that might just be economically hurting since this story hit the fan) sounds a tad vindcitive and retaliatory to me.
It’s called bad faith – and malice. And it will get you into trouble.
The hospital’s law firm probably just collectively winced.
All of this emphasizes the reasons why anonymous complaints should carry no weight in medical peer or board review . . . it’s why whistle-blower should be required to sign their names – and be protected when it is determined they acted in good faith.
Here’s the thing: I’ve been fighting my fight for over eleven years. I had quite a few supporters amongst my coworkers (doctors and nurses) at the hospital in the beginning (many of whom told me that they were terrified to speak out for fear of losing their jobs – as I had). But as the years passed, quite a few of them got disgusted and left (moving on with their lives while I was legally battered). Meanwhile, for the most part, those who I reported stayed and flourished.
Given the bodies I have unburied in my own case, how do you think my ex-coworkers at the hospital feel about me now?
And do you think I care?
I am sure that this issue is more complicated than we know. For one thing, not all the details have been made public. My concern is that I feel it’s unbelievable that two nurses should be subject to criminal charges for reporting behavior they felt to be unethical. At most it would seem that the doctor and/or hospital could bring a civil suit against them. Expressing a professional opinion should not be a crime. It seems to me that constitutional rights are being violated here.
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