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.
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Texas Tort Reform and TBM protection = no shortage of doctors. Whistleblowing Nurses = bye bye Texas!
If the FDA would classify these supplements as medicine instead of food, cases such as this would cease to be a problem. Subjecting the “supplements” to evidence-based scrutiny is long overdue.
Medical whistleblowers have little or no real protection against retaliation by a hosptial. It’s been a huge, albeit under-reported problem for years and years. Doctors have been literally destroyed. The AMA doesn’t care. JCAHO doesn’t care. DHHS doesn’t care. And our individual state medical boards do not care.
I did battle over this story over on Orac’s “Respectful Insolence” a week or so ago . . . describing/linking my own decade-long story of medical-legal woe in my (NC) hometown (while I was in public service to a “non-profit” no less).
I was threatened, then fired for saving a newborn’s life and reporting it to peer review (and later, the NC Medical Board). My life was subsequently turned to trash as I was legally assaulted for telling the government I served the truth. And OBTW, in the wake of that cluster-screw, I’ve reported MULTIPLE FELONIES (black & white perjury/contmept/fraud) on the part of the two “non-profit” executives who did every despicable thing one could think of to shut me up/destroy me – and I can’t get anyone at the state or Federal level to even investigate. It’s ridiculous! The lid is clamped down tight – and it’s because I took on a bunch of mill-town good-ole-boys with friends in high places (of course, in my neck of the words, the high places have been run by Democrats for years and years – the same Democrats whose hearts supposedly bleed for public service programs such as the one I served in).
Anyway, for my trouble over at Orac’s, I was told that I had “no credibility” . . . because I dared pointedly criticize President Obama’s plan to “reform” healthcare without offering any substantive protection whatsoever to medical whistleblowers . . . or doing anything to fix the holes in HIPPA and HCQIA (medical peer review) that whistleblowers can fall through (as these nurses clearly have).
What the President is doing (without a real clue as to what he is doing) IS an “Obamanation”.
This story out of Texas is an abomination – just as much as mine is. Doctors and nurses do the right thing by patients and are crucified for it . . . and no one in a position of oversight cares.
Occasionally, someone in the blogosphere will throw out a bone – a particular case is “disturbing” or merits (only very temporary) outrage. But no one (particularly not the Fourth Estate) is doing anything to help – or stop what has been going on.
I’ve been at this eleven years (much longer than these unfortunate nurses). It just gets old.
It doesn’t matter whether supplements are classified as medicine or food, the point is that a physician should not be PEDDLING anything to patients. But the bigger point is, who is TMB accountable to? And where are TMB’s ethics guidelines?
Since reports to any medical board are taken so seriously, and may be simply angry patients “getting even”, it seems to me that anonymity should not be allowed. This is too important. By the same token, it’s absurd for these nurses to face jail time. This could have been resolved without punishment. The docs crime is pretty petty and he could have simply been counseled on whether his practice was allowed or not. It’s hard to believe.
It appears that anonymous and doc99 have both missed the point of this post. THis case is not about the prosecution of a good intentioned doctor. This is about the out of control Texas Medical Board and the simple fact that nurses are being prosecuted for rightfully looking out for patients. This doctor was not just suggesting herbal remedies, my understanding is that he was actually trying to sell them directly to patients while in the ER. I’m pretty sure you can’t do that. Even if it is legal for a doctor to use the ER as his personal AMWAY sales venue, nurses should be able to report questionable medical practice without fear of being locked up. Texas is kind of old school. Doctors are still pseudo Gods and reporting a bad doctor is difficult, even when the physician is obviously bad and the fact is well known by other
physicians and administrators. Having a bad doctor removed from practice via the hospital or physician credentialing procedures is
nearly impossible. Reporting a bad doc to the board may be the only option if someone is
truely concerned about a doctors practice. Unfortunately the Texas Medical Board has a long history of being out of control. They
operate under the assumption that a doctor is guilty until proven innocent, and they are
devastatingly slow.
The TMB has struggled with allowing anonymous complaints, and they never were
very anonymous at all. This obviously puts
nurses in a tough spot. It is a sad testament
to our system when nurses cannot voice their
concern for patient safety.
I guess it’s OK for chiropracters to crack your spine and get paid for it, acupuncturists to poke you and get paid, healing touch practicianers to rub you and get paid, herbalists to sell you herbs, massage therapists rub you and get paid, etc….. but if an MD tries to sell herbal products/vitamins or even medications its a crime. Makes perfect sense.
I have not heard good things about the Texas Medical Board.
Dan, you are spot on about anonymity. Despite a little thing called “due process” (medical licensure and hospital privileges, once granted, are protected property rights), many Medical Boards still cling to anonymity as an investigative tool – on the premise that medical badness will not get reported because those doing the reporting are afraid.
The thing IS that NO ONE can remain anonymous in a serious complaint – particularly in smaller hospitals. There is no real security there. If medical whistleblowers were truly protected and could sign their names to legitimate/good-faith complaints without fear of reprisal, they would not need to be anonymous.
Of course, those of us who have been in the blogosphere for a while saw what anonymity did for our dear, departed Flea.
“Leave MD’s Alone”, doctors are paid to practice medicine.
Personally benefiting from (i.e. directly selling) what they “prescribe” (even herbs or vitamins) is called a conflict of interest.
This story is too vague and confusing to make a good deliberation on it. What and when was this physician peddling? Why wouldn’t a hsopital administration be interested? very odd…I cannot comment on “other deeds” since it is not specific. The charge against the nurses sounds HIPPA like. Did they contact the patients personally? or use the patient information in another way?
Mary: Optometrists sell glasses, contacts, medications, etc. Dentists sell false teeth, whiteners, toothbrushes, etc. Patients are not being forced to buy anything. It seems that physicians are being singled out and your response indicates that you have been brain-washed as well that it is wrong for physicians to be entrepreneurs.
I have to support “Leave Doctors Alone”. I agree that we have been brainwashed while having our pockets picked at the same time. No docs want their kids to be docs because the profession has been crippled. I see no conflict of interest.
Regarding BOM’s, I don’t know about Texas, but many states investigate ANY complaint against a doctor and it can really ruin your day/life. You need to know your accusor. I still don’t see why punishment is doled out when it is so much better to educate rather than punish. I believe the board should represent doctors, not police them. But I also believe the police should protect the public, not watch them.
Regarding this article. Did the nurses talk to the doc directly first, as human beings generally should do to resolve conflicts?
Hey, I see an ethical problem with an ER doctor trying to sell herbal remedies to his patients. It’s one thing for a patient to seek out a doctor who employs or discusses alternative treatments. It’s another one to get stuck with one who forces you to listen to a sales pitch for medicine’s he sells on the side for profit.
The ED sort of sticks you with a doctor to treat your emergency. The audience, if not captive in the legal sense, is in the practical sense. If you don’t listen to his sales pitch, will he treat you as well as if you did? It seems improper to me.
Actually, personally I don’t think any of those things are necessarily OK, either. Except for the massage therapy (as long as the therapist isn’t into therapeutic touch or other woo), the rest is usually quackery. Stick to the case at hand.
The point is that the doctor being investigated used his position of authority to sell dubious herbal remedies to patients in the ER. Not ethical, and reporting him was the correct thing to do.
Newsdoc: “Why wouldn’t a hospital adminsitration be interested?” You’re kidding, right? The very same hospital that crucified me (a lowly Pediatrician) for saving a baby’s life developed a great case of torticollis when it came to looking in the direction of one of its big-money OB’s (who only had an extramarital affair with one of the LDRP nurses and wound up aborting his own child). Ethics smethics. It’s been my experience that many administrators only care about the warm bodies that serve their mission – and that mission is PROFIT.
HIPPA ties your hands in a lot of things. Hospitals can get away with a whole lot of ugly hiding behind patient privilege, privacy and confidentiality. It’s definitely NOT to the patient’s benefit – and often not to his/her doctor’s.
“Leave MD’s Alone”, I’ve got to wonder. You woudn’t happen to be the doctor – or a friend of the doctor – who lodged the bogus criminal charges against these nurses?
Dan, we clearly disagree about conflicts of interest, but you are spot-on about the duty of a Medical Board not only to discipline/punish, but also to represent them – in an environment where power has been increasingly taken out of their hands and handed over to the corporate types with no appreciation for the ethics of the profession and no requirement to honor them. Just ask JCAHO. They’ve developed all kinds of ways to go after “disruptive” doctors – but have no mechanism in place to address corrupt administrative behavior.
You’re also a little naive, if you feel that a nurse – or even group of nurses – would be confortable directly challenging a doctor about percieved bad behavior. As this case clearly demonstrates, these nurses couldn’t expect anyone to have their back.
If you look at the lawsuit that the nurses filed, it is pretty clear that virtually all of the problem is not with the TMB.
The sheriff (who happens to be the business partner of the doctor in selling naturopathic crap) committed perjury in getting a search warrant to access the computer the letter to the TMB was written on. The TMB specifically told the sheriff (in writing) that the information the nurses provided to the TMB was not a violation of HIPAA.
If you can be prosecuted, convicted, and imprisoned in Texas for something that is not a crime, the problems of Texas go far beyond the TMB.
Of course the problems of Texas do go far beyond the TMB. A man was convicted of setting fire to his house and murdering his young daughters based on a bogus investigation. He was executed even though there was substantial evidence that there was no arson and that he was innocent. Of course the governor of Texas is trying to cover up the investigation and fired the head of the team investigating it and installed his own lackey.
Yes, the TX arson case was insane. Yet, here in NH a man was arrested because he moved his dad’s ashes to the mantel and his mom wanted them somewhere else. There’s no end to the craziness and I wish it would stop.
Without being specific about TX, I still resent the conflict of interest. Of course, in my mind I don’t picture a high pressure sales pitch. I picture him mentioning the herbs in passing and asking if there is interest. There are an awful lot of people interested in herbal medicine and it is also a legitimate field. We certainly don’t own the knowledge base on medicine. We kill more people with NSAID’s and bitch about addiction to opiates which are safer but addictive. How do we treat addiction? Send them to NA with a 95% failure rate. Maybe herbal therapy would be better.
I think it’s sad that the nurses could not approach the doc, but this clearly involves personalities. Maybe the doc was not approachable. Maybe the nurses were vindictive. Who knows?
Why is medicine held to a different standard than other professions? If a roofer sells you on a certain membrane, it may affect whether your family survives a hurricane or it could be bogus. Either way, lives are at stake. If we are to be held to this deity-like standard than show me the money, or respect, or autonomy, or SOMETHING.
Ah, good-ole-boy justice. I know it well.
Perjury, for all of the hoopla about accountability and transparency in law and medicine is very rarely prosecuted as the serious crime it is – unless a DA wants to make a name from him/herself. I reported multiple felonies (on the part of “non-profit” hospital execs) back in 2003 and have yet to get the US or NCAG to even take a look. No investigation. No nothing.
The sheriff’s shenanigans sound very much like a case we in North Carolina are currently watching play out in Lincolnton. That sheriff was indicted for obstruction of justice.
I’m not prepared to let the TMB off the hook so easily. It is the pattern of these insulated/politically-incestuous state medical boards to sit on the sidelines and say/do very little while good people suffer and stew. The TMB’s stance – as well as that of the Texas Nursing Board – should be a whole lot more IN YOUR FACE in terms of protecting these nurses from what is clearly malicious prosecution.
Orac is right. The nurses did what they were supposed to do. And they should have been protected from crap like this. It never should have happened.
Same old, same old. Different day. And most folks don’t care.
Any Doctor peddling herbal remedies is a quack and should loose their license to practise medicine. If a Doctor, who went through eight years of gruelling education, is trying to push “naturopathic” and “herbal” medications as a viable alternative to scientifically proven methods, then either those eight years were clearly wasted or the good Doctor’s IQ has suddenly plummeted into the mid double-digits.
Trust no one!
Hey Mary,
“What the President is doing (without a real clue as to what he is doing) IS an “Obamanation”.”
Really? He hasnt done ANYTHING yet and you are blaming him…. Do the 8 years prior to his election even register in your head? Because this was an issue long before you had a scapegoat.
so how many “real” doctors do you know that actually sell things for personal gain? yeah… they write perscriptions maybe even sell you braces or other such equipment from the hospital… but what of that goes into there pocket… none. yeah they get paid for perscribing you things but they dont sell you things and SHOULD NOT. if its a conflict of intrest to get a vacation for perscribing you drugs then its damn well a conflict of intrest to peddle fake medication to a group of people pritty much traped in a room with the dipshit.
yes i acknowlege that we dont know everything that is going on… maybe the doc was just offering advice to people that wanted to chat with him… but being stuck in an ER waiting room who dosnt want to talk to a doc? no matter what was going on he was taking advantage of people and the nurces should be rewarded for their effert to protect the people. but a doctor that persicutes nurses like this probly isnt a nice guy that would take personal/profesional advice very well, especally from a subordinate.
sorry about my horrible spelling.
I am outraged! But at this time I am not sure who to be outraged at! Can someone please help me?
FYI, when I practiced in Florida, all the plastic surgeons and dermatologists had lines of skin care products that they sold through their office. Don’t know if that still is the case, but is that unethical?
“Suuure”.
I did this over at Orac’s with the Obama lovers, but I can repeat myself a little bit here.
Did you ever hear the words “hope” and “change” in the Obama campaign?
“He hasn’t done anything.” Why yes, I know that. But that does not make him blameless. Because, you see, NC&USDHHS know I’m here. The NC (Roy Cooper) & US (Eric Holder) AG’s offices know I’m here. We’ve had ten months of listening to these partisian blow-hards pontificate about healthcare reform . . . my case in North Carolina – and this case in Texas – SCREAMS about all of the reasons why we need it . . . and yet the Obama administration has done a whole lot of nothing . . . with cases that would be comparatively easy to pursue/fix (perjury is pretty much black and white – malicious prosecution can be quickly nipped in the bud) and would send a very strong message to hospitals who might trounce on medical whistle-blowers. So I’ve got to thank you for making my point.
I’ve been fighting my battle since the Clinton administration. I will assume you remember the “man from Hope” and Hillary’s village? I begged then-DHHS Secretary (Shalala) for help in enforcing the government’s own (NHSC) site agreements, and was essentially treated like I did not exist for almost nine months (DHHS desk-dwebs even parroted the beyond-warped legal postition of the hospital – until a Congressman intervened and they actually had a lawyer with a brain in Bethesda look at the case). Then they threw me one bone (the required payment of my my malpractice tail) and took another dive (completely ignoring the lost Federal funds and the destruction of a practice) – never to be heard from again – even as I legally twisted in the wind – under attack for fighting back.
But hey. Let’s do what John Kerry and John Edwards (on behalf of the the sane folks in the state of North Carolina – those of us who always knew Edwards was a poser and a fake – I’d like to apologize to the American people) and even Obama want – and create MORE public service (translation: indentured servitude) programs for young/naive/idealistic doctors to get screwed in.
North Carolina has been under the control of Democrats for nearly my entire adult life. Our medico-legal system is so corrupt and slanted towards the corporate that doctors have NO CHANCE of pulling themselves out of any hole they might fall into.
Meanwhile, our so-called “advocacy” (the AMA and state medical societies) and regulatory agencies (JCAHO and DHHS) are a huge, worthless joke.
OBTW, Obama is married to an ex-hospital executive (who is credited with helping craft a patient-dumping scheme in Chicago). Do you think my “Scapegoat-in-Chief’s” point of view on doctors might be a little scewed?
It certainly was here: http://drjshousecalls.blogspot.com/2009/08/obama-slams-pediatricians-mr-president.html
And here: http://drjshousecalls.blogspot.com/2009/08/physician-shortages-up-close-personal.html
I’d like to say one more thing – to the gutless coward who came over to my blog this morning (presumably an Obama fan directed there from here) and told me I was “another NC Rep full of sh*t” and to “keep crying”. (1) I’m an Independent. (2) You didn’t get published at Housecalls, but I’m happy to address you here. (3) Trying growing up and dropping the nasty ad hominems and maybe listening to those of us who once drank “the village’s” Koolaid and saw our lives poisoned for it. (4) I don’t cry anymore. I make the people who hurt me cry.
If Obama did not want to talk about cases like mine, he should not have brought up the subject of healthcare reform.
Thank you, Kevin, for putting up this post and giving me room to make my points.
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