Tuesday, September 22, 2009

Nurses charged with felony for reporting woo pushing doctor to Texas medical board

I know I’m late with this. In fact, I’m woefully behind on blogging in general thanks to a couple of weeks on the road and a busy work schedule when I returned home. But, better to weigh in late than never. This is the case of Vicki Galle, RN, and Anne Mitchell, RN. I won’t cover the details---Orac has done that---but I have a few questions and points to raise which have not, as far as I can tell, been covered by others.

This episode raised issues on so many levels it’s hard to talk about it without conflating them. On one level it’s about abuse of prosecutorial discretion (not much to discuss there---it’s patently clear, and all seem to agree, this was excessive). On other levels it’s about whistleblower protection, cronyism and ill conceived hospital policies and procedures. Then there are the legal questions. The nurses, in referencing patient records in reporting Dr. Rolando Arafiles to the Texas medical board, were exempt from HIPAA penalties but is there some Texas statute that regulates release of information from public hospitals? It’s a stretch, but who knows? One of Orac’s commenters even raised the “nurses get no respect” issue which, in my view, is not what this is really about.

And what are the issues before the Texas medical board concerning Dr. Arafiles? That he endangered patients by pushing herbs? Most herbal woo is harmless. Was if fraud? Although I strongly believe herbal woo is fraud it is not considered so in the general public perception, or even as it is being taught in academic medical centers. Is it a violation of Stark rules prohibiting self-referral and, if so, is that in the jurisdiction of the medical board? I don’t know.

What hasn’t been discussed enough is that this is a story of incorporation of woo into conventional medicine and two individuals who called it out. Galle and Mitchell were not just a couple of RNs working at Winkler County Memorial Hospital; they had significant roles in quality review and credentialing according to their civil complaint. As they tried to go through the proper administrative channels they were stonewalled---concerns were ignored and meetings to discuss the matter were repeatedly canceled. The abuse here was not only on the part of the sheriff and prosecutor but also on the part of hospital administrators who, no doubt, considered Galle and Mitchell guilty of “disruptive behavior.”

Although there were issues surrounding Dr. Arafiles besides the herbs clearly the herbal woo was a major focus of the complaint to the medical board, falling under the category of “non-therapeutic prescribing or treatment” according to exhibit B.

Given the increasing acceptance and promotion of quackery in hospitals and academic medical centers, the reporting of a doctor for promoting woo is a novel and courageous act. But it took place at a 25 bed hospital in Podunk USA. Can you imagine someone doing this at Yale or the University of Arizona?

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