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Thursday, May 7, 2009

The Nightmare of Dr. Shirley Pigott (Update)

Talk to most any competent and knowledgeable doctor and they are likely to tell you that one of the flaws of our entire health care system is that doctors negotiate with the insurance companies rather than having the individual negotiate with the insurance company. Think about that as I tell this story that starts with the video I am about to show. This is an arrest that happened September 29th, 2007. This started as a speeding ticket that ended with a violent confrontation.









The driver is Dr. Shirley Pigott. On this night she was headed to Houston Intercontinental Airport on Saturday, September 29, 2007, to attend the annual meeting of the American Academy of Family Physicians in Chicago. She was to meet Doug Curran MD, President of the Texas Academy of Family Physicians, to discuss a grievance. At the time, she was alleging that he retaliated against her by having her investigated for what she described as a trivial complaint by his cohort on the BCBS Advisory, Keith E Miller MD, who was Chairman of the TMB Disciplinary Process Review Committee. She was stopped by two Texas State Police Officers, Alfred Ochoa and Daniel Terronez. The events of that night are unclear so here is her testimony of what happened that night.






07:53 minutes: Officer Terronez goes to his car, gets in, and backs up, with the obvious intent to wedge me in.

08:31 minutes: Ochoa: "Stop! You're going to cause a [sic] accident! What are you doing?!?" I realigned myself at a 45 degree angle from the highway.

09:16 minutes: Officer Terronez walks to the right rear of my car and begins bashing the window in with his heavy flashlight. This is no emergency according to the Texas Penal Code. According to the Texas Penal Code, he is using overwhelming force.

09:18 minutes: Terronez continues his violent attack. I haltingly start off..

09:19 minutes: Ochoa: "Stop! There's
traffic coming!" Terronez continues to bash in my right rear window
violently.09:21 minutes: I pull out onto the highway, moving faster. Terronez
does not even pause, although he is facing oncoming traffic, and should have
seen the rapidly approaching 18-wheeler barreling down upon us - particularly
because Ochoa was screaming about it.

09:30 minutes: Seeing the 18-wheeler, Ochoa
yells a side-splitting exclamation: "THERE'S TRAFFIC COMING!!! YOU'RE GOING TO
GET RUN OVER!!!"

09:45 minutes: Terronez does not even pause. On the contrary,
the video shows him running after my car striking it violently, forcing me to
flee as I told him I would!

09:49 minutes: I stomp on the accelerator and almost collide with the monster truck I had not seen nor heard. If the driver had not swerved left (without slowing) and I had not swerved right, I would have been obliterated by a semi-truck hurtling down the highway at 70 mph. My children would now be orphans. As I quickly accelerate, the truck can be seen on the video flying by. The Doppler sound effect confirms its top speed. When I reach 107 mph, the car smells like it's burning so I go no faster. I continue at 107 mph for 93 seconds until I see a place that may be open for business. I slow down and see that it's not.11:22 minutes: I accelerate back up to 55 mph until
I'm inside the Wharton City Limits and see other law enforcement officers waiting as I had originally requested.

15:12 minutes: I pull over beyond the parked patrol cars and wait for the officers. To my dismay, officer Ochoa and Terronez are the ones who approach me again. I requested for one of the new officers to question me. I wait for the other officers to gather around, then get out.





Just over a year later, she was charged with a first degree felony aggravated assault with a deadly weapon against an officer in the line of duty. The same day she was first charged, her husband, Dr. Dale Pigott, killed himself. She is now facing potentially spending the rest of her life in prison.



As you should have been able to tell, everything I have just said is part of a much longer story. All of this is either the paranoid rantings of Dr. Shirley Pigott, or she has been treated for nearly eight years like no American should, and she's about to face spending the rest of her life in jail.

If you believe Dr. Pigott, here is essentially what happened. For years, she, like most private family physicians, has done battle with her main insurance carrier, Blue Cross/Blue Shield, over proper payment. She eventually formed an alliance with other private family physicians all over the country in order to stand up the insurance company's heavy handed tactics in billing. The group she lead was making headway and as a result, BCBS formed an alliance with several powerful doctors in order to commit sham peer review against Dr. Pigott. Their attempts eventually fizzled out and failed, and then she was targeted with this particular arrest.



To understand the story, here is a list of most of the main characters and their role in it.


Dr. Doug Curran is private family physician in a modest area of Texas. He is also the former head of the Texas Academy of Family Physicians and continues to be one of three members of the super secret BCBS Texas Medical Advisory Committee. The TAFP is the Texas branch of the American Academy of Family Physicians. The AAFP is the most powerful special interest group representing family physicians. Dr. Curran serves on the super secret BCBS Texas Medical Advisory Committee with two other doctors, Dr. Keith Miller and Dr. Fred Merian. Dr. Miller is currently a private family physician in Center, Texas and he was during the events in question the head of the Texas Medical Board Disciplinary Committee. That committee is in charge of judging cases of purported malfeasance by doctors in Texas. Dr. Fred Merian is the third person on the BCBS Texas Medical Advisory Committee and he was during the time in question also the head of the Texas Medical Association. The TMA is the biggest association of doctors in Texas.

Dr. Shirley Pigott is a practicing private family physician for twenty five year private family physician in Victoria, Texas. She was also during the time in question an active member in the TAFP. . Dee Whittlesey was the "physician's advocate" for BCBS during the time in question. ) Dr. Pigott went through the process of medical peer review at the Texas Medical Board. This involved a process called an informal settlement conference. This was the TMB's equivalent of a hearing and this hearing was presided by Dr. Keith Miller. The committee rendered its findings in writing, and the process of appealing these findings went through a state agency called the State Office of Administrative Hearings (SOAH).



Dr. Doug Curran was once both head of Texas Academy of Family Physicians and one of three members of the BCBS Texas Medical Advisory Committee. A few years back, he was featured in this print ad. Within months, this puff piece appeared on the internet. It featured some flattering comments from Dee Whittlesby of Blue Cross Blue Shield. Blue Cross Blue Shield carries the insurance for about one third of all Texans. As such, they have a regional monopoly for health insurance in Texas.

Now, remember what I said at the beginning. Dr. Curran is clearly in a conflict of interest. He's a member of some board on BCBS, he's featured in their advertisements, at the very same time he's head of the most powerful group representing doctors in Texas. In other words, he represents doctors at the same time he is in bed, so to speak, with the very insurance companies that he and the doctors he represents have to negotiate with.




All of this Dr. Pigott discovered during a nearly five year ordeal that was reaching its zenith when Dr. Pigott began driving toward Houston's airport to meet Dr. Curran to confront him again when she was stopped by two state police on September 29th, 2007.


For years Dr. Pigott had always had disputes with BCBS over billing.
Over the course of several meetings with other doctors in the profession, she found out that most private family physicians had similar experiences. Throughout the country members complained that they were being squeezed, intimidated, and targeted by insurance companies. Many members complained that the AAFP wasn't doing enough to represent their interests against insurance companies. After about a year, the group finally decided to stop complaining and do something about it. What eventually grew was a group of doctors that called themselves the "35 group" (because the group initially had 35 members). They formed an alliance of private family physicians that was going to demand action from the AAFP.

The "35 group"* came up with three mandates that they planned on presenting first at the state level and eventually nationally. The three mandates were as follows: 1)the AAFP was going to be more aggressive in representing the interests of family physicians, 2)it was not acceptable for insurance companies to refuse to pay for medically necessary office tests or minor procedures 3)a clearing house would be created for complaints of family physicians to be shared among members of AAFP.

These three mandates would serve as the bedrock for a new commitment for the AAFP to serve the interest of its private family doctor members more aggressively.

Dr. Pigott was put in charge of getting these three mandates through the Texas branch of the AAFP later that year in 2005. The proper procedure in the TAFP would for these three mandates to be debated in the Health Care and Managed Care Services Committee. The committee was enthusiastic about the three mandates and there was near unanimous agreement that this be moved to the full TAFP. Only one doctor argued against the resolutions - Dr. Doug Curran. Dr. Curran was not even a member of this particular committee. He was however the President Elect of the TAFP and decided to sit in on this particular hearing. At this time, Dr. Pigott had only heard of Dr. Curran, and this was her first direct contact with him. Despite Curran's dissension, the mandates passed and eventually they were passed in the national organization (AAFP) later that year.

In March of 2006, Dr. Pigott treated a peculiar patient. (due to the doctor/patient relationship the name obviously can't be revealed) The standard procedure that Dr. Pigott uses in her practice, initially, for a patient who wants her "health risks" evaluated is to take a medical history and order several basic lab tests. Then, when the tests come back, Dr. Pigott would meet with the patient to interpret the tests. It is this second appointment where Dr. Pigott would teach the patient what the tests meant and what the patient can do to improved her health risks. It is now that proper dieting, exercise, and frankly general lifestyle changes can be recommended based on the results of the tests. This particular patient didn't want any part of the second meeting. She sent Dr. Pigott's office a letter requesting that the tests be mailed to her, in violation of Dr. Pigott's policy. A second letter was more confrontational and threatened a complaint to the medical board if the tests weren't sent. According to a board rule, the patient has the right to receipt of those tests within 15 calendar days.

Because the behavior was so unusual, things unfolded before anyone realized. Dr. Pigott's administrative staff received the letters. The tests weren't sent because that is not the procedure. Dr. Pigott wasn't made aware of the letters until just more than 15 days had gone by. The tests were then sent out and no one thought about it again for a while.

In July of 2006, Dr. Pigott again prepared to present that year's mandates on behalf of the group of 35. These were several specific mandates in pursuit of accomplishing the goals of the mandates passed the previous year. Dr. Pigott expected this particular hearing to go fairly smoothly. She had been in contact with the TAFP for months, and each of the mandates had been announced to the organization. Dr. Pigott believed prior to the hearing that this would nothing more than a mere formality.

The hearing went nothing like she expected right from the start. The hearing was scheduled for two hours and it was an hour and forty five minutes before she was even allowed to speak. Each of her proposals was met with resistance. Members claimed that mandates were already being covered by other mandates, or that they had already been addressed. No matter what Dr. Pigott proposed, the committee had a confrontational response to it. Not only were each of the mandates killed but Dr. Pigott felt humiliated by the treatment of the committee. The person that was leading the charge in resisting each of these mandates was of course none other than Dr. Curran. Again, he wasn't even part of the committee, but rather decided to sit in as part of his duties as President.

Within months, several other things happened. First, Dr. Pigott was formally notified in writing of an upcoming informal settlement conference to settle a complaint by the previous patient who claimed that Dr. Pigott didn't return their lab reports in proper time.

Then, Dr. Curran appeared in the advertisement and puff piece I spoke about earlier.

Dr. Pigott found these two things to signal a gross conflict of interest. In fact, it likely violated the Texas Medical Practices Act's position on so called testimonial advertising. Dr. Pigott began reaching out to anyone that would listen. She went up the chain of command at not only the TAFP but the AAFP. She even reached out to Dee Whittelsey herself. She even made several attempts to contact Curran himself. She called Jim White and Doug Henley along with Whittelsey and Curran.

The responses ranged from no comment to simply that none of what she complained about was in fact a conflict of interest. Dr. Pigott was not satisfied. She decided to use listserve. Listserve is the intranet chat room for all members of the AAFP. She complained on listserve that she believed the advertisement, the article, along with Curran's confrontational behavior amounted to a conflict of interest.

Finally, Dr. Curran confronted Dr. Pigott directly by phone. During a twenty minute conversation, Curran vigorously defended his actions and refused to acknowledge any conflict of interest. Then, out of the blue Curran said this,

by the way, do you know I'm on the BCBS Texas Medical Advisor Commitee
By September of 2007, her case came up in the informal settlement conference in front of the disciplinary committee chaired by Dr. Keith Miller. Dr. Pigott expected nothing more than a minor slap on the wrist. After all, not sending out lab reports with 15 days (she says the lab reports got to the patient in about 20 days) is frankly the medical violations equivalent of j walking.Instead, Dr. Miller began questioning Dr. Pigott very heavily. Throughout the hearing Miller tried to get Pigott to admit to wrong doing. He asked questions like

isn't the failure to give lab reports a violation of your oath as a doctor
Dr. Pigott felt like a witness on cross examination. This simple hearing about a technical violation turned into an interrogation.

Of course, within weeks, the incident that started the story occurred.

There was typical around a six month lag time between the informal hearing and the written findings being issued and thus this portion wouldn't pick up until the beginning of March of 2007.

In one week, at the end of February and the beginning of March, three simultaneous though seemingly divorced (on the surface at least) events happened. First, she received a letter from the AAFP saying that her list serve privileges would be suspended. Then, Dr. Pigott attended a special hearing of the TAFP to discuss the concerns that she had raised about Dr. Curran. Since he had promised to cease all the activities that concerned her, Dr. Pigott had decided that it was no longer necessary to bring any mandates against him up for debate. Thus, when called, she merely said she was fine.

The TAFP, lead by Curran himself, then proceeded to charge three mandates against Dr. Pigott: 1)Dr. Pigott acted nastily and inappropriately toward Dr. Curran, 2)the Committee had treated Dr. Pigott appropriately at the 2006 meeting (when all of the mandates she brought to the floor were voted down), and 3)Dr. Pigott must write a letter to everyone she contacted regarding this matter and essentially make a mea culpa.

Then, when she got home from the meeting, she received the written findings from the TMB Disciplinary Committee. (keep in mind again that this is all over a patient not receiving lab results in fifteen but about twenty days) Here are some highlights.

Board to take disciplinary action against Respondent based upon Respondent's unprofessional or dishonorable conduct that is likely to injure the public, in particular, the disruptive behaviors that could reasonably be expected to impact the quality of her patients' care, as described in Board Rule 190.8(2)(Q).(3) [c04-Vio Rule 165 – Med Recds] Section 164.051 (a)...For a period of one year from the date of the Board's entry of this Order, Respondent's practice shall be monitored by a physician

...

The Compliance Division of the Board shall designate the monitor and may change the monitor at any time for any reason. The monitor shall have expertise in a similar specialty area as Respondent. The Compliance Division shall provide a copy of this Order to the monitor, together with other information necessary to assist the monitor

....

The Compliance Division shall select records for at least 30 patients seen by Respondent during each three-month period following the last day of the month of entry of this Order

Thus, to conclude, for being late in getting lab results, Dr. Pigott
wasunprofessional or dishonorable conduct that is likely to injure the public, in particular, the disruptive behaviors that could reasonably be expected to impact the quality of her patients' care
The punishment for this behavior included being monitored by a doctor appointed by the TMB and access to up to 30 patient's records. I believe the term draconian comes to mind when analyzing this punishment.At this point, Dr. Pigott finally realized for sure that something was rotten in Denmark, as Shakespeare might say. Dr. Pigott decided not to accept the findings. In her letter, Dr. Pigott disputed everything the disciplinary committee found and for the first time she used the term, sham peer review.

This incident is an egregious example of what is commonly termed sham peer review. Without conscience, certain members of the Board have defamed my character and have determined to cause me harm.
Sham peer review is a process by which medical peer reviews like the one that Dr. Pigott had just gone through get corrupted. They can be summarized by one simple phrase: judge, jury, and executioner. The corrupting forces usually not only bring the charges, but they are the ones presenting the charges, and also in a position to rule on them. (veterans of my work will remember the case of Dennis Lennox in which he faced his own cousin of sham peer review. The concept of judge, jury and executionor certainly applied to his case as well) In this case, while there is no proof, the patient was likely a plant, and the corrupting forces always planned to bring the case in front of Dr. Keith Miller so that he could issue this draconian charge.

She decided to investigate some of the players. The most important discovery was the discovery in the TMB website that listed in the bio of Dr. Keith Miller was his position in the BCBS Texas Medical Advisory Board. She began making inquiries to members of the TMB, TAFP, AAFP, and BCBS itself. Everyone she spoke to neither confirmed or denied his position on this panel. She shared what she had found with the TMB attorney Katie Johnonius. Johnonius was unmoved, and thus the battle would now move to SOAH, the medical peer review version of appeals courts.

Once she discovered this new information, she took everything she had and hired Austin, Texas lawyer Clark Watts. Watts took what she gave him and approached Scott Freshour, head of litigation at the TMB. (the head of litigation would take over the case from here). Freshour and Watts agreed to a reduced penalty. This penalty removed most of the draconian language but still instituted a heavy fine and other stiff measures (continuing education, lighter monitoring, etc). Pigott refused to take this. Watts approached Freshour again and this time they settled on a $500 fine and 10 hours of continuing education in patient safetyThe Group of 35, family physicians from all over the country formed to try and do three things: 1)the AAFP was going to be more aggressive in representing the interests of family physicians, 2)it was not acceptable for insurance companies to refuse to pay for medically necessary office tests or minor procedures 3)a clearing house would be created for complaints of family physicians to be shared among members of AAFP. It was the job of each member of the group of 35 to go back to their respective state's Association of Family Physicians to gain momentum for each of these three mandates. Dr. Pigott was in charge of building consensus for these three mandates in Texas. One day, while representing the Group of 35 in a committee meeting within the TAFP, Dr. Pigott first ran into Dr. Doug Curran. He was the only holdout in an idea that Dr. Pigott was presenting on behalf of the Group of 35.


At about this time, Dr. Pigott was involved with a peculiar patient. The patient demanded their blood work without making another appointment. Then, the patient filed a complaint when the X rays weren't released within the allotted time which was supposed to be 15 days. The patient got about 45 days after the appointment.


This initial complaint eventually lead to Dr. Pigott appearing in front of the Texas Medical Board Disciplinary Board then headed by Dr. Keith Miller. Dr. Miller also served on the BCBS advisory board at this time with Dr. Dough Curran. On nothing more than the ridiculous trumped up technicalities, the TMB disciplinary committee eventually heard her case early September of 2007. Eventually the committee made these fndings which included suspension of her license. At about the same time, Dr. Miller was removed from his position from the Texas Medical Board Disciplinary Committee. (Dr. Miller resigned August 31st, 2007)





Miller’s resignation was due to the intense scrutiny of his abusive and tyrannical actions against physicians while on the TMB. It was also due to his relationship with Bridget Hughes, his Nurse Practitioner. Bridget Hughes, who was found to be a narcotics addict by the Texas Board of Nurse Examiners while employed by Miller, continues to work as Miller’s nurse practitioner at his office in Center, Texas. Hughes had her prescription writing ability suspended when she was disciplined by the Texas Board of Nurse Examiners (TBNE) on April 16, 2007 for stealing (50) triplicate prescriptions from her previous supervising physician employer and forging his name to obtain narcotics for her own use



Much of the evidence against Dr. Miller that eventually lead to his dismissal was introduced by Dr. Shirely Pigott herself. By then, Dr. Pigott had formed something called the Texas Medical Board Watch. This became one of the only watchdog groups over the TMB. Among the corruption discovered by Dr. Pigott is how the TMB looks the other way while Dr. Mark Blotcky systematically corrupts the Dallas County divorce and child custody system. They've also gone after Dr.'s Chris Kuehne and Dr. Bill Rea among a list of doctors that lists in the thousands.

Dr. Pigott, herself, was grilled in her own hearing in front of the TMB Disciplinary Committee. At one point, Dr. Miller proclaimed.



isn't the failure to give lab reports a violation of your oath as a doctor

By February of 2007, the TMB Disciplinary Comittee had delivered their findings. The initial punishment included suspension of her license, monitoring of her practice for a period of a year among several rather draconian punishments. Rather than accepting this punishment, Dr. Pigott countered with her own written response. In the response, Dr. Pigott accused the TMB of orchestrating a sham peer review against her. Dr. Pigott then hired Clark Watts, a lawyer who had once been a surgeon until he had a sham peer review orchestrated against him. She took all of the evidence against the TMB, Dr. Doug Curran and Dr. Keith Miller, and the multiple conflict of interests she discovered. The case was eventually settled with a slap in the wrist that included a few hundred dollar fine.

All of this would have finally had a happy ending for Dr. Pigott. That is until the arrest on September 29th, 2007.

Since her arrest, a new charge was brought against Dr. Pigott to the very same TMB Disciplinary Board. This time, as a result of her arrest and ultimate grand jury indictment, the TMB Disciplinary Committee, on March 24th of this year, suspended her license to practice medicine. The news of this suspension was carried in Dr. Pigott's local newspaper, the Victoria Advocate.






The action last week came after a determination that Pigott's continuation in the practice of medicine presents a continuing threat to the public welfare, according to a Texas Medical Board news release.

The action was based on Pigott's failure to comply with a previous board order, unprofessional and dishonorable conduct, and impaired mental status, according to the release.



This is all very peculiar because this particular story is the only time that Dr. Pigott appears in the Advocate. Even more peculiar is that the story has 69 comments, and counting, attached to it. That's an impressive number for a story in a major newspaper, let alone for some crime announcement in the local newspaper of a little town in Victoria. The comments are impassioned and they go both ways.


So, there is the story as condensed as I can tell it. Dr. Pigott now faces a trial date and is currently unemployed.

UPDATE:

Here the latest twist in the story.

3 comments:

Debbie said...

It is true that doctors and hospitals, as well as other medical facilities, make deals with the insurance companies. This is usually good for the patient, giving them a better deal. There are doctors who are opting out of these arrangements, therefore making themselves "out of network" for a patient's insurance.

This means if the patient goes to these physicians, their insurance will NOT pay, and the patient will end up paying the entire amount out-of-pocket. The physicians most times will require payment in advance or have the patient sign some kind of promissory note or something similar.

If the patient can afford this, they can choose their own doctor. if they cannot afford to pay the entire bill themselves then they are subject to the in-network doctors. There are many problems with our current system, but I don't thing government-run healthcare is the answer.

As to Dr. Pigott, I don't know...

Debbie Hamilton
Right Truth

mike volpe said...

If you want insurance companies to amass power you do it that way. Doctors have a lot less power with an insurance company than a patient would.

By making the negotiation between the doctor and the insurance company you are giving them way too much power.

Anonymous said...

on 4/7/11: Dr. Pigott's Criminal Appeal will take place at 10:30 a.m. in Corpus Christi.