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.

Responding to Mr. Merian: BCBS Vs. Private Family Physicians the Follow Up

Introduction: A couple of months ago, I wrote this piece. The piece focused on the story of Dr. Shirley Pigott. Dr. Pigott is a private family physician in Victoria, Texas and has been for more than two decades. She has also been active within the Texas Academy of Family Physicians. In 2002, she had a billing dispute with her biggest insurance provider BCBS of Texas. Blue Cross Blue Shield of Texas is not only the biggest insurer of the patients of Dr. Pigott, but they insure about one third of the folks in Texas altogether. In other words, it is difficult to be a physician in Texas unless you are a part of their network.



At roughly the same time that this billing dispute began, Dr. Pigott and her colleagues also began complaining to each other about how difficult the insurance companies were making it on them. Keep in mind that private family physicians have no salary. Everything they make comes from whatever they charge their patients. Since one third of patients in Texas can be expected to be covered by BCBS, BCBS is in a position to make things very difficult for family physicians if they so choose.



In about 2004, Dr. Pigott formed a group called the group of 35, of family physicians around the country, that decided that enough was enough. They decided that it was time for the American Academy of Family Physicians to fight harder for private family physicians. Initially, this group took three demands, or mandates as they are called, to the state levels of the AAFP. Dr. Pigott was given the responsibility of presenting these mandates to the Texas Academy of Family Physicians. The mandates essentially simply asked the TAFP to recognize the struggles that family physicians go through and fight harder for them.



Dr. Pigott presented the mandates to the proper committee within the TAFP. It was completely well received except for one doctor. That doctor's name is Dr. Doug Curran. Dr. Curran was then the President Elect of the TAFP. He wasn't even on the committee and was merely visiting the committee that day. Despite his objections, the three mandates passed the committee, the full TAFP, and eventually the AAFP.



At about this same time, Dr. Pigott received a complaint from the Texas Medical Board Disciplinary Committee. At the time, this committee was headed by Dr. Keith Miller. (as you can see if you go to most previous link Dr. Miller has been the subject of controversy and eventually resigned from the committee) In fact, this particular link minced no words in describing Dr. Keith Miller.

Notorious Texas Medical Board (TMB) henchman, Dr. Keith Miller, abruptly resigned his position on the TMB on Friday, September 7, 2007. Miller’s resignation was due to the intense scrutiny of his abusive and tyrannical actions against physicians while on the TMB.

(This will become important because my accuser will also go on to defend Dr. Miller)



The dispute involved a patient that demanded their medical records. Dr. Pigott customarily reviewed the medical records at a follow up appointment. This patient didn't make a follow up appointment and rather demanded the records be sent to their home. Since this broke protocol, Dr. Pigott didn't mail out the records for significantly longer than the law required which is 15 days. While this is a technical violation of the rules of medicine, it is a very mild one and should be the subject of a very mild punishment, if any at all.



Instead, because these records weren't mailed out on time, Dr. Pigott began a nearly four year battle against the TMB disciplinary committee. At one point, the board threatened all sorts of draconian punishments: one year probation during which she would be monitored by another physician, provide the board with random patient records upon request, a $500 fine and force Dr. Pigott to pay for the doctor that would monitor her, and this is among a whole host of punishments numerated 1-10 with several subsets for most. Again, these draconian punishments were in response to Dr. Pigott sending out medical records in an untimely manner. Furthermore, Dr. Keith Miller was later the subject of investigation of much corruption, including another story by me, and his nurse practioner Bridget Hughes was found by the Texas Nursing Board (must then click link download attachment) to have doctored 50 prescriptions of drugs like methadone. Furthermore, it was Dr. Craig McMullen, the doctor that employed Hughes prior to Miller, that discovered this. In other words, Dr. Miller hired Hughes despite knowing full well that she had committed a serious breach medical ethics.



Now, while her proceedings against the TMB disciplinary committee were going on, Dr. Pigott was continuing in a leadership role within the group of 35. She continued presenting mandates and continued fighting on behalf of private family physicians. At one such meeting, she came up against Dr. Doug Curran again. He was now the President of the TAFP and he visiting the committee she was presenting to, again, even though he wasn't a member of the committee. Once again, he confronted and objected to everything Dr. Pigott presented only this time most of the committee objected with him. Dr. Pigott told me that not only were her mandates rejected but she felt humiliated to the point of tears.



At around this time, Dr. Pigott discovered that Dr. Curran was the subject a full spread photo advertisement for Blue Cross Blue Shield, and then within weeks, she discovered this puff piece about Dr. Curran in which members of BCBS are quoted in glowing praise of him. Dr. Pigott began complaining to members of the TAFP as well as other medical authorities that she believed that Dr. Curran had a conflict of interest between his representation of doctors and his close alliance with BCBS.



Her complaints became so noisy that Dr. Curran confronted her and in the middle of their conversation Dr. Pigott says that he told her this...

Do you know that I am a member of the Blue Cross Blue Shield Texas Medical Advisory Board with Dr. Keith Miller, and Dr. Fred Merian.

Now, Dr. Keith Miller I have already touched on but Dr. Fred Merian is also the former President of the Texas Medical Association. Throughout my original piece, I refer to the BCBS Texas Medical Advisory Board as super secret. Of course, this is a bit provocative. It isn't hidden like secret parts of the CIA, however, you will find scant little information about it on the internet. You will certainly not be able to confirm on the internet who serves on this board. Most importantly, why are three doctors also working for the insurance company. This is of course an inherent conflict of interest.



Ultimately, Dr. Pigott discovered enough about what happened and then hired a legendary attorney and she wound up being given a slap on the wrist.



Several months later though, Dr. Merian's son found my article and found plenty to object to. Here is his first comment.

You have a lot of nerve maligning my father like that. I am Dr. Merian's son. My father is the most ethical and caring doctor there is. And your labeling him as some corporate shill is downright libeleous. And since when is it wrong to go after doctors who are overcharging their patients?Do you even attempt to contact the three Doctors whom you labeled with this article? I know all three, and they have impeccable reputations with both their patients and their fellow Doctors.All of these Doctors earned their positions, is being from a small town mean you are not qualified to make policy in this state? Do you have to be from Houston or Austin in order to be qualified to hold a position of leadership?

Now, on one hand, I can understand and admire Mr. Merian's instinct to furiously defend his father's reputation. On the other hand, I found it rather peculiar that Mr. Merian was the one up in arms. After all, his dad was mentioned in passing and only because Dr. Curran identified him as one of three on this BCBS Medical Advisory Board. Furthermore, at this point, there is a mountain of evidence that Dr. Keith Miller is NOT a doctor of "impeccable reputation". I, myself, have presented several cases of corruption he was involved with. The Texas Medical Board's Disciplinary Committee was the suject of an investigation by the Texas legislature.



Furthermore, the reputation of the three is beside the point, the story that is the subject of the original piece speaks for itself. You either believe it and draw appropriate conclusions or you don't. That said, Mr. Merian wrote this response in which he attempted to take me to task for my reporting. Let's take things one by one. Here is how he concludes.

My father practiced medicine in Yoakum, Texas (pop 6000) before moving to Victoria, Texas (pop 45,000). Your implication here, of course is that individuals from small towns are inherently unqualified to serve in high profile positions, and therefore can only reach those positions through corruption and collusion. Again, you make this statement with no proof to back it up. In order for your allegation (that my father was put in the Presidency of the TMA by BCBS) to be true, you need to be able to back it up. My father (and Dr. Curran) were elected to their positions by the membership of their organizations. You are accusing thousands of Doctors of selling out to BCBS, all the while offering no proof at all. But challenging me to refute it. This is a logical fallacy known as "Shifting the burden of Proof" The burden is on you to prove your allegations, otherwise they are invalid and not credible.

This statement is absurd on its face. The original story is split into three parts because it is so long. Even the introduction to this piece is probably too long and yet that is the only way I can present all of the relevant information of the story. Furthermore, this is not the only piece I have done about corruption within the Texas Medical Board. You either believe the story or you don't. I believe I have given plenty of supporting evidence to make my reporting solid. The audience can judge.



That said, if you believe this story, and furthermore, if you believe my other stories about the corruption at the TMB, it absolutely leads to troubling conclusions? I never said that doctors from small towns can't be in positions of power. I said that given the evidence I presented, we should all ask how these three got where they got. I find it very troubling that three doctors are in positions of power within the medical community all the while they are also working for the biggest insurance company in a position for which you can find scant information about.



We don't allow lawyers to represent both the plaintiff and the defendant. A lobbyist that concurrently represented a pro family group while they represented Planned Parenthood would be the subject of serious questions. Mortgage brokers can't also work for banks. By the same token, there is a serious conflict of interest if a doctor represents other doctors while they are also representing the interests of the insurance companies. That's exactly what is happening when Dr. Merian is President of the Texas Medical Association while working for the BCBS Medical Advisory Board.



Mr. Merian claims his dad is a pillar of the community and has dedicated his life to doing good. I don't doubt that however so are tens of thousands of doctors in Texas, and yet, it is his dad that concurrently was President of the TMA and part served on a board for the biggest insurance company in Texas. Given what happened to Dr. Pigott, and the role BCBS Texas Medical Advisory Board played, this should be troubling to everyone.



Then, Mr. Merian says this about the BCBS Medical Advisory Board.

A simple Google Search of the BCBSTX.com site pulled up quite a bit of information on it. Including this description:

The Texas Medical Advisory Committee and the Texas PeerReview
Committee serve in an advisory capacity to the Medical Director and HMO Blue Texas regarding health care delivery issues that affect members and participating network Physicians and other Professional Providers. The Committees participate in the development, implementation, and evaluation of required peer review activities

.


That's not quite a bit of information. In fact, this is a snippet as part of a web page related to something totally different within BCBS of Texas. This medical advisory board doesn't have its own web page. BCBS doesn't disclose who is on it and how they got there. They don't publish the minutes of the meetings. All that BCBS does is define what it is as part of a totally different web page. Again, given the role that BCBS Medical Advisory Board played within this story I find this lack of disclosure very troubling.



Then, Mr. Merian says this.

Now, it is obvious this board is not "super secret" so we will move on to
some of your other allegations against my father.You also alleged:

Three doctors, Dr. Doug Curran, Dr. Keith Miller, and Dr. Fred Merian, were simultaneously in significant positions of power in the Texas medical community. Dr. Curran was the head of the Texas Academy of Family Physicians. Dr. Miller was head of the Texas Medical Board's Disciplinary Committee. Dr. Merian was head of the Texas Medical Association. At the same time, these three were also members of the super secret BCBS Texas Medical Advisory Board. In other words, they were playing both sides of the fence. They represented the interests of doctors, and at the same time represented the interests of BCBS against doctors.Dr. Curran was not sworn in as President of the TAFP until 2006, and he served 1 year (not several years as you claimed), Dr. Miller was not appointed to the Board of Medical Examiners until 2003. And my father took his office as President of the TMA in 2002, and he also only served one year. So, you are wrong in alleging that these three men held their offices simultaneously. Also, the President of the TMA while being the visible face of Doctors in Texas, holds NO power outside the TMA. The TMA is not involved in the certification, regulation or discipline of Doctors in Texas. It is also not involved in negotiating with insurance companies for doctors, nor in
the distribution of benefits. Therefore, there is no conflict of interest. Besides, that is a determination for the TMA Board of Directors, the ethics committee and house of Delegates. Both of which were aware of my fathers position, neither of which objected.

This may technically be true, however all of this folks were in positions of power within each of organization long before they became head of each of their organizations. Again, it is just absurd to say that being President of the Texas Medical Association, which he himself says is the face of Doctors, doesn't represent doctors. Furthermore, the fact that no one objected to Dr. Merian simultaneously serving on the BCBS Medical Advisory Board should be troubling not some validation. Furthermore, while the TMA may not have been involved in discipline and certification, the TMB Disciplinary Board was, and Dr. Keith Miller was head of that for several years, while he was part of this group.

Then, Mr. Merian said this.

Physicians advisory boards advocate FOR doctors. You asked how I knew such
boards existed? Simple internet search. (and, I have worked in or around the insurance industry for over 10 years, there are all kinds of advisory boards) Here is the information for the board at Aetna Insurance. The kicker? 19 state Medical
Associations asked for such a board to be created. If such boards were so Anti-doctor, why would 700,000 Doctors demand such a board be created? They wouldn't.

This so called internet search is a google search of the words "physicians advisory board insurance". Of course, some combination of those words will come up a lot. That's how a google search works. Furthermore, if BCBS uses it in a nefarious manner it is reasonable to believe other corrupt insurance companies might want to create one as well. What's more, one paragraph after Mr. Merian painstakingly tried to convince the audience that the TMA doesn't represent doctors, he proclaims that 19 Medical Associations asked for such a board to be created. Who exactly were they representing when they asked for this?

I would also be in favor of such a medical advisory board. Only, if this board actually represented doctors, they wouldn't be a part of the insurance company. A board that looks to try to hash out the differences between doctors and insurance companies in a manner that is beneficial to both wouldn't be a part of the insurance company. Such a board would have representatives of doctors and representatives of the insurance companies working independently of either. Furthermore, their actions would be out in the open. They would have a web site. They would publish their minutes. They would publish their conclusions. This particular board does none of those things. It is very easy to take a well meaning concept and corrupt it. I never said that medical advisory boards are necessarily a bad idea. I said this one is corrupt and I proved it by several stories all split into three parts.

Furthermore, as it applies here, the board was used as a tool of intimidation. If you believe Dr. Pigott, then clearly Dr. Curran wanted her to believe that being a part of this board meant that he could damage her.

Which brings me back to the beginning. In his defense of his father, Mr. Merian never challenged any of the contents of the story. Dr. Pigott did become a leader within the community of private family physicians. She did work painstakingly to make the TAFP and the AAFP work more on behalf of private family physicians. While she was doing this, she was simultaneously brought in front of the TMB disciplinary committee because she didn't send out medical records in a timely manner. They did attempt to punish her in a draconian manner, and it was only after she identified this group within the BCBS that the TMB backed down. Those are the facts. I have backed up each of those facts.

My favorite latin phrase is Res Ipsa Loquitor, the facts speak for themselves. I believe the facts of this story speak for themselves.

Blue Cross/Blue Shield Vs. Private Family Physicians...Corruption in Texas III

If this is the first time you have read this series, then I suggest you read part 1 and part 2 first.

There are only three ways to digest what I have revealed in the first two parts of this piece. The first is that Dr. Shirley Pigott is off her proverbial rocker and I have been taken in by a fraudulent story. Thus, by extension, there is no larger meaning. The second is that Dr. Pigott's story is true and accurate however her case happened in a vacuum. The third, and the one I will explore, is that her case opens up a pandora's box of corruption in which BCBS has decided to systematically corrupt the system in order to weaken their rivals the private family physicians.

Let's review what I have laid out. Three doctors, Dr. Doug Curran, Dr. Keith Miller, and Dr. Fred Merian, were simultaneously in significant positions of power in the Texas medical community. Dr. Curran was the head of the Texas Academy of Family Physicians. Dr. Miller was head of the Texas Medical Board's Disciplinary Committee. Dr. Merian was head of the Texas Medical Association. At the same time, these three were also members of the super secret BCBS Texas Medical Advisory Board. In other words, they were playing both sides of the fence. They represented the interests of doctors, and at the same time represented the interests of BCBS against doctors. Furthermore, Curran and Miller played a crucial role in attempting to weaken and intimidate Dr. Pigott in a process known as sham peer review.

It is possible but unlikely that these three found their way into these simultaneous roles by accident. It is also possible but unlikely that Curran and Miller played such a crucial role in Dr. Pigott's sham peer review by accident. It is also possible but unlikely that the Texas Medical Advisory Committee at BCBS is the only state in which such a committee exists.--

What is more likely is that these three were helped into their position of power by BCBS in order to help execute corruption against doctors like Dr. Pigott. It is also much more likely that most if not all states have their version of the Texas Medical Advisory Board.

Again, the relationship between private family physicians and insurance companies like BCBS is a naturally confrontational one. That's because, like I mentioned in part 2, private family physicians are the most motivated class of doctors to maximize the amount of money they charge the insurance companies. This naturally confrontational relationship is probably good for the system as long as both groups maintain relatively equal power and both play by the rules. What this case illustrates is that BCBS isn't playing by the rules. I will also illustrate that the power is not split anywhere near equally.

It's important to understand that the private family physician is not the high ticket field in medicine. Private family physicians treat patients before they get sick. Thus, their bills are nowhere near the range of doctors like surgeons. While this may not mean anything to the average reader, it's important to realize that doctors leave medical school with likely six figures worth of student loans. There is an immediate lack of motivation for the field of private family physician among most other fields of medicine.

Yet, the private family physician is on the front lines health care. They treat patients before they get sick, and their worth is measured by how few of their patients actually do get sick. The concept of preventive medicine is most often practiced by the private family physician. You will only see a surgeon once you already are sick. You see the private family physician in order not to get sick. In fact, this is a concept that BCBS likely understands all too well. It's likely that they don't want to eliminate private family physicians. More likely, BCBS would simply like them to work for the medical equivalent of slave labor. In the case of Dr. Shirely Pigott, BCBS could have simply kicked her out of their contract. They had already found that her billing records were bloated and she had become a leader in bringing about change to challenge BCBS' own strong arm billing tactics.

BCBS never took that step, and that's likely because most of Dr. Pigott's patients never got sick. Her practice ultimately made them money. What BCBS wanted to do was pay her as little as possible for keeping her patients, and their insurance clients, well. This would be just fine if they were playing fairly and if the power was spread relatively equally between the two. Unfortunately, neither of those two happened.

It is likely that there are cases like Dr. Pigott's all over the country. It is likely that BCBS is trying to do such things to private family physicians everywhere. If that is so, then what BCBS is doing is destroying the market for future private family physicians. All those doctors who's job it is to keep us well will slowly disappear. While BCBS would like to keep them around at slave wages, that isn't how markets work. If it is impossible to make a good living in private family practice, then eventually medical students will stop gearing their educations toward that practice.

This campaign will have the future of health care at its center, and I doubt that anyone will talk about this case. That's too bad. This case of corruption and many others like it contribute just as much as any other reason to the skyrocketing costs of health care. It is my opinion that BCBS has decided to systematically weaken the one class of true capitalists in the medical system. If the system has been corrupted by one of the players, and the corruptor is sytematically making it impossible to work in another part of the sytem, then I would say that has just as much to do with the breakdown of the system as anything. Yet, none of the Presidential candidates are talking about cleaning up the systemic corruption going on in the system.

Did you know that health insurance providers enjoy limited exemptions to the Sherman Antitrust Act?

The exemption that the insurance industry has extends only to insureds. Insurance companies do not have an antitrust exemption in dealing with providers

Maybe, that's why in Texas BCBS holds insurance for about one third of all patients. Does it sound as though BCBS and the private family physicians enjoy relatively the same amount of power? In Texas, BCBS is nearly the only game in town as far as insurance providers. If you are a doctor and not licensed with BCBS, then I wish you luck in maintaining your practice. The doctor needs BCBS a lot more than the other way around. Thus, the old saying applies

absolute power corrupts absolutely

BCBS enjoys relative immunity from Sherman and the doctors have no choice but to use them. Is it really altogether surprising that the organization then goes on and attempts to corrupt the system?

Then, there is the media. Why am I the first media of any kind to publish Dr. Pigott's story? It certainly wasn't from lack of trying on her part. She approached most of the major media outlets in Texas. None of the print and television media followed up with this story.

This isn't the first time that I have been involved in a case of major fraud involved in the medical field in which the media has been nearly silent. I have covered the corruption at Grady Hospital in Atlanta, and there the AJC has been largely silent on the corruption as well. I also broke the story of a cover up of a serial killer nurse in South Carolina and in that case the media in South Carolina also refused to tell that story. Dr. Andrew Agwunobi has gone on a cross country tour of medical corruption and none of the media anywhere on his stops have ever done anything more than go through the motions in investigating him.

It is hard to know why the media won't cover this story, however I would bet that health insurance companies like BCBS are major advertisers. Their motivations are ultimately beside the point. Corruption only exists if the media fails to do its job. Until the media starts to take this sort of corruption seriously it will continue.

This problem won't be solved easily, but there is a good place to start. The place to start is by making sham peer review illegal and by the government on all levels making prosecution of its perpetrators a top priority. I have only scratched the surface with my reporting. There are thousands of doctors being abused by sham peer review every year. Not only does it disrupt and even ruin their lives, but it also corrupts the entire health care system. We can't solve the so called health care crisis if the system is corrupted. Hopefully, everyone reading this understands the implications of what it leads to. As we continue with the health care debate, it's time someone addresses the systemic corruption within it. Until we do, all other solutions will be of little use. A corrupt system is a broken one, and that is what we have in health care today.

For yet another case of corruption at the Texas Medical Board please read this story.

Blue Cross Blue Shield Vs. Private Family Physicians...Corruption in Texas Part One

This is Dr. Doug Curran and the picture you are looking at is an advertisement he did for Blue Cross/Blue Shield. This testimonial and the story that surrounds has major implications on the way that health care is determined today. This is the first of a three part series that will examine Curran's role in a serious and systematic corruption by Blue Cross Blue Shield. In the first part, I will lay out some serious charges against Curran and some other colleagues as well as Blue Cross Blue Shield itself. In the second part, I will lay out the evidence to prove those charges. In the third part, I will give my conclusions for what all of this means in the larger health care debate.

Dr. Curran is a private family practioner in Athens, Texas at the East Texas Medical Center. By appearing in this advertisement, Curran appears to have violated the Texas Medical Practice Act's ban on so called testimonial advertising. Furthermore, he violates all sorts of ethics regarding conflicts of interest by appearing in an advertisement for his most significant insurance carrier. The whole affair becomes even more curious when only a few months later a puff piece with quotes from BCBS hierarchy as well as references to BCBS finds its way through the internet.

Dr. Doug Curran is everywhere these days. The longtime Athens-based family physician has been spotted in a few magazines you may have heard of, such as Newsweek and Sports Illustrated.

Through his longtime association with Blue Cross Blue Shield of Texas, Curran appears – wearing his white lab coat, clutching a stethoscope and looking more serious than one usually finds him – in a series of their print ads.

While those ads have garnered him the most attention over the last few months, a less visible appearance in another magazine carries even more prestige.On page S-18 of December's Texas Monthly (S for Super), Curran's name is listed under the Family/General Practice section of "Texas Super Doctors 2005."

...

Dr. Dee Whittlesey describes Curran as "a physician's physician.""He's a man who cares deeply for his patients and will go to any lengths to make sure they get the best care," said Whittlesey, who serves as VP in the Office of Physicians Advocacy for Blue Cross Blue Shield of Texas. Before that she worked 23 years in obstetrics and gynecology.

As you can see, besides appearing for an advertisement for BCBS, Dr. Dee Whittlesey of BCBS is quoted within this article. Furthermore, his connection to BCBS is mentioned multiple times throughout the article. It is one thing to have a good and professional relationship with your insurance provider, however it is quite another to simply get into bed with them. This article and the advertisement previous to it are two examples of a long and winding story in which Curran wasn't merely friendly and professional with BCBS, but in bed with them.

Besides being a small town doctor, Dr. Curran was also, for several years, the head of the Texas Academy of Family Physicians (TAFP). This is the Texas branch of the most powerful organization that represents the INTERESTS OF FAMILY PHYSICIANS. Furthermore, Dr. Curran is one of three members of super secret committee of the Blue Cross Blue Shield Texas Medical Advisory Board. This is a committee that the general public is likely not supposed to know exists. This committee reviews the performance of other family physicians that are contracted with Blue Cross Blue Shield and determines if any have stepped out of bounds. Furthermore, this committee is intimately involved in determining proper punishment for those physicians that Blue Cross Blue Shield determines to have stepped out of bounds. In other words, Dr. Curran is playing both sides of the proverbial fence. Not only is he representing the interests of family physicians, (Of course, many times those interests confront the interests of BCBS) but he then turns around and represents the interests of BCBS against family physicians.

Curran serves on this BCBS committee with two other physicians, Dr. Keith Miller, and Dr. Fred Merian. Dr. Keith Miller was also the long time head of the Texas Medical Board Disciplinary Committee and Merian was the head of the Texas Medical Association. Furthermore, Miller is a private family physician in a town called Center, Texas. This is a town of a few thousand, and Miller has spent his entire professional life serving in relatively small towns like Center, Texas.

Several issues should already come to mind. Why are three such powerful people also in a position of power at BCBS? How does a doctor centered in a relatively small town wind up finding himself in the middle of so much disciplinary and decision making power? The answer is that these three were put there by BCBS to corrupt the system to punish private family physicians in Texas that BCBS determined were too expensive.

The relationship between private family physicians and BCBS, and other insurance companies frankly, is a naturally confrontational one. Unlike doctors at big hospitals, private family physicians get paid by the medical version of commissions. Ulike doctors at large hospitals or hospitals associated with universities, private doctors only get paid when they have patients. Furthermore, there is a sliding scale that BCBS, and other insurance companies use, to determine how much they get paid. The more comprehensive leads to more fees. This is determined by patient evaluation forms that doctors fill out. Whereas doctors at hospitals rarely if ever fill these forms out, private doctors use this as the lifeblood of their business. Think of private family doctors as the ultimate capitalist in the medical field. They have to fight for every nickel they make, and they are the ones most motivated to fight for it.

The BCBS Texas Medical Advisory Committee reviews the billing of private doctors in Texas. Keep in mind that Dr. Miller, for one, is himself a private Texas doctor. This is of course an obscene conflict of interest. Unfortunately, the corruption doesn't end there. BCBS employs these three to procure a practice known as sham peer review. Sham peer review is the corrupted process of medical peer review . Instead of determining whether or not a doctor stepped outside of medical guidelines, sham peer review merely punishes doctors that powerful forces deem a threat. The process can be summed up the phrase: judge, jury and executionor. The corrupt force finds a way to bring up trumped charges, they have someone on the panel's jury, and they usually have someone presenting the evidence. Dr. Miller's position as head of the disciplinary board puts him in a unique position to corrupt a legitimate peer review and turn it into a sham peer review. In other words, these three don't merely work for BCBS to perform private physician evaluations, but rather, they are strategically placed by BCBS within all parts of the medical system to corrupt it to punish those doctors that BCBS determines to be a threat.

As such, these three doctors have gotten into bed with BCBS in order to help BCBS root out those of their colleagues that they determine too expensive to keep around.

In part 2, I will tell the story of Dr. Shirley Pigott. She is just one of those doctors that BCBS determined too expensive to keep around, and as such, she wound up crossing paths with all three as she was systematically retaliated against through sham peer review.

Please read part two here.