UPDATE: Check out my new book, The Definitive Dossier of PTSD in Whistleblowers, and in chapter three this story, and especially its mentally debilitating effects, is explored in much greater detail.
Introduction: If this is your first introduction of this story please read part one, part two, and part three. I will be referencing them often and you will be confused if you haven't read them.
Let's review what I have laid out. In 1986, Jim Singer was a practicing psychologist in Dubois, Pennsylvania. He treated a patient with a series of problems including alcoholism and a history of abuse. Singer suggested that the patient go through counseling with the rest of his family. During the course of that treatment, Singer began to suspect that the patient's younger 16 year old sister was being abused. When the sixteen year old was confronted, she admitted, in front of several witnesses, that she was being abused.
Singer immediately called the proper authorities as he was required to by his status as a mandated reporter. From the beginning, DCFS was more interested in protecting the abuser than the child. The child was never given an attorney and her father continued to make contact with her.
Within a year of reporting the incident, Singer began losing many of the patients and then he was accused of wrongdoing by seven separate patients all at roughly the same time. Singer had been a practicing psychologist for nearly fifteen years and never had a complaint. Now, he was facing seven different complaints all at once. Even though this should have raised all sorts of red flags, the Psychology board proceeded with charges against Singer. In fact, there was even evidence that DCFS paid off patients to turn on Singer and make false claims against him.
Within a few years, Singer was nearly out of money and eventually his license was suspended indefinitely. Singer never regained his license in Pennsylvania and only recently had it reinstated in West Virginia.
Since the beginning of his case, he reached out to nearly single politician. Most were initially helpful. Letters were written to folks like Janet Reno and Bill Clinton himself. Tom Ridge even tried to get Singer's case heard in front of the appropriate Senate Committee. In fact, politicians local, state, and national were attempting to help Singer. Most peculiar, politicians helped a lot more prior to the release of this police report (summarized here). Even though this police report confirmed everything that Singer had been saying for nearly a decade, and accused much of the Pennsylvania political apparatus of criminal wrongdoing. Despite, or maybe as a result, of this new police report, the powerful politicians of Pennsylvania began to be strangely non responsive.
As such, Singer's case continues to be unresolved. Neither the accused or anyone else involved in wrongdoing has been brought to justice. The whole entire affair has been swept under the proverbial rug. How does this happen? The accuser worked for the phone company. Did he really have enough power to orchestrate a sham that sweeps his abuse under the rug while at the same time ruining Singer's career? If it wasnt' him, who was it? Those are all questions that no one has the answer to. What is clear is that DCFS and everyone else mandated to protect children in Pennsylvania failed miserably in their jobs in this case. Mark Spotz, who went on a spree killing, was also a product of the DCFS in Pennsylvania.
Given what I have reported here, can anyone imagine the horror that Spotz likely went through when the state was supposed to be protecting him? If the state of Pennsylvania protected the abuser and attacked the reporter in this case, how many other cases are there? What is going on here?
While this case is complicated with many twists and turns, it comes down to this simple narrative. The state of Pennsylvania was supposed to protect the abused child and keep the reporter anonymous and protected. Instead, the child was given no protection. The accuser was protected, and on top of it, the state looked the other way (or worse) while the reporter was retaliated against. As such, an affair that started more than twenty years ago continues unresolved today. A career is ruined, and who knows what has happened to the life of a then sixteen year old child. On top of it, no one seems to care.
Finally, here are some other similar cases of doctors being taken advantage of in other parts of the country... stories like a doctor in South Carolina that was targeted for reporting on a serial killer nurse, a doctor in Texas targeted by Blue Cross/Blue Shield, a nurse that was targeted after he reported on illegal drug testing at his hospital, the Texas Medical Board's systematic targeting of doctors, and the tragic case of obscene corruption at Atlanta's Grady Hospital. Finally, you can check out a similar case in which a doctor in Rhode Island was also targeted after she reported on suspected child abuse.
Showing posts with label sham peer review. Show all posts
Showing posts with label sham peer review. Show all posts
Thursday, June 26, 2008
Monday, June 23, 2008
HCQIA and Sham Peer Review: The Petition
HCQIA (Health Care Qaulity Improvement Act) was a well intentioned law that wound up helping to facilitate sham peer review. It was a complicated bill passed in 1986. Among many of its provisions, it gave near total immunity for doctors that are part of medical peer review. With their newfound powers, much of the apparatus in many of the states that performed medical peer review were corrupted.
This law has given license to such corrupt organizations as the Texas Medical Board to absolutely run wild and do what they please with impugnity.
This law has given license to such corrupt organizations as the Texas Medical Board to absolutely run wild and do what they please with impugnity.
I have been running a serious of stories in which doctors were the victims of sham peer review. These are stories like a doctor in South Carolina that was targeted for reporting on a serial killer nurse, a doctor in Texas targeted by Blue Cross/Blue Shield, a nurse that was targeted after he reported on illegal drug testing at his hospital, the Texas Medical Board's systematic targeting of doctors, and the tragic case of obscene corruption at Atlanta's Grady Hospital. Finally, you can check out a similar case in which a doctor in Rhode Island was also targeted after she reported on suspected child abuse.
In all of these, the folks that were corrupting the system were in fact being shielded by HCQIA as well. As such, it made perpetration of sham peer review that much easier.
Here is a petition to support a bill that would protect doctors when they blow the whistle on poor patient care. This would amend HCQIA to protect doctors. So far, the signature volume has been underwhelming so I hope you will take a minute to stop by.Thursday, May 22, 2008
Lennox, Kuritzky, and Sham Peer Review
Medical peer review is a process by which doctors that have been accused of stepping out of bounds are judged by their peers.
When medical peer review is corrupted it is known as sham peer review.
I have over the last several months introduced examples of how sham peer review has threatened doctor's livelihood and disrupted their lives in tragic ways.
In South Carolina, Dr. Blake Moore discovered that one of the nurses, Lynetted Vaughn, on staff at his hospital, Williamsburg Community Hospital, was administering legal doses of drugs to terminally ill patients. In other words, he discovered a serial killer. He reported her activities to hospital administration. Vaughn is exactly the sort of medical professional that medical peer review was intended for. Unfortunately, rather than disciplining Vaughn (for what should have been the beginning of criminal proceedings), the entire hospital administration turned on Dr. Moore himself.
A colleague accused him of making racist remarks, and this started a long process of sham peer review. In that case, as with all cases of sham peer review, the problem could be defined by this: judge, jury, and executioner. The employee who accused him of racism had been sent at the behest of the hospital administration to claim false charges. Dr. Moore was a whistleblower and sham peer review is a common tactic of corruptors to deal with whistleblowers. The problem was that the peer review was being administered by other corrupt entities that were in bed with the administration.
In Texas, Dr. Shirley Pigott became a target of yet another sham peer review. What she discovered was that her main insurance provider, Blue Cross/Blue Shield, had determined that she was charging them an unacceptable level of fees and they decided to use sham peer review to punish her and force her to cut her fees. BCBS used Dr. Keith Miller, who was simultaneously head of the Texas Medical Board's Disciplinary Committee and a part of the super secret Blue Cross Blue Shield Texas Medical Advisory Board, to orchestrate a sham peer review against her. In fact, there are likely thousands of doctors in Texas that were the victims and I highlighted to stories of two others, Dr. Bill Rea and Dr. Chris Kuhne, here.
The reasons for sham peer review range because this is a problem that is systemic. (I hope to introduce many more stories of medical professionals that had been wronged in the months to come)It ranges from punishing rivals, to whistleblowers, to jealousy, to mere corrupt individuals drunk on power. The thing that ties them together is that corrupt forces join together to create charges, prosecute them, and make judgement. If the same corrupting force charges a doctor, prosecutes the doctor, and acts as the jury, you can see that the proverbial deck is stacked against that doctor. That of course is a sham and that is why it is referred to as sham peer review.
Now, the only difference between the cases of Kevin Kuritzky and Dennis Lennox and the standard sham peer review is that neither Kuritzky or Lennox were doctors. In fact, what first drew me to the situation surrounding CMU was the similarities between the way in which the administration treated Lennox and they way in which Emory University treated their student, Kevin Kuritzky.
Kuritzky began reporting serious abuses in patient care at Emory's teaching hospital, Grady Hospital. Rather than having his concerns looked at, the administration deemed Kuritzky a threat. Emory employed William Casarella to not only investigate charges against Kuritzky but to prosecute the charges and act as the head of the jury at Kuritzky's disciplinary hearing. As such, 41 days prior to graduating from medical school, Kevin Kuritzky was expelled.
In fact, Kuritzky has told me that just prior to the start of his expulsion hearing, Casarella approached him and told him that he was through. Does this sound like Kuritzky was part of a fair process?
So, we get to the situation surrounding the confrontation between Dennis Lennox and CMU. The elements here are largely the same. Lennox ran a painstaking campaign for more than a year to try and expose corruption that he saw in the hiring of Gary Peters to the distinguished Griffin Chair. Peters was simultaneously running for U.S. Congress in a district hundreds of miles away. As such, Lennox felt that Peters should choose one or the other. He continued to challenge the administration and refused to drop the matter until Peters made the choice.
He was ultimately proven right as last week CMU announced that they would likely change their policy and force all administration to choose between running for Congress and serving in the administration.
Of course, as the events were unfolding, the administration didn't see it that way. Thus, in October, Lennox was approached by a member of the administration, Peter Kofer, in the evening inside a university building. Because Lennox refused to identify himself, Kofer immediately took formal action. Kofer's complaint went directly to Peter Voison who is not only a member of the CMU staff but a colleague of Peter's himself. This incident lead to formal charges and ultimately a formal disciplining of Lennox. The disciplinary hearing was conducted in secret without Lennox' attendance, so we don't know who was on the jury. That said, I think we can all bet that the jury was made up entirely of colleagues of Gary Peters.
The common elements are the same. The same corrupt administration that viewed Lennox as a threat brought charges against him. They prosecuted the charges and they acted as the jury. In fact, in Lennox' case, the administration was so brazen that the hearing was held without his attendance. He wasn't even allowed to be there to defend himself. If the same corrupt administration brings charges against you, prosecutes them, and acts as the jury, then that is a sham.
What both Kuritzky and Lennox faced was the academic equivalent of sham peer review. It's important to keep that in mind as we analyze the outcome of the fiasco that surrounded Lennox, CMU, and Gary Peters. Last week, the administration announced that they would likely change their policy and Peters would be forced to choose between running for Congress and being a Griffin Chair.
While that is great, what hasn't been resolved is what will happen to th perpetrators of the sham that targeted Lennox. The common thread of any third world nation is obscene corruption at all levels. The sham perpetrated on Lennox exposed a corruption at all levels of the university. His case received a great deal of media attention. Yet, at all times, the case against him moved forward with no one in the administration ever stepping in to do the right thing. From the President, Michael Rao, to the Dean of Students, Pamela Gates, to everyone else, these folks were either actively in on the sham or they looked the other way while it continued.
Sham peer reviews don't happen by accident. They are carefully orchestrated to create a desired outcome. Neither was the sham perpetrated against Dennis Lennox merely a twist of fate or an accident. This was a carefully orchestrated plot that either involved all levels of the administration or merely had some look the other way. As such, if the administration is allowed to continue with their jobs in tact, then the message is that the sham perpetrated against Lennox is acceptable. Furthermore, these shams don't happen in a vacuum. If this administration orchestrated this sham on Lennox, they will do it again. They must be held accountable for their corruption or CMU will find itself tolerant of more of it in the future. Unless we want to deal with the next Dennis Lennox the next time they step out of line, the entire administration must be held to account for the sham that they orchestrated.
Medical peer review is the process by which a committee of physicians investigates the medical care rendered in order to determine whether accepted standards of care have been met.
A Medical Peer Review is meant to provide independent medical opinions conducted by an objective group of physicians and relevant medical staff that quickly resolve complex problems that hospitals, physicians and insurance carriers face. They are often used to help solve systems problems endemic to healthcare institutions and thereby reduce legal liability associated with them. The review of chart notes and other medical reports are used to help render objective written opinions.
The term has been improperly used, however, as a synonym for performance appraisal. Several organizations have co-opted the term "peer review" as a guise for performance appraisals meant to be used as negotiating tools.
A medical peer review committee can act at the request of a patient, a physician, or an insurance carrier depending on the politics of the venue.
When medical peer review is corrupted it is known as sham peer review.
Sham peer review or malicious peer review, a concept explained by Roland Chalifoux in Medscape General Medicine, is the practice of using a medical peer review process to remove a doctor who is seen to be disruptive, too great an advocate for change, or competitive with other doctors within the same institution.[1] While technically sham peer review is a concept that applies to every discipline, it has most commonly been applied to the healthcare industry recently.
In healthcare, the lines between peer review of physicians and performance appraisal by non-peers has been blurred. Administrators, nurses, and even patients play a role in performance appraisals, while peer review is a system that is only supposed to involve the physicians themselves.
Scientific peer review has traditionally been held to be achievable only when research and investigations are able to be examined openly. Medical peer review, in contrast, is protected from open examination by rules of confidentiality. In this way it also diverges from true peer review.
I have over the last several months introduced examples of how sham peer review has threatened doctor's livelihood and disrupted their lives in tragic ways.
In South Carolina, Dr. Blake Moore discovered that one of the nurses, Lynetted Vaughn, on staff at his hospital, Williamsburg Community Hospital, was administering legal doses of drugs to terminally ill patients. In other words, he discovered a serial killer. He reported her activities to hospital administration. Vaughn is exactly the sort of medical professional that medical peer review was intended for. Unfortunately, rather than disciplining Vaughn (for what should have been the beginning of criminal proceedings), the entire hospital administration turned on Dr. Moore himself.
A colleague accused him of making racist remarks, and this started a long process of sham peer review. In that case, as with all cases of sham peer review, the problem could be defined by this: judge, jury, and executioner. The employee who accused him of racism had been sent at the behest of the hospital administration to claim false charges. Dr. Moore was a whistleblower and sham peer review is a common tactic of corruptors to deal with whistleblowers. The problem was that the peer review was being administered by other corrupt entities that were in bed with the administration.
In Texas, Dr. Shirley Pigott became a target of yet another sham peer review. What she discovered was that her main insurance provider, Blue Cross/Blue Shield, had determined that she was charging them an unacceptable level of fees and they decided to use sham peer review to punish her and force her to cut her fees. BCBS used Dr. Keith Miller, who was simultaneously head of the Texas Medical Board's Disciplinary Committee and a part of the super secret Blue Cross Blue Shield Texas Medical Advisory Board, to orchestrate a sham peer review against her. In fact, there are likely thousands of doctors in Texas that were the victims and I highlighted to stories of two others, Dr. Bill Rea and Dr. Chris Kuhne, here.
The reasons for sham peer review range because this is a problem that is systemic. (I hope to introduce many more stories of medical professionals that had been wronged in the months to come)It ranges from punishing rivals, to whistleblowers, to jealousy, to mere corrupt individuals drunk on power. The thing that ties them together is that corrupt forces join together to create charges, prosecute them, and make judgement. If the same corrupting force charges a doctor, prosecutes the doctor, and acts as the jury, you can see that the proverbial deck is stacked against that doctor. That of course is a sham and that is why it is referred to as sham peer review.
Now, the only difference between the cases of Kevin Kuritzky and Dennis Lennox and the standard sham peer review is that neither Kuritzky or Lennox were doctors. In fact, what first drew me to the situation surrounding CMU was the similarities between the way in which the administration treated Lennox and they way in which Emory University treated their student, Kevin Kuritzky.
Kuritzky began reporting serious abuses in patient care at Emory's teaching hospital, Grady Hospital. Rather than having his concerns looked at, the administration deemed Kuritzky a threat. Emory employed William Casarella to not only investigate charges against Kuritzky but to prosecute the charges and act as the head of the jury at Kuritzky's disciplinary hearing. As such, 41 days prior to graduating from medical school, Kevin Kuritzky was expelled.
Emory claims Kuritzky was dismissed for "plagiarism, repeatedly missing required clerkship training involving patient care, lying to his professors, and engaging in other unprofessional, dishonest and unethical conduct."
In fact, Kuritzky has told me that just prior to the start of his expulsion hearing, Casarella approached him and told him that he was through. Does this sound like Kuritzky was part of a fair process?
So, we get to the situation surrounding the confrontation between Dennis Lennox and CMU. The elements here are largely the same. Lennox ran a painstaking campaign for more than a year to try and expose corruption that he saw in the hiring of Gary Peters to the distinguished Griffin Chair. Peters was simultaneously running for U.S. Congress in a district hundreds of miles away. As such, Lennox felt that Peters should choose one or the other. He continued to challenge the administration and refused to drop the matter until Peters made the choice.
He was ultimately proven right as last week CMU announced that they would likely change their policy and force all administration to choose between running for Congress and serving in the administration.
Of course, as the events were unfolding, the administration didn't see it that way. Thus, in October, Lennox was approached by a member of the administration, Peter Kofer, in the evening inside a university building. Because Lennox refused to identify himself, Kofer immediately took formal action. Kofer's complaint went directly to Peter Voison who is not only a member of the CMU staff but a colleague of Peter's himself. This incident lead to formal charges and ultimately a formal disciplining of Lennox. The disciplinary hearing was conducted in secret without Lennox' attendance, so we don't know who was on the jury. That said, I think we can all bet that the jury was made up entirely of colleagues of Gary Peters.
The common elements are the same. The same corrupt administration that viewed Lennox as a threat brought charges against him. They prosecuted the charges and they acted as the jury. In fact, in Lennox' case, the administration was so brazen that the hearing was held without his attendance. He wasn't even allowed to be there to defend himself. If the same corrupt administration brings charges against you, prosecutes them, and acts as the jury, then that is a sham.
What both Kuritzky and Lennox faced was the academic equivalent of sham peer review. It's important to keep that in mind as we analyze the outcome of the fiasco that surrounded Lennox, CMU, and Gary Peters. Last week, the administration announced that they would likely change their policy and Peters would be forced to choose between running for Congress and being a Griffin Chair.
While that is great, what hasn't been resolved is what will happen to th perpetrators of the sham that targeted Lennox. The common thread of any third world nation is obscene corruption at all levels. The sham perpetrated on Lennox exposed a corruption at all levels of the university. His case received a great deal of media attention. Yet, at all times, the case against him moved forward with no one in the administration ever stepping in to do the right thing. From the President, Michael Rao, to the Dean of Students, Pamela Gates, to everyone else, these folks were either actively in on the sham or they looked the other way while it continued.
Sham peer reviews don't happen by accident. They are carefully orchestrated to create a desired outcome. Neither was the sham perpetrated against Dennis Lennox merely a twist of fate or an accident. This was a carefully orchestrated plot that either involved all levels of the administration or merely had some look the other way. As such, if the administration is allowed to continue with their jobs in tact, then the message is that the sham perpetrated against Lennox is acceptable. Furthermore, these shams don't happen in a vacuum. If this administration orchestrated this sham on Lennox, they will do it again. They must be held accountable for their corruption or CMU will find itself tolerant of more of it in the future. Unless we want to deal with the next Dennis Lennox the next time they step out of line, the entire administration must be held to account for the sham that they orchestrated.
Friday, May 16, 2008
The Texas Medical Board Vs. Doctors...More Corruption in Texas I
This past week, I introduced a case of corruption in health care in Texas. The particular case I discovered is only the opening of a pandora's box of curruption that has its nexus in the Texas Medical Board. In 2002, The Dallas Morning News ran a series of articles that wound up having all sorts of unintended consequences.
The Dallas Morning News series was a well meaninged attempt to point out that the Texas Medical Board was not strenuously pursuing its duty in holding bad and irresponsible doctors responsible. It lead to not only a massive increase in the TMB budget but also a license for aggressive action.
Unfortunately, the unintended consequences were that the TMB wound up being corrupted and sources I have spoken with believe that thousands of doctors may have been the victim of a process known as sham peer review. Up until the summer of last year, the nexus of this corruption was a gentleman named Dr. Keith Miller. Those that have read my previous series know that Miller is a small town doctor, head of the TMB's Disciplinary Committee, and also a member of the super secret Blue Cross/Blue Shield Texas Medical Advisory Board. We will likely never know the extent of his entire body of corruption however here is a summary of why he was forced off the board last year.
Miller's resignation was merely the tip of the ice berg in resignations of corrupt individuals on the TMB. Earlier this year, TMB executive director announced his retirement.
He did so under a cloud of suspicion. Back in October of 2007, the higher ups at the TMB showed up for Senate hearings in which they thought that their yearly budget was going to be discussed. They were blind sided when a plethora of doctors were called to give testimony about conflicts of interest, abuse of power, and incidents of sham peer review.
Because there are likely so many victims, the motivations ranged. Because Miller simultaneously held the dual position as head of the Disciplinary Committee and henchman for BCBS, many times he was simply doing the dirty work of the insurance company, including the incident I wrote about in my first series. It is also rumored that in the aftermath of the 2002 article, the TMB created quotas for prosecutions, and so it is likely some doctors may in fact have been targeted because the TMB simply hadn't convicted enough doctors yet.
The poster child, so to speak, for the victim of the TMB corruption is Dr. Bill Rea. Dr. Rea is a leader in the innovative field of environmental medicine. He was trained at the prestigious Parkland Hospital in Dallas, Texas. Furthermore, he doesn't accept insurance from his patients. This is important because Dr. Rea's patients then take their bills and contact their insurance companies themselves after they have paid Dr. Rea. Unlike most doctors, this gives Dr. Rea a great deal of power against insurance companies that other doctors don't have. Whereas insurance companies can simply kick a doctor out of their network if they become too expensive or too much hassle, kicking out their patients leads directly to their own lower bottom line.
This set up is important because the complaints against came from anonymous sources. Dr. Rea estimated that he has treated over 30,000 patients and has been practicing medicine for decades. Up until these anonymous sources complained, he had the overwhelming respect of his patients. In fact, once word spread of the charges against Dr. Rea, many of his patients wrote letters to the TMB in support of their doctor. So called anonymous sources are standard operating procedures for corrupt medical review boards and their corrupt partners. In fact, here is the hypothesis from Dr. Rea himself.
The nature of an anonymous source is such that the truth will never be known about who it was that initiated the complaint and what their motivation was. What cannot be argued is that Dr. Rea's patients came to his defense in an overwhelming manner. It cannot be argued that Dr. Rea achieved a terrific professional reputation prior to these charges. Furthermore Dr. Rea presented 18 expert witnesses at his hearing that all said his treatment was entirely within ethical guidelines.
While Dr. Rea's case has received a great deal of media attention, there are likely thousands of more doctors that have been wronged by the TMB who's story has not received the attention they deserve.
Furthermore, if you take a look at the links, you will find none that are linked to any major media source. While the Dallas Morning News was all too eager to point out when the TMB was not performing their job strenuously enough, they, along with their media partners, were totally asleep at the wheel when the results of their story lead to such an overreach.
In fact, this story has largely been driven Dr. Steven Hotze, the American Academy of Physicians and Surgeons, Texas Medical Board Watch. All of these folks have done yoeman's work in exposing this corruption, they have in effect done the job that the media was supposed to do. Much of this corruption goes back to 2003 and even before, and yet much of it has only come to light within the last year. Furthermore, while many bad apples, like Miller, have been dealt with, the public at large is mostly unaware at the obscene level of corruption he and his cohorts have committed. This can and must be laid directly at the feet of the media in Texas who's job it is to make sure this sort of corruption is exposed.
The fact that the Dallas Morning News was all too willing to bring to light a lack of action on the part of the TMB, but totally uninterested in the corruption that the story started is not only shameful but downright dangerous.
In part 2, I will put my direct focus on another case of sham peer review at the TMB that has received absolutely no media attention.
Please follow this link for part two of this story.
In 2002 a series of stories in The Dallas Morning News detailed the board's reluctance to punish doctors who sexually assaulted patients or whose repeated mistakes injured or killed patients. The Legislature responded by strengthening the board's regulatory powers and giving it more money for investigators. The number of disciplinary actions brought against physicians by the board nearly tripled from 2001 to 2007.
The Dallas Morning News series was a well meaninged attempt to point out that the Texas Medical Board was not strenuously pursuing its duty in holding bad and irresponsible doctors responsible. It lead to not only a massive increase in the TMB budget but also a license for aggressive action.
Unfortunately, the unintended consequences were that the TMB wound up being corrupted and sources I have spoken with believe that thousands of doctors may have been the victim of a process known as sham peer review. Up until the summer of last year, the nexus of this corruption was a gentleman named Dr. Keith Miller. Those that have read my previous series know that Miller is a small town doctor, head of the TMB's Disciplinary Committee, and also a member of the super secret Blue Cross/Blue Shield Texas Medical Advisory Board. We will likely never know the extent of his entire body of corruption however here is a summary of why he was forced off the board last year.
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.
Miller's resignation was merely the tip of the ice berg in resignations of corrupt individuals on the TMB. Earlier this year, TMB executive director announced his retirement.
At today’s meeting of the Executive Committee of the Texas Medical Board, Donald Patrick, M.D., J.D., announced that he will retire from his position as Executive Director on August 28, his 70th birthday.
He did so under a cloud of suspicion. Back in October of 2007, the higher ups at the TMB showed up for Senate hearings in which they thought that their yearly budget was going to be discussed. They were blind sided when a plethora of doctors were called to give testimony about conflicts of interest, abuse of power, and incidents of sham peer review.
Greetings! Three months of grueling preparation paid off handsomely as the Texas Medical Board took one crushing blow after another from the questions of the legislators on the committee and from the testimonies from the physicians and others at the October 23, 2007 House Appropriations Subcommittee on Regulatory Hearing. This hearing was convened to investigate the abuse of power by the Texas Medical Board. It was a marathon session lasting 11-1/2 hours. Without this hearing we would not have been able to expose the corruption at the TMB. We all owe a debt of gratitude to Representative Fred Brown who, by holding this hearing, demonstrated indomitable courage and determination in the face of extreme political pressure to abandon it.
The hearing made it clear that there is an unholy cabal made up of Don Patrick, Executive Director, Mari Robinson, Director of Litigation and Enforcement, and Roberta Kalafut, President of the TMB, who have despoiled the TMB. There can be no reform without removing them from the board.
Because there are likely so many victims, the motivations ranged. Because Miller simultaneously held the dual position as head of the Disciplinary Committee and henchman for BCBS, many times he was simply doing the dirty work of the insurance company, including the incident I wrote about in my first series. It is also rumored that in the aftermath of the 2002 article, the TMB created quotas for prosecutions, and so it is likely some doctors may in fact have been targeted because the TMB simply hadn't convicted enough doctors yet.
The poster child, so to speak, for the victim of the TMB corruption is Dr. Bill Rea. Dr. Rea is a leader in the innovative field of environmental medicine. He was trained at the prestigious Parkland Hospital in Dallas, Texas. Furthermore, he doesn't accept insurance from his patients. This is important because Dr. Rea's patients then take their bills and contact their insurance companies themselves after they have paid Dr. Rea. Unlike most doctors, this gives Dr. Rea a great deal of power against insurance companies that other doctors don't have. Whereas insurance companies can simply kick a doctor out of their network if they become too expensive or too much hassle, kicking out their patients leads directly to their own lower bottom line.
This set up is important because the complaints against came from anonymous sources. Dr. Rea estimated that he has treated over 30,000 patients and has been practicing medicine for decades. Up until these anonymous sources complained, he had the overwhelming respect of his patients. In fact, once word spread of the charges against Dr. Rea, many of his patients wrote letters to the TMB in support of their doctor. So called anonymous sources are standard operating procedures for corrupt medical review boards and their corrupt partners. In fact, here is the hypothesis from Dr. Rea himself.
The complaint against me was almost certainly made by United Health Care/Oxford. All five patients cited in thecomplaint had no knowledge that they or their information was being used in this way. Further, none of the patients are alleging mistreatment or malpractice against me and all five are still under my care. Additionally, these patients have allwritten to the Texas Medical Board and informed them that they are not part ofthis complaint and they are not making any allegations against me of any kind.
Two of the patients have stated that I saved their lives.The Texas Medical Board has dismissed the protests of these patients andcontinues to pursue charges against me. Further, the board refuses to officiallyreveal who made the complaint, what I am alleged to have done, or what evidencewas presented against me. They continually maintain that this information isprotected and does not have to be revealed.
However, we are almost certain that United Health Care/Oxford is behind the complaint. All five patients were from Manhattan (New York City), New Yorkand all had the same insurance company - United Health Care/Oxford. As youknow, our clinic does not take insurance, so all patients file claims directly with their respective insurance companies. We therefore do not have any direct connection with this insurance company. Evidence showing these facts was supplied to the Texas Medical Board, but was apparently disregarded as they have decided to pursue the charges despite the evidence.
The nature of an anonymous source is such that the truth will never be known about who it was that initiated the complaint and what their motivation was. What cannot be argued is that Dr. Rea's patients came to his defense in an overwhelming manner. It cannot be argued that Dr. Rea achieved a terrific professional reputation prior to these charges. Furthermore Dr. Rea presented 18 expert witnesses at his hearing that all said his treatment was entirely within ethical guidelines.
The TMB’s attorney informed Dr. Rea’s attorney that it didn’t matter what was said or what evidence was presented, Dr. Rea’s license would be revoked. Despite the fact that 18 physicians evaluated and approved of Dr. Rea’s treatment, one hired board expert denigrated it. At the end of the sham review hearing, Dr. Miller recommended that Dr. Rea’s license be revoked.Dr. Rea continues to fight these charges at a great personal and financial cost to him. (for a complete wrap up of the unbelievable corruption in the case of Dr. Bill Rea take a look at this link)
While Dr. Rea's case has received a great deal of media attention, there are likely thousands of more doctors that have been wronged by the TMB who's story has not received the attention they deserve.
Furthermore, if you take a look at the links, you will find none that are linked to any major media source. While the Dallas Morning News was all too eager to point out when the TMB was not performing their job strenuously enough, they, along with their media partners, were totally asleep at the wheel when the results of their story lead to such an overreach.
In fact, this story has largely been driven Dr. Steven Hotze, the American Academy of Physicians and Surgeons, Texas Medical Board Watch. All of these folks have done yoeman's work in exposing this corruption, they have in effect done the job that the media was supposed to do. Much of this corruption goes back to 2003 and even before, and yet much of it has only come to light within the last year. Furthermore, while many bad apples, like Miller, have been dealt with, the public at large is mostly unaware at the obscene level of corruption he and his cohorts have committed. This can and must be laid directly at the feet of the media in Texas who's job it is to make sure this sort of corruption is exposed.
The fact that the Dallas Morning News was all too willing to bring to light a lack of action on the part of the TMB, but totally uninterested in the corruption that the story started is not only shameful but downright dangerous.
In part 2, I will put my direct focus on another case of sham peer review at the TMB that has received absolutely no media attention.
Please follow this link for part two of this story.
Saturday, May 10, 2008
Blue Cross/Blue Shield Vs. Private Family Physicians...Corruption in Texas II
Introduction: Please note, if you haven't read the prologue to this piece, you can find that here. The prologue is an introduction to the overriding principles that this case uncovers. Please take a minute to read that in order to understand this portion better.
As the story I am about to tell unraveled for me, I couldn't help but notice some similarities between it and the movies of two of my favorite directors, Sergio Leone and Robert Altman. Those two film legends often told their tale by unfolding multiple story lines all at the same time and skipping from one sub plot, seemingly randomly, until the entire puzzle fit into place at the end of the film. Such is the story of the way in which BCBS, and their surrogates Dr. Doug Curran, Dr. Keith Miller, Dr. Fred Merian, retaliated against private family physician Dr. Shirley Pigott of Victoria, Texas. This story, much like other stories of corruption that I've covered, has many twists and turns.
Since, the reader can easily get lost in all the twists and turns, I will introduce many of the characters and entities that are involved first. 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. Jim White was the executive director of the TAFP during the period in question. Dr. Doug Henley was the Executive Director of the AAFP during the time in question. Dee Whittlesey was the "physician's advocate" for BCBS during the time in question. )Katie Johnsonius was an attorney at the Texas Medical Board. Scott Freshour was head of litigation at the TMB. Finally, Robert Simpson was lead general counsel at the TMB. (all during the period 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. Pigott eventually hired former surgeon and semi retired attorney Clark Watts to represent her at this hearing.
The story starts in the middle of 2002 when BCBS sent Dr. Pigott a correspondence. BCBS determined that her billing practices raised suspicions and thus they were going to formally challenge them. Unbeknownst to Dr. Pigott at the time was that the committee responsible for going over her billing was the BCBS Texas Medical Advisory Committee made up of Curran, Miller, and Marien. This case was resolved several months later with BCBS deciding that some of Dr. Pigott's treatment bills were too large, and they took their standard financial action. (in other words they docked Dr. Pigott some fees and payments)
At roughly the same time, there was a growing and more restless set of AAFP members. These members were private family physicians. 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 this advertisement for BCBS
Then this puff piece about Dr. Curran appeared on the internet
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,
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
Dr. Pigott felt like a witness on cross examination. This simple hearing about a technical violation turned into an interrogation. 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.
The next event was a memo emailed throughout the AAFP. The memo essentially said that Dr. Curran would no longer appear in advertisements for BCBS. The memo was worded carefully. It never assigned any wrongdoing to any of Curran's prior actions, however it did essentially say that Curran would cease all the activities that Dr. Pigott was concerned about.
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.
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.
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 safety.
While Pigott considered even a one cent fine extortion, she finally relented and accepted the terms of the reduced penalty. Pigott then proceeded to take her story to any of the media on Texas. She approached the Dallas Morning News, the Houstin Chronicle, the Corpus Christi Caller Times, the San Antonio Express, as well as her local Victoria Advocate. She even approached her local ABC affiliate. Despite the potential far reaching implications if this story is accurate, she was denied every single time. In fact, she told me that the conversations we had (I would estimate between 5-6 hours) in preparation for this story were the most that any media ever gave her. Even though one could reasonable hypothesis, that this case would open up a pandora's box that could lead potentially to uncovering systemic corruption perpetrated by BCBS upon the entire medical system, the media would have none of this story.
The media has also largely ignored the travails of Dr. Keith Miller subsequent to some of the events described here. A google search of Dr. Keith Miller finds only certain activist groups reporting on his corruption
The story mentioned regarding a nurse of his stealing 50 pills of a controlled substance and forging Dr. Miller's name. Yet, this nurse practioner, Bridget Hughes, has never been brought up on charges, and you aren't going to find much mention of this crime anywhere in the Texas media.
In part 3, I will discuss my conclusions and the implications I see of this case, including the near black out by the media. So please follow the link for the conclusion of this series.
As the story I am about to tell unraveled for me, I couldn't help but notice some similarities between it and the movies of two of my favorite directors, Sergio Leone and Robert Altman. Those two film legends often told their tale by unfolding multiple story lines all at the same time and skipping from one sub plot, seemingly randomly, until the entire puzzle fit into place at the end of the film. Such is the story of the way in which BCBS, and their surrogates Dr. Doug Curran, Dr. Keith Miller, Dr. Fred Merian, retaliated against private family physician Dr. Shirley Pigott of Victoria, Texas. This story, much like other stories of corruption that I've covered, has many twists and turns.
Since, the reader can easily get lost in all the twists and turns, I will introduce many of the characters and entities that are involved first. 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. Jim White was the executive director of the TAFP during the period in question. Dr. Doug Henley was the Executive Director of the AAFP during the time in question. Dee Whittlesey was the "physician's advocate" for BCBS during the time in question. )Katie Johnsonius was an attorney at the Texas Medical Board. Scott Freshour was head of litigation at the TMB. Finally, Robert Simpson was lead general counsel at the TMB. (all during the period 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. Pigott eventually hired former surgeon and semi retired attorney Clark Watts to represent her at this hearing.
The story starts in the middle of 2002 when BCBS sent Dr. Pigott a correspondence. BCBS determined that her billing practices raised suspicions and thus they were going to formally challenge them. Unbeknownst to Dr. Pigott at the time was that the committee responsible for going over her billing was the BCBS Texas Medical Advisory Committee made up of Curran, Miller, and Marien. This case was resolved several months later with BCBS deciding that some of Dr. Pigott's treatment bills were too large, and they took their standard financial action. (in other words they docked Dr. Pigott some fees and payments)
At roughly the same time, there was a growing and more restless set of AAFP members. These members were private family physicians. 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 this advertisement for BCBS
Then this puff piece about Dr. Curran appeared on 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.BCBS was referenced in connection to Curran throughout the article and Dee Whittelsey was even quoted in the article throwing fawning praise at Curran. 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.
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."
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 CommitteeBy 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. 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.
The next event was a memo emailed throughout the AAFP. The memo essentially said that Dr. Curran would no longer appear in advertisements for BCBS. The memo was worded carefully. It never assigned any wrongdoing to any of Curran's prior actions, however it did essentially say that Curran would cease all the activities that Dr. Pigott was concerned about.
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)Thus, to conclude, for being late in getting lab results, Dr. Pigott was
...
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
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
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 safety.
While Pigott considered even a one cent fine extortion, she finally relented and accepted the terms of the reduced penalty. Pigott then proceeded to take her story to any of the media on Texas. She approached the Dallas Morning News, the Houstin Chronicle, the Corpus Christi Caller Times, the San Antonio Express, as well as her local Victoria Advocate. She even approached her local ABC affiliate. Despite the potential far reaching implications if this story is accurate, she was denied every single time. In fact, she told me that the conversations we had (I would estimate between 5-6 hours) in preparation for this story were the most that any media ever gave her. Even though one could reasonable hypothesis, that this case would open up a pandora's box that could lead potentially to uncovering systemic corruption perpetrated by BCBS upon the entire medical system, the media would have none of this story.
The media has also largely ignored the travails of Dr. Keith Miller subsequent to some of the events described here. A google search of Dr. Keith Miller finds only certain activist groups reporting on his corruption
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. 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.
The story mentioned regarding a nurse of his stealing 50 pills of a controlled substance and forging Dr. Miller's name. Yet, this nurse practioner, Bridget Hughes, has never been brought up on charges, and you aren't going to find much mention of this crime anywhere in the Texas media.
In part 3, I will discuss my conclusions and the implications I see of this case, including the near black out by the media. So please follow the link for the conclusion of this series.
Friday, May 9, 2008
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.
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