On October 31, 2001, Dr. Chris Kuhne received the first in a series of letters from Dee Whittlesey (that is the same Dee Whittlesey that played an active role in the sham peer review perpetrated on Dr. Shirley Pigott) The summary of the letter was that in the opinion of Blue Cross Blue Shield, Dr. Kuhne had fallen outside of the matrix of the amount of money that a doctor in his specialty should make. In other words, in the opinion of BCBS, Dr. Kuhne was charging too much. Dr. Kuhne specializes in obstetrics and gynecology or in other words, he treats any and all ailments that a female might have.
This letter was the beginning of a long battle between Dr. Kuhne and his main insurance provider BCBS. He estimates that roughly half his business is covered by BCBS, and thus this is an insurance provider that he must maintain in order to maintain any semblance of his business.
On Mar 7, 2003, his dispute with BCBS took a terrible turn for his business. Following a long and thorough investigation of his billing practices, BCBS determined that they were simply unacceptable and they terminated their relationship with Dr. Kuhne. He had been deselected, an extraordinary step that is almost never taken. Once BCBS has accepted a doctor into their network, they usually on deselect said doctor under the most extreme of cases.
Of course, the journey that Dr. Kuhne took with BCBS didn't end there. At the end of 2005, BCBS changed the manner in which they determined their matrices for billing. In layman's terms, they used to figure out billing based on gross amounts, and at the end of 2005, they started figuring it out per patient. After reviewing Dr. Kuhne's case, they determined that in fact the reason he made more money was simply because he served more patients than most doctors. In other words, his removal was entirely without cause and they immediately put him back in the network where he remains today. In fact, by 2007, BCBS awarded Dr. Kuhne their coveted Blue Compare award. This is given to those doctors that BCBS feels exhibited the most care in minimizing the costs incurred to their patients.
In other words, in a journey that started in 2001, BCBS went from kicking Dr. Kuhne out of its network for billing too much, to giving him an award for frugal billing. Besides the award, BCBS didn't compensate Dr. Kuhne in any manner for the three years they nearly fatally disrupted his business.
While Dr. Kuhne was having his battle with BCBS, he was simultaneously involved in another battle with a titan of Texas medicine, the Texas Medical Board. Here he crossed paths with another familiar name, Dr. Keith Miller the head of the TMB Disciplinary Board.
Two separate cases only months apart began Dr. Kuhne's battle with the TMB (a battle that continues to still be unresolved even today even though most of his adversaries have been exposed as corrupt. A battle I may add that has cost Dr. Kuhne in excess of 100,000 dollars in legal fees). Each of the two cases began during the middle of 2004.
The first case was rather mild. It started when a patient of his (obviously doctor patient confidentiality prohibits naming the patient) decided to switch doctors and asked for her medical records. Dr. Kuhne sent her a letter and stated that the records would cost her $43. When he didn't hear from the patient, he kept the records. After a few months, the patient corresponded and essentially verbalized that it was silly that he keep her records over a small fee. Dr. Kuhne agreed and went ahead and forwarded the record without charging a fee.
While the files were forwarded satisfactorially, the time period wound up being out of technical bounds for acceptable TMB standards. Because Dr. Kuhne didn't forward the records in a swift enough period, this landed him in front of the TMB, in a case that still remains unresolved today about four years later.
The second case was significantly more serious in terms of the scope of the charges. Another patient accused Dr. Kuhne of making lewd sexual comments, sexual assault, and other sexually related allegations.
In each of the cases, Dr. Keith Miller played an active role. In the case involving sexual assault, Dr. Miller lead the informal settlement conference proceedings, and in the other, he was a member of the TMB board that ultimately decided his fate.
First, let's go over again the sequence of events that are involved in any matter that winds up in front of the TMB. First, the doctor is given formal written notice of charges against them. Then, something called an informal settlement conference is heard. This is an oral hearing in front of members of the disciplinary board in which evidence is heard, witnesses are called, and the disciplinary board questions the witnesses. Months later the disciplinary board issues its findings. After this, if the doctor is unsatisfied with the verdict, they can move to appeal in front of what is called the State Office of Adminstration Hearings (S.O.A.H.)
The S.O.A.H. hearing is held in front of a law judge and that judge issues their findings. Then, the law judge presents their findings in front of the full TMB, a group of about 16-18 doctors and a few civilians, that rule on all the evidence that has been presented in front of them including the findings of the law judge.
In both cases, the disciplinary board initially ruled against Dr. Kuhne, and in each case the law judge for SOAH ruled in favor of Dr. Kuhne. In both cases, the full TMB then still ruled against Dr. Kuhne.
In Dr. Kuhne's case regarding the sexual assault, the case followed closely with another I have mentioned. That is the case of Dr. Bill Rea. In the case of Dr. Rea, Dr. Rea called up no less than 18 expert witnesses that that testified that Dr. Rea had done nothing wrong and that the charges against him were frivilous and wrong. In Dr. Rea's case, the TMB put up one expert, their own hired gun, to claim that Dr. Rea was being fairly targeted. In the case of Dr. Rea, the TMB went with the testimony of their one expert over the 18 that testified in favor of Dr. Rea. In Dr. Kuhne's case, he also put up more than a dozen experts and once again the TMB put up one hired gun. Again, in Dr. Kuhne's case, the TMB ruled in favor the testimony of one hired gun over the experts that testified on behalf of Dr. Kuhne.
The two cases have other important similarities. Both Dr. Rea and Dr. Kuhne were long standing and respected doctors and they had each even finished their residency at the respected Parkland Hospital in Dallas, Texas.
The two cases have important distinctions as well. Dr. Rea is a leader in the field of environmental medicine and he accepts no insurance. His patients pay him first and then take that bill to BCBS or whatever provider they may have. It is much more difficult for BCBS, or any other insurer, to argue with the patient themselves rather than with the doctor over billing. In other words, Dr. Rea is the insurance company's worst financial nightmare, a doctor they can't control. Dr. Kuhne, on the other hand, was involved in his own battle with BCBS at the beginning of each of these cases.
According to Dr. Kuhne's recollection, the final verdict in each of the cases in front of the full TMB was split. All the doctors voted in his favor (except Dr. Miller), and all the osteopaths voted against him. (with the civilians casting the deciding vote and voting slightly against him) This is important because a check of the current make up of the TMB finds only one osteopath. That osteopath is Dr. Roberta Kalafut and she is the current, and then, head of the TMB. Each of the other osteopaths were either purged from the board or left for other reasons. Dr. Keith Miller resigned from the board under the grips of all sorts of allegations of corruption.
(Updated, based on the criticism of a poster)
One other thing that is important to understand is that Dr. Kalafut received far less training and is far less skilled in medicine than either Dr. Kuhne or Dr. Rea. She went to osteopathic school and not a full medical school. Furthermore, she graduated from the fairly modest, Sinai Hospital, in Maryland. In other words, both Dr. Kuhne and Dr. Rea were being judged by a medical professional far less superior to them. Furthermore, her own bio on the TMB website is misleading.
Roberta Kalafut, D.O., of Abilene, earned her medical degree from Ohio University College of Osteopathic Medicine and completed her residency in physical medicine and rehabilitation at Johns Hopkins Hospital and Sinai Hospital of Baltimore, Maryland.
While technically she did spend time at both Johns Hopkins and Sinai, that's only because the hospitals are neighbors. All Sinai residents spend a few rotations at the prestigious Johns Hopkins, however she didn't graduate from there and the time she spent at Johns Hopkins was token at best.
Now, first this raises the question why was half the board made up of them. That can only be answered by the government of Texas and the TMB itself. More than that, when Dr. Kalafut was judging Dr. Kuhne and Dr. Rea, she was judging doctors far superior to her. It's like a journey man basketball player deciding the worth of Michael Jordan's basketball skills. The make up of the board at the time of the events opened it up intuitively for corruption and a total lack of fairness.
Finally, by 2007, Dr. Kuhne waged his battle for going on three years. By this point, he had allied himself with a Dr. Steve Hotze along with a group of doctors including Dr. Bill Rea that all felt they were the subject of sham peer review by the TMB. In October of 2007, they took their case to the Texas legislature. The results were scathing.
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.Finally, at this hearing, Mari Robinson stated under oath that Dr. Kuhne signed an affidavit admitting to sexual misconduct. Dr. Kuhne has stated categorically that he signed no such agreement, and so far this agreement has NOT been produced. Mari Robinson is not only the Director of Litigation at the TMB but a licensed attorney. If she did lie under oath that is immediate grounds for removing her from the bar. That doesn't even speak to the criminal liability of potential perjury charges.
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.
This whole sordid affair continues to unfold. The most shocking part is that charges against both Dr. Chris Kuhne and Dr. Bill Rea still haven't been resolved. Despite the fact that there is overwhelming evidence that the body that pursued them was obscenely corrupt their cases are now in the Texas state court system. (that's because their appeals were exhausted through the TMB system) These cases continue to be a mental, emotional, and financial drain on all the doctors that have been targeted. It is impossible to know for sure just how many doctors were the victims of the kind of sham peer review that these two were, and unfortunately most will never have their stories told.
These two cases, along with that of Dr. Shirley Pigott, are likely to open up a pandora's box of corruption throughout the medical system that infects the state of Texas. I have only begun to discover it all and I will continue to report on it.
Read the conclusion to this series here.