Winkler County nurse whistleblower case

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Winkler County, Texas

The Winkler County nurse whistleblower case was a series of legal proceedings in West Texas that centered around the retaliation upon two nurses who submitted an anonymous state medical board complaint against a physician in 2009. The case attracted national attention for its implications on whistleblowing by nurses. After witnessing what they believed to be unsafe medical care, nurses Anne Mitchell and Vicki Galle submitted an anonymous complaint against Dr. Rolando Arafiles to the Texas Medical Board (TMB).

When he learned of the complaint, Arafiles spoke with the sheriff in Winkler County, who was his friend and one of his patients. Arafiles alleged that the nurses were engaging in harassment with their reports to the medical board. The sheriff investigated and obtained the TMB complaint, which provided enough information about Mitchell and Galle to make them identifiable. Galle and Mitchell were terminated from the hospital and faced criminal charges of misuse of official information. Galle's charges were dropped before trial and Mitchell was acquitted by a jury. In the aftermath of Mitchell's trial, Arafiles, several county officials and a hospital administrator all faced jail time for their roles in the retaliation against the nurses.

The case raised questions about the extent of whistleblower protection for healthcare providers who report patient care concerns to licensing authorities. Texas law included remedies against retaliation for whistleblowers, but no known U.S. state had whistleblower laws that address appropriate prosecutorial conduct. According to the Texas Nurses Association, "No one ever imagined that a nurse would be criminally prosecuted for reporting a patient care concern to a licensing agency."[1] After the Mitchell case, protection from prosecution was incorporated into Texas whistleblower laws. The TMB stopped investigating anonymous complaints about physicians in September 2011.

Background[edit]

The case originated at Winkler County Memorial Hospital (WCMH), a 15-bed hospital in Kermit, Texas.[2] Mitchell and Galle were registered nurses at WCMH. The two nurses held multiple roles at the hospital and both were employed there for more than 20 years. Galle headed quality improvement and utilization management for the hospital, while Mitchell served as its compliance officer. Galle and Mitchell also split the responsibilities of the medical staff coordinator position. Mitchell held a part-time role as the county's emergency management coordinator.[1] She also had experience as a travel nurse and as an instructor and director in a licensed vocational nursing program.[3]

In April 2008, Arafiles arrived at WCMH.[4] He had attended medical school in the Philippines and had come to the United States to train in Baltimore and Buffalo.[5] Texas issued a medical license to him in 1998.[6] The year before Arafiles came to Winkler County, the TMB restricted his ability to supervise nurse practitioners and physician assistants for three years and fined him $1,000. In that case, Arafiles allegedly failed to adequately supervise a physician assisant at a weight loss clinic and failed to exercise independent medical judgement when applying protocols written by the clinic's owner.[7]

Mitchell and Galle had concerns about Arafiles's care soon after he arrived at WCMH.[4] The doctor's practice in Kermit included the use of alternative medicine therapies such as herbal remedies. Witnesses later said that Mitchell made comments at work which characterized Arafiles as a "witch doctor".[8] Other coworkers said that Mitchell had legitimate concerns about the quality of the physician's patient care; they said that Mitchell first raised the issues with the hospital's administration, but that her concerns were not addressed.[8] In one incident, Arafiles was alleged to have performed a skin graft on a patient in the emergency room despite not having surgery privileges at the hospital. Another patient came to the hospital with a crushed finger and Arafiles allegedly sutured a rubber tip, which was taken from the scissors in a suture kit, onto the patient's finger.[9]

Mitchell and Galle sent an anonymous complaint to the TMB detailing their concerns with Arafiles's care of nine patients in 2008 and 2009. The letter said that the nurses feared losing their jobs if their identities were revealed in connection with the complaint.[1] Arafiles became aware of the complaint and spoke to Winkler County Sheriff Robert Roberts, his patient and friend, alleging that the complaint amounted to harassment. The TMB issued a copy of the complaint to Roberts with the understanding that it would only be used to investigate criminal activity by Arafiles. Roberts sent the complaint to Arafiles and to WCMH administrator Stan Wiley. As WCMH was a small hospital, details from the letter identified Mitchell and Galle as the sources of the complaint. Roberts obtained warrants to search the nurses' computers and he found the letter to the TMB.[10]

Termination and criminal charges[edit]

Mitchell and Galle were terminated from WCMH in June 2009.[6] A few days later, both nurses were arrested.[11] They were charged with misuse of official information, a felony that carries the possibility of ten years imprisonment and fines up to $5,000. Roberts said that the nurses filed the complaint as a personal vendetta rather than as a good faith reporting of facts. He also noted that the nurses did not seek permission from the patients whose medical records were sent to the TMB; however, the reports did not include the names of patients and federal law exempts medical board reports from patient privacy laws.[12]

The case attracted national attention in July 2009 when the American Nurses Association (ANA) and Texas Nurses Association (TNA) began to raise awareness about the plight of the nurses. Galle later said, "We didn't have any support - emotional or financial - until TNA and ANA stepped in."[13] TNA filed a complaint with the Texas Department of State Health Services (DSHS) that resulted in an onsite investigation of the hospital.[14] By February 2010, the TNA Legal Defense Fund had collected more than $45,000 in donations to the defense of Galle and Mitchell.[15]

The charges against Galle were dropped before her case went to trial. Mitchell's case was tried by county attorney Scott Tidwell, a political supporter of Roberts and the personal attorney for Arafiles, in February 2010. Both the TMB executive director and the county attorney in nearby Andrews County discouraged Tidwell from trying the case.[16] At trial, Mitchell did not testify. The relationship between Arafiles and Roberts was raised during the proceedings. Arafiles introduced Roberts to a supplement-selling program known as Zrii, and recommended the supplements to his patients. Roberts sold the supplements, but he said that his friendship with Arafiles had not impacted his actions with the nurses and that he did not have a business relationship with Arafiles.[12]

Attorneys with the office of the Texas Attorney General took on Mitchell's case after being contacted by the TMB. Assistant Attorney General David Glickler later said that the case was the most bizarre he had seen in an 11-year stint with the office. "We're used to dealing with cases where public officials have enriched themselves at the expense of the office and the public trust, like bribery and theft. But there was no financial benefit to the bad actors in this case."[17] The jury in Mitchell's case deliberated for around an hour before acquitting her. Those present in the courtroom said that each juror approached Mitchell after the verdict and hugged her.[12] In comments he made after the trial, jury foreman Harley Tyler said he wondered why the nurses were arrested. ANA president Rebecca Patton said that the verdict was "a resounding win on behalf of patient safety."[8]

Aftermath[edit]

A few months after Mitchell's trial, Galle and Mitchell split a $750,000 settlement in a civil lawsuit against Arafiles, Wiley, Winkler County, WCMH and other defendants. The nurses, who both live in Jal, New Mexico, were unable to find employment in nursing after being terminated from WCMH. DSHS also assessed a $15,850 fine against the hospital for inadequate supervision of Arafiles and illegal termination of Galle and Mitchell.[4] After signing the settlement in the civil suit, Wiley reinforced his support of Arafiles, saying, "He’s done a lot of good in this county. If you have a heart attack or anything of that nature in the emergency room, he is definitely the doctor that you want to take care of you."[18]

Several officials faced criminal charges for their involvement in the prosecution or termination of Galle and Mitchell. Wiley was the first to go to trial after he was indicted on two felony counts of retaliation. He pleaded guilty to the lesser of the two charges. He was sentenced to 30 days in jail and a $2,000 fine and agreed to cooperate in the prosecution of other involved officials.[16] Wiley terminated Galle and Mitchell after they submitted the anonymous medical board complaint.[6] He submitted his resignation from the hospital in August 2010, but the WCMH board of directors declined to accept it. He resigned again in October 2010.[19]

Roberts was convicted on two counts of misuse of official information, two counts of retaliation and two counts of official oppression. In June 2011, he was sentenced to 100 days in jail, four years of felony probation and a $6,000 fine. After the sentence, Roberts was removed as sheriff and forced to surrender his license as a peace officer.[20] Convicted on similar charges, Tidwell was removed from office and sentenced to 120 days in jail, ten years of probation and a $6,000 fine.[21] Tidwell's trial publicly uncovered a 2004 guilty plea he entered after being charged with soliciting a prostitute.[16]

By mid-2011, Arafiles had moved his practice to East Texas and was affiliated with Cozby Germany Hospital in Grand Saline. A hospital administrator there said that she had looked into some of the allegations against Arafiles that she found on the Internet but that no one had formally complained to her about Arafiles.[22] In November 2011, Arafiles entered a guilty plea on two counts of misuse of official information. Two other charges were dismissed and a pending indictment for aggravated perjury was dropped. Arafiles was forced to surrender his medical license, sentenced to 60 days in jail and five years of probation, and assessed a $5,000 fine.[23]

Several of the people involved in the nurses' case had assumed new employment by the summer of 2012. Mitchell found employment in New Mexico and was working with the developmentally disabled.[17] Galle, who with Mitchell earned the Dean's Advocacy Award from the Texas Tech University Health Sciences Center in 2010,[3] entered retirement. Arafiles was working at a Pizza Hut restaurant in Kermit. Wiley left Winkler County for Lubbock. Tidwell was appealing the revocation of his license to practice law.[17]

New legislation stopped the TMB from investigating anonymous complaints concerning physicians as of the fall of 2011. The change was seen as a victory by physicians rights groups, who said that it would promote accountability in the investigations of physicians. Other groups worried that the new law would discourage the reporting of legitimate complaints against physicians. The board received 6,849 complaints in 2010; four percent of the complaints were submitted anonymously.[24]

See also[edit]


References[edit]

  1. ^ a b c "Winkler County Case: Frequently Asked Questions". Texas Nurses Association. Retrieved October 19, 2013. 
  2. ^ Blesch, Gregg. "Lone Star State showdown: Trial looms for nurses who reported concerns about doctor". Modern Healthcare. Retrieved October 19, 2013. 
  3. ^ a b "School of Nursing Distinguished Alumni 2010". Texas Tech University Health Sciences Center. Retrieved October 22, 2013. 
  4. ^ a b c Sack, Kevin (August 10, 2010). "Texas Nurses Fired for Alleging Misconduct Settle Their Suit". The New York Times. Retrieved October 19, 2013. 
  5. ^ Sack, Kevin. "In Texas, a trial and possible prison time for reporting a doctor". Pittsburgh Post-Gazette. Retrieved October 19, 2013. 
  6. ^ a b c Blaney, Betsy. "Former Winkler County hospital administrator Stan Wiley takes plea in retaliation case". Lubbock Avalanche-Journal. Retrieved October 19, 2013. 
  7. ^ Lowes, Robert. "Physician in Whistle-Blower Case Charged by Texas Medical Board". Medscape. Retrieved October 19, 2013. 
  8. ^ a b c Sack, Kevin (February 11, 2010). "Whistle-Blowing Nurse Is Acquitted in Texas". The New York Times. Retrieved October 19, 2013. 
  9. ^ Mustian, Jim. "Discipline still unclear for Arafiles". Odessa American. Retrieved October 19, 2013. 
  10. ^ "Veteran Texas Sheriff Sentenced To Jail In Nurse Retaliation Case". KWTX-TV. Retrieved October 19, 2013. 
  11. ^ "Timeline of Winkler County nurse saga". Odessa American. Retrieved October 23, 2013. 
  12. ^ a b c Berard, Yamil and Darren Barbee. "Whistle-blower nurse is acquitted in West Texas". Fort Worth Star-Telegram. Retrieved October 19, 2013. 
  13. ^ "Justice is Served: Texas Physician Pleads Guilty". American Nurses Association. Retrieved October 19, 2013. 
  14. ^ "Winkler County Hospital Faces $15,850 Fine". Texas Nurses Association. Retrieved October 19, 2013. 
  15. ^ "Not Guilty - Texas Jury Acquits Winkler County Nurse". Texas Nurses Association. Retrieved October 19, 2013. 
  16. ^ a b c Inglis, Toni. "Final of four Winkler County 'good ol' boys' faces charges in court". Austin American-Statesman. Retrieved October 19, 2013. 
  17. ^ a b c Inglis, Toni. "Whistle-blower nurses see justice in the end". Austin American-Statesman. Retrieved October 22, 2013. 
  18. ^ Mustian, Jim. "Nurses settle civil suit". Odessa American. Retrieved October 19, 2013. 
  19. ^ Mustian, Jim. "Wiley resigns - again". Odessa American. Retrieved October 19, 2013. 
  20. ^ "Winkler County Sheriff Found Guilty on All Counts, Sentence Handed Down". KWES-TV. Retrieved October 19, 2013. 
  21. ^ "Scott Tidwell Sentenced for Retaliating Against Kermit Nurses". KWES-TV. Retrieved October 19, 2013. 
  22. ^ Berman, Beau. "Dr. Rolando Arafiles Working at East Texas Hospital 6/9/11". CBS 7 News. Retrieved October 19, 2013. 
  23. ^ Guaderrama, Robert. "Arafiles Takes a Deal that Includes Jail Time 11/07/11". CBS 7 News. Retrieved October 19, 2013. 
  24. ^ Roser, Mary Ann. "New law bans anonymous complaints about doctors". Austin American-Statesman. Retrieved October 19, 2013.