Physician in Whistle-Blower Case Charged by Texas Medical Board

July 15, 2010

July 15, 2010 — The Texas Medical Board (TMB) has charged a family physician at the center of a nationally publicized whistle-blower case involving 2 nurses with poor medical judgment, nontherapeutic prescribing, failure to maintain adequate records, overbilling, witness intimidation, and other violations.

The charges follow a report that the 2 nurses — Anne Mitchell, RN, and Vickilyn Galle, RN — made anonymously to the TMB last year about patient care rendered by Rolando Arafiles, Jr, MD, at Winkler County Memorial Hospital in Kermit, Texas, where the 2 nurses and Dr. Arafiles worked.

After the TMB contacted him about the report, Dr. Arafiles asked the sheriff of Winkler County to investigate its source. The sheriff, the physician's acknowledged friend and patient, traced the report back to Mitchell and Gale, who were then charged in a state court with misuse of official information, which is a third-degree felony.

The American Nurses Association at the time called the criminal prosecution "outrageous," arguing that nurses were obligated to stand up for patient safety.

The charge against Galle was dropped, but the hospital fired her as well as Mitchell. In February, a jury found Mitchell not guilty in less than an hour, rejecting the prosecution's argument that she blew the whistle on Dr. Arafiles as part of a personal vendetta.

In a complaint filed last month with a state administrative court, the TMB charged Dr. Arafiles with 9 instances of substandard care. In 1 case, the TMB stated, he sutured part of the rubber from suture-kit scissors to a patient's torn and broken thumb (in his trial testimony, Dr. Arafiles said he was attempting to stabilize the fracture). And when another patient was admitted to the hospital for an abscess caused by methicillin-resistant Staphylococcus aureus, Dr. Arafiles rubbed an olive oil solution — not on the hospital's formulary and not approved by the US Food and Drug Administration for this purpose — on the abscess, according to the TMB. The nurses had reported to the TMB that Dr. Arafiles promoted the use of herbal medicines.

The TMB also alleged that Dr. Arafiles:

  • diagnosed hypothyroidism in 1 patient without any testing and diagnosed the same disorder in a second patient despite normal thyroid function tests;

  • prescribed hormone replacement therapy (HRT) for a woman whose lab work showed testosterone, estradiol, and progesterone levels within the normal range — HRT was contraindicated for the woman because of a history of deep vein thrombosis, which reoccurred after HRT was initiated;

  • performed and billed for unnecessary genitourinary exams;

  • failed to adequately document the care he provided; and

  • engaged in witness intimidation regarding the 2 whistle-blowing nurses.

The attorney representing Dr. Arafiles in the TMB action, Jennifer House, told Medscape Medical News in an email that her client "certainly denies that he engaged in any questionable medical treatment." House also wrote that Dr. Arafiles had a constitutional right to "to seek the involvement of law enforcement personnel with regard to the actions of the nurses in question" and that the decision to criminally prosecute them was not his, but "a matter of discretion among law enforcement personnel."

Dr. Arafiles, she added, "can challenge the action of the [TMB] without questioning its importance in the regulation of medical practices in Texas."

TMB Had Already Disciplined Dr. Arafiles in 2007

The TMB complaint against Dr. Arafiles represents his second run-in with the board. In 2007, the TMB placed a 3-year restriction on his license after determining that he had failed to adequately supervise a physician assistant in his work at a weight-loss clinic and to "make an independent judgement" about protocols that the clinic owner had developed for treating obesity.

The board fined Dr. Arafiles $1000 and prohibited him from supervising or delegating prescriptive authority to physician assistants and nurse practitioners, as well as supervising a surgical assistant. He was ordered to complete continuing medical education in ethics, medical records, and the treatment of obesity.

In the midst of his current dealings with the TMB, Dr. Arafiles is a defendant in a civil suit filed by nurses Anne Mitchell and Vickilyn Galle in federal court. The nurses allege that Dr. Arafiles, their former hospital, and county officials had violated, among other things, their freedom of speech. The defendants deny any wrongdoing in the case.

The Texas Department of State Health Services also proposed imposing a $15,850 fine on Winkler County Memorial Hospital in April for violations involving an unnamed physician who matches the description of Dr. Arafiles. Part of the proposed fine stemmed from the hospital having fired 2 employees who submitted a physician's patient records to the TMB.

As of press time, the Texas Department of State Health Services had not responded to questions about whether the hospital had paid the fine or chosen to contest it.

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