Punish the Nurse

I know this case as been making the rounds of the health care blogs, so if you’ve seen it before, you can perhaps safely ignore this post.

For everyone else, do you know what happens when nurses get all uppity and ethical and report a physician for breaches of safe practice? You get arrested and threatened with ten years’ imprisonment:

When veteran nurse Anne Mitchell wrote a confidential letter last year to the Texas Medical Board, complaining about a doctor she thought practiced shoddy medicine, she assumed it would be anonymous.

Instead, Dr. Rolando Arafiles Jr. fired her after reporting her to the local sheriff — a former patient and admirer of the doctor — for maliciously ruining his reputation.

Police in Kermit, Texas, searched Mitchell’s computer and found the letter, then charged her with “misuse of official information” in her role at Winkler Memorial Hospital, a third-degree felony in Texas under an abuse-of-power statute.

Today, 52 and out of work, Mitchell could face 10 years in prison for doing what she believed was her obligation under the law — to report unsafe medical practices.

Arafiles had, among other things, sutured the rubber tip of a glove to a crushed finger in order to protect it, and performed a skin graft in the Emergency Department which subsequently (and unsurprisingly) failed. In that wasn’t enough, Arafiles was flogging his own herbal remedies, consisting of white grape juice, to his patients on the side while providing treatment.

The second day of the trial proper was yesterday, and was full of interesting information. According to a local account, it turns out the arresting sheriff, who was so full of love and admiration for the good doctor, was selling the herbal supplement on side. And, incredibly, the physician himself thinks diabetes has no impact on wound healing.

It’s an unfortunate confluence of corrupt local politics and hospital complicity — the administration where Arafiles worked was fully aware of his shortcomings and refused to act — in a toxic culture of entitlement, where if things go wrong, and accountability is demanded, you blame the nurse. In the end, you have to wonder who needs to be on trial.

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  1. #1 by JC on Wednesday 10 February 2010 - 1036

    Sick. If they convict her, it will just enable the culture of silence and secrecy that surrounds poor physician practice. And why did the MD fire her, if she worked at a hospital?

    • #2 by torontoemerg on Wednesday 10 February 2010 - 1107

      You’re dead right.

      As far as I can tell from admittedly sketchy news reports, she went through the usual channels through the hospital administration, got no traction (for a number of reasons), then decided she had to report the physician. When it was discovered she had filed the complaint, the hospital fired her at the behest of the physician, the official reason given that she had acted in “bad faith” because the hospital had Officially Decided the was nothing more to see,and she, effectively, went over their heads. Which raises a whole slew of questions related to accountability: in short, is a nurse ultimately ethically bound to her employer, or to her own conscience and professional standards of practice?

  2. #3 by mog on Wednesday 10 February 2010 - 2009

    This is a subject that worries me, and other healthcare professionals that I know. Whistleblowers need to be protected. Of course there has to be protection against malicious complaints but if we put the patient first- and we should- then whistleblowers need protection and policies need to be in place.

  3. #4 by DreamingTree on Thursday 11 February 2010 - 0849

    Makes me want to break out in song: Deep in the Heart of Texas! Seriously.

  4. #5 by paedsnurse on Thursday 11 February 2010 - 2209

    That really bothers me. Aren’t we supposed to be advocating for our patients? So reporting that a doctor is practicing shoddily so that our patient population will be safer. What harm is that? And I still don’t understand how it’s misuse of official information. I really hope common sense takes over and they let her go.

  5. #6 by Gert on Friday 12 February 2010 - 1107

    About 35 years ago an anaesthesiologist at one of our local hospitals was repeatedly reported by OR nurses for (no kidding) having oral sex behind the barrier during surgeries with unconscious patients. At least a couple of RN’s were fired by hospital admin. before action was finally taken. Eventually the MD was fired or let go. We were told this story as nursing students…..the point being that nurses have a hard time being pt. advocates but it was our responsibility nonetheless.

    If that Texas physician is as goofy as all that, sounds like the nurse will be exonerated….but what a cost!

  6. #7 by JennJilks on Monday 15 February 2010 - 1109

    Then, there is my former neighbour, his ex-wife babysat my youngest son.
    He is trying to get back his licence to practice medicine despite being convicted of molesting a patient.

    It is shameful. THEY LIVED BESIDE ME. They had 3 children, plus one adopted young boy, with FAS. A black child with many issues. Both mom and dad screamed at the boy continually. They took out their anger at my son, too. It was a terrible time for us, especially when the sh1t hit the newspapers.

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