The Texas Nurse Trial – How Did We Get Here? [The Questionable Authority]
The more I look at the circumstances that lead up to the criminal prosecution of a nurse in Texas for informing the State Medical Board of her concerns with a local physician, the more I wind up wondering just how things wound up where they are. It's easy - and far from inaccurate - to view this as a case of the good ol' boy network gone bad, or as an example of a quack doctor twisting the system to turn the accusers into the accused. The more I think about it, though, the more I'm starting to think that we've really been looking at part of the picture. We've been missing something that's probably just as important - the role played by the totally screwed up medical care delivery system in this country.
Let's start by taking another look at Dr. Rolando Arafiles. He graduated from medical school in the Phillipines in 1977. In 1994, he did an internship at Harbor Hospital in Baltimore. Two years later, he finished a residency in Family Medicine at SUNY Buffalo - but I can find no indication that he has ever been board certified in FP or any other specialty. In 2007, the Texas Medical Board restricted him from supervising physician's assistants because he had failed to properly supervise (pdf) a PA at a weight-loss clinic he worked for, and had failed to ensure that the clinic protocols met standards of care.
At the trial yesterday, Arafiles reportedly had difficulty even defining "standard of care". He said that diabetics heal as easily as anyone else. He was questioned about a number of medical errors he's made, and he explained that contrary to reports, he had not in fact intentionally sewn part of a suture kit to a patients finger, but had instead done so accidentally. According to the hospital administrator, Arafiles has been reprimanded for mistakes a number of times since he was hired in 2008, which was confirmed by a surprise state inspection.
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