Transcript of the trial now available at this site:

Anne Mitchell RN

Two West Texas nurses faced up to 10 years in prison and a fine of up to $10,000 for reporting concerns about the substandard care of Dr. Rolando Arafiles Jr. How did this happen? Nurse Vicki Galle and Nurse Anne Mitchell were part of the tiny staff of a tiny hospital in a tiny town in West Texas. Winkler County Memorial Hospital has 15 beds, employs 15 registered nurses and 17 licensed practical nurse, and has 7,000-8,000 people in the entire county. Both nurses worked at the hospital for over 20 years. Vicki and Anne reported concerns about Dr. Arafiles to the Texas Medical Board. They, as well as others, were concerned that his practices were inconsistent with the quality of care and patient safety. They were also concerned about his use of non-therapeutic treatments and prescriptions. The two nurses provided medical record numbers to the Board, but no patient names, to support their concerns.

When the physician was notified by the Texas Medical Board that he had been reported to the Board, he filed a complaint with the sheriff (who was one of his patients) alleging that he was being harassed. Sheriff Roberts tracked down the two nurses, who were indicted for misuse of official information and fired. The Texas Medical Board wrote a letter to the District and County Attorneys of Winkler County challenging the notion that the information provided to them was for nongovernmental purposes. They explained that the Board was exempt from HIPAA requirements and is a governmental agency.

Nevertheless, the case proceeded. Nurses throughout the country responded with an outpouring of support and dollars to build up the legal fund for the nurses. Patient advocacy, specifically reporting concerns about a practitioner’s standard of care, is protected under Texas laws and supported by the Nursing Code of Ethics. The case was seen as having the potential to affect the future of patient safety throughout the entire country.

The criminal case against Nurse Galle was dismissed on 2/1/2010, a week before trial was to start. But the case against Nurse Mitchell proceeded. The jury heard details of the cases of substandard care. During cross-examination, Dr. Arafiles struggled to define “standard of care”.

Doctor Rolando Arafiles said he supports the reporting process, but not in this case because he felt Anne Mitchell was harassing him when she sent an anonymous complaint to the Texas Medical Board. The defense grilled the doctor about medical mistakes he made including one where he injected a needle into the bone of a patient and another where he sent a child with appendicitis home without treatment. The prosecution and defense agreed to nickname the instances on record in which Dr. Arafiles made medical mistakes. Those cases are being called, “Turkey Toe”, “Appendix Boy”, “Rubber Finger Tip”, and “Skin Graft”. “Rubber Finger Tip” references the instance when Dr. Arafiles sewed a part of a suturing kit onto a patient. It was a part of the kit not meant to be used on patients. During testimony, Dr. Arafiles said he meant to use it as a brace and accidentally sewed it to the patient.

During his cross-examination, Dr. Arafiles discussed the nutritional supplement called, “Zrii” that he recommended to patients. The doctor admitted that Sheriff Roberts sold Zrii and even held meetings at the local Pizza Hut to recruit others to sell the product. According to the defense, the main ingredient in Zrii is white grape juice and it sells for around $40 a bottle.

At one point, Dr. Arafiles was asked whether diabetic patients might have a tendency to heal worse than patients without diabetes. To the dismay of the audience, he said no, that there is no difference. The audience gasped, after which point Hon. Judge James Rex told the audience to keep quiet or else risk being thrown out of the courtroom.

It took the jury less than an hour to return a not guilty verdict on 2/11/2010. The jury foreman said the panel of six men and six women voted unanimously on the first ballot and questioned why Nurse Mitchell had ever been arrested. “We just did not see the wrongdoing of sending the file numbers in, since she’s a nurse” said the foreman. After the verdict, the nurses’ lawyers quickly turned to the lawsuits they filed in federal court against the county, the hospital, and various officials, charging that the firings and indictments amounted to a violation of due process and their First Amendment rights. Nurse Mitchell’s lawyer said, “We are glad that this phase of this ordeal has ended and that Anne has been restored to her liberty, but there was great damage done, in this case, and this does not make them whole.”

President of the American Nurses Association Rebecca Patton called the verdict “a resounding win on behalf of patient safety. The message the jury sent is clear: the freedom for nurses to report a physician’s unsafe medical practices is non-negotiable.”
Sources:
http://www.nytimes.com/2010/02/12/us/12nurses.html
http://www.texasnurses.org
cbs7news, Beau Berman

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