The 200+ bed non-profit hospital has a history of less-than-stellar relations with its medical staff for the past few years. The conflicts have centered on whether Summersett should have to release financial reports, tax returns and other internal documents.The issue is currently the subject of an on-going lawsuit.

Summersett has also been accused of strong-arming the Board of Directors and kicking off people who asked too many questions regarding his actions.

Relations hit a boiling point recently when the contracts for the hospital’s emergency room doctors weren’t renewed. The ED is now being staffed with doctors outsourced from outside the immediate area.

Recently, doctors, nurses, other staff and members of the local community staged a rally complete with protest signs (“Summersett we regret”) and 60′s-style chants of “CEO’s got to go.”

Summersett didn’t release a statement, but the hospital Board of Directors did, noting the technological improvements Knapp has made, new services its offering and reiterating its mission of providing the highest quality healthcare to the community. It didn’t mention the outsourcing of the ER staffing or address the protesters’ other complaints.

Dr. Sam Jahani was arrested in Texas. Authorities are still looking for Dr. Eric Peper, who currently lives in Florida.

Peper worked for Jahani’s clinics in the Denver area between 2006 and 2010.

Prosecutors allege that both doctors defrauded Medicaid, Medicare and Rocky Mountain Health Plans by billing for procedures that weren’t rendered — including some medical services provided after the patients had died. They’re also charged with over-prescribing painkillers to patients that caused their deaths.

The feds estimated the doctors made more than $43.2 million in fraudulent claims in those four years.

The patient, Dallas Wiens of Fort Worth, Texas, is 25 and listed in good condition. A team of 30 doctors performed the operation which gave Wiens a new nose, lips and facial skin as well as muscles and nerves to provide the skin with sensation.

Wiens was injured in an electrical accident in November 2008, leaving him blind and without lips, a nose or eyebrows. The surgery wasn’t able to restore his eyesight, due to nerve damage.

The hospital wouldn’t release any information on the donor, or say when exactly the surgery was performed. Wiens is expected to not look exactly like he used to, nor like the donor. Instead, his face will be a combination of his own underlying bone structure and the donor’s facial features.

The federal health reform law helped make the surgery financially possible, since it allows Wiens to afford the expensive drug regimen he’ll need to maintain the transplanted tissue. Wiens was uninsured when he was injured and Medicaid covered approximately two dozen procedures, until his disability payments put him over the income limit.

Under the health reform law, he qualifies for coverage on his father’s insurance until he’s 26. At that point, Medicare will kick in.

That’s the lesson recently learned by Kawai Ary-Berry, a licensed massage therapist in Lubbock, Texas. She was found guilty of a range of health care fraud offenses, including billing the federal worker’s compensation fund for services never performed, billing for massage services she improperly coded as physical therapy and fraudulently billing the government for “equipment rental” when she had patients sit in a sauna.

Berry now faces 78 months in federal prison, to be followed by three years of supervised release, and must pay $1.6 million in restitution.

The hospitals at the center of the investigation are University of Texas Southwestern Medical Center and Parkland Memorial Hospital.

One of the main allegations is that UT Southwestern didn’t supervise residents as they should have to meet the requirements for procedures billed to Medicare and Medicaid.

UT Southwestern in particular is known for giving second-year residents wide latitude to perform some procedures with minimal supervision. The feds are investigating whether procedures actually done by the residents were billed as though they had been performed by the hospitals’ physicians.

The residents were working at Parkland. It’s not clear to what extent the feds are investigating that hospital’s involvement.

Parkland Memorial Hospital in Dallas used a two-prong approach to cut the average wait time to be seen by a doctor from four or more hours to 54 minutes.

The hospital changed its procedures for treating ED patients to make it faster to get the sickest patients admitted to other units, and to send the least serious cases to the hospital’s urgent care clinic.

Patients seem to notice and appreciate the difference. Previously, up to 18% of ED patients left without being treated — presumably in part because of the long wait times. Now, only 4% leave without being seen.

The more efficient system helped the hospital handle an unexpected surge in ED visits this year. Parkland is on track to see up to 200,000 ED patients this year — one-third more than it had expected.

On average, patients seen at the urgent-care clinic are treated and released within three hours. Patients to be admitted to the hospital have a “dwell” time (time to be evaluated and to get a room assignment) of just under nine hours.

The Patient Protection and Affordable Care Act (PPACA) offers additional funding for some programs and will provide access to insurance for many who don’t currently have it. But even those benefits won’t outweigh the hidden costs in some states.

States like Massachusetts and Wisconsin, which have relatively few uninsured residents due to expanded state programs, stand to gain significantly: Their additional outlay of funds will be minimal, and they’ll still be eligible for billions in federal funds.

Other states like Alabama and Texas, with many more uninsured residents and limited Medicaid coverage, face significant costs getting everyone covered — millions more are  now eligible.

For example, to help close a budget deficit, Arizona slashed insurance coverage for 350,000 residents just in the past month. Under PPACA, those people will be back on the insurance rolls — and the state has to foot the bill.

An estimated 275,000 people will die in the next decade because of a lack of health insurance. That’s the conclusion of a new report by Families USA.

The report is in line with other research that pinned deaths due in part to lack of health insurance at 18,000 in 2000 (Institute of Medicine), and 22,000 in 2006 (Urban Institute).

The reason: Uninsured patients are less likely to get regular check-ups and screenings that can catch serious conditions when they’re more treatable. The uninsured are also more likely to forgo or skip treatments, like getting prescriptions refilled, due to the extra costs.

The report is likely a conservative estimate — it calculated that uninsured patients’ mortality rates are 25% higher — but other, more recent research shows death rates increasing by closer to 40%.

According to the report, roughly 64% of the deaths are projected to be in just 12 states. They are:

• California (34,600)
• Texas (31,700)
• Florida (25,400)
• New York (13,900)
• Georgia (11.500)
• North Carolina (9,600)
• Illinois (9,400)
• Ohio (8,900)
• Louisiana (7,700)
• Michigan (7,600)
• Pennsylvania (7,500), and
• Tennessee (7,500).

Mitchell, an experienced nurse and the former compliance officer at Winkler County Memorial Hospital, was charged with “misuse of official information” by the county prosecutor after the doctor she reported for suspected malpractice said he felt “harassed” by her allegations. She had anonymously reported Dr. Rolando Arafiles for several instances of alleged improper care.

Her trial, which became a nationwide controversy watched closely by health professionals at all levels, ended today with her acquittal on all charges.

However, Mitchell is countersuing  the hospital, the county sheriff, prosecutor and Arafiles in federal court for vindictive prosecution and denial of her First Amendment rights. She is joined in that suit by Vickilyn Galle. Galle is a former colleague of Mitchell’s who also reported Arafiles. Charges were also brought against her by the prosecutor, but dropped before the trial began. Mitchell and Galle were both fired from Winkler County Memorial after it was discovered they had sent the report to the Texas Medical Board.

Mitchell’s acquittal should help uphold protections for medical whisteblowers across the country.

A nurse who reported a doctor’s unorthodox-at-best techniques now finds herself facing criminal charges of misusing official information.

Last June, Anne Mitchell and Vickilyn Galle, two nurses at Winkler County Memorial Hospital in Texas, sent an anonymous letter to the Texas Medical Board detailing their concerns about Dr. Rolando Arafiles’ treatment of patients.

Mitchell and Galle each have more than 20 years of nursing experience and their duties included quality improvement issues. Mitchell also served as the hospital’s compliance officer.

The letter they sent to the board included relevant file numbers, but no patient names. They cited six specific problematic cases, among them: Arafiles had performed an unsuccessful skin graft in the ER without surgical privileges. In another case, Arafiles sutured a rubber tip to a patient’s crushed finger — a technique that the Dept. of State Health Services later deemed inappropriate care. The nurses also claimed that Arafiles had e-mailed patients, encouraging them to purchase an herbal supplement he sold on the side.

The nurses stated in the letter that they weren’t signing it because hospital administrators had already been alerted to the problems, had not acted, and the nurses feared retribution if their actions were discovered.

Harassment or Whistle-blowing?

Their fears appear to have been well-founded.

After Arafiles heard about the report from the medical board, he told the county sheriff — a personal friend who credits the doctor with saving his life after a heart attack — that he felt the report amounted to harassment.

In response, the sheriff got a search warrant, seized computers at the hospital, and eventually discovered that Mitchell and Galle were responsible. They were fired in June 2009.

Shortly afterward, the county prosecutor brought charges against the women for “misusing official information.” Eventually, charges against Galle were dropped, but Mitchell’s trial started this week. A third nurse who had reported Arafiles in her own letter to the medical board after resigning from the hospital was not charged.

Mitchell and Galle have countersued in federal court, alleging vindictive prosecution and a denial of First Amendment rights by the hospital, sheriff, prosecutor and Arafiles.

Public opinion seems to be with the nurses. The Texas Medical Board’s executive director warned prosecutors this trial could scare other clinicians from reporting malpractice. Several nurses’ associations have raised money for Mitchell’s legal fees. And most legal experts believe Mitchell’s actions fall under the state whistle-blower protection laws.

We’ll keep you posted on this case as it develops.