Introduction: I will be making references that you simply won't be able to follow unless you read part one and part two. Furthermore, I will make references to other cases I have covered. I will provide a link everytime so feel free to link over and get details.

The cruelest of cruel ironies of this story is that the only thing that Tim Goosby could have done to avoid the nightmare that he found himself in is to not have taken the job in the first place. The only other way he could have avoided this nightmare is to have corrupted himself and gotten into bed with the corruptors that he blew the whistle on. Just think about that for a minute and realize that any system structured for such an outcome is one that needs a total and complete overhaul.

The most glaring problem in the system is the obscene amount of power all centered in the hands of the Texas Nursing Board. The entire appeals process beyond the nursing board in Texas is entirely to bring recommendations back to the board itself. If the TNB is corrupt (and it is), then the entire appeals process is irrelevant. In the case of Tim Goosby, a law judge ruled in his favor when he appealed the corrupt verdict. That meant absolutely nothing because the law judge's ruling was non binding. It was only meant as a guide for the TNB which always had the ultimate say. Thus, once the TNB got the motivation to punish Goosby, there was no escaping their wrath.

The second tragic and glaring weakness of the system is the total lack of protection whistle blowers have. Tim Goosby found out about ILLEGAL DRUG TESTING. That isn't merely som clerical error or finding out that someone comes in five minutes late often. Dr. Dan Dugi was testing a drug not yet approved on unsuspecting patients. Tim Goosby faced one of two choices. He either looked the other way and allow this evil to continue, or worse, he blew the whistle and wound up making his own life a living hell. If whistle blowers face absolutely no protection, then what that does is encourage corrupt behavior at hospitals all over the place. The reason that Dr. Dugi so brazenly broke the law is exactly because he knew that he could punish and eliminate anyone that tried to get in his way. The lack of protections for whistleblowers currently not in our legal system encourages the medical field to continue with the kind of corruption we see here.

Lastly, the Texas medical field is corrupt in a manner that should alarm all residents not only in Texas but in the United States. The case of Dr. Shirley Pigott revealed that Blue Cross/Blue Shield has corrupted the entire medical system in order to punish and intimidate doctors it doesn't like. BCBS is the single biggest health insurer in the state of Texas. The cases of Dr. Chris Kuhne and Dr. Bill Rea show that the Texas Medical Board has been completely corrupted and thousands of Texas doctors have faced the wrath of sham peer review as a result. Now, we have the case of Tim Goosby.

This case reveals that the Texas Nursing Board is as corrupt as the other entities, and it punishes some nurse for blowing the whistle, while protecting other nurses that have the right connection.You simply cannot have a system this corrupted with absolutely no consequences beyond "merely" those of the targeted professionals. The medical system in Texas is corrupted at every level. In the case of Dr. Shirley Pigott, BCBS employed the Texas Medical Board, Texas Medical Association, and Texas Association of Family Physicians, to orchestrate its corruption.

What this means is that nearly every single entity that is supposed to make sure that medicine is performed properly in Texas is actually corrupted and creates the opposite effect. Furthermore, the case of Tim Goosby also revealed a governor's office that's either incompetent or corrupt, but ultimately one, that is asleep at the wheel while its entire medical system is totally corrupted.

This affects all aspects of the way in which medicine is performed both in Texas and in the U.S. Everything from health insurance rates, to patient care, to medical professional competence is affected. You simply are not going to solve the "health care crisis" if this situation is not solved first. If the single biggest health care provider is allowed to corrupt the system, and every single government and professional agency is its partner, then there are no fixes unless this is fixed first.

Lastly, aren't doctors and nurses American citizens also? If they are, then I firmly believe that they deserve the same expectation of civil rights as everyone else. How would any of you reading this feel if you tried to do the right thing and as a result had the rest of your life turned into a living hell? Would you feel as though you received the same civil rights that this country was founded on? Why are we all then standing by and allowing all of these doctors to have their civil rights snatched from them by corrupt forces all over their field? To me at least, this is not the least bit acceptable, and it needs to stop immediately. It won't as long the public in general turns a blind eye to it. As the saying goes

evil flourishes when good men stand by and do nothing

It's time that everyone demand action. If you read this and don't demand serious systematic changes, then you are tacitly approving of the way in which each of the doctors and thousands more were treated.For other examples of obscene corruption in health care check out this amazing tale out of South Carolina and of course the one that started it all for me Grady Hospital in Atlanta

Introduction: Please take a look at part one of this series prior to reading this part.


The video linked here includes testimony from Tim Goosby, a nurse anesthetist, in front of Congress just a couple weeks back. Mr. Goosby is an independent registered nurse anesthetist.

Goosby's story starts in in mid 2003 when he was approached by the CEO of Cuero Community Hospital, Jim Buckner, to become the new nurse anesthetist. Cuero Community Hospital is the lone public hospital in Cuero, Texas. Cuero is a small town of only a few thousand folks, mostly Hispanics, poor, and many times illegal. The job offer came with one caveat. The hospital's other nurse anesthetist, Mark Crawford, had recently been caught stealing drugs as well as doctoring prescriptions to overcharge patients. While these were serious violations of ethics and standards, Crawford wasn't going to fired. Rather, after undergoing psychological evaluations, a temporary leave, along with other punishment, Crawford would return to the hospital and they would share duties.





Within a few month's of Crawford's return to the hospital, Goosby was approached by multiple nurses with new claims that Crawford hadn't changed his behavior. In fact, now the nurses claimed that Crawford was even doctoring prescriptions that Goosby had signed. Goosby immediately approached Crawford with the accusations.





Crawford immediately denied everything. Goosby demanded that he see all of Crawford's patient records. To this, Crawford replied

you will never see the patient records

Finally, after enough grilling, Crawford admitted to everything he was accused of. Goosby immediately went to the CEO, Jim Buckner, with what he had found. Buckner decided to arrange a meeting of all the hospital medical staff so that Goosby could present his evidence to them.





At the staff meeting, a small group of doctors, headed by Dr. Daniel Dugi and Dr. Tim Spradlin, continued to ask the same question of Goosby. Did he tell anyone outside of the hospital what he discovered about Crawford? Of course, he hadn't yet. The next day after a mysterious meeting with Dugi and Spradlin, Mark Crawford left the hospital as well as the town of Cuero never to be heard from in those parts again. (Of course, he later resurfaces in other parts of Texas as the link clearly shows).





As Goosby later found out, Dr. Dugi along with Dr. Spradlin, lead a pseudo mafioso group of doctors that became the de facto rogue administration, and the real administration was too weak to do anything to stop them. The next few months were a living professional hell for Tim Goosby courtesy of Dr. Dugi and his group of medical mafioso. They spread rumors attacking his character. They tried to turn the rest of the staff against him. All of these things were much easier to do given that Goosby was the "new guy" while Dugi, Spradlin, et al had each been at Cuero for many years. Furthermore, Goosby was now doing the work of two nurse anesthetists he was being worked to death. Cuero, like most hospitals, needs the staff's approval before any new medical staff member is hired on. Of course, Dugi made sure than no new nurse anesthetist was hired on.





Within months, Goosby found out why he was being targeted so viciously. Several nurses again approached Goosby. They claimed that Dr. Dugi was making them perform illegal drug tests on patients. Dr. Dugi was associated with a company called Activ Group, Inc. and the two entities had formed a partnership to bring the drug Providex to market. Only, according to the nurse, they weren't going through normal FDA channels to test the drug, but rather they were using the patients at Cuero as human guinea pigs.





Goosby immediately took what he learned to the hospital CEO, Jim Buckner, as well as the head of nursing at Cuero, Judy Krupala. His concerns were rejected by everyone he approached.





Meanwhile, in mid 2004, he was sent in to perform a fairly standard anesthesic procedure. A patient, who also happened to be a fellow nurse at the hospital (obviously due to doctor patient privilege the name can't be revealed), was undergoing a biopsy on his chest. Goosby was sent in to administer the anesthesia. The standard procedure in such a case for the nurse anesthetist to do two things prior to administering the anesthesia: 1) explain the consent form and have the patient sign it and 2) explain the assessment form and have the patient sign it. Goosby insists that both of these things were done just as they were done in thousands of procedures he performed prior.





Within months, this same nurse/patient accused Goosby of not providing these two forms to them. Goosby insisted to the CEO that of course he did, and he even provided the signed consent forms. The CEO backed up Goosby, however at the behest of Dugi the matter was still referred to the Texas Board of Nursing. This started an ordeal for Goosby that continues today.





What Goosby found in the TNB was an organization no less corrupt than the hospital that referred him. Unfortunately for Goosby, he had a DUI charge from a few years earlier that he failed to report to the Texas Nursing Board when he first went to work in the state. While this is a legitimate charge the normal penalty for such a failure is $250. Instead, this charge was used as the basis of what eventually lead to Goosby having to surrender his license in Texas for a year.





After receiving formal written charges, Goosby faced the board in an oral hearing known as an Informal Settlement Conference. Despite presenting the board with copies of the two forms in question and having the patient recant their story under examination, the board still ruled against Goosby. Instead, the TNB used his failure to report the DUI as the subject of an order to remove his license. Of course, such a draconian punishment goes against their own guidelines. (as I said earlier, such an infraction normally results in a $250 fine)





Goosby appealed the decision to a law judge. (this is standard procedure) In front of the law judge, Goosby's attorney referenced a prior decision, Turner Vs. Texas Board of Nursing, in which another nurse was similarly punished outside the guidelines of the case. The law judge sided with Goosby, however there is a serious problem in the manner in which the TNB operates...as Goosby would soon find out. While the law judge can make their ruling, the TNB doesn't have to accept that ruling. Ultimately, what they say is final, and the judge's ruling is only meant to be used as a guide. Of course, in the case of a corrupt board, like the TNB, such a rule puts far too much power in the hands of the corruptors.





Thus, despite having the ruling of the law judge on his side, Goosby was stuck. He could continue to appeal his punishment to the same law judge but the same corrupt nursing board would continue to reject that ruling and insist on their own. In the meantime, the long legal battle had drained nearly all of his financial resources. In fact, at one point, Goosby was approached by the TNB attorney, Liz Higginbotham, and told that they were determined to remove his license, and that he could either surrender it while he still had money or when he was broke. Goosby agreed under the condition that there be no mention that he administered anesthesia without consent or advisement, the two significant charges. Thus, in 2005, Tim Goosby lost his license to practice nursing in Texas for failing to report a prior DUI to the board.





Finally, after nearly two years of fighting the TNB, Goosby agreed to surrender his nursing license in the state of Texas for a period of one year. Of course, this opened up its own pandora's box. Once his license was removed in Texas, other states began to ask questions as well. Suddenly, his license was being threatened in a number of states including: Illinois, Colorado, and his home state of Wisconsin. Defending himself in all of these other states put further financial hardship on Goosby.





Nearly broke, Goosby was given a carrot by the state of Wisconsin. If he got his license restored in Texas, he would be allowed to work in Wisconsin. Of course, he needed to go back to the same corrupt TNB to do it. Through his attorney, he reached out to the TNB. The TNB agreed to restore his license under one condition. Goosby had to face the board and he couldn't speak.





At the hearing, the board once again accused him of administering anesthesia without consent or advisement, two things they promised to remove from his record, and then took it a step further. They now accused Goosby of being a drug addict. In his re instatement order, Goosby was accused of a laundry list of misdeeds including drug use. He was given 90 days to sign the order.





Upon the advice of colleagues, he was told under no circumstances to sign the order. Signing it would be a death sentence to his career. As soon as that order was posted on the TNB site, his license would be threatened by every other state. Instead he was told to reach out to the media. That is what he did.





As such, he became the main source for this investigative series by KPRC of Houston investigative reporter Stephen Dean's expose of illegal drug testing at Cuero Community Hospital. While Dean was painstaking in his coverage of Dr. Dugi's illegal drug testing, the corruption perpetrated at the TNB to Goosby became nothing more than an afterthought in the story.

That nurse, Timothy Goosby, is now licensed to practice in Minnesota. He said he surrendered his Texas nursing license and was forced out of his job at Cuero Community Hospital in retaliation for reporting the drug testing.

He surrendered his license for failing to disclose two drunk driving arrests when he applied for his Texas license. He told Local 2 Investigates the infraction was only discovered when the people involved in the drug testing started filing several accusations against him in response to his being a "snitch."

While Goosby refused to sign the order, the TNB put it up on their site regardless. In an ironic twist of fate, this lead to small bit of redemption for Goosby. The charges were so serious now that many other states did thorough investigations. As such, what they found was what you are reading...that the TNB orchestrated on Tim Goosby a sham peer review. In fact, the state of Illinois used the term "railroaded" in describing the case. The state of Wisconsin allowed Goosby to work in the state though his prior license revokation makes him a significant insurance liability.





Meanwhile, Jim Buckner waited until 2008 to finally speak on the record about some of the things that happened at Cuero Community Hospital. That just happened to be the statute of limitations on many of the crimes he witnessed. In the Dean expose, Buckner said that he left the hospital as a result of what he saw there regarding the drug testing. (It just apparently took him nearly five years to see it) He was replaced as CEO by a gentleman named Darly Stefka. Stefka was the head pharmacist at Cuero when the illegal drug testing was going on.



The pharmacist in charge when the drug was first added to the "formulary," or list of medicines being dispensed to patients by the hospital, has now been elevated to CEO of Cuero Community Hospital.


Darryl Stefka, Cuero Community Hospital's current CEO declined to answer questions on camera, but he insisted the drug's use was "very legitimate." When asked whether it was tested on patients without their knowledge, he answered, "I'm sure they knew."



Mark Crawford popped up on the radar of the TNB in 2007, Crawford was caught at a hospital in El Paso doing many of the same things that he did at Cuero. He was let off with a warning and a fine. There is one case that you won't find on the TNB site. Bridget Hughes was caught stealing 50 triplicate prescriptions, forging signatures, and using them for her own use. For this, her license to write prescriptions was removed for one year, but she was still allowed to keep her license to be a nurse. Hughes was the head nurse for Dr. Keith Miller, former head of the Texas Medical Board Disciplinary Committee. The disposition of her case has "mysteriously" been removed from the TNB site. (though as soon as I figure out how to transfer my copy from PDF, it will be placed back up on the internet)



Finally, Goosby took his pleas all the way to the governor's office of Rick Perry. Goosby pleaded with the governor's office to have the TNB investigated. According to a letter dated May 7, 2008, Dede Keith, in the communications office, told Goosby that the governor's office would share Goosby's concerns with Katherine Thomas, head of the Texas Board of Nursing. In other words, the Texas Governor's office thought it would be appropriate if the exact same corrupt TNB investigated itself.

This particular story was the climax of a nearly five year ordeal for a nurse anasthesist that found him the target of a sham peer review that dwindled his savings and nearly cost him his license.

The Texas agency in charge of disciplining doctors has launched its own investigation into the drug testing allegations uncovered by Local 2 Investigates at Cuero Community Hospital.

Former staff members at the publicly funded hospital near Victoria say patients were used as "human guinea pigs" without the patients' knowledge, with a drug that was never approved for trials or use on humans.

The Texas Medical Board was made aware of the allegations nearly two years ago, but the agency's enforcement director said the case had been closed since patient names were not included in the complaint.

What you can't tell from this story is that the main source for it is a nurse anesthetist that worked alongside Dr. Dugi at Cuero Community Hospital. You won't find the name of this nurse anesthetist anywhere in this particularly referenced story, and he is only mentioned in passing in the series of stories that the news station, KPRC in Houston, did on this investigation. (for now I will also not reveal his name but that's only dramatic effect because his name along with his entire story will be revealed in part two of this series) That's too bad because the investigation that KPRC uncovered was only the beginning of his long ordeal.

Dr. Dugi, the doctor referenced, worked at Cuero Community Hospital in Cuero, Texas a town of a few thousand. He lead what eventually amounted to a pseudo mafioso group of doctors that became the de facto rogue and corrupt administration. The actual administration was weak and powerless to stop Dr. Dugi from controlling the hospital. Cuero is a town of mostly Hispanics, poor, and many illegals. As such, Dr. Dugi turned many of his elderly patients into guinea pigs for testing a drug that he wanted to bring onto the market. Rather than going through a formal FDA process, Dr. Dugi thought it would be easier to simply test the drug on real patients at his own hospital.

This nurse anaesthetist discovered what was happening and reported it to the administration. As a result of his whistle blowing, he was retaliated against and ultimately wound up facing an even more corrupt Texas Board of Nursing. He had to battle for over four years against what amounted to nothing more than trumped up charges and eventually even had his license revoked by the state for a year. The whole process has left him nearly broke and has totally shattered any semblance of a medical career.

Not only is none of this mentioned in the piece, but most of the same players that corrupted the TNB continue to lead it to this day. The nurse anaesthetist took his pleas all the way to the governor's office of Rick Perry. His pleas were met with a letter that told him that they would have the Texas Nursing Board look into it. Let's make sure everyone understands this. It was the very same Texas Nursing Board that he wanted to have investigated. Thus, the governor's office wanted the corrupt nursing board to investigate itself. That speaks for itself.

Furthermore, while this nurse anesthetist was being systematically targeted the TNB was showing shocking leniency for real bad apples. For instance, this particular case linked regards Mark Crawford. Crawford was himself a nurse anesthetist at Cuero Hospital through a bulk of 2003. In 2007, he was caught not only doctoring orders so that patients were over billed but doctoring prescriptions so that he could feed his own drug habit. The TNB let Crawford off with a warning and a fine.

So, why wasn't the whole story told? That I don't know, however I do know the investigative reporter, Stephen Dean, was told the whole story and chose only to focus on the corruption at Cuero Community Hospital for his own investigation.

It's too bad because had he focused on the entire story, he would have discovered a corrupted TNB that targets certain nurses on sham charges while protecting other nurses. He would have found a link between the corrupt Texas Nursing Board and the equally corrupt Texas Medical Board. Furthermore, he would have found a governor's office that looked the other way and did nothing while all of this corruption went on.

As such, I guess that leaves it to me to tell the entire story. That of course is part two of this series.

On October 31, 2001, Dr. Chris Kuhne received the first in a series of letters from Dee Whittlesey (that is the same Dee Whittlesey that played an active role in the sham peer review perpetrated on Dr. Shirley Pigott) The summary of the letter was that in the opinion of Blue Cross Blue Shield, Dr. Kuhne had fallen outside of the matrix of the amount of money that a doctor in his specialty should make. In other words, in the opinion of BCBS, Dr. Kuhne was charging too much. Dr. Kuhne specializes in obstetrics and gynecology or in other words, he treats any and all ailments that a female might have.

This letter was the beginning of a long battle between Dr. Kuhne and his main insurance provider BCBS. He estimates that roughly half his business is covered by BCBS, and thus this is an insurance provider that he must maintain in order to maintain any semblance of his business.

On Mar 7, 2003, his dispute with BCBS took a terrible turn for his business. Following a long and thorough investigation of his billing practices, BCBS determined that they were simply unacceptable and they terminated their relationship with Dr. Kuhne. He had been deselected, an extraordinary step that is almost never taken. Once BCBS has accepted a doctor into their network, they usually on deselect said doctor under the most extreme of cases.

Of course, the journey that Dr. Kuhne took with BCBS didn't end there. At the end of 2005, BCBS changed the manner in which they determined their matrices for billing. In layman's terms, they used to figure out billing based on gross amounts, and at the end of 2005, they started figuring it out per patient. After reviewing Dr. Kuhne's case, they determined that in fact the reason he made more money was simply because he served more patients than most doctors. In other words, his removal was entirely without cause and they immediately put him back in the network where he remains today. In fact, by 2007, BCBS awarded Dr. Kuhne their coveted Blue Compare award. This is given to those doctors that BCBS feels exhibited the most care in minimizing the costs incurred to their patients.

In other words, in a journey that started in 2001, BCBS went from kicking Dr. Kuhne out of its network for billing too much, to giving him an award for frugal billing. Besides the award, BCBS didn't compensate Dr. Kuhne in any manner for the three years they nearly fatally disrupted his business.

While Dr. Kuhne was having his battle with BCBS, he was simultaneously involved in another battle with a titan of Texas medicine, the Texas Medical Board. Here he crossed paths with another familiar name, Dr. Keith Miller the head of the TMB Disciplinary Board.

Two separate cases only months apart began Dr. Kuhne's battle with the TMB (a battle that continues to still be unresolved even today even though most of his adversaries have been exposed as corrupt. A battle I may add that has cost Dr. Kuhne in excess of 100,000 dollars in legal fees). Each of the two cases began during the middle of 2004.

The first case was rather mild. It started when a patient of his (obviously doctor patient confidentiality prohibits naming the patient) decided to switch doctors and asked for her medical records. Dr. Kuhne sent her a letter and stated that the records would cost her $43. When he didn't hear from the patient, he kept the records. After a few months, the patient corresponded and essentially verbalized that it was silly that he keep her records over a small fee. Dr. Kuhne agreed and went ahead and forwarded the record without charging a fee.

While the files were forwarded satisfactorially, the time period wound up being out of technical bounds for acceptable TMB standards. Because Dr. Kuhne didn't forward the records in a swift enough period, this landed him in front of the TMB, in a case that still remains unresolved today about four years later.

The second case was significantly more serious in terms of the scope of the charges. Another patient accused Dr. Kuhne of making lewd sexual comments, sexual assault, and other sexually related allegations.

In each of the cases, Dr. Keith Miller played an active role. In the case involving sexual assault, Dr. Miller lead the informal settlement conference proceedings, and in the other, he was a member of the TMB board that ultimately decided his fate.

First, let's go over again the sequence of events that are involved in any matter that winds up in front of the TMB. First, the doctor is given formal written notice of charges against them. Then, something called an informal settlement conference is heard. This is an oral hearing in front of members of the disciplinary board in which evidence is heard, witnesses are called, and the disciplinary board questions the witnesses. Months later the disciplinary board issues its findings. After this, if the doctor is unsatisfied with the verdict, they can move to appeal in front of what is called the State Office of Adminstration Hearings (S.O.A.H.)

The S.O.A.H. hearing is held in front of a law judge and that judge issues their findings. Then, the law judge presents their findings in front of the full TMB, a group of about 16-18 doctors and a few civilians, that rule on all the evidence that has been presented in front of them including the findings of the law judge.

In both cases, the disciplinary board initially ruled against Dr. Kuhne, and in each case the law judge for SOAH ruled in favor of Dr. Kuhne. In both cases, the full TMB then still ruled against Dr. Kuhne.

In Dr. Kuhne's case regarding the sexual assault, the case followed closely with another I have mentioned. That is the case of Dr. Bill Rea. In the case of Dr. Rea, Dr. Rea called up no less than 18 expert witnesses that that testified that Dr. Rea had done nothing wrong and that the charges against him were frivilous and wrong. In Dr. Rea's case, the TMB put up one expert, their own hired gun, to claim that Dr. Rea was being fairly targeted. In the case of Dr. Rea, the TMB went with the testimony of their one expert over the 18 that testified in favor of Dr. Rea. In Dr. Kuhne's case, he also put up more than a dozen experts and once again the TMB put up one hired gun. Again, in Dr. Kuhne's case, the TMB ruled in favor the testimony of one hired gun over the experts that testified on behalf of Dr. Kuhne.

The two cases have other important similarities. Both Dr. Rea and Dr. Kuhne were long standing and respected doctors and they had each even finished their residency at the respected Parkland Hospital in Dallas, Texas.

The two cases have important distinctions as well. Dr. Rea is a leader in the field of environmental medicine and he accepts no insurance. His patients pay him first and then take that bill to BCBS or whatever provider they may have. It is much more difficult for BCBS, or any other insurer, to argue with the patient themselves rather than with the doctor over billing. In other words, Dr. Rea is the insurance company's worst financial nightmare, a doctor they can't control. Dr. Kuhne, on the other hand, was involved in his own battle with BCBS at the beginning of each of these cases.

According to Dr. Kuhne's recollection, the final verdict in each of the cases in front of the full TMB was split. All the doctors voted in his favor (except Dr. Miller), and all the osteopaths voted against him. (with the civilians casting the deciding vote and voting slightly against him) This is important because a check of the current make up of the TMB finds only one osteopath. That osteopath is Dr. Roberta Kalafut and she is the current, and then, head of the TMB. Each of the other osteopaths were either purged from the board or left for other reasons. Dr.Keith Miller resigned from the board under the grips of all sorts of allegations of corruption.

(Updated, based on the criticism of a poster)

One other thing that is important to understand is that Dr. Kalafut received far less training and is far less skilled in medicine than either Dr. Kuhne or Dr. Rea. She went to osteopathic school and not a full medical school. Furthermore, she graduated from the fairly modest, Sinai Hospital, in Maryland. In other words, both Dr. Kuhne and Dr. Rea were being judged by a medical professional far less superior to them. Furthermore, her own bio on the TMB website is misleading.

Roberta Kalafut, D.O., of Abilene, earned her medical degree from Ohio University College of Osteopathic Medicine and completed her residency in physical medicine and rehabilitation at Johns Hopkins Hospital and Sinai Hospital of Baltimore, Maryland.

While technically she did spend time at both Johns Hopkins and Sinai, that's only because the hospitals are neighbors. All Sinai residents spend a few rotations at the prestigious Johns Hopkins, however she didn't graduate from there and the time she spent at Johns Hopkins was token at best.

Now, first this raises the question why was half the board made up of them. That can only be answered by the government of Texas and the TMB itself. More than that, when Dr. Kalafut was judging Dr. Kuhne and Dr. Rea, she was judging doctors far superior to her. It's like a journey man basketball player deciding the worth of Michael Jordan's basketball skills. The make up of the board at the time of the events opened it up intuitively for corruption and a total lack of fairness.

Finally, by 2007, Dr. Kuhne waged his battle for going on three years. By this point, he had allied himself with a Dr. Steve Hotze along with a group of doctors including Dr. Bill Rea that all felt they were the subject of sham peer review by the TMB. In October of 2007, they took their case to the Texas legislature. The results were scathing.

Texas Medical Board took one crushing blow after another from the questions of the legislators on the committee and from the testimonies from the physicians and others at the October 23, 2007 House Appropriations Subcommittee on Regulatory Hearing. This hearing was convened to investigate the abuse of power by the Texas Medical Board. It was a marathon session lasting 11-1/2 hours. Without this hearing we would not have been able to expose the corruption at the TMB. We all owe a debt of gratitude to Representative Fred Brown who, by holding this hearing, demonstrated indomitable courage and determination in the face of extreme political pressure to abandon it.

The hearing made it clear that there is an unholy cabal made up of Don Patrick, Executive Director, Mari Robinson, Director of Litigation and Enforcement, and Roberta Kalafut, President of the TMB, who have despoiled the TMB. There can be no reform without removing them from the board.

Finally, at this hearing, Mari Robinson stated under oath that Dr. Kuhne signed an affidavit admitting to sexual misconduct. Dr. Kuhne has stated categorically that he signed no such agreement, and so far this agreement has NOT been produced. Mari Robinson is not only the Director of Litigation at the TMB but a licensed attorney. If she did lie under oath that is immediate grounds for removing her from the bar. That doesn't even speak to the criminal liability of potential perjury charges.

This whole sordid affair continues to unfold. The most shocking part is that charges against both Dr. Chris Kuhne and Dr. Bill Rea still haven't been resolved. Despite the fact that there is overwhelming evidence that the body that pursued them was obscenely corrupt their cases are now in the Texas state court system. (that's because their appeals were exhausted through the TMB system) These cases continue to be a mental, emotional, and financial drain on all the doctors that have been targeted. It is impossible to know for sure just how many doctors were the victims of the kind of sham peer review that these two were, and unfortunately most will never have their stories told.

These two cases, along with that of Dr. Shirley Pigott, are likely to open up a pandora's box of corruption throughout the medical system that infects the state of Texas. I have only begun to discover it all and I will continue to report on it.

If this is your first taste of this series then I suggest reading part one and part two.

At this point, I want to take stock of what Dr. Kuhne and Dr. Rea's battle against the Texas Medical Board means in the larger context of what I have found and what it means in the health care debate.

On the television show the Shield about a corrupt cop named Vic Mackey, there was one episode that was a sort of pre qual. This episode was done prior to anything else that had happened in the show. By this point we had seen Mackey involved in all sorts of obscene corruption. (I won't give examples so that those that haven't seen the show aren't spoiled) This episode focused on Mackey's first day in his new role on the Strike Force.

In that episode, he and his team cut a small corner in order to make an arrest that higher ups were putting pressure on them on. At the end of the episode Mackey remarked to a fellow strike team member that doing it this way was a lot easier.

The point of the episode was not only to show that corruption starts small, but also to show that it is easier to be corrupt.

Both of those I believe are lessons of this tale. In 2002, the Dallas Morning News ran a series of stories condemning the Texas Medical Board for not being aggressive enough in prosecuting bad doctors. As a result of this story, the TMB was given license to act aggressively. They did, only as it turns out, they acted in a corrupt and aggressive manner.

In some perverted ways, the pressure to deliver more convictions naturally lead to more corruption. That's because it is much easier to trump up charges than to investigate legitimate claims. Legitimate claims take up significant resources, time, and financial resources that the TMB may not have or want to extend.

What has happened as a result is that thousands of doctors have been targeted on frivilous or even made up matters. I have shown three, Dr. Rea, Dr. Kuhne and Dr. Shirley Pigott. Yet, these three are merely an opening to a pandora's box that would lead to thousands of doctors who's professional careers have been systematiclly torn apart by corrupt governing bodies with nefarious agendas.

In fact, I am in the finishing stages of a story that will blow the lid on the Texas State Nursing board and show it is no less corrupt than the TMB.

So, how does all of this come about? Well, first, the TMB and the nursing board report up to the highest executive in the state of Texas, Rick Perry. If both these boards are systematically corrupt, then ultimately responsibility lies with him. Most of the corrupt players like Dr. Keith Miller, Dr. Roberta Kalafut were either chosen directly by Perry himself or spent years corrupting the board while he was governor. His lack of action in confronting their corruption ultimately means that he must be held to account for the thousands of lives ruined by this corrupt board.

Now, those reading this are likely to look at these cases in the abstract. Imagine yourself in the position of one of these doctors that was the victim of sham peer review in which charges were trumped, prosecuted, and judged by the exact same corrupt force. Dr. Kuhne has had to spend six figures to defend himself. His case is still not resolved to this day and it all started in 2004. Dr. Pigott was threatened with the removal of her license and with it her career on charges so absurd that they are the medical equivalent of J walking. Of course, their stories have finally been told. What about all those doctors that suffered in silence?

Of course, Texas is not the only state in which I have discovered systemic corruption. I found myself involved in all of these stories after working on uncovering the systematic corruption at Grady Hospital, one of the three largest hospitals in the country. Grady has been pilfered and corrupted for decades, and that corruption continues to this day. In that situation, most of the corruptors continue to be gainfully associated or employed by Grady to this day.

In South Carolina, Dr. Blake Moore exposed one of his nurses as a serial killer. Rather than prosecuting the nurse, Dr. Moore is in the fourth year of legislative battle with the State of South Carolina. In fact, for the last two plus years, the opposition to his case has been handled directly by the Attorney General, Henry McMasters, himself.

I am in the process of uncovering the systematic cover up of child abuse by the Connecticut Medical Board. I am certainly not suggesting that every medical board in the country is corrupt, but how many is too much? Why is the public perfectly comfortable with the Texas Medical Board being systematically corrupt?

This brings me to the next problem. That is the media. The media was all over the story when they discovered that the TMB wasn't prosecuting cases aggressively enough. When that lead directly to abuse the media was nowhere to be found. All of the doctors I spoke to in Texas told me that I had given them more time than any of the traditional media in their state. Isn't the systemic abuse of doctors a story worth printing? How can the corruption be cleaned up if no one even knows it exists?

In Atlanta, the Atlanta Journal Constitution isn't merely asleep at the wheel in reporting the systemic corruption going on at Grady Hospital, but they are likely active participants in its cover up. If the media refuses to expose corruption, then the corruptors have free reign to act as they will.

All of this is NOT just abstract. I have already shown that Blue Cross/Blue Shield has likely systematically corrupted the system to target those doctors that it feels cost them too much money. The stories I have uncovered lead me only to conclude that at least the states of Texas, Georgia, and South Carolina have their entire health care system systematically corrupted. Does anyone really think that the corruption is limited to these three states only. Is it really any wonder that health care costs are skyrocketing? Does anyone really think that we can continue to sit by while the system is corrupted from top to bottom and expect to "fix health care". Maybe, just maybe, it is the systemic corruption that is in and of itself ailing health care.

While the politicians are debating universal health care, health savings accounts, and tax breaks, no one is talking about the systemic corruption that is eating away at the system. Dr. Kuhne told me that he firmly believes that the aggressive TMB action has caused doctors in Texas to practice medicine much more defensively and be careful of their every little movement or wind up facing the wrath of frivilous TMB charges.

Furthermore, the tragic irony is that the TMB is ultimately a fairly unnecessary entity even if it doing its job properly. The medical system provides several layers of protection to patients against bad doctors. The market is the first layer. Bad doctors simply lose patients. The second is the plethora of rules and regulations that doctors always have to follow. The third is that all insurance companies have their own investigative bodies and patients that were wronged can always report their cases to them. Despite its questionable usefulness, the board has not only been corrupted but systemically corrupted.

Furthermore, sham peer review is not even a criminal offense. Sham peer reviews can only be pursued civilly. Furthermore, members of the TMB, and other government organs, enjoy total immunity from any prosecution anyway. Thus, this creates a great deal of power centered in the hands of groups like the TMB, and at the same time, the media refuses to act as a watchdog to make sure that power is used properly.

Thus, I can only lead to conclude that the health care crisis will not be resolved in any meaningful way by either political party until stories like the ones I am bringing to light are exposed to the mainstream, and the systemic corruption they expose is dealt with and eliminated. Until then, any rhetoric on fixing the so called health care crisis is nothing more than cheap rhetoric perpetrated by folks that have no idea what the inherent problem is.

If this is the first time you have read this series, then I suggest you read part 1 and part 2 first.

There are only three ways to digest what I have revealed in the first two parts of this piece. The first is that Dr. Shirley Pigott is off her proverbial rocker and I have been taken in by a fraudulent story. Thus, by extension, there is no larger meaning. The second is that Dr. Pigott's story is true and accurate however her case happened in a vacuum. The third, and the one I will explore, is that her case opens up a pandora's box of corruption in which BCBS has decided to systematically corrupt the system in order to weaken their rivals the private family physicians.

Let's review what I have laid out. Three doctors, Dr. Doug Curran, Dr. Keith Miller, and Dr. Fred Merian, were simultaneously in significant positions of power in the Texas medical community. Dr. Curran was the head of the Texas Academy of Family Physicians. Dr. Miller was head of the Texas Medical Board's Disciplinary Committee. Dr. Merian was head of the Texas Medical Association. At the same time, these three were also members of the super secret BCBS Texas Medical Advisory Board. In other words, they were playing both sides of the fence. They represented the interests of doctors, and at the same time represented the interests of BCBS against doctors. Furthermore, Curran and Miller played a crucial role in attempting to weaken and intimidate Dr. Pigott in a process known as sham peer review.

It is possible but unlikely that these three found their way into these simultaneous roles by accident. It is also possible but unlikely that Curran and Miller played such a crucial role in Dr. Pigott's sham peer review by accident. It is also possible but unlikely that the Texas Medical Advisory Committee at BCBS is the only state in which such a committee exists.--

What is more likely is that these three were helped into their position of power by BCBS in order to help execute corruption against doctors like Dr. Pigott. It is also much more likely that most if not all states have their version of the Texas Medical Advisory Board.

Again, the relationship between private family physicians and insurance companies like BCBS is a naturally confrontational one. That's because, like I mentioned in part 2, private family physicians are the most motivated class of doctors to maximize the amount of money they charge the insurance companies. This naturally confrontational relationship is probably good for the system as long as both groups maintain relatively equal power and both play by the rules. What this case illustrates is that BCBS isn't playing by the rules. I will also illustrate that the power is not split anywhere near equally.

It's important to understand that the private family physician is not the high ticket field in medicine. Private family physicians treat patients before they get sick. Thus, their bills are nowhere near the range of doctors like surgeons. While this may not mean anything to the average reader, it's important to realize that doctors leave medical school with likely six figures worth of student loans. There is an immediate lack of motivation for the field of private family physician among most other fields of medicine.

Yet, the private family physician is on the front lines health care. They treat patients before they get sick, and their worth is measured by how few of their patients actually do get sick. The concept of preventive medicine is most often practiced by the private family physician. You will only see a surgeon once you already are sick. You see the private family physician in order not to get sick. In fact, this is a concept that BCBS likely understands all too well. It's likely that they don't want to eliminate private family physicians. More likely, BCBS would simply like them to work for the medical equivalent of slave labor. In the case of Dr. Shirely Pigott, BCBS could have simply kicked her out of their contract. They had already found that her billing records were bloated and she had become a leader in bringing about change to challenge BCBS' own strong arm billing tactics.

BCBS never took that step, and that's likely because most of Dr. Pigott's patients never got sick. Her practice ultimately made them money. What BCBS wanted to do was pay her as little as possible for keeping her patients, and their insurance clients, well. This would be just fine if they were playing fairly and if the power was spread relatively equally between the two. Unfortunately, neither of those two happened.

It is likely that there are cases like Dr. Pigott's all over the country. It is likely that BCBS is trying to do such things to private family physicians everywhere. If that is so, then what BCBS is doing is destroying the market for future private family physicians. All those doctors who's job it is to keep us well will slowly disappear. While BCBS would like to keep them around at slave wages, that isn't how markets work. If it is impossible to make a good living in private family practice, then eventually medical students will stop gearing their educations toward that practice.

This campaign will have the future of health care at its center, and I doubt that anyone will talk about this case. That's too bad. This case of corruption and many others like it contribute just as much as any other reason to the skyrocketing costs of health care. It is my opinion that BCBS has decided to systematically weaken the one class of true capitalists in the medical system. If the system has been corrupted by one of the players, and the corruptor is sytematically making it impossible to work in another part of the sytem, then I would say that has just as much to do with the breakdown of the system as anything. Yet, none of the Presidential candidates are talking about cleaning up the systemic corruption going on in the system.

Did you know that health insurance providers enjoy limited exemptions to the Sherman Antitrust Act?

The exemption that the insurance industry has extends only to insureds. Insurance companies do not have an antitrust exemption in dealing with providers

Maybe, that's why in Texas BCBS holds insurance for about one third of all patients. Does it sound as though BCBS and the private family physicians enjoy relatively the same amount of power? In Texas, BCBS is nearly the only game in town as far as insurance providers. If you are a doctor and not licensed with BCBS, then I wish you luck in maintaining your practice. The doctor needs BCBS a lot more than the other way around. Thus, the old saying applies

absolute power corrupts absolutely

BCBS enjoys relative immunity from Sherman and the doctors have no choice but to use them. Is it really altogether surprising that the organization then goes on and attempts to corrupt the system?

Then, there is the media. Why am I the first media of any kind to publish Dr. Pigott's story? It certainly wasn't from lack of trying on her part. She approached most of the major media outlets in Texas. None of the print and television media followed up with this story.

This isn't the first time that I have been involved in a case of major fraud involved in the medical field in which the media has been nearly silent. I have covered the corruption at Grady Hospital in Atlanta, and there the AJC has been largely silent on the corruption as well. I also broke the story of a cover up of a serial killer nurse in South Carolina and in that case the media in South Carolina also refused to tell that story. Dr. Andrew Agwunobi has gone on a cross country tour of medical corruption and none of the media anywhere on his stops have ever done anything more than go through the motions in investigating him.

It is hard to know why the media won't cover this story, however I would bet that health insurance companies like BCBS are major advertisers. Their motivations are ultimately beside the point. Corruption only exists if the media fails to do its job. Until the media starts to take this sort of corruption seriously it will continue.

This problem won't be solved easily, but there is a good place to start. The place to start is by making sham peer review illegal and by the government on all levels making prosecution of its perpetrators a top priority. I have only scratched the surface with my reporting. There are thousands of doctors being abused by sham peer review every year. Not only does it disrupt and even ruin their lives, but it also corrupts the entire health care system. We can't solve the so called health care crisis if the system is corrupted. Hopefully, everyone reading this understands the implications of what it leads to. As we continue with the health care debate, it's time someone addresses the systemic corruption within it. Until we do, all other solutions will be of little use. A corrupt system is a broken one, and that is what we have in health care today.

Introduction: Please note, if you haven't read the prologue to this piece, you can find that here. The prologue is an introduction to the overriding principles that this case uncovers. Please take a minute to read that in order to understand this portion better.

As the story I am about to tell unraveled for me, I couldn't help but notice some similarities between it and the movies of two of my favorite directors, Sergio Leone and Robert Altman. Those two film legends often told their tale by unfolding multiple story lines all at the same time and skipping from one sub plot, seemingly randomly, until the entire puzzle fit into place at the end of the film. Such is the story of the way in which BCBS, and their surrogates Dr. Doug Curran, Dr. Keith Miller, Dr. Fred Merian, retaliated against private family physician Dr. Shirley Pigott of Victoria, Texas. This story, much like other stories of corruption that I've covered, has many twists and turns.





Since, the reader can easily get lost in all the twists and turns, I will introduce many of the characters and entities that are involved first. Dr. Doug Curran is private family physician in a modest area of Texas. He is also the former head of the Texas Academy of Family Physicians and continues to be one of three members of the super secret BCBS Texas Medical Advisory Committee. The TAFP is the Texas branch of the American Academy of Family Physicians. The AAFP is the most powerful special interest group representing family physicians. Dr. Curran serves on the super secret BCBS Texas Medical Advisory Committee with two other doctors, Dr. Keith Miller and Dr. Fred Merian. Dr. Miller is currently a private family physician in Center, Texas and he was during the events in question the head of the Texas Medical Board Disciplinary Committee. That committee is in charge of judging cases of purported malfeasance by doctors in Texas. Dr. Fred Merian is the third person on the BCBS Texas Medical Advisory Committee and he was during the time in question also the head of the Texas Medical Association. The TMA is the biggest association of doctors in Texas.





Dr. Shirley Pigott is a practicing private family physician for twenty five year private family physician in Victoria, Texas. She was also during the time in question an active member in the TAFP. Jim White was the executive director of the TAFP during the period in question. Dr. Doug Henley was the Executive Director of the AAFP during the time in question. Dee Whittlesey was the "physician's advocate" for BCBS during the time in question. )Katie Johnsonius was an attorney at the Texas Medical Board. Scott Freshour was head of litigation at the TMB. Finally, Robert Simpson was lead general counsel at the TMB. (all during the period in question) Dr. Pigott went through the process of medical peer review at the Texas Medical Board. This involved a process called an informal settlement conference. This was the TMB's equivalent of a hearing and this hearing was presided by Dr. Keith Miller. The committee rendered its findings in writing, and the process of appealing these findings went through a state agency called the State Office of Administrative Hearings (SOAH). Dr. Pigott eventually hired former surgeon and semi retired attorney Clark Watts to represent her at this hearing.





The story starts in the middle of 2002 when BCBS sent Dr. Pigott a correspondence. BCBS determined that her billing practices raised suspicions and thus they were going to formally challenge them. Unbeknownst to Dr. Pigott at the time was that the committee responsible for going over her billing was the BCBS Texas Medical Advisory Committee made up of Curran, Miller, and Marien. This case was resolved several months later with BCBS deciding that some of Dr. Pigott's treatment bills were too large, and they took their standard financial action. (in other words they docked Dr. Pigott some fees and payments)





At roughly the same time, there was a growing and more restless set of AAFP members. These members were private family physicians. Throughout the country members complained that they were being squeezed, intimidated, and targeted by insurance companies. Many members complained that the AAFP wasn't doing enough to represent their interests against insurance companies. After about a year, the group finally decided to stop complaining and do something about it. What eventually grew was a group of doctors that called themselves the "35 group" (because the group initially had 35 members). They formed an alliance of private family physicians that was going to demand action from the AAFP.

The "35 group"* came up with three mandates that they planned on presenting first at the state level and eventually nationally. The three mandates were as follows: 1)the AAFP was going to be more aggressive in representing the interests of family physicians, 2)it was not acceptable for insurance companies to refuse to pay for medically necessary office tests or minor procedures 3)a clearing house would be created for complaints of family physicians to be shared among members of AAFP. These three mandates would serve as the bedrock for a new commitment for the AAFP to serve the interest of its private family doctor members more aggressively.

Dr. Pigott was put in charge of getting these three mandates through the Texas branch of the AAFP later that year in 2005. The proper procedure in the TAFP would for these three mandates to be debated in the Health Care and Managed Care Services Committee. The committee was enthusiastic about the three mandates and there was near unanimous agreement that this be moved to the full TAFP. Only one doctor argued against the resolutions - Dr. Doug Curran. Dr. Curran was not even a member of this particular committee. He was however the President Elect of the TAFP and decided to sit in on this particular hearing. At this time, Dr. Pigott had only heard of Dr. Curran, and this was her first direct contact with him. Despite Curran's dissension, the mandates passed and eventually they were passed in the national organization (AAFP) later that year.

In March of 2006, Dr. Pigott treated a peculiar patient. (due to the doctor/patient relationship the name obviously can't be revealed) The standard procedure that Dr. Pigott uses in her practice, initially, for a patient who wants her "health risks" evaluated is to take a medical history and order several basic lab tests. Then, when the tests come back, Dr. Pigott would meet with the patient to interpret the tests. It is this second appointment where Dr. Pigott would teach the patient what the tests meant and what the patient can do to improved her health risks. It is now that proper dieting, exercise, and frankly general lifestyle changes can be recommended based on the results of the tests. This particular patient didn't want any part of the second meeting. She sent Dr. Pigott's office a letter requesting that the tests be mailed to her, in violation of Dr. Pigott's policy. A second letter was more confrontational and threatened a complaint to the medical board if the tests weren't sent. According to a board rule, the patient has the right to receipt of those tests within 15 calendar days.


Because the behavior was so unusual, things unfolded before anyone realized. Dr. Pigott's administrative staff received the letters. The tests weren't sent because that is not the procedure. Dr. Pigott wasn't made aware of the letters until just more than 15 days had gone by. The tests were then sent out and no one thought about it again for a while.

In July of 2006, Dr. Pigott again prepared to present that year's mandates on behalf of the group of 35. These were several specific mandates in pursuit of accomplishing the goals of the mandates passed the previous year. Dr. Pigott expected this particular hearing to go fairly smoothly. She had been in contact with the TAFP for months, and each of the mandates had been announced to the organization. Dr. Pigott believed prior to the hearing that this would nothing more than a mere formality.

The hearing went nothing like she expected right from the start. The hearing was scheduled for two hours and it was an hour and forty five minutes before she was even allowed to speak. Each of her proposals was met with resistance. Members claimed that mandates were already being covered by other mandates, or that they had already been addressed. No matter what Dr. Pigott proposed, the committee had a confrontational response to it. Not only were each of the mandates killed but Dr. Pigott felt humiliated by the treatment of the committee. The person that was leading the charge in resisting each of these mandates was of course none other than Dr. Curran. Again, he wasn't even part of the committee, but rather decided to sit in as part of his duties as President.

Within months, several other things happened. First, Dr. Pigott was formally notified in writing of an upcoming informal settlement conference to settle a complaint by the previous patient who claimed that Dr. Pigott didn't return their lab reports in proper time. Then, Dr. Curran appeared in this advertisement for BCBS





Then this puff piece about Dr. Curran appeared on the internet

Dr. Doug Curran is everywhere these days. The longtime Athens-based family physician has been spotted in a few magazines you may have heard of, such as Newsweek and Sports Illustrated.

Through his longtime association with Blue Cross Blue Shield of Texas, Curran appears – wearing his white lab coat, clutching a stethoscope and looking more serious than one usually finds him – in a series of their print ads.

While those ads have garnered him the most attention over the last few months, a less visible appearance in another magazine carries even more prestige.On page S-18 of December's Texas Monthly (S for Super), Curran's name is listed under the Family/General Practice section of "Texas Super Doctors
2005."

BCBS was referenced in connection to Curran throughout the article and Dee Whittelsey was even quoted in the article throwing fawning praise at Curran. Dr. Pigott found these two things to signal a gross conflict of interest. In fact, it likely violated the Texas Medical Practices Act's position on so called testimonial advertising. Dr. Pigott began reaching out to anyone that would listen. She went up the chain of command at not only the TAFP but the AAFP. She even reached out to Dee Whittelsey herself. She even made several attempts to contact Curran himself. She called Jim White and Doug Henley along with Whittelsey and Curran.


The responses ranged from no comment to simply that none of what she complained about was in fact a conflict of interest. Dr. Pigott was not satisfied. She decided to use listserve. Listserve is the intranet chat room for all members of the AAFP. She complained on listserve that she believed the advertisement, the article, along with Curran's confrontational behavior amounted to a conflict of interest.

Finally, Dr. Curran confronted Dr. Pigott directly by phone. During a twenty minute conversation, Curran vigorously defended his actions and refused to acknowledge any conflict of interest. Then, out of the blue Curran said this,

by the way, do you know I'm on the BCBS Texas Medical Advisor Committee

By September of 2007, her case came up in the informal settlement conference in front of the disciplinary committee chaired by Dr. Keith Miller. Dr. Pigott expected nothing more than a minor slap on the wrist. After all, not sending out lab reports with 15 days (she says the lab reports got to the patient in about 20 days) is frankly the medical violations equivalent of j walking.

Instead, Dr. Miller began questioning Dr. Pigott very heavily. Throughout the hearing Miller tried to get Pigott to admit to wrong doing. He asked questions like

isn't the failure to give lab reports a violation of your oath as a doctor

Dr. Pigott felt like a witness on cross examination. This simple hearing about a technical violation turned into an interrogation. There was typical around a six month lag time between the informal hearing and the written findings being issued and thus this portion wouldn't pick up until the beginning of March of 2007.

The next event was a memo emailed throughout the AAFP. The memo essentially said that Dr. Curran would no longer appear in advertisements for BCBS. The memo was worded carefully. It never assigned any wrongdoing to any of Curran's prior actions, however it did essentially say that Curran would cease all the activities that Dr. Pigott was concerned about.

In one week, at the end of February and the beginning of March, three simultaneous though seemingly divorced (on the surface at least) events happened. First, she received a letter from the AAFP saying that her list serve privileges would be suspended. Then, Dr. Pigott attended a special hearing of the TAFP to discuss the concerns that she had raised about Dr. Curran. Since he had promised to cease all the activities that concerned her, Dr. Pigott had decided that it was no longer necessary to bring any mandates against him up for debate. Thus, when called, she merely said she was fine.

The TAFP, lead by Curran himself, then proceeded to charge three mandates against Dr. Pigott: 1)Dr. Pigott acted nastily and inappropriately toward Dr. Curran, 2)the Committee had treated Dr. Pigott appropriately at the 2006 meeting (when all of the mandates she brought to the floor were voted down), and 3)Dr. Pigott must write a letter to everyone she contacted regarding this matter and essentially make a mea culpa.

Then, when she got home from the meeting, she received the written findings from the TMB Disciplinary Committee. (keep in mind again that this is all over a patient not receiving lab results in fifteen but about twenty days) Here are some highlights.

Board to take disciplinary action against Respondent based upon Respondent's unprofessional or dishonorable conduct that is likely to injure the public, in particular, the disruptive behaviors that could reasonably be expected to impact the quality of her patients' care, as described in Board Rule 190.8(2)(Q).(3) [c04-Vio Rule 165 – Med Recds] Section 164.051 (a)

...

For a period of one year from the date of the Board's entry of this Order, Respondent's practice shall be monitored by a physician

...

The Compliance Division of the Board shall designate the monitor and may change the monitor at any time for any reason. The monitor shall have expertise in a similar specialty area as Respondent. The Compliance Division shall provide a copy of this Order to the monitor, together with other information necessary to assist the monitor.

...

The Compliance Division shall select records for at least 30 patients seen by Respondent during each three-month period following the last day of the month of entry of this Order

Thus, to conclude, for being late in getting lab results, Dr. Pigott was

unprofessional or dishonorable conduct that is likely to injure the public, in particular, the disruptive behaviors that could reasonably be expected to impact the quality of her patients' care

The punishment for this behavior included being monitored by a doctor appointed by the TMB and access to up to 30 patient's records. I believe the term draconian comes to mind when analyzing this punishment.

At this point, Dr. Pigott finally realized for sure that something was rotten in Denmark, as Shakespeare might say. Dr. Pigott decided not to accept the findings. In her letter, Dr. Pigott disputed everything the disciplinary committee found and for the first time she used the term, sham peer review.

This incident is an egregious example of what is commonly termed sham peer review. Without conscience, certain members of the Board have defamed my character and have determined to cause me harm.

Sham peer review is a process by which medical peer reviews like the one that Dr. Pigott had just gone through get corrupted. They can be summarized by one simple phrase: judge, jury, and executioner. The corrupting forces usually not only bring the charges, but they are the ones presenting the charges, and also in a position to rule on them. (veterans of my work will remember the case of Dennis Lennox in which he faced his own cousin of sham peer review. The concept of judge, jury and executionor certainly applied to his case as well) In this case, while there is no proof, the patient was likely a plant, and the corrupting forces always planned to bring the case in front of Dr. Keith Miller so that he could issue this draconian charge.

She decided to investigate some of the players. The most important discovery was the discovery in the TMB website that listed in the bio of Dr. Keith Miller was his position in the BCBS Texas Medical Advisory Board. She began making inquiries to members of the TMB, TAFP, AAFP, and BCBS itself. Everyone she spoke to neither confirmed or denied his position on this panel. She shared what she had found with the TMB attorney Katie Johnonius. Johnonius was unmoved, and thus the battle would now move to SOAH, the medical peer review version of appeals courts.

Once she discovered this new information, she took everything she had and hired Austin, Texas lawyer Clark Watts. Watts took what she gave him and approached Scott Freshour, head of litigation at the TMB. (the head of litigation would take over the case from here). Freshour and Watts agreed to a reduced penalty. This penalty removed most of the draconian language but still instituted a heavy fine and other stiff measures (continuing education, lighter monitoring, etc). Pigott refused to take this. Watts approached Freshour again and this time they settled on a $500 fine and 10 hours of continuing education in patient safety.

While Pigott considered even a one cent fine extortion, she finally relented and accepted the terms of the reduced penalty. Pigott then proceeded to take her story to any of the media on Texas. She approached the Dallas Morning News, the Houstin Chronicle, the Corpus Christi Caller Times, the San Antonio Express, as well as her local Victoria Advocate. She even approached her local ABC affiliate. Despite the potential far reaching implications if this story is accurate, she was denied every single time. In fact, she told me that the conversations we had (I would estimate between 5-6 hours) in preparation for this story were the most that any media ever gave her. Even though one could reasonable hypothesis, that this case would open up a pandora's box that could lead potentially to uncovering systemic corruption perpetrated by BCBS upon the entire medical system, the media would have none of this story.

The media has also largely ignored the travails of Dr. Keith Miller subsequent to some of the events described here. A google search of Dr. Keith Miller finds only certain activist groups reporting on his corruption

Notorious Texas Medical Board (TMB) henchman, Dr. Keith Miller, abruptly resigned his position on the TMB on Friday, September 7, 2007.

Miller’s resignation was due to the intense scrutiny of his abusive and tyrannical actions against physicians while on the TMB. It was also due to his relationship with Bridget Hughes, his Nurse Practitioner. Bridget Hughes, who was found to be a narcotics addict by the Texas Board of Nurse Examiners while employed by Miller, continues to work as Miller’s nurse practitioner at his office in Center, Texas. Hughes had her prescription writing ability suspended when she was disciplined by the Texas Board of Nurse Examiners (TBNE) on April 16, 2007 for stealing (50) triplicate prescriptions from her previous supervising physician employer and forging his name to obtain narcotics for her own use.

The story mentioned regarding a nurse of his stealing 50 pills of a controlled substance and forging Dr. Miller's name. Yet, this nurse practioner, Bridget Hughes, has never been brought up on charges, and you aren't going to find much mention of this crime anywhere in the Texas media.

In part 3, I will discuss my conclusions and the implications I see of this case, including the near black out by the media. So please follow the link for the conclusion of this series.