Scott Tidwell v. State

Court of Appeals of Texas·Decided December 4, 2013·No. 08-11-00322-CR·Published

Opinion

COURT OF APPEALS

EIGHTH DISTRICT OF TEXAS

EL PASO, TEXAS

§

SCOTT TIDWELL, No. 08-11-00322-CR §

Appellant, Appeal from §

v. 109th District Court §

THE STATE OF TEXAS, of Winkler County, Texas §

Appellee. (TC # 5191)

§

OPINION

Scott Tidwell appeals his convictions of misuse of official information (Counts 1 and 2), retaliation (Counts 3 and 4), and official oppression (Counts 5 and 6). After a jury found Appellant guilty of each count, the trial court assessed punishment at imprisonment for ten years, probated for ten years, and a fine of $4,000 for Counts 1, 2, 3, and 4, and confinement for 120 days for Counts 5 and 6. For the reasons that follow, we affirm.

FACTUAL SUMMARY

Tidwell’s convictions are based on conduct which occurred during the investigation and criminal prosecution of two nurses, Anne Mitchell and Vickilyn Galle, for filing complaints with the Texas Medical Board against Dr. Rolando Arafiles. In related cases, the Winkler County Sheriff and a hospital administrator were also charged and convicted. The hospital administrator entered a negotiated plea of guilty and testified against Tidwell. Because Tidwell challenges the

legal sufficiency of the evidence supporting his convictions, we will set forth a detailed account of the underlying facts.

The Hospital, the Administrator, and the Medical Personnel Winkler County Memorial Hospital in Kermit consists of a family clinic1, emergency department (ED), and nineteen beds for in-patients, but it does not house an operating room or surgery unit. It is a critical access hospital and surgical procedures are not performed.

Naomi Warren was a nurse practitioner who worked in the clinic portion of the Hospital.

Stan Wiley became the administrator of the Hospital in January 2007. Anne Mitchell has been a registered nurse since 1981 and she was working at the Hospital in an administrative role when Wiley became the administrator. As the Hospital’s Compliance Officer, Mitchell’s duties included medical staff credentialing. Vickilyn Galle is a registered nurse who was employed at Memorial Hospital from 1994 until 2009. She was the Quality Assessment Performance Improvement Coordinator, but she and Mitchell shared other duties including those of the Medical Staff Coordinator. As part of their regular duties, Galle reviewed all inpatient admissions and Mitchell reviewed the majority of the emergency room visits.

In January 2007, Memorial Hospital had only two doctors, Suirta and Nuraj Choudhary, a husband and wife team. A third doctor, Dr. Khoa Pham, began working at the Hospital in July 2007. The Choudharys moved to Houston in late 2007 leaving Dr. Pham as the sole physician. Dr. Pham became the medical director. Wiley recruited Dr. Rolando Arafiles who was practicing emergency room medicine in Monahans. Wiley informed the Hospital’s board and the County Commissioners that Dr. Arafiles’ medical license was restricted as the result of a sanction imposed by the Texas Medical Board (TMB), but he recommended that the Board hire

1 The clinic portion of the facility is known as the Winkler County Rural Health Clinic.

Dr. Arafiles.2 The Board hired Dr. Arafiles despite the restriction. A few months later, the Board hired a third doctor recruited by Wiley, Dr. Kenneth Winton.

Concerns with Dr. Arafiles Mitchell, Galle, and Warren began having concerns about Dr. Arafiles shortly after he began practicing at the Hospital. As part of her regular duties, Mitchell checked his credentials and became aware that he could not supervise nurse practitioners as the result of the sanction imposed by the TMB. The restriction on his license concerned Mitchell because the bylaws of the Hospital provided that a physician with a restricted license could not be on the active medical staff. Prior to Dr. Winton being hired, Dr. Pham was the only physician who could supervise Naomi Warren, the nurse practitioner who practiced at the Rural Health Clinic, and if he was on vacation or out of town, she would be unable to treat patients.

Mitchell’s duties included reviewing records from the ED for compliance with the standard of care. Some cases were automatically routed to her for review by the medical records department. These were cases where a patient was transferred, where a patient left against medical advice, and where the patient returned to the ED within a certain period of time. Other cases would be routed to her or Galle if staff spotted a matter of concern. Several cases were routed to Mitchell for her review concerning patients Dr. Arafiles saw in the ED during his six month provisional period. In September 2008, Mitchell became concerned because Dr. Arafiles had performed surgeries in the ED. In one case, a patient presented at the ED with an injured hand. Dr. Arafiles removed skin from the patient’s abdomen and grafted it onto the injured area of the hand. This constituted a non-emergency surgical procedure. Another patient had a crush- type injury to a finger. Dr. Arafiles sewed a piece of rubber resembling a thimble onto the tip of

the patient’s finger. A third patient had injured a toe by dropping a heavy object onto it. 2 The TMB restricted Dr. Arafiles’ license in February 2007 for a three-year period.

Dr. Arafiles stabilized the toe by inserting a needle into the bone. This constituted a surgical procedure which should have been performed by an orthopedic surgeon.

Galle’s duties included review of the in-patient cases. She was also responsible for sending medical records out for peer review through the Texas A&M RCHI3 program. She began noticing a recurring problem whereby Dr. Arafiles would diagnose and admit a patient to the Hospital even though the diagnosis was not supported by the appropriate criteria and medical documentation. When this occurred, Galle took action to obtain the necessary documentation, including requesting it from Dr. Arafiles. If she did not obtain the documentation necessary to support the diagnosis, she would request that the patient be downgraded to a 24-hour observation. Galle also became concerned that Dr. Arafiles had not followed the standard of care in some cases and he had performed surgical procedures, including a skin graft, in the ED.

In September 2008, Wiley became aware of the surgical procedures performed by Dr. Arafiles in the ED, including the skin graft. The Hospital’s insurance would not cover any surgical procedures so this presented risk and liability issues which concerned Wiley. Consequently, Wiley instructed Mitchell to pull the patient records and meet with the assistant director of nursing, Donna Paehl, to determine what had happened. On September 30, Wiley sent an email to Drs. Arafiles, Pham, and Winton reminding them that they could not perform any surgical procedures either at the ED, clinic, or at a patient’s home. Wiley mentioned home visits in the email because Dr. Arafiles had expressed a willingness to make home visits.

The Nurses’ and Dr. Pham’s Efforts to Address Standards of Care A medical staff meeting took place on October 8, 2008. It was attended by Wiley, Galle, Mitchell, Warren, and Drs. Pham, Arafiles, and Winton. At these meetings, Galle and Mitchell

would typically discuss “write-ups” based on their review of the patient charts. Galle would also 3 RCHI is an acronym for Rural and Community Health Institute.

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