The LA County Coroner has released further information about Michael Jackson's death, indicating that Jackson had enough of the sedative Propofol (Diprivan) in his system to have major surgery.

Propofol, in combination with many other sedatives and pain medications, led Jackson to stop breathing and eventually to cardiac arrest. Typically when propofol is used, close monitoring is required and if the patient is not on a ventilator, oxygen is provided and breathing continuously monitored.

In Jackson's case, the available oxygen tank was empty, there was no monitor, and there was no IV pump to insure the Propofol was given at a proper dose.

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Representative John Murtha, has died from complications from a laparoscopic gallbladder surgery.

The surgery is a minimally invasive procedure, and patients typically go home within 48 hours of the procedure.  Reports indicate that surgeons may have "hit the intestines" during the surgery, sending Murtha to the ICU where he died today.

Murtha, a former marine, was an outspoken member of the committee that determined the budget for the Pentagon.

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I just read this article and now I'm angry. Really angry.  All because of a doctor who deserved to be reported to the state medical board for poor patient care. He was reported by two nurses who were then fired for their actions and charged with a felony. Yes, that's right, they were charged with a felony for reporting substandard medical care by a physician.

Here is the story in a nutshell:  two nurses anonymously report  doctor Rolando G Arafiles Jr. to the Texas State Medical Board for ongoing incompetence.  They reference the case numbers of six patients to whom they felt Arafiles provided substandard medical care.  The state board reports to Arafiles that there has been a complaint filed against him. Doctor tells his Sheriff buddy/patient, Robert L Roberts Jr.  Then, Sheriff/buddy Roberts and doctor narrow down the list of suspects who did the reporting.  Sheriff/buddy obtains a search warrant by claiming "harassment" and searches the computers belonging to the two nurses and finds the complaint letter in question.  Both nurses are charged with a felony for  "misuse of official information" and fired by the hospital although they have a combined 47 years of nursing experience.

The reality is this: the sheriff believes that doctor Rolando Arafiles, Jr. saved his life during a heart attack, so he is out to defend the doctor no matter how incompetent he is.  No matter how inappropriate his actions, or how egregious the doctor's incompetence, the doctor's honor is apparently being defended by the sheriff.  Did I mention that Quackwatch.com indicates that Arafiles and sheriff Roberts own a "herbal supplement" business together and that it is common for Arafiles to email his patients and encourage them to buy the supplement?  He has also encouraged patients to stop their medication and use his herbal supplement instead?

So, how incompetent is he, if you ask anyone other than the sheriff? Well, his license is restricted due to "irregularities"  at a weight loss clinic. He may not supervise physician assistants or nurse practitioners.  He once sewed a piece of rubber onto a patient's injured finger for protection (?!?), he has performed surgical procedures without surgical privileges (a skin graft) which failed, and the hospital was in the process of disciplining him when the nurses reported his actions to the state medical board.

Why am I so angry? First, this case sets a precedent that it is ok to be incompetent and practice mediocre medicine as long as you know people who can make the lives of the reporting nurses miserable.  However, the far  bigger issue is this: this case sends the message that nurses should be afraid to report incompetent physicians or they too will be fired, put on trial and face ten years in prison, all while the incompetent physician will happily continue practicing mediocre medicine.

Do you want a nurse caring for you that will ignore incompetence because of fear of reprisals, or do you want the nurse who is your advocate and can report improper behavior when it happens without fear of a felony conviction?

As nurses, the first duty is to the patient, caring for them and when necessary, protecting them.  While doctors take an oath to "first do no harm" sometimes it is nurses who prevent them from doing harm.  I've seen it more times than I care to think about in my own practice.

So what kind of nurse do you want? The one who is watching out for you, or the one who is afraid to watch out for you?

Shame on the town of Kermit, Texas for their failure to censure an out of control sheriff and for their failure to support the nurses who cared for them.

Shame on doctor Rolando G. Arafiles Jr!

Shame on Sheriff Robert L Roberts!

Shame on Winkler County Memorial Hospital in Texas for firing nurses who care about patients... and keeping doctors who shouldn't.

BRAVO to Vickilyn Galle and Anne Mitchell.  May there always be nurses like you to protect patients from incompetent physicians, especially those who are friends with the sheriff.  You are my nursing heroes.

Read How to Find a Surgeon and find out how you can find a doctor whose license isn't restricted.

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