Sunday, August 21, 2005
Letter Explaining the Unfairness of Texas State Board of Medical Examiners towards neurosurgeon Roland Chalifoux Jr.,DO
July 14, 2004
To whom it may concern:
Re: Roland Chalifoux, DO and the TSBME
I offer this letter as a helpful insight as to how this physician was ensnarled by the peer review process and Texas State Board of Medical Examiners (TSBME). It is a lamentable fact of present day medicine in America that there are too many doctors who are motivated by greed, slavish acceptance of maintaining competitive positioning, unprofessionalism, and biased reasoning when called upon to judge other physicians instead of an honest, legitimate and professional evaluation of those doctors. In a similar vein, the malpractice crisis is also due to many of our compatriots who have been less than honest and accurate with their testimony. Hippocrates stated, “Medicine is the most distinguished of all the arts, but through ignorance of those who practice it, and of those who casually judge such practitioners, it is now of all the arts by far the least esteemed.” Remember what the poet W. H. Auden said in “A Certain World”, “in order to be a good doctor a man must also have a good character, this is, to say, whichever weaknesses and foibles he may have he must love his fellow human beings, in the concrete and desire their good before his own.”
I worked with Dr. Chalifoux when he first came to Fort Worth in 1995. We worked together, both, at Osteopathic Medical Center (OMCT) and at John Peter Smith Hospital where I was the chief of neurosurgery. I observed his care of trauma patients and other patients at the large county hospital which was also a level II trauma center. He was a young and inexperienced neurosurgeon but he displayed excellent potential and good surgical skills for his level. Unfortunately, he ran into a political situation at Osteopathic Medical Center (pts. T.L. and E.F). The previous practicing neurosurgeon had gone to Erie, Pennsylvania but decided he wanted to come back. Dr. Chalifoux had taken a position at the University of North Texas Health Science Group, and did not care to have this individual back for various reasons. Regrettably, the chief of surgery at the medical school, a personal friend of this physician, overlooking previous quality of care issues, and Dr. Chalifoux’s strong objections and brought him back. Their relationship was stormy, precarious and untenable. Someone had to go. The E.F. case (i.e., the giant aneurysm), presented an opportunity to terminate Dr. Chalifoux. He really never did anything to justify his suspension from Osteopathic Medical Center except his opposition to the chief of surgery’s favoritism and influential and tenacious support of a flawed neurosurgeon, which resulted in his dismissal and termination. One of the TSBME’s reviewers’ himself stated during Dr. Chalifoux’s hearing that he did not deserve to have his privileges or medical license suspended for this case.
Unfortunately, the reality is that once you have had a peer review action, there tends to be a domino effect at other hospitals unless one is very, very cautious and extremely fortuitous. Of course, being a DO neurosurgeon at primarily MD institutions places one in a more vulnerable and precarious situation. Ft. Worth and the surrounding Tarrant County area is a very political environment as far as health care competition and hospital politics are concerned.
He then went to Plaza Medical Center which was controlled primarily by one neurosurgical group who initially asked him to join them. But he refused. When it was time to have his privileges renewed, he was required to have a number of cases proctored after a peer review hearing (pts. M.L., J.S., G.B., P.R., T.T., C.Y.), even though he had successfully completed over 85 cases at that facility. Interestingly, this neurosurgical group is currently involved in an anti-competitive, Medicare fraud, etc., lawsuit against it with Columbia Plaza Medical Center and Columbia North Hills to involve preferential referrals, financial arrangements, inappropriate surgeries, etc.
At Columbia North Hills, he did over 60 cases but nevertheless when he came up for reappointment because of what had occurred at Columbia Plaza Medical Center and Osteopathic Medical Center, they decided to not reappoint him. He had to go to a hearing. They only had one case (pt. A.J.) that they were concerned about and really presented no credible evidence justifying not renewing his privileges. The hospital’s own expert under oath found no quality of care issues with that particular patient even though the TSBME’s two experts found many problems with the care of this patient.
At Columbia Medical Center of Arlington when he came up for privileges, he again was not reappointed because of the various peer review actions and had a hearing, which was run by his primary neurosurgical competitor and chief of staff and here again, failed to overcome the substantial obstacles confronting a physician facing exaggerated allegations. He was later exonerated by TSBME reviewers with regards to these cases at Columbia Medical Center of Arlington which interestingly enough dealt with similar types of cases that he was later suspended for at the other hospitals.
Finally, a similar scenario played out at Dallas-Ft. Worth Medical Center (pts. B.R., H.S., C.P., E.A.). He was not reappointed for his past history and even though the peer review hearing committee cleared him of all charges, certain individuals at the Board of Trustees level overturned their decision. If one reviews the PFD, it is interesting to note that both the SOAH judges and the hearing panel at DFW found that Dr. Chalifoux properly treated these patients while the TSBME’s two experts thought otherwise.
Dr. Chalifoux’s hospital issues started in April 1997 with his suspension at OMCT and continued at the other hospitals yearly as his two year credentialing reappointments came up. After his last credentialing issue at DFW in 1999, he was practicing at Tri-City Hospital, Kindred Hospital, HEALTHSOUTH Fort Worth, and Irving Surgery. He never had a peer review action at any of those facilities since the medical staff and administration fully understood the politics of medicine and how unfairly Dr. Chalifoux had been treated. In fact, Dr. Chalifoux had been practicing at those facilities from 1999 till the TSBME suspended him in July 2002 without any adverse peer review hearing. By the time of the TSBME suspension in July 2002, Dr. Chalifoux had completed over 500 neurosurgical cases since the DFW hearing without any hospital issues. Each time there was a peer review action, his name and reputation was brought before the TSBME. I reviewed all of the cases that were used against him at the various hospitals; I can tell you there were no major violations of any standards of care and his results were quite good and acceptable and do not reflect a danger to the public. Actually, Dr. Chalifoux is as good if not better than many of the neurosurgeons in Tarrant County. He was very vulnerable however because he did not have influential elements within the hospital environment protecting him.
When the Texas State Board of Medical Examiners (TSBME) temporarily suspended his license in July 2002, they only had employed two experts which they used to review most of his cases except those from Columbia Arlington Hospital that were cleared earlier by the TSBME. The argument used by the TSBME on July 19,2002 the day of his temporary suspension was that Dr. Chalifoux was a “clear and continuous danger to patients” since he had had peer review issues at four hospitals from 1997-1999. Following those hearings Dr. Chalifoux was still performing surgeries at three area hospitals where he maintained privileges. These hospital staffs knew Dr. Chalifoux and recognized that the problem was a combination of anti-competitiveness and politics. Between the last peer review hearing in 1999 and his temporary suspension on July 19, 2002, Dr. Chalifoux had performed an additional 546 cases without any adverse hospital complaints or hearings. How is this considered to be a “clear and present danger” to patients?
The TSBME relied on retired neurosurgeons who had reviewed Dr. Chalifoux in the past. These retired individuals did not do their own fusions which is what many of the cases involved. Dr. Awad who at that time was at the Univ. of Colorado only testified on E.A. and was paid $1,000/hr. Dr. Chalifoux presented a total of 25 unpaid witnesses. These witnesses included one patient (C.Y.) and a family member of a patient (T.T.). One witness was a nurse practioner who was formerly an investigator at the TSBME. Three hospital administrators and 19 competent qualified and bona fide expert physician witnesses were presented. They included Dr. Eugene George Professor of Neurosurgery at U.T. Southwest Medical Center, Dr. Wolff Kirsch of Loma Linda University, as well as Dr. Bailes and Dr. Fukushima from West Virginia University.
It is important to understand that during the early part of 2002, the TSBME was under significant public scrutiny and political grandstanding to become more aggressive in punishing doctors particularly after the public and political hierarchy supported the amendment that permitted capping malpractice settlements for pain and suffering at $250,000. A retired neurosurgeon turned lawyer was hired as the new director and he has established a reputation as being very unfair and circumventing due process in order to increase the number of doctors being sanctioned. There have been many complaints from Texas doctors about the board’s heavy handedness. For example, Dr. Chalifoux was criticized by the TSBME experts for performing a very complicated cerebral AVM on a young woman and despite achieving an excellent result and the fact that she came to defend him at his hearing, the TSBME and Columbia Plaza Medical Center criticized him about a Dilantin level which is “ridiculous and absurd” according to Wolff Kirsch, MD professor of neurosurgery, at Loma Linda Medical Center. The complaints on the AVM case (C.Y.) along with most of the other allegations are picayune. Every neurosurgeon in the country would face similar castigation if being judged for such issues in their practice.
One could detect a definite prejudicial and biased attitude by the two MD neurosurgeons, which I think was quite unfair. Two judges have basically cleared him of all cases except the issues surrounding E.F. (giant aneurysm) which remains controversial. There are many neurosurgeons with similar cases but they have not lost their licenses. I agree that it does appear disconcerting when a physician has lost his license and has had apparent problems at multiple hospitals. The natural assumption is that he is a bad doctor, but that is not always the case, particularly, in the present political environment with increasing competition and decreasing reimbursements. Sure, Dr. Chalifoux has had complications just as any neurosurgeon, but nothing that would justify the loss of his license. He was unfortunately a new DO neurosurgeon who came to a very politically charged area and ran into a series of very difficult situations not totally of his own making. I believe he will prevail and get his Texas license back.
The Administrative Law Judges reviewing this case concluded in the Proposal for Decision (PFD) that Dr. Chalifoux is an intelligent, skillful, and competent physician and has sincere concern for his patients. The ALJ’s alleged one issue in one patient AJ (delayed CSF leak) out of a total of 282 fusion procedures he had completed from 1995-2002, a (.3%) complication rate. He allegedly had two craniotomy complications out of a total of 104(1.9%) which is not outrageous considering the complexity of these surgeries. It is obvious that the new ALJ’s had a daunting task of reviewing transcripts without being at the actual hearing. By the time the new ALJ’s took over the review of the transcripts, Dr. Chalifoux had been waiting 18 months since the completion of the hearing in early November 2002. It took these new ALJ’s two months what took the first ALJ 16 months and she never completed the task. Dr. Chalifoux’s family has been put on hold for over 2 years. His practice is closed, has filed bankruptcy, and still has to deal with a malicious and malignant TSBME which will never admit that these allegations against Dr. Chalifoux were arbitrary and capricious to begin with. What’s worst is that the TSBME at the very best was able to defend 5 of 83 allegations (6.02%) while Dr. Chalifoux at best defended himself 100% or at worst in 78 of 83 (93.97%). It is a real shame that the TSBME can be allowed to do such a reckless and substandard job at gathering and starting an investigation without criticism from the Texas legislature or former Governor Bush and the current Governor who appointed them. What is even worst is the fact that the TSBME’s two experts gave testimony on these allegations which were proven to be at the very best 93.97% WRONG yet nothing will happen to Dr. Evans or Barrish since they are colleagues of Dr. Patrick. Either these two retired neurosurgeons KNEW they were giving false and misleading testimony and need to be disciplined for Ethics violations or WORST, they truly did not know what they were talking about and should never had been called upon to give expert testimony.
The real tragedy concerning Dr. Chalifoux is that on the other side of the coin there are various neurosurgeons within Tarrant County who due to their connections continue to perform marginal and mediocre work, which ends up hurting many patients, but rarely are sanctioned or, reviewed. The real story is he was suspended and terminated unfairly and maliciously and each hospital with the assistance of his competition and the TSBME did not give him a chance to practice and exonerate himself though his surgical skills were good and acceptable.
Respectfully,
John B. Payne, DO
To whom it may concern:
Re: Roland Chalifoux, DO and the TSBME
I offer this letter as a helpful insight as to how this physician was ensnarled by the peer review process and Texas State Board of Medical Examiners (TSBME). It is a lamentable fact of present day medicine in America that there are too many doctors who are motivated by greed, slavish acceptance of maintaining competitive positioning, unprofessionalism, and biased reasoning when called upon to judge other physicians instead of an honest, legitimate and professional evaluation of those doctors. In a similar vein, the malpractice crisis is also due to many of our compatriots who have been less than honest and accurate with their testimony. Hippocrates stated, “Medicine is the most distinguished of all the arts, but through ignorance of those who practice it, and of those who casually judge such practitioners, it is now of all the arts by far the least esteemed.” Remember what the poet W. H. Auden said in “A Certain World”, “in order to be a good doctor a man must also have a good character, this is, to say, whichever weaknesses and foibles he may have he must love his fellow human beings, in the concrete and desire their good before his own.”
I worked with Dr. Chalifoux when he first came to Fort Worth in 1995. We worked together, both, at Osteopathic Medical Center (OMCT) and at John Peter Smith Hospital where I was the chief of neurosurgery. I observed his care of trauma patients and other patients at the large county hospital which was also a level II trauma center. He was a young and inexperienced neurosurgeon but he displayed excellent potential and good surgical skills for his level. Unfortunately, he ran into a political situation at Osteopathic Medical Center (pts. T.L. and E.F). The previous practicing neurosurgeon had gone to Erie, Pennsylvania but decided he wanted to come back. Dr. Chalifoux had taken a position at the University of North Texas Health Science Group, and did not care to have this individual back for various reasons. Regrettably, the chief of surgery at the medical school, a personal friend of this physician, overlooking previous quality of care issues, and Dr. Chalifoux’s strong objections and brought him back. Their relationship was stormy, precarious and untenable. Someone had to go. The E.F. case (i.e., the giant aneurysm), presented an opportunity to terminate Dr. Chalifoux. He really never did anything to justify his suspension from Osteopathic Medical Center except his opposition to the chief of surgery’s favoritism and influential and tenacious support of a flawed neurosurgeon, which resulted in his dismissal and termination. One of the TSBME’s reviewers’ himself stated during Dr. Chalifoux’s hearing that he did not deserve to have his privileges or medical license suspended for this case.
Unfortunately, the reality is that once you have had a peer review action, there tends to be a domino effect at other hospitals unless one is very, very cautious and extremely fortuitous. Of course, being a DO neurosurgeon at primarily MD institutions places one in a more vulnerable and precarious situation. Ft. Worth and the surrounding Tarrant County area is a very political environment as far as health care competition and hospital politics are concerned.
He then went to Plaza Medical Center which was controlled primarily by one neurosurgical group who initially asked him to join them. But he refused. When it was time to have his privileges renewed, he was required to have a number of cases proctored after a peer review hearing (pts. M.L., J.S., G.B., P.R., T.T., C.Y.), even though he had successfully completed over 85 cases at that facility. Interestingly, this neurosurgical group is currently involved in an anti-competitive, Medicare fraud, etc., lawsuit against it with Columbia Plaza Medical Center and Columbia North Hills to involve preferential referrals, financial arrangements, inappropriate surgeries, etc.
At Columbia North Hills, he did over 60 cases but nevertheless when he came up for reappointment because of what had occurred at Columbia Plaza Medical Center and Osteopathic Medical Center, they decided to not reappoint him. He had to go to a hearing. They only had one case (pt. A.J.) that they were concerned about and really presented no credible evidence justifying not renewing his privileges. The hospital’s own expert under oath found no quality of care issues with that particular patient even though the TSBME’s two experts found many problems with the care of this patient.
At Columbia Medical Center of Arlington when he came up for privileges, he again was not reappointed because of the various peer review actions and had a hearing, which was run by his primary neurosurgical competitor and chief of staff and here again, failed to overcome the substantial obstacles confronting a physician facing exaggerated allegations. He was later exonerated by TSBME reviewers with regards to these cases at Columbia Medical Center of Arlington which interestingly enough dealt with similar types of cases that he was later suspended for at the other hospitals.
Finally, a similar scenario played out at Dallas-Ft. Worth Medical Center (pts. B.R., H.S., C.P., E.A.). He was not reappointed for his past history and even though the peer review hearing committee cleared him of all charges, certain individuals at the Board of Trustees level overturned their decision. If one reviews the PFD, it is interesting to note that both the SOAH judges and the hearing panel at DFW found that Dr. Chalifoux properly treated these patients while the TSBME’s two experts thought otherwise.
Dr. Chalifoux’s hospital issues started in April 1997 with his suspension at OMCT and continued at the other hospitals yearly as his two year credentialing reappointments came up. After his last credentialing issue at DFW in 1999, he was practicing at Tri-City Hospital, Kindred Hospital, HEALTHSOUTH Fort Worth, and Irving Surgery. He never had a peer review action at any of those facilities since the medical staff and administration fully understood the politics of medicine and how unfairly Dr. Chalifoux had been treated. In fact, Dr. Chalifoux had been practicing at those facilities from 1999 till the TSBME suspended him in July 2002 without any adverse peer review hearing. By the time of the TSBME suspension in July 2002, Dr. Chalifoux had completed over 500 neurosurgical cases since the DFW hearing without any hospital issues. Each time there was a peer review action, his name and reputation was brought before the TSBME. I reviewed all of the cases that were used against him at the various hospitals; I can tell you there were no major violations of any standards of care and his results were quite good and acceptable and do not reflect a danger to the public. Actually, Dr. Chalifoux is as good if not better than many of the neurosurgeons in Tarrant County. He was very vulnerable however because he did not have influential elements within the hospital environment protecting him.
When the Texas State Board of Medical Examiners (TSBME) temporarily suspended his license in July 2002, they only had employed two experts which they used to review most of his cases except those from Columbia Arlington Hospital that were cleared earlier by the TSBME. The argument used by the TSBME on July 19,2002 the day of his temporary suspension was that Dr. Chalifoux was a “clear and continuous danger to patients” since he had had peer review issues at four hospitals from 1997-1999. Following those hearings Dr. Chalifoux was still performing surgeries at three area hospitals where he maintained privileges. These hospital staffs knew Dr. Chalifoux and recognized that the problem was a combination of anti-competitiveness and politics. Between the last peer review hearing in 1999 and his temporary suspension on July 19, 2002, Dr. Chalifoux had performed an additional 546 cases without any adverse hospital complaints or hearings. How is this considered to be a “clear and present danger” to patients?
The TSBME relied on retired neurosurgeons who had reviewed Dr. Chalifoux in the past. These retired individuals did not do their own fusions which is what many of the cases involved. Dr. Awad who at that time was at the Univ. of Colorado only testified on E.A. and was paid $1,000/hr. Dr. Chalifoux presented a total of 25 unpaid witnesses. These witnesses included one patient (C.Y.) and a family member of a patient (T.T.). One witness was a nurse practioner who was formerly an investigator at the TSBME. Three hospital administrators and 19 competent qualified and bona fide expert physician witnesses were presented. They included Dr. Eugene George Professor of Neurosurgery at U.T. Southwest Medical Center, Dr. Wolff Kirsch of Loma Linda University, as well as Dr. Bailes and Dr. Fukushima from West Virginia University.
It is important to understand that during the early part of 2002, the TSBME was under significant public scrutiny and political grandstanding to become more aggressive in punishing doctors particularly after the public and political hierarchy supported the amendment that permitted capping malpractice settlements for pain and suffering at $250,000. A retired neurosurgeon turned lawyer was hired as the new director and he has established a reputation as being very unfair and circumventing due process in order to increase the number of doctors being sanctioned. There have been many complaints from Texas doctors about the board’s heavy handedness. For example, Dr. Chalifoux was criticized by the TSBME experts for performing a very complicated cerebral AVM on a young woman and despite achieving an excellent result and the fact that she came to defend him at his hearing, the TSBME and Columbia Plaza Medical Center criticized him about a Dilantin level which is “ridiculous and absurd” according to Wolff Kirsch, MD professor of neurosurgery, at Loma Linda Medical Center. The complaints on the AVM case (C.Y.) along with most of the other allegations are picayune. Every neurosurgeon in the country would face similar castigation if being judged for such issues in their practice.
One could detect a definite prejudicial and biased attitude by the two MD neurosurgeons, which I think was quite unfair. Two judges have basically cleared him of all cases except the issues surrounding E.F. (giant aneurysm) which remains controversial. There are many neurosurgeons with similar cases but they have not lost their licenses. I agree that it does appear disconcerting when a physician has lost his license and has had apparent problems at multiple hospitals. The natural assumption is that he is a bad doctor, but that is not always the case, particularly, in the present political environment with increasing competition and decreasing reimbursements. Sure, Dr. Chalifoux has had complications just as any neurosurgeon, but nothing that would justify the loss of his license. He was unfortunately a new DO neurosurgeon who came to a very politically charged area and ran into a series of very difficult situations not totally of his own making. I believe he will prevail and get his Texas license back.
The Administrative Law Judges reviewing this case concluded in the Proposal for Decision (PFD) that Dr. Chalifoux is an intelligent, skillful, and competent physician and has sincere concern for his patients. The ALJ’s alleged one issue in one patient AJ (delayed CSF leak) out of a total of 282 fusion procedures he had completed from 1995-2002, a (.3%) complication rate. He allegedly had two craniotomy complications out of a total of 104(1.9%) which is not outrageous considering the complexity of these surgeries. It is obvious that the new ALJ’s had a daunting task of reviewing transcripts without being at the actual hearing. By the time the new ALJ’s took over the review of the transcripts, Dr. Chalifoux had been waiting 18 months since the completion of the hearing in early November 2002. It took these new ALJ’s two months what took the first ALJ 16 months and she never completed the task. Dr. Chalifoux’s family has been put on hold for over 2 years. His practice is closed, has filed bankruptcy, and still has to deal with a malicious and malignant TSBME which will never admit that these allegations against Dr. Chalifoux were arbitrary and capricious to begin with. What’s worst is that the TSBME at the very best was able to defend 5 of 83 allegations (6.02%) while Dr. Chalifoux at best defended himself 100% or at worst in 78 of 83 (93.97%). It is a real shame that the TSBME can be allowed to do such a reckless and substandard job at gathering and starting an investigation without criticism from the Texas legislature or former Governor Bush and the current Governor who appointed them. What is even worst is the fact that the TSBME’s two experts gave testimony on these allegations which were proven to be at the very best 93.97% WRONG yet nothing will happen to Dr. Evans or Barrish since they are colleagues of Dr. Patrick. Either these two retired neurosurgeons KNEW they were giving false and misleading testimony and need to be disciplined for Ethics violations or WORST, they truly did not know what they were talking about and should never had been called upon to give expert testimony.
The real tragedy concerning Dr. Chalifoux is that on the other side of the coin there are various neurosurgeons within Tarrant County who due to their connections continue to perform marginal and mediocre work, which ends up hurting many patients, but rarely are sanctioned or, reviewed. The real story is he was suspended and terminated unfairly and maliciously and each hospital with the assistance of his competition and the TSBME did not give him a chance to practice and exonerate himself though his surgical skills were good and acceptable.
Respectfully,
John B. Payne, DO
// posted by texas shammed @ 12:41 PM 
