Bad Medicine

Before two West Texas nurses brought him down, Dr. Rolando Arafiles peddled dangerous treatments in towns across Texas.
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The case of Dr. Rolando Arafiles could well be the oddest in the history of Texas medicine. In 2008, Arafiles was hired as a doctor at Winkler Memorial Hospital in Kermit, a small West Texas town between Odessa and the New Mexico border. Within months of starting his job, Arafiles began selling supplements out of the clinic where he worked. He put patients on bizarre and potentially life- threatening treatments for conditions they didn’t have. He performed botched surgeries in unsterile rooms. When two nurses—Anne Mitchell and Vickilyn Galle—complained anonymously to the Texas Medical Board about him, Arafiles went after the nurses. He allegedly brought Stan Wiley, hospital administrator; Robert Roberts, the county sheriff; and Scott Tidwell, the county attorney into a conspiracy to find, fire, arrest, and indict Mitchell and Galle.

In March, the Observer chronicled Arafiles’ bizarre treatments and the corruption in Winkler County that resulted in criminal cases against the nurses who turned in Arafiles. When our story ran in early 2011, Arafiles, Roberts, Tidwell, and Wiley had all been indicted on charges of retaliation and official oppression. Since then, Roberts and Tidwell have been tried and convicted on all counts. (The trials have been marked by a sort of dark comedy—the October 5 punishment phase of Tidwell’s trial saw a number of prostitutes he had patronized—at $2,000 to $4,000 per visit—while his wife was in a coma, take the stand.)

And on Nov. 7, Arafiles himself accepted a plea deal. He pled guilty to charges of retaliation and misuse of official information. He will spend two months in the Andrews County jail and five years on probation. He will have to pay a $5,000 fine and relinquish his medical license.

Since our piece on Dr. Arafiles and the nurses who brought him down—a version of which later ran on the public radio program This American Life—we’ve been besieged by questions about him. We have a very good idea of what he was doing at the Winkler County Memorial Hospital. But where was he before? It seemed difficult to believe that a doctor with such erratic practices would have just suddenly appeared in West Texas. It seemed hard to believe that Kermit was his first mistake. He had to have a history.

And, in fact, Arafiles had lengthy history of subjecting patients in several other Texas towns to unusual—even dangerous—treatments. The Texas Medical Board had investigated complaints against Arafiles and done little.

The more we dug into Arafiles past, the more a troubling circular pattern emerged. In his wanderings across Texas—from Victoria to Crane to his wilderness years as a contract doctor to, finally, Kermit—Arafiles did the same things over and over, with the same results. He moved into town. He charmed the townsfolk. He began practicing medicine that can be charitably described as questionable; less charitably as dangerous. He peddled fringe treatments of dubious medical value. He tried to turn town authority figures against anyone who challenged him. He turned litigious when challenged. Eventually, he was stopped, but not punished. He left town, he moved on to somewhere else, and he did it all over again. And perhaps he would still be doing it today had two brave nurses in Kermit not put a stop to it.

 

Arafiles claims to have gone to medical school at University of the East in Quezon City, in the Philippines. He did a residency at State University of New York (SUNY) Buffalo and an internship at Harbor Hospital in Baltimore, a non- accredited teaching hospital.

After gaining certification, Arafiles left New York in 1998 and moved to Victoria, Texas. Victoria had three hospitals, and most doctors in town rotated between them as needed.

Dr. Joseph Sigel worked in a call group with Arafiles. The doctors usually worked together, sharing patients and work. The idea was to reduce documentation and hours for everyone. After a while, though, Sigel says, he quit working with Arafiles. Having less work wasn’t worth the hassle, he said.

“He sold weird drugs, and he was erratic. He was so bizarre in his treatment that when it was his turn, I would usually tell him I’d take care of my own patients, admit my own patients. Didn’t want to offend him.”

Despite the fact that Arafiles is the most famous—or infamous—doctor to come out of Victoria in living memory, it’s nearly impossible to get anyone to talk about him. Everyone I talked to—secretaries, administrators, and physician assistants—seemed to recognize his name. They would laugh knowingly, or sigh audibly into the phone, or just say, “Oh, him.” And then they would either decline to talk, or they would promise to call me back, and then they never would. This happened literally half a dozen times; the only people who would talk are doctors who have left Victoria—like Sigel—or disgruntled former patients.

But here’s what we know.

At the same time that he was working in the hospitals, Arafiles was working at a holistic care clinic performing what’s called chelation therapy. Chelation is a process by which you rid the body of heavy metals like arsenic or mercury. The doctor injects the patient with an IV solution full of a chelating agent, which binds to the heavy metal and allows it to flush out of the patient’s system. The process was developed after World War I to cleanse the bodies of soldiers who had survived poison gas attacks in the trenches, and it’s an accepted, FDA-approved treatment for certain kinds of poisoning.

But Arafiles used chelation as an alternative remedy—as a preventative treatment, a way for patients to cleanse their blood of real or imagined “toxins.” This is fringe treatment—the FDA warns against using chelation therapy in treating anything other than metal poisoning. It’s been shown to be no better than placebo, and it’s risky, with side effects ranging up to kidney failure and death.

Arafiles ran his clinic oddly, several patients say. Richard Moenke started seeing Arafiles in 2002 for chelation to help him with arsenic poisoning he had suffered from polluted well water. He only made it through a few visits.

“He had dollar signs in his eyes,” Moenke says. “Everything he did was about making a profit. He was constantly double billing. He would charge patients by the half-hour, and then keep them waiting half an hour, and then charge for that.”

Hope Dennis and her husband, Alan, went to Arafiles for chelation therapy at his Victoria clinic as well. They didn’t have any known heavy-metal poisoning—they went, Hope says, to clean out their arteries. The couple had previously gotten almost 50 treatments at a clinic in San Antonio, and they had liked their results.

Hope didn’t like Arafiles, so Alan started going by himself, as much as twice a week. One day he went in not feeling well. He told Arafiles he felt off, but the doctor didn’t seem to hear him. Arafiles gave the chelation treatment, but afterward and Alan felt even worse. He waited around trying to see Arafiles, but Arafiles wouldn’t see him. He drove himself home.

“When he got home,” Hope said, “I went, ‘Oh my god.’ His right eye was half mast, and he was kind of slurring his words. I took him to the ER, and he had an MRI, and they said, you had a stroke.”

Arafiles, the Dennis’ say, later told them that he had been using 10 times the normal amount of hepboron, a blood thinner used in chelation. Since then, Alan has had two or three mini strokes. His balance is off; he gets tired easily. And his eyes burn all the time—he describes it as being like “being at a barbecue and getting smoke in your eyes, but all the time.” He had planned to spend his retirement playing golf; because of his eyes and his balance, he can’t do that now.

In 2003 or 2004—the chronology is unclear—Arafiles closed his chelation business and was hired to work at a Victoria weight loss clinic supervising a physician’s assistant working there. According to a later Texas Medical Board report, the clinic practiced medicine far outside what was medically accepted. It gave phentermine, an amphetamine-like stimulant, to patients whose obesity wasn’t serious enough to warrant it, according to the report. The clinic gave diuretics to the patients on phentermine to treat their hypertension—even if they didn’t have hypertension. Arafiles later told the board that he understood these policies were wrong, but he followed them anyway “to convince the clinic’s owner to change the protocol.” Meanwhile, the Medical Board found that he had spent less than 5 percent of the time the clinic was open supervising the physician’s assistant.

The Texas Medical Board’s response to these charges shows how seriously it took them. Arafiles was denied the right to supervise nurses or physicians assistants for three years.

“That was a big deal,” says Leigh Hopper, public information officer at the Medical Board. “You know how usually when you go to the doctor, a nurse takes you to an examination room and takes your vitals, and finds out what’s wrong with you? He couldn’t do that anymore. He had to see every patient, every time they came in, himself. He had to give every shot. He had to do everything. It really hurts a doctor’s ability to make money.”

The Texas Medical Board passed its findings on to New York, where Arafiles was still licensed. The New York Medical Board’s summary of the case gives a damning list of Arafiles’ failings as a doctor. They found him guilty of “failing to practice medicine in an acceptable professional manner consistent with public health and welfare.” Of “unprofessional or dishonorable conduct that is likely to deceive, defraud, or injure the public.” Of allowing his assistants to prescribe “a drug that is non-therapeutic in nature.”

What’s striking about this case is that these are almost exactly the irregularities that the nurses in Kermit complained about years later; complaints that Arafiles would powerfully retaliate against.

By 2007, when the case was finally over, he had long since left Victoria. He reached a settlement with the Texas Medical Board. They put him on three years probation; not allowing him to supervise nurses or physicians’ assistants. There is no evidence that he held to this condition—certainly, by the time he got to Kermit, he was still on probation, and still supervising nurses.

New York, for its part, agreed to drop charges provided Arafiles surrender his license to practice in New York, or to ever seek reapplication.

 

The proceedings against Arafiles took time, though. In 2005 he left Victoria, taking a job in Crane, a small town in far West Texas, about 30 miles south of Odessa. He interviewed at Crane Hospital. At first, he impressed the administrator, Bill Barnes.

“He interviewed well—very charismatic,” Barnes said when I reached him on the phone. “Seemed very compassionate. He knew the language; he knew what to say.”

At the time, Arafiles was still the subject of open complaints with the Texas Medical Board—stemming from his time in Victoria—but Barnes hired Arafiles to work in the hospital and attached rural-health clinic. It was a two-year contract. He lasted less than three months. Arafiles—the only doctor in town—sometimes wouldn’t show up for work, Barnes says. He used up all his vacation time in his first three months. He complained that the job—admittedly, a long-hour, high- stress one—was “working him to death.” One night, when he was supposed to be running the ER, he didn’t come in. Barnes spent all night driving around town looking for him.

When he did make it into the clinic, his behavior was odd. Soon after arriving, he tried to convince Barnes to let him start enrolling patients in trials for experimental drugs. Barnes turned him down flat.

“I told him he was there to provide health care services in population of Crane,” Barnes says, “and we didn’t do clinical trials. And he turned against me.”

In his short time in Crane, Arafiles had become close with the county judge, Donny Henderson. The two played golf together. Officially, Henderson served as the tie-breaker on the hospital board; unofficially, he ran it, Barnes says. During a dispute with the previous administrator, Stan Wiley, Henderson fired half the board and restacked it with three friends—enough for him to fire Wiley. (In one of the strange coincidences that seems to be a hallmark of this story, Wiley ended up as hospital administrator in Kermit).

“Henderson took Arafiles’ side in any dispute,” Barnes says. “They tried to fire me.”

But the effort failed, and it was Arafiles who ended up quitting, breaking his contract. By this time, the board had found out that Arafiles had lied about having malpractice insurance—a huge liability. They decided to just let him go.

I asked Barnes why they didn’t report Arafiles to the Texas Medical Board for any of this. He sighed. “It was hard to get all the evidence that was needed—we didn’t have a compliance officer. Nurses were complaining a little, but nothing serious enough to report him. We should have reported him for letting his malpractice insurance lapse, but we just let him go. We just wanted to be rid of him.”

Arafiles left, spending the next three years doing contract work across Texas. He did ER rotations for a company based in Rockport, rotating around the state. At one point, he and Barnes ran into each other again: Arafiles was sent to a hospital in Sweeney, where Barnes had taken a new job after leaving Crane. Barnes called the management group Arafiles worked for and demanded that they remove him.

In 2008, Arafiles applied for the job at Winkler Memorial Hospital in Kermit. He listed Bill Barnes as a reference. Stan Wiley—now administrator at Winkler—called Barnes for a recommendation.

Barnes was emphatic. “I said, Stan, you want to stay away from him, he’s trouble. Then we talked a bit, and he thanked me, and that was it.”

Soon after their conversation, Wiley hired Arafiles to work at Winkler Memorial Hospital.

  • slimjims

    Thanks for this update. I was definitely wondering why such a shady character could have gotten away with so many years of bad medical practice.

    I have to say, though, that I’m not so fond of the Texas Medical Board after reading this. Arafiles’ probation and restrictions don’t seem harsh enough; perhaps if they enforced their punishment the nurses and patients of Winkler county would not have been treated so wrongly. My “ughs” reactions go to: 1. Scott Tidwell, 2. Stan Wiley 3. Sheriff Robert Roberts and 4. Texas Medical Board. Ugh. Just ugh.