The Virtual Revolution: The Great Levelling?

From BBC Documentaries:

In the first in this four-part series, Dr Aleks Krotoski charts the extraordinary rise of blogs, Wikipedia and YouTube, and traces an ongoing clash between the freedom the technology offers us, and our innate human desire to control and profit.

Whistle-Blowing Nurse Is Acquitted in Texas

By KEVIN SACK

A West Texas jury took but an hour Thursday to acquit a nurse who had been charged with a felony after alerting the state medical board that a doctor at her hospital was practicing unsafe medicine.

The uncommon prosecution had ignited deep concern among health care workers and advocates for whistle-blowers about a potential chilling effect on the reporting of malpractice.

But after a four-day trial in Andrews, Tex., a state court jury quickly found that the nurse, Anne Mitchell, was not guilty of the third-degree felony charge of “misuse of official information.” Conviction could have carried a prison sentence of up to 10 years and a fine of up to $10,000.

The prosecution said Mrs. Mitchell, 52, who had been a nurse at Winkler County Memorial Hospital for 25 years, had used her position to obtain and disseminate confidential information — patient file numbers — in her letter to the medical board with the intent of harming Dr. Rolando G. Arafiles Jr. The prosecutor argued that state law required that reports of misconduct be made in good faith, and that Mrs. Mitchell had been waging a vendetta against Dr. Arafiles since his arrival at the hospital in April 2008.

Witnesses testified that they had heard Mrs. Mitchell refer to Dr. Arafiles, a proponent of alternative medicine and herbal remedies, as a “witch doctor.”

But other nurses vouched that Mrs. Mitchell’s concerns were legitimate, and that internal complaints were not dealt with adequately by the hospital’s administration.

The jury foreman said the panel of six men and six women voted unanimously on the first ballot, and questioned why Mrs. Mitchell had ever been arrested.

“We just didn’t see the wrongdoing of sending the file numbers in, since she’s a nurse,” said the foreman, Harley D. Tyler, a high school custodian.

Mrs. Mitchell, who did not testify in her defense, said after the verdict that she had been trying only to protect her patients.

“It’s a duty to every nurse to take care of patients,” she said, after wiping away tears of relief.

The prosecution has so polarized the small town of Kermit, where the hospital is located, that the judge moved the trial to a neighboring county. The case was investigated by Sheriff Robert L. Roberts Jr., a friend and admiring patient of Dr. Arafiles, and tried by the county attorney, Scott M. Tidwell, a political ally of the sheriff and, according to testimony, Dr. Arafiles’s personal lawyer.

Sheriff Roberts said he was disappointed in the verdict but did not regret the prosecution.

“The defense had to spin this as a reporting issue, that nurses were not going to be able to report bad medical care, and it’s never been that,” he said. “We encourage people to report bad medical care. But I encourage public servants to report it properly.”

Mrs. Mitchell and Vickilyn Galle, a co-worker who helped her write the anonymous letter to the medical board, were fired by the hospital last June, shortly before being indicted. The charges against Mrs. Galle, 54, were dismissed late last month at the prosecutor’s discretion.

After the verdict, the nurses’ lawyers pivoted quickly to the lawsuit they have filed in federal court against the county, the hospital and various officials, charging that the firings and indictments amounted to a violation of due process and their First Amendment rights.

“We are glad that this phase of this ordeal has ended and that Anne has been restored to her liberty,” said Mrs. Mitchell’s lawyer, John H. Cook IV, “but there was great damage done in this case, and this does not make them whole.”

Mr. Cook presented broad evidence that the nurses’ concerns about Dr. Arafiles, 47, were well founded, and that Mrs. Mitchell had violated no laws or regulations in alerting the governmental body that licenses and regulates physicians. He walked the jury through a series of questionable cases involving Dr. Arafiles, including one in which the doctor performed a skin graft in the hospital’s emergency room, despite not having surgical privileges, and another where he sutured a rubber tip to a patient’s crushed finger for protection.

Some watchdog groups worried that the prosecution would stifle reporting of improper medical care, regardless of the outcome. But Rebecca M. Patton, president of the American Nurses Association, called the verdict “a resounding win on behalf of patient safety.”

Ms. Patton said, “The message the jury sent is clear: the freedom for nurses to report a physician’s unsafe medical practices is non-negotiable.”

Jim Mustian contributed reporting from Andrews, Tex.

Nurse to Stand Trial for Reporting Doctor

By KEVIN SACK

KERMIT, Tex. — It occurred to Anne Mitchell as she was writing the letter that she might lose her job, which is why she chose not to sign it. But it was beyond her conception that she would be indicted and threatened with 10 years in prison for doing what she knew a nurse must: inform state regulators that a doctor at her rural hospital was practicing bad medicine.

When she was fingerprinted and photographed at the jail here last June, it felt as if she had entered a parallel universe, albeit one situated in this barren scrap of West Texas oil patch.

“It was surreal,” said Mrs. Mitchell, 52, the wife of an oil field mechanic and mother of a teenage son. “I said how can this be? You can’t go to prison for doing the right thing.”

But in what may be an unprecedented prosecution, Mrs. Mitchell is scheduled to stand trial in state court on Monday for “misuse of official information,” a third-degree felony in Texas.

The prosecutor said he would show that Mrs. Mitchell had a history of making “inflammatory” statements about Dr. Rolando G. Arafiles Jr. and intended to damage his reputation when she reported him last April to the Texas Medical Board, which licenses and disciplines doctors.

Mrs. Mitchell counters that as an administrative nurse, she had a professional obligation to protect patients from what she saw as a pattern of improper prescribing and surgical procedures — including a failed skin graft that Dr. Arafiles performed in the emergency room, without surgical privileges. He also sutured a rubber tip to a patient’s crushed finger for protection, an unconventional remedy that was later flagged as inappropriate by the Texas Department of State Health Services.

Charges against a second nurse, Vickilyn Galle, who helped Mrs. Mitchell write the letter, were dismissed at the prosecutor’s discretion last week.

The case has been infused with the small-town politics of this wind-whipped city of 5,200 in the heart of the Permian Basin, 10 miles from the New Mexico border. The seeming conflicts of interest are as abundant as the cattle grazing among the pump jacks and mesquite.

When the medical board notified Dr. Arafiles of the anonymous complaint, he protested to his friend, the Winkler County sheriff, that he was being harassed. The sheriff, an admiring patient who credits the doctor with saving him after a heart attack, obtained a search warrant to seize the two nurses’ work computers and found the letter.

Both sides acknowledge that the case has polarized the community, and the judge has moved the trial to a neighboring county.

The state and national nurses associations have called the prosecution an outrage and raised $40,000 for the defense. Legal experts argue that in a civil context, Mrs. Mitchell would seem to be protected by Texas whistle-blower laws.

“To me, this is completely over the top,” said Louis A. Clark, president of the Government Accountability Project, a group that promotes the defense of whistle-blowers. “It seems really, really unique.”

Until they were fired without explanation on June 1, Mrs. Mitchell and Mrs. Galle had worked a combined 47 years at Winkler County Memorial Hospital here, most recently as its compliance and quality improvement officers.

The nurses, who are highly regarded even by the administrator who dismissed them, said the case had stained their reputations and drained their savings. With felony charges pending, neither has been able to find work. They said they could feel heads turn when they walked into local lunch spots like El Joey’s Mexican restaurant.

“It has derailed our careers, and we’re probably not going to be able to get them back on track again,” said Mrs. Galle, 54, a grandmother who is depicted around town as the soft-spoken Thelma to Mrs. Mitchell’s straight-shooting Louise. “We’re just in disbelief that you could be arrested for doing something you had been told your whole career was an obligation.”

It was not long after the public hospital hired Dr. Arafiles in 2008 that the nurses said they began to worry. They sounded internal alarms but felt they were not being heeded by administrators.

Frustrated and fearing for patients, they directed the medical board to six cases “of concern” that were identified by file numbers but not by patient names. The letter also mentioned that Dr. Arafiles was sending e-mail messages to patients about an herbal supplement he sold on the side.

Mrs. Mitchell typed the letter and mailed it with a separate complaint signed by a third nurse, who wrote that she had resigned because of similar concerns about Dr. Arafiles. That nurse was not charged.

To convict Mrs. Mitchell, the prosecution must prove that she used her position to disseminate confidential information for a “nongovernmental purpose” with intent to harm Dr. Arafiles.

Mari E. Robinson, executive director of the Texas Medical Board, has warned in a blistering letter to prosecutors that the case will have “a significant chilling effect” on the reporting of malpractice.

The nurses’ lawyers, John H. Cook IV and Brian Carney, have filed a civil lawsuit in federal court charging the county, hospital, sheriff, doctor and prosecutor with vindictive prosecution and denial of the nurses’ First Amendment rights.

Nonetheless, the sheriff, Robert L. Roberts Jr., and the prosecutor, Scott M. Tidwell, express confidence in their case.

“The only side of the story that the town has heard is that these are sisters of mercy, missionaries of peace,” said Mr. Tidwell, who is trying the case because the district attorney is in poor health. “The town has not heard the whole story.”

Dr. Arafiles, 47, who attended medical school in his native Philippines and trained in Baltimore and Buffalo, said his lawyer had advised him not to talk. “I’ve been brutalized and abused,” he said. “I’m the victim in this case, and that is all I can say.”

Several Texas laws would seem to enshrine a nurse’s right, and perhaps duty, to report a physician when he or she believes that patients are at risk. Lawyers on both sides agree that the case will hinge on whether a jury believes that Mrs. Mitchell reported in good faith. In civil whistle-blower cases, the Supreme Court of Texas has held that good faith requires only a reasonable belief that the conduct being reported is illegal.

The hospital administrator, Stan Wiley, said in an interview that Dr. Arafiles had been reprimanded on several occasions for improprieties in writing prescriptions and performing surgery and had agreed to make changes. Mr. Wiley, who said it was difficult to recruit physicians to remote West Texas, said he knew when he hired Dr. Arafiles that he had a restriction on his license stemming from his supervision of a weight-loss clinic.

In a surprise inspection last September, state investigators found several violations by Dr. Arafiles and concluded that the hospital had discriminated against the nurses by firing them for “reporting in good faith.”

But Sheriff Roberts, who has held the post for 18 years, said the state would show that the complaint had been filed in vengeance. “If it’s made to destroy somebody’s reputation or forcing them to leave town,” he said, “then I don’t believe it is good faith.”

Sheriff Roberts called Dr. Arafiles “the most sincerely caring person I have ever met.”

Mr. Wiley said he believed that the nurses had acted in bad faith because they went to the state despite his internal efforts to discipline Dr. Arafiles. But, he said, “I don’t believe they did it on a personal vendetta.”

Mrs. Mitchell said all she saw at the hospital was delay.

“The medical staff needed to make a decision on him,” she said. “You don’t get a second chance to save somebody’s life.”