By Chris Lane
By Jeff Balke
By Aaron Reiss
By Angelica Leicht
By Dianna Wray
By Aaron Reiss
By Camilo Smith
By Craig Malisow
The Thursday after Labor Day, state Attorney General Dan Morales flew into Hobby Airport to personally announce a health care fraud case so seemingly flagrant and outlandish that CBS Evening News dispatched its Dallas correspondent for a network exclusive. In a press release accompanying the announcement, Morales said his office was filing suit against 18 defendants "who dangerously and recklessly risked the health and safety of sick patients by posing as licensed physicians, assisting with surgeries, then fraudulently charging insurance companies and patients for doctors' services."
Those "bogus" doctors, Morales said, were little more than "criminals behind surgical masks" who practiced a form of "quackery." As many as ten patients had died in ten months at one hospital where the supposedly fake doctors had assisted in operations, Morales told reporters, and his office was investigating to see if the deaths were connected to their work. It was, as CBS anchor Dan Rather told his audience, "an incredible story."
Rather had no idea how right he was -- for all the wrong reasons.
For the next two weeks, assisted by a mostly compliant and unquestioning media, Morales' office continued to portray hundreds of surgeries in several hospitals as a gigantic fraud practiced by renegade unlicensed doctors with foreign medical degrees (or no medical degrees at all) that had netted a Houston firm millions of dollars.
"Is it big?" said Morales' local consumer fraud attorney, Pat Tulinski. "You betcha. Is it a gigantic fraud? You betcha. Is this the tip of the iceberg? You betcha."
But when Tulinski showed up in court last week for a hearing on the state's case against Assistant Surgeons of Texas, the dangers to public health seemed to have miraculously abated. Instead of putting on a promised parade of witnesses, the state's attorneys withdrew into conference rooms with the defendants' lawyers, where they hammered out an agreed temporary injunction that allows the defendants back into operating rooms to do exactly what they have been doing for the last ten years: assisting licensed surgeons by holding instruments, making sutures and otherwise acting as an extra pair of hands in the operating room.
If the headline-hungry Morales has any evidence that those operating room technicians have actually harmed anyone, he's still keeping it to himself. What the attorney general heralded as a case of dangerous medical malpractice devolved into a more prosaic dispute about insurance billing and whether people with foreign medical degrees and no state license should be addressed as "doctor."
And Jaime Olmo, the Puerto Rican graduate of a Caribbean medical school who created Assistant Surgeons of Texas at the request of a Houston hospital, must work under a cloud of suspicion until his case comes to trial in January. Meanwhile, his education and character and those of his colleagues and employees have been ridiculed by the state and CBS, which did three reports on Morales' case. Hospitals have suspended their contracts while their lawyers investigate, and Olmo and the doctors who worked with him for years are asking: why did it all happen?
In thousands of hospitals across the country, not just in Houston and Texas, surgical assistants have been invited into operating rooms by hospitals and physicians, giving rise to a new class of health technicians that has been haphazardly regulated. Only New York licenses surgical assistants; in Texas, they work under the supervision of licensed physicians.
Texas law says that a licensed surgeon can designate anyone to work in surgery, as long as that person is directly under the surgeon's supervision. Some surgical assistants have no college degrees at all, but are trained in hospitals to do such highly specialized work as holding retractors, tying off blood vessels, handing instruments or making sutures. They are required to have extensive knowledge of anatomy and physiology. A great many surgical assistants hold medical degrees from other countries, but have not undergone the five years of study in this country required to obtain a Texas license. There is a national certification, in which the experience and credentials of surgical assistants are reviewed by the National Surgical Assistant Association in Champaign, Illinois. To be certified, a surgical assistant must have done 750 hours of supervised operating room work for three years and pass a written examination.
Several physicians interviewed by the Press say that they have worked with Olmo and many of the other defendants for years, and praised their accomplishments and help in surgery. They want them back. Obstetrician Alan Molson, who's worked with Olmo at West Houston Medical Center since 1986 and has performed thousands of surgeries with surgical assistants, says he would rather scrub with a surgical assistant than a resident or a family practitioner any day.
"Residents lack the hands-on experience of surgical assistants," said Molson. "In my experience, family physicians tend to try to control an operation." Few family physicians are available to help out in surgery anyway, another physician says, because the cost of surgical malpractice insurance is so high, and because insurance companies are reluctant to pay for a second licensed physician in a surgery.
The real source of controversy has been whether insurance companies should pay for the services of surgical assistants and whether Assistant Surgeons of Texas has misrepresented its employees as physicians.