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"I feel it is my moral and legal obligation to self-report this to the State Board" of Medical Examiners, the letter continues. Calling it "a temporary post-traumatic occurrence," Ringer wrote that he'd kicked the habit and would never again fall prey to temptation. "Please guide me to accomplish this today so that my sincerity is unquestionable," the letter concludes.
Addressed to his attorney, the letter apparently was never sent.
For a guy under the malpractice microscope, Ringer hasn't had much problem attracting customers. Public records list him as owning a 24-foot pleasure boat and a fleet of automobiles, including a Lincoln Mark VIII, a Mercedes convertible and a Ford Expedition and pickup truck. He also owns a piece of a cattle company, A&R Cattle, and until recently lived in a house valued at $350,000. Financial records compiled by Michelle Barr from Ringer's appointment book show he billed patients for more than $750,000 last year.
A lot of the payments were in cash. Barr says the greenbacks collected each day would be put in envelopes and stuck in a drawer. "At the end of the day, he always took it," she says. Ringer allows that patients give him cash. "Usually it's not a lot," he says. "I'll just keep it in my pocket and wander around with it for a few days until there's enough to make a deposit."
That shouldn't take too long, if Barr's records are accurate. Ringer collected $127,000 in cash last year, with another $258,000 in "unspecified" payments she says could have been by check, charge or cash -- the method was not logged into the book. Ringer also collected a disability payment last year of more than $10,000 for his head injury, according to Barr. He was supposed to get additional money, but his insurer has put a hold on further payments pending an investigation.
The cash flow from his practice might come to an abrupt halt if the Board of Medical Examiners finds that Ringer violated his probation, or if it files new charges against him as a result of the recent malpractice claims or a new investigation into drug abuse or other allegations.
That would seem to provide ample opportunity for action, but the board isn't well equipped to deal with problem doctors: If a physician compiles three malpractice suits in a five-year period that result in either convictions or settlement, the board is required by the state to conduct an investigation. But the overwhelming number of physicians who meet the criteria -- 2,500 the past five years -- make the requirement impractical, so the board developed a point system to screen out all but the most egregious cases. The system factors in the settlement amounts, among other considerations.
State law requires liability insurers to report settlement claims to the board. In Ringer's case, since he has no insurance, he must report the amounts himself. But the board has no way of knowing if the amounts doctors report are accurate or if the settlements are reported at all. Reports must be filed within 30 days, but as an internal board analysis of malpractice data states, "There have always been problems enforcing this timeframe, and reports are often received many months or even years after the claim was filed."
Probation violations could jump-start a revocation proceeding, but at least on the surface, Ringer seems to be living up to the terms. Enforcement of such items as the chaperone requirement and community service, however, are difficult to police. In 1999 Ringer claimed he did fund-raising for a local organization, Northwest Assistance Ministries. "All I did was just go out and hit people up for money," he says. Those people, according to a handwritten list, included most of his employees and several relatives, Barr and Williamson among them. Both deny ever contributing to the cause.
Last year Ringer reported that he worked off his 120 hours at the Harris County Sheriff's Department's District 1 office on Cypresswood. "Just clowning around and doing office work, really," he says. "Shuffle papers, make coffee." That might explain the note he wrote asking his office manager to coordinate dates and times with a deputy there, then type up the information to forward to the board.
The sheriff's department is responsible for investigating the missing drugs, which could potentially mean a different kind of legal trouble for Ringer. But the department has assisted Ringer in more ways than helping him work off his time. After Capunay was arrested and she and fellow employee Cannon were discharged, Barr and Williamson say, Ringer hired Deputy Mike Lecompte to work off-duty security at the clinic for more than a month -- the same Mike Lecompte who investigated the disappearance of the Demerol with Barr.
Lecompte would not confirm his employment with Ringer. "That's my personal business, not yours," he said testily. He did say he prepared a report after meeting with Barr and Ringer and then referred the case to the Harris County Organized Crime Unit; sheriff's department spokesman Robert Van Pelt was researching the status of that investigation but had not received word at press time, though Lecompte says that as far as he knows, it's ongoing.
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