Dr. Steven Hotze's Weird War Against the Texas Medical Board
It's October 23, 2007, and one of the most powerful men in Houston Republican circles is telling the president of the Texas Medical Board she needs a spanking.
Dr. Steven Hotze is testifying before the State House Committee on Appropriations, accusing Dr. Roberta Kalafut of running the medical board like the Gestapo. Hotze, a physician who serves a clientele composed almost exclusively of über-affluent women, alleges that Kalafut flipped out during a board hearing he attended.
"You stood up and made an ass out of yourself!" Hotze proclaims from his seat behind a table that's facing a panel of legislators. "It was horrible. If I hadn't been in such a precarious situation, I would have given you a good tongue-lashing — you deserved it! Your momma needed to take you over her knee, is what she needed to do."
Exit Kalafut. The Abilene spine specialist books out of the room, which is filled mostly with Hotze's allies, and makes a beeline to the ladies' room, where she promptly loses it. Hotze's diatribe came about nine hours into an 11-and-a-half-hour ambush of Kalafut and fellow board members and staff. What was to have been a routine appropriations hearing turned out to be a Trojan horse for disgruntled physicians who believed they had been unfairly targeted by a rogue board bent on driving them out of business.
Hotze was especially ticked that the board had the nerve to go after his pal Dr. William Rea, a Dallas physician, just because the guy injected an allergy patient or two with "homeopathic" antigens the board originally thought were derived from diesel fumes and jet fuel. Hotze believed Rea – who claimed to heal upwards of 30,000 people during his career – deserved a Nobel Prize. And now his friend was being hounded by the medical board.
And Rea's not alone. There's the poor, innocent neuropath who found himself in the medical board's crosshairs just because he left an anesthetized patient with an open surgical site in the operating room for 12 minutes without an attending physician while he hit the cafeteria chow line. There's the ob-gyn who told a patient suffering from female sexual dysfunction that he needed to examine her throat in order to determine whether she had had oral sex. The family-practice physician who led police officers on a high-speed chase, saying she was afraid the medical board had sent them after her. Victims, all.
The anti-board physicians' demands were clear: no more anonymous complaints that they said deprived doctors of due process. No more "star chamber proceedings held in secret," as Hotze says. No more intimidation, no more draconian disciplinary actions over trivial matters. Also, Kalafut and her cronies had to go. Whoever would be installed in their places would require greater oversight, so that healers of men could inject their patients with distilled jet fuel in peace. There should be a Texas medical oversight committee, whose members would be appointed by legislators.
Kalafut is missing all this, because she's unleashing a cascade of profanity upon a hapless aide to Governor Rick Perry who has found her in the hallway and who is trying to apologize. Kalafut doesn't need this malarkey. It's a volunteer position that causes her to be away from her medical practice 30 days a year, with the belief that she can help protect patient safety, and here she is, set up like a bowling pin.
But when she leaves the Capitol building, she won't be leaving the battle behind. The Arizona-based Association of American Physicians and Surgeons, a far-right group whose medical journal publishes articles claiming HIV does not cause AIDS and decrying sweaty, coughing, leprosy-carrying illegal immigrants as a public health threat, has sued the Texas Medical Board — and Kalafut individually — over alleged jackbooted tactics.
The litigation will span six torturous years and will last beyond Kalafut's term as president. She will consider it an attempt by a fringe group to decimate the medical board and strip it of any real power to discipline doctors who are a threat to public safety. Before it ends, one physician will pin her husband's suicide on the board's incessant hounding; legislators will take an unusual, personal interest in the disciplinary actions against an associate of Hotze's; and Kalafut's reputation will be attacked.
There's a lot of weirdness to cover. You may want to take 12 to grab a bite.
In 2002, the Dallas Morning News ran a series of scathing articles exposing the Texas Medical Board's laissez-faire approach toward physicians addicted to drugs, physicians addicted to having sex with their own patients, and straight-up quacks.
Also that year, Perry appointed Kalafut to the medical board. A year later, the state legislature enacted tort reform, which put caps on awards in malpractice cases.
"During my Senate confirmation hearings, I came away with the impression that if the Legislature was going to pass tort reform, which the physicians wanted, we at the Medical Board would have to step up to the plate and regulate our own," Kalafut explains in an email to the Houston Press. " We had to increase our disciplinary efforts and report on a regular basis our stats to the Legislature and any legislator that requested them."
The Ohio native also explained that her father, a judge elected to the bench at the age of 32, instilled in her a sense of civic duty.
In 2005, Kalafut became the medical board's first female president, and that year, the board unwittingly kicked off its six-year battle by investigating William Rea of Dallas.
Rea professed to treat something called "multiple chemical sensitivity," which is not a diagnosis recognized in mainstream medicine. Licensed in 1965, Rea was a board-certified thoracic surgeon who took a detour into "environmental medicine" in the 1970s. He would at one point claim to be board-certified in that field, which is not recognized by the American Board of Internal Medicine.
Rea's crowning achievment was the Environmental Wellness Center, advertised as a hypoallergenic paradise where patients considered nuts by old-fashioned physicians could get the help they needed. The patients paid handsomely for "heat depuration therapy," more commonly known as "saunas." They paid to stay in "less-toxic" patient housing five blocks from the clinic. The 550-square-foot rooms featured such amenities as "organic" shower curtains and "non-toxic grout floors."
The medical board was especially alarmed by Rea's practice of testing for multiple chemical sensitivity by injecting patients with what he called an "electromagnetic imprint" of all kinds of fun stuff, including jet fuel, ethanol, propane and formaldehyde. (The board ultimately accepted Rea's testimony that the antigens did not contain extracts from the actual chemicals.)
The board claimed that its investigation was prompted by an anonymous complaint, which Rea described in a 2007 letter to patients as really just part of "an organized nationwide effort to destroy the specialty of environmental medicine and to eliminate from practice physicians who diagnose and treat patients suffering from chemical sensitivities." He suspected the complaint was lodged by UnitedHealthcare, since he claimed that all five patients cited in the complaint were covered by that company, and none had any problems with their treatment — in fact, the letter claimed, "two of the patients have stated that I saved their lives."
As part of the complaint process, Rea's treatment regimens for the patients were peer-reviewed and found lacking. Rea and some other doctors subjected to such outside analysis would characterize the process as "sham" peer review. (Rea settled with the board in 2010, agreeing to revise patients' informed-consent forms and to not use any "new" therapy that contains any amount "of the active ingredient of substances that are classified as hazardous substances and/or carcinogens" by any state or federal agencies.)
Unfortunately for the board, Rea had a particularly powerful ally: Steven Hotze, a Houston physician who in 1986 aligned himself with a group called the Coalition on Revival, which believed that all disease and disability is caused by the sin of Adam and Eve; that doctors shouldn't provide medical services on the Sabbath; and that Christians "need better health" than "non-Christian counterparts, for the advancement of God's Kingdom."
Like Rea's, Hotze's approach to medicine is unconventional. Hotze traffics in scientific certainties either ignored or unreported by his mainstream counterparts. Birth control pills, for example, stifled the production of women's pheromones, "making them less attractive to men." But perhaps Hotze's finest contribution to the world of medicine is the groundbreaking discovery that men who have lost their testicles to disease or injury "have difficulty reading a map [and] performing math problems."
Hotze used his radio talk show to denounce the medical board and rally support. He contributed generously to Republican campaigns, both personally and through one of his PACs, Texans for Patients' and Physicians' Rights. (Hotze declined to comment for this story.)
Hotze and contributors to his PAC meant to "weaken the [board] through select legislators, the very ones that help[ed] to enact tort reform," Kalafut wrote in an email.
The board's purse strings were controlled largely by former Texas Rep. Fred Brown (R-Bryan), head of the regulatory subcommittee of the House Appropriations Committee. Hotze had called on Brown to convene a special hearing to examine the board's disciplinary actions. He didn't exactly have to twist Brown's arm — as explained in a Dallas Morning News article, Brown was a bit miffed that the medical board was investigating a Bryan gynecologist who was Brown's business partner in something called Physicians Insurance Group of Texas.
Brown also took a special interest in the board's investigation of one of Hotze's associates, Dr. David Sheridan, whom the medical board accused of relying on "junk science" in treating poorly diagnosed patients with unproven "bio-identical hormones." (These can allegedly help castrati reclaim wayward map-reading skills.)
Sheridan was scheduled to have a private hearing with the board in what is known as an informal settlement conference. Legislators are allowed to sit in on the meetings provided they sign a confidentiality agreement that states they are observing the proceedings for "legislative purposes" only.
In August 2007, Brown wrote a letter to the board's then-executive director, Dr. Donald Patrick, saying he was "extremely interested in the outcome" of Sheridan's settlement conference.
Another legislator — Texas Rep. John Zerwas (R-Simonton), who is also a doctor — wrote Patrick, ostensibly in his capacity as physician, not politician.
Battle of the Piney Woods: SFA vs. SHSU
TicketsSat., Oct. 1, 3:00pm
University of Houston Cougars Football vs. Tulsa Golden Hurricane Football
TicketsSat., Oct. 15, 11:00am
Rice University Owls Football vs. UTSA Roadrunners Football
TicketsSat., Oct. 15, 6:00pm
Rice University Owls Football vs. Prairie View A&M University Football
TicketsSat., Oct. 22, 2:30pm
Although complaints filed by patients are supposed to be confidential, Zerwas used the patient's name in his letter stating that he reviewed the complaint of Sheridan. (Zerwas declined to comment for this story.)
"In my capacity as Chief Medical Officer of the Memorial Hermann Healthcare System, one of my responsibilities is to evaluate the care which physicians on our hospital staff provide their patients," Zerwas wrote. (According to a Memorial Hermann spokesperson, Sheridan has never been on the hospital system's staff.) "In the case of Dr. David Sheridan, it appears to me that this complaint should have been dismissed without requiring an Informal Settlement Conference."
Zerwas wrote that he planned on attending Sheridan's conference and requested in advance "some explanation of your rationale in scheduling an ISC on this case." (Sheridan reached a settlement with the board in 2010 in which he agreed to revise a patient consent form as well as disclose to patients that Hotze had a financial interest in the pharmacy to which they were directed.)
"I felt totally betrayed and demoralized by the very legislators that directed me to enforce tort reform, and to make the [board] strong and police its own," Kalafut wrote to the Press. "I felt betrayed by the Governor's office, who allowed this to happen to its volunteer board."
Kalafut also claims that, around this time, colleagues told her that a private detective had come to their offices. She tells the Press that Hotze "hired a private detective to come to Abilene to find whatever damning piece of information he could find on me and my husband." (Hotze would later deny the allegation.)
Hotze's multipronged attack also included the filing of a complaint with the Travis County District Attorney's Office accusing Kalafut and Patrick of "misconduct" and requesting an investigation. (A Travis County assistant district attorney would later decide "that there is insufficient evidence to find that criminal activity has occurred.")
"Remember that the wheels of justice grind slowly, but they grind very fine," Hotze wrote in a December 2007 email to his colleagues and supporters. He also wrote, "We are getting ready to take legal action before Christmas which will shake [the] very foundation of the TMB...If the members of the TMB were not so arrogant, duplicitous and self righteous, then I would almost feel sorry for them because of the untenable position in which they will shortly find themselves."
That same month, Kalafut received a memorable Christmas card. Postmarked Dallas, with a return address of "A.B.I.T.H.," it bore a message penciled in big block letters: "One can not be too careful in the enemies they chose. You have chosen unwisely. You will pay."
It's 2012, and Andrew Schlafly, attorney for the Association of American Physicians and Surgeons, is at the group's annual meeting, in San Diego, explaining how he's tearing the Texas Medical Board a new one.
The lawsuit — historic in scope — was proceeding perfectly.
"As far as I know, there has never in the history of the United States been a lawsuit like ours which brought a state medical board to trial for its misconduct," Schlafly says from behind a podium.
He assures the audience that the case is being closely monitored by nervous medical boards everywhere. And not only that, he noticed that very morning that the sore on his foot that had been oozing pus had suddenly healed itself after months. This was a good omen.
"Texas is the leader in some of the behind-the-scenes programs of medical boards," Schlafly says, pointing out that the Lone Star State is home to the Federation of State Medical Boards and therefore a major influence on other boards' policies.
"That is a well-funded organization that pushes out some of these bad anti-doctor ideas into medical boards all around the country," he says. And the fact that the medical board in the foundation's home state — "a bullying board that terrorized everybody" — was facing a federal comeuppance would send a serious message.
Schlafly's words are like a soothing homeopathic palliative to the members of the Association of American Physicians and Surgeons, a professional organization that offers a healthy alternative for doctors who feel there's a little too much evidence in evidence-based medicine.
Founded in 1943 as an organization as much political as professional, the AAPS sued the federal government in 2010 over the Affordable Care Act and lobbies against the "evil" of Medicare. The group considers itself the protector of both physicians' and patients' rights, the moral alternative to the government stooges at the American Medical Association.
The association's Journal of American Physicians and Surgeons is also notable for running articles on the connections — debunked by mainstream medicine — between vaccines and autism, and abortions and breast cancer. The Spring 2005 issue included an article titled "Illegal Aliens and American Medicine," which notes how "illegal alien women come to the hospital in labor and drop their little anchors" and then have the audacity to "cynically ply our compassion against us." As early as 2004, the association complained of the Texas Medical Board's complaints process, accusing the board of exaggerating allegations "to make [the] accused physician sound worse than he or she is" and of failing to realize that "complaints from hospitals, lawyers, or disgruntled patients can stem from anticompetitive motives or from issues such as a billing dispute."
Once Hotze, Rea and sympathetic legislators criticized the medical board, the AAPS knew the gloves had to come off. First, the association needed to find a lawyer who'd be willing to take on the establishment. A lawyer whose ideals aligned with theirs. There was no better choice than Schlafly.
For one thing, his lineage was impeccable: He's the son of prominent conservative activist Phyllis Schlafly, who in the 1970s fought tooth-and-claw against the proposed Equal Rights Amendment, which stated that "equality of rights under the law shall not be abridged...on account of sex."
Andrew Schlafly is also the founder of Conservapedia, Wikipedia's bizarro twin, which tells us, among other things, that a key tenet of the Homosexual Agenda is preventing five-year-old gay kids from "attending therapy to repair their sexual preference." (Note: Per Conservapedia, if a five-year-old boy is gay, there's a strong chance that either he devotes too much time to figure skating instead of baseball or he hates his dad.)
The lawsuit was filed against the medical board as a whole and its 19 members individually; however, all the individual claims except Kalafut's were dropped. The association accused her of cooking up frivolous complaints and using her position to circumvent the review process in order to sink her competition. The suit also accused Kalafut's physician husband, Dr. Ed Brandecker, of aiding in the conspiracy.
The AAPS chose Abilene physician Dan Munton as its star witness against Kalafut. Now the head of a successful Abilene sports medicine practice, Munton was once partners with Kalafut and her husband. He had left the practice in 2002, spent two years in St. Louis and, upon returning, received his first confidential complaint. He figured Kalafut had to be behind it. Even after Kalafut and her husband waived their confidentiality, proving they did not file the complaint, Munton and the association pressed on.
"To say I was lonely and sad is an understatement," Kalafut wrote to us. "No one was out there defending me...There appeared to be a feeding frenzy at my expense, fueled locally by my ex-partner and others, and statewide by" Hotze and the association.
The smear campaign and nasty emails continued. One morning, Brandecker opened the clinic's email in-box and read a message from "Grim Reaper": "Dear Dr. Faggot Brandecker, Do you really think it's a good idea to publicly advertise your location and where you can be found after what you and that bitch whore of a wife of yours has done to destroy people's lives??"
By this time, Kalafut says, she was already rattled after the 2007 Christmas card threat. She tells the Press by email that she was "assigned a deputy from [the] DPS criminal investigation unit."
"I and my husband were advised to obtain a concealed handgun permit. I was instructed to park in a different location every day and to always look over my shoulder when alone outside."
These were, Kalafut would later say, "very, very lonely years."
The smear campaign against the medical board and Kalafut had a high-profile driver in Hotze, whose prolific PAC newsletter rants and radio-show tirades predicted how the lawsuit would bring an end to the board as Texans knew it. But he had help from a fleet of physicians who felt they were wronged and were eager to support Hotze's crusade.
One of the more vocal supporters was Victoria family physician Shirley Pigott, whom Hotze invited on his radio show to explain how she had been targeted by a former board member after she exposed what she believed was a serious conflict of interest.
Pigott had first caught the medical board's attention in 2005, when the board responded to a complaint over a minor record-keeping matter. Pigott entered into an agreed order with the board, under the terms of which she would obtain ten hours of continuing medical education within one year, and she was fined a $500 administrative penalty.
But Pigott soon suspected that at least one board member was conspiring against her. She believed she was being followed and harassed. This feeling came to a head in September 2007, when she was pulled over for speeding on U.S. 59 between El Campo and Wharton.
Pigott would later argue that it was late at night and that she suffered from a mental condition that made her falsely perceive certain situations as threatening. She would also write on numerous blogs that she could not be certain the DPS officer who pulled her over was not actually a rapist in disguise. Or possibly just a goon dispatched by the board. Ultimately, Pigott fled from the officer who pulled her over and a detective who had later come to the scene.
According to court records, and Pigott herself, when the DPS trooper attempted to smash her window with his flashlight, Pigott gunned her Prius, narrowly avoided an oncoming 18-wheeler, and drove at speeds exceeding 100 mph for 93 seconds. Pigott was charged with two felony counts of evading arrest with a motor vehicle, as well as felony assault of a peace officer.
Four months later, Pigott's husband, a Victoria College chemistry professor, was found dead in a trash bin behind Pigott's clinic. A justice of the peace would rule his death a suicide via overdose of Prozac and Ambien. (Citing health reasons, Pigott declined to comment for this story.)
In a subsequent email to her and Hotze's supporters, Pigott wrote that her husband "was a casualty of a corrupt Texas Medical Board." She claimed that "the Texas Medical Board was aiming at me; they missed and killed my husband. I will hang them on the gallows they have built for innocent doctors."
In March 2009, while Pigott's charges were pending, the medical board suspended her license. The suspension order stated that the board's forensic psychiatrist concluded that Pigott "is more likely than not psychotic" and "is a continuing threat to her patients and/or the public due to her impaired status."
Five months later, she was convicted of the felony evasion charges and sentenced to two years in prison. She remained a martyr of the movement.
It's unclear if Hotze or anyone else knew that, a year before she went to prison, Pigott emailed Kalafut asking for a job as a board consultant.
"I believe the [B]oard has reached a turning port," Pigott wrote. After listing the many reasons why she was the perfect candidate, Pigott wrote, "What do you think? Will you consider my offer?"
She did not get the job.
On September 25, 2013, approximately six months after closing arguments and six years after the suit was filed, U.S. District Court Judge Lee Yeakel dismissed the AAPS's complaints.
"The Association's body of proof is inferential and conjectural, failing to convince the court that there is legal merit to any of the Association's allegations," Yeakel wrote.
He also wrote, "The Association has failed to provide any evidence beyond conjecture that Kalafut would somehow work in concert with state officials to manipulate the outcome of physician complaints before the Board."
The AAPS waived its right to appeal and appears to be focusing its efforts on abolishing the Affordable Care Act.
Even though she was vindicated, Kalafut is still disturbed by the online detritus of the smear campaign. Posts about Kalafut and the Board causing a man to kill himself. Posts about her being prosecuted by the Travis County District Attorney. None of it true.
She tells us that when Schlafly "asked what I wanted for a 'settlement,' my attorney relayed that I wanted them to withdraw all the negative Internet postings on me, send a statewide retraction to all the physicians they bombarded with mailing about me...His response was that they didn't feel they did anything wrong. They wished me well and would welcome me into their organization. They were also willing to give me $5,000 'if that would help me put this all behind me.'"
Instead, Kalafut filed suit (still pending) to recover approximately $80,000 in attorneys' fees.
And she passed on the opportunity to join the association.
Get the This Week's Top Stories Newsletter
Every week we collect the latest news, music and arts stories — along with film and food reviews and the best things to do this week — so that you'll never miss Houston Press' biggest stories.