On the heels of allegations that former Austin State Hospital psychiatrist Charles Fischer sexually abused children in his care, an American-Statesman investigation has found that the state hospital system currently employs at least three doctors with a documented history of inappropriate and in one case criminal sexual behavior.
According to records with the Texas Medical Board, three male psychiatrists have been punished for inappropriate sexual relationships. One of them pleaded no contest to sexual indecency with a child in the late 1980s. The other two were sanctioned by medical boards in the 2000s after they were accused of having sexual relations with adult patients they treated before working at the state hospitals.
http://liarcatchers.com/fraud_investigation.html
“They were hired because they were qualified candidates whose licenses were in good standing at the time they were hired,” said Carrie Williams, spokeswoman for the Department of State Health Services, which runs the hospitals. “They have good work histories with us.”
On Thursday, several days after the Statesman presented the state with information about Rusk State Hospital psychiatrist Gary Paul Kula, who was punished twice by the Oklahoma medical board for sexual relationships with adult patients, the department reassigned him to a hospital job in which he does not have one-on-one contact with patients. Williams said she could not comment on what prompted Kula’s reassignment.
Unlike Fischer, none of these men is publicly accused of abusing children. In fact, these doctors do not treat people younger than 18.
But at a time when state officials are scrutinizing how they protect patients from sexual abuse, the employment history of these doctors raises questions about who works at state hospitals and what kind of risks the state is willing to take in its hiring decisions. It also highlights the challenges the facilities have attracting and maintaining psychiatrists in the face of staffing shortages, difficult working conditions and starting salaries that until recently were significantly lower than those in the private sector.
No matter what the challenges, patients always come first, Williams said. For now, the state feels comfortable with employing these three doctors.
“That said, we are scrutinizing all aspects of how we protect patients, including reviewing the allegations and discipline histories of all of our hospital employees, how we monitor those allegations and how we assess risk,” she said.
Williams said state rules prevent her from detailing whether patients have filed complaints against these doctors and, if so, the nature and frequency of any allegations. But mental health advocates say hiring psychiatrists with such records is imprudent.
“The hospitals shouldn’t give them a chance at all,” said Beth Mitchell with Disability Rights Texas, a federally appointed advocacy group for people with disabilities. “You’re putting them into the most vulnerable population.”
Bars to employment
Texas’ 10 state-run psychiatric hospitals are inpatient facilities for 2,500 adults and children with serious mental illnesses such as schizophrenia and depression. The hospitals — located in cities including Austin, San Antonio and El Paso — provide patients with medication, therapy and other services.
Psychiatrists are the core of that care. Although treatment is provided by a team of professionals that includes social workers and psychologists, doctors hold the most power, ultimately determining what drugs to administer and when to release patients from the hospital.
The state takes great care when hiring those doctors, Williams said. Officials require psychiatrist candidates to undergo criminal background checks and drug testing. They review the department’s database on abuse and neglect confirmations. They check out a psychiatrist’s medical license and disciplinary history in all 50 states.
The department also has a list of bars to employment, Williams said. A criminal conviction for aggravated assault, indecent exposure or Medicaid fraud, for example, would take a candidate out of the running.
But the case of Rusk State Hospital psychiatrist Larry Hawkins shows such rules on criminal histories are more complicated than they appear.
In 1984 , Hawkins, who is now 56, was arrested amid accusations that he fondled a 13-year-old boy while on a camping trip at Pedernales State Park, according to records from the Blanco County Courthouse and Statesman newspaper archives. The following year, as Hawkins’ criminal case worked its way through the system, Austin State Hospital hired him to work as a psychiatrist.
In 1987 , Hawkins pleaded no contest to felony indecency with a child and was sentenced to eight years’ probation by a Blanco County judge, records show. A plea of no contest means the person does not deny the charge, nor admits guilt.
Hawkins, who earns $193,000 a year, did not return calls seeking comment for this story. But according to documents from the Texas Medical Board, Hawkins told the board he was innocent of the charge and pleaded to avoid possible jail time.
After his plea agreement, the medical board decided the psychiatrist could keep his license, with restrictions such as not working with children for 18 months .
“His superiors/supervisors consider him an excellent physician and have requested that he be permitted to remain on staff at the hospital,” the medical board wrote in its order allowing Hawkins to continue practicing. “The Austin State Hospital generally has trouble recruiting and retaining qualified physicians due to budget deficits, inadequate remuneration and difficult working conditions.”
In 1990 , after two years and six months of probation, the court allowed Hawkins to withdraw his plea, and the indictment was dismissed, according to records from the Blanco County Courthouse.
Under the state’s current rules, people with convictions for indecency with a child cannot work at the state hospitals. But that rule wasn’t established until 1993 and would not apply to Hawkins, Williams said. Plus, the fact that his indictment was dismissed makes him eligible for employment.
Hawkins does not work with children at the hospital.
“If we didn’t feel comfortable with a particular person working with our patients, we would absolutely take action,” Williams said.
Relationships with patients
The agency also has at least one employee with a confirmed complaint by the Department of Family and Protective Services: Alejandro Munoz, 58, a psychiatrist at Terrell State Hospital.
In late 2005, the Texas Medical Board penalized Munoz for having an “inappropriate relationship” with a 23-year-old patient while working at West Texas Centers for Mental Health Mental Retardation in Big Spring. According to the medical board records, the Department of Family and Protective Services, which investigates claims of abuse against people with disabilities in institutions or community programs, confirmed the relationship with his female patient, who had depression and bipolar disorder.
The medical board fined Munoz $2,000 and ordered him to attend a class called “A Continuing Education Course for Physicians Who Cross Sexual Boundaries.”
Munoz did not return telephone calls seeking comment. He was hired by Terrell State Hospital in June 2006 and earns $189,000 a year. Public records indicate that he does not have a criminal record.
Though Williams said she could not detail the specifics of that hiring decision, confirmation of such relationships is not a bar to employment for psychiatrists. Such situations are judged on a case-by-case basis.
“You’re looking at whether this is an ethical violation or a criminal violation or anything in between,” she said.
Kula , the Rusk State Hospital psychiatrist who was reassigned last week, has had multiple problems with his medical license over the past 23 years, public records show.
In 1988 , Kula was working in Oklahoma when the state’s medical board put him on three years’ probation because it said he had engaged in a sexual relationship with a patient, according to records with the Oklahoma Board of Medical Licensure and Supervision. Kula later married that woman, board records state.
Thirteen years later, Kula’s license was suspended. In its order, the Oklahoma medical board said that while working at a mental health center in Ardmore, Kula kissed and groped a female patient against her will. The board also accused him in those records of meeting another patient at hotels for a sexual relationship.
That woman sued Kula, and the lawsuit was settled for $120,000, according to documents filed in U.S. District Court for the Western District of Oklahoma.
In 2002, the Oklahoma medical board lifted his suspension and placed him on probation for five years . Kula, who also held a Texas medical license, was hired at Rusk State Hospital in 2005 . He earns $186,000 a year.
Under Texas law, it is a second-degree felony for mental health service providers to engage in sexual relations with their patients. Other states, including Connecticut, Idaho, Minnesota and Arizona, have similar laws.
Gary Schoener , a Minneapolis psychologist who has helped states craft such legislation, said that romantic entanglements between doctors and patients can be disastrous. Therapy is an intensely emotional experience that gives patients a distorted view of their doctors or therapists, making them unable to meaningfully consent to a sexual relationship, he said.
Such incidents can destroy families and careers, Schoener said. Sometimes, it also leads to suicide.
“There’s no earthly reason why this should happen,” he said. “You have some pretty devastating results.”
Colleen Horton , a program officer with the Austin-based Hogg Foundation for Mental Health , questions the state’s decision to employ people such as Kula and Munoz. The risk to patients is just too high, she said.
“I think there’s obviously some holes in the way we’re determining who can work in these places and continue to work in these places,” she said. “That needs to change.”
Finding the right people
An overwhelming number of psychiatrists at Texas’ state hospitals have no blemishes on their professional licenses, according to the Statesman’s review of medical board records. But finding enough people to work there has been difficult.
Of the 153 psychiatrist positions currently funded at all 10 hospitals , 28 are vacant, Williams said.
Officials said a big part of the problem is that, until recently, the hospitals offered salaries that were far lower than not only those in the private sector but in prisons and other institutions as well.
In January , the average starting salary for a state hospital psychiatrist was $160,000 , according to a report by the Department of State Health Services.
That was far below the average of $188,000 offered to doctors starting out at the Texas Department of Criminal Justice, the $192,000 paid at state supported living centers for people with intellectual disabilities and the $203,000 those in the private sector earn, the report said.
But the state hospitals have made progress in this area. This year, the legislature gave them an additional $5 million for psychiatrist salaries, and now new doctors make about $185,000. Those increases took effect in October .
Despite the previously low salaries, the department never cut corners or compromised on quality to fill empty slots, Williams said.
“We look at the pool of applicants and choose the best person for the job,” she said. “Sometimes, that pool is smaller than we’d like, but we’ll go without a psychiatrist before hiring someone who we believe is a risk.”
Williams said the state takes measures to protect its patients from abuse, such as reporting all allegations to the Department of Family and Protective Services, using cameras in some buildings and screening job candidates.
In the wake of the Fischer allegations, the department recently added new rules to protect patients. Staffers accused of sexual abuse must now be transferred or put on emergency leave while they are being investigated. Therapy or treatment room doors must remain unlocked during sessions.
The Fischer case has been painful, Williams said, but the department is determined to learn from it.
“We’re not done here,” she said. “This is not the end of the road for us. We have more improvements to make and more changes to come.”
