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Cash reserves of more than $1 billion were built up, in part, by skimping on staff and building upkeep.

By REESE DUNKLIN
Staff Writer
Dallas Morning News
rdunklin@dallasnews.com

Parkland Memorial Hospital quietly amassed more than $1 billion in cash reserves even as deteriorating patient-care conditions brought it to the brink of closure, an analysis of financial records shows.

The Dallas County taxpayer-supported hospital built the reserve over the last several years, in part by reducing staff and available beds, neglecting its aging building and moving hundreds of millions from the operating budget to help finance construction of a new hospital.

Federal regulators have since forced Parkland to plow at least $75 million back into operations to remedy lapses that they said threatened patients’ lives. That has prompted questions about whether focus on the new $1.2 billion hospital complex exacerbated Parkland’s patient-safety breakdowns.

Dr. Allan Shulkin, a member of Parkland’s governing board from 2004 to 2009, said a reason he left was because he was “a little troubled by what I thought to be an over-emphasis” on construction. He recalled hospital management assuring the board that patient care was under control and sufficiently funded.
It is clear now neither was the case, he said.

“Did we — the board, my board, the current board — get so focused on the new building that we forgot about operations?” said Shulkin, a pulmonary specialist who trained at Parkland in the mid-1970s. “I worry that that began to happen.”

Parkland officials declined Dallas Morning News interview requests. They referred to annual year-end statements of the Parkland Health & Hospital System for information about hospital finances. The News analyzed 10 years of such statements, obtained under the Texas Public Information Act. The statements don’t clearly explain how much money Parkland has at its disposal, but the hospital eventually said its “reserves” encompass cash, investments and assets limited to use, which is akin to savings.

By the Sept. 30 close of fiscal year 2012, those sources totaled just over $1 billion. Of that, about $315 million was restricted to new construction or bond debt repayment.

“We have plenty of cash on hand,” Ted Shaw, Parkland’s interim chief financial officer, told the Board of Managers during a December public meeting.

Parkland benefits from one of the nation’s biggest local-government hospital subsidies — a property tax that generates more than $400 million annually, about a quarter of Parkland’s total revenue. The tax rate is the second-highest for a Texas public hospital, at 27.1 cents per $100 in assessed property value.

Dr. Dana Forgione, an expert on health-care finance and accounting at UT-San Antonio, said public hospitals often don’t make clear how much they have in reserves so as to avoid questions from taxpayers.

“How can they have $1 billion and they couldn’t improve quality a little bit? Those are the questions they don’t want,” Forgione said after reviewing Parkland’s two most recent annual statements. “I understand there’s got to be a trade-off between current expenditures and long-term investment in new and improved facilities. But $1 billion is a lot of money, right?”

Starting in fiscal 2005, Parkland took surplus revenue from daily operations and saved the funds for construction of a new state-of-the-art hospital. Officials have touted what became a 17-story facility on Harry Hines Boulevard as “the largest hospital construction project in the United States,” likening it in size to Cowboys Stadium.

By 2011, Parkland had set aside more than $400 million, records show. The surpluses came from cutting spending on staff and charging higher prices for treating its mostly poor, uninsured patients, among other things.

The amount saved was higher than the $350 million in “cash reserves” that hospital officials had promised to contribute as part of a bond deal approved by voters in 2008. That election gave Parkland permission to sell more than $700 million in construction bonds — the biggest chunk of the new hospital’s financing.

Parkland’s total cash supply peaked at nearly $1.5 billion in early 2011 and began to decline as construction got under way.

Kevin Holloran, a health-care analyst from the Standard & Poor’s credit-rating agency, said Parkland’s balance sheet looked a “little rich.” But the cash levels were a “blip right now on the radar screen” because of construction.

“Cash becomes a very contentious topic at a public hospital. ‘Shouldn’t you spend it all down?’” Holloran said. “But if you’re about to build a new hospital, our opinion would be they financially, soundly did a good thing to put away some money.”

As Parkland’s cash supply grew, the hospital’s medical care in 2008 was coming under “near constant surveillance and investigation” because of “scores of patient complaints, injuries and death,” a federal report later showed.

The scrutiny intensified in 2011, when the U.S. Centers for Medicare & Medicaid Services found that Parkland’s patients were in “immediate jeopardy” of injury and death because of poor staffing and hospital conditions. Federal regulators took the unusual step of placing Parkland under independent safety monitoring in lieu of closure, making it the nation’s largest hospital to face such oversight.

In their February 2012 overview report on Parkland, the monitors said some hospital units lacked enough staff to accommodate emergency patients, worsening overcrowding and treatment delays in the ER. Cuts in the women and infants’ specialty hospital led to bed shortages and “unsafe” nurse-to-patient ratios. The building had soiled floors and holes in walls — duct tape covered one in an operating room — that jeopardized infection control.

The monitors quoted Parkland employees as saying that some safety problems were “the result of a budget reduction in a previous fiscal year” and “budgeted staffing constraints imposed last year.” Some concerns, such as the ER backlogs, were flagged by hospital consultants as far back as 2004, The News found.

The state also faulted Parkland for a “failure to adequately staff nurses in certain areas of the facility” — including the psychiatric ER, where a 2011 patient death triggered the CMS crackdown. In August 2012, the Texas Department of State Health Services fined Parkland a record-setting $1 million.

James A. Smith, former chair of the Texas Society of CPAs and managing director of a Dallas accounting firm, said Parkland’s leaders couldn’t blame patient-care problems on a lack of money, based on his analysis of the two most recent annual financial statements.

“Knowing what we know now,” Smith said, “it seems to me like the construction project, which was a grandiose plan, sucked an awful lot of air out of the room financially.”

For at least a decade, Parkland administrators and board members have argued that a new hospital was the cure to old Parkland’s problems.

“Indeed, Parkland’s future is largely being pinned to the public hopes arising from a new billion-dollar hospital that is making its way up from the ground across the street,” federal safety monitors noted last year. “But hospitals are not simply buildings, bricks and mortar.”

The existing hospital, which opened in 1954, had long been overcrowded. Even $140 million in improvements wouldn’t bring the structure into code compliance, consultants said at one point. And if Parkland hoped to compete for new patients, it needed modern facilities like those of other Dallas hospitals, officials said.

But expansion planning stalled in 2003. Parkland suffered a $76 million budget shortfall that year and started cutting about 500 jobs. County commissioners, who approve Parkland’s budget and appoint its board, were angered they weren’t consulted about new construction and hired outside consultants to study Parkland’s operations.

In February 2004, the board chairwoman sought a succession plan for Dr. Ron Anderson, putting his two-decades-long tenure as hospital CEO in doubt. She didn’t succeed and quit two months later, along with three other members who clashed with Anderson. A newly constituted board led by Dr. Lauren McDonald and other Anderson supporters extended his contract, and Anderson announced that his priority was to “get into a new hospital.” He did not respond to requests for an interview.

With political tensions easing, commissioners in 2005 appointed a blue-ribbon panel to explore construction options. In 2007, it proposed replacing Parkland with an 862-bed hospital. The replacement was about one-fourth larger, along with clinics and offices. Construction would be completed in phases, each likely needing voter approval. The first — featuring a medical, surgical and trauma facility — would tentatively open in 2013 at a cost $840 million.

As final plans were drawn up, Parkland administrators recommended a different approach: Building all at once.

The final bill could drop by $100 million to about $1.2 billion by avoiding the price inflation and redundancies of a gradual move-in, according to a 2008 planning briefing The News obtained. Accelerating construction, though, would require another $400 million sooner in the process.

To make that work, $747 million in bonds and a property tax-rate hike as high as 2.5 cents would be necessary. Parkland promised “to reduce the burden on taxpayers” by raising $150 million in private donations and using $350 million in “cash reserves.”

Parkland’s cash supply was nearly $600 million by mid-2008, after doubling in the previous three-year span. One-time windfalls and record-setting budget surpluses had stabilized Parkland’s finances. Commissioners also let Parkland keep its tax rate at 25.4 cents per $100 in valuation to generate extra money from higher property values.

That meant Parkland could immediately put $250 million of the $350 million into the project, according to the 2008 planning briefing. Enough cash would remain that Parkland could operate for at least four months without collecting another dime — above the median “days cash on hand” for hospitals with strong credit ratings, the briefing said.

The cash commitment helped reduce the amount of bonds needing voter approval but was about $130 million more than originally planned. Parkland forecast that its cash and investments would grow once construction began, according to the briefing.

Aiding that growth, hospital officials said, would be “revenue enhancements” and “productivity and expense improvements.” Parkland’s briefing described those as price increases above inflation and “strategic pricing” of patient services, as well as improvements in billing coding, “employee productivity” and “salary and benefit costs.”

Parkland did not define specific terms for achieving those savings but said doing so could gain $150 million between 2009 and 2014 — perhaps even eliminating need for an additional 1-cent tax hike once the new campus opened.

When Parkland’s board voted for the build-at-once plan in summer 2008, it prompted applause. “When the project got derailed almost five years ago,” Anderson said, “I wasn’t sure that this day would ever come.”

Two months later, safety inspectors showed up unannounced.

The inspectors, working on behalf of CMS, found that Parkland patients were undergoing surgery without informed consent, as federal rules require. The American Medical Association’s code of ethics says patients have the right to approve or reject their surgeon in advance.

Yet Parkland’s consent forms and other records reviewed by inspectors in September 2008 were unclear over who was performing the surgery — faculty physicians from UT Southwestern Medical Center, which staffs Parkland, or resident trainees. Consultants as far back as 2004 had found that many UTSW physicians weren’t supervising residents and urged Parkland to make changes, including hiring its own doctors.

In late October, two weeks before the November bond election on the new hospital, Parkland officials presented CMS a new consent form and insisted they saw no evidence of residents operating unsupervised. Six days later, CMS told Parkland it had revised the original inspection report to remove references to “deficiencies.” The incident remained out of public view until The News reported on it in March 2010.

Another complaint in September 2008 did get noticed. A 58-year-old man named Mike Herrera died after languishing 17 hours untreated in the main emergency room — the type of problem consultants foreshadowed in 2004. A national hospital accrediting agency, the Joint Commission, cited Parkland for about a dozen safety failures.

Parkland enacted new ER procedures and made 10 nursing hires early in the next year, as it promised CMS. Anderson, however, later said Herrera, who had a history of heart disease, was probably going to die even “had our system been working.”

Shortly after Dallas County voters overwhelmingly approved construction of the new hospital, Parkland’s board agreed to reserve the $250 million, as planned, plus another $16 million in cash for the project.

The new building, by that point, was taking more and more of the board’s time, said Shulkin, the former member. Meetings were lasting longer, and new ones were added to the schedule.

“There was a sort of new charge and direction for the board,” he said. “I got the sense that there was a lot of enthusiasm, ‘Oh, man, let’s do the new building.’”

Shulkin said he understood the project’s enormity. But that should not “distract from what we do today” — patient care, he said.

“I thought, hire the people and build it. We’ve still got a hospital to run. We still have patients to take care of,” said Shulkin, who practices at Medical City Dallas Hospital and serves on the Texas Medical Board. “We don’t need to be picking out the drapes.”

Herrera’s ER death had been appalling, he said, and frustrated some board members who had “demanded that the ER’s long waits had to stop.”

In March 2009, Shulkin decided to depart the board months earlier than planned.

“I knew, for me, I didn’t fit in there anymore,” he said. “If so much of the demands on the board are the development and construction of the new building, then let the people who are going to be there at the end be at the beginning as well.”

A month later, Parkland awarded $100 million in contracts to construction managers and designers. At a news conference to announce the firms, administrators talked excitedly about having a first-class, environmentally friendly building that was “patient-centered.” Anderson added that Parkland would no longer be a place of last resort, but rather “a hospital of choice.”

Construction bonds for the new Parkland were sold in August 2009, doubling its cash supply from about $600 million to more than $1.3 billion.

Then in January 2010, Parkland met its election pledge to put $350 million toward the new hospital. The board unanimously approved hospital administrators’ recommendations to transfer a lump sum of $53 million and monthly $2.5 million allotments during the next year from operations.

Before the vote, then-board member Louis Beecherl III cautioned that taking the money from operations at that time left Parkland “with a pretty fine line here of comfort.”

“If we don’t earn a positive bottom line, we’re going to be in real trouble,” Beecherl said, noting Parkland might not be able to build new community clinics if money became tight. “We need to be careful about what we’re doing here.”

Another board member, Alan Walne, said the money could be used for operations if necessary later. But there needed “to be pressure to bear that … we can put these other dollars away and can, in fact, perform in a manner that we told the voters we would,” according to a tape-recording of the meeting.

Parkland’s chief financial officer at the time, John Dragovits, told the board that the hospital would enforce fiscal “discipline so that we’re not in that situation.” Anderson added, “This is first things first.”

In a recent interview, Beecherl said his comment had “nothing to do with patient care.” He simply wanted Parkland to ensure a strong bottom line to maintain investor confidence, he said. Two credit-rating agencies, Fitch and Standard & Poor’s, had given Parkland’s bonds their highest scores, which reduced borrowing costs.

Asked whether Parkland’s large construction project had created financial pressures, Beecherl said the only pressure was finishing it.

“We were functioning in a 60-year-old building, and patient care was not up to current-day standards because of the age of the facility,” said Beecherl, an energy businessman. “The quicker we could build a new facility, the quicker we could get in and improve patient care to modern-day standards.”

Walne added, in an interview, that there was no talk that “we can skimp on patient care so that we can spend on a new hospital.”

“At the end of the day,” he recalled, “when we’d gotten everything taken care of, any dollars that we had … [in surplus,] we would try to set those dollars aside for the new hospital.”

As the hospital broke ground across Harry Hines Boulevard in October 2010, Parkland was also delivering on the “operational improvements” promised before the bond election.

Parkland earned nearly $150 million more in revenue between fiscal years 2009 and 2011 despite the sluggish economy. The hospital did that through price hikes in commercial insurance contracts, rate increases in Parkland’s managed-care plan for Medicaid recipients and “record-breaking reimbursements” through improved medical billing.

Parkland also cut salaries, wages and benefits. From fiscal 2007 to 2009, those expenses had increased by nearly $130 million. But in 2010, they were up only $33 million and, in 2011, they declined $3 million. That was the first reduction since 2003, when state budget cuts prompted layoffs.

A similar trend was apparent in the number of full-time employees, according to a News analysis of data Parkland produced in a public information request.

From fiscal 2007 to 2009, nurses and other classifications of caregivers increased by 9 percent, and Parkland’s total workforce was up by 8 percent. Both exceeded a nearly 7 percent growth in patient volumes.

In 2009 through 2011, however, nurses and caregivers increased by 1 percent, and the total workforce decreased by about 1 percent. Both lagged behind an 8 percent growth in patient volumes.

The cutbacks included about 200 jobs that Parkland eliminated to save $14 million in the fiscal 2010 budget. Officials had cited fears that property values would decline. Parkland said at the time most of the jobs were clerical, and an unspecified number would have been phased out because of a shift to electronic medical records. About half were already vacant, officials said.

For their 2009 and 2010 efforts, top hospital executives and administrators were awarded year-end “incentive” payments. Those bonuses totaled about $6 million for achieving goals such as reducing ER wait times and improving Parkland’s net income.

In recent interviews, former board members Walne and Shulkin said they may have asked administrators to justify staffing expenses, in general. But they recalled no edict to slow hiring or salary spending starting in fiscal year 2009.

“The question of staff was always,” Walne said, “do you have the resources you need to meet the goals you’re trying to achieve in the increase in quality?”

Walne said periodic safety inspections and News coverage of Parkland’s patient care failures had not suggested a “chronic problem” by the time his term ended in early 2011. The Joint Commission, he noted, had also extended Parkland’s accreditation after doing its own inspection in 2010 and was “very complimentary, quite frankly, of the care that was going on.”

“We would have reacted to whatever the recommendations would have been to accommodate patient care,” said Walne, who runs his family’s auto paint and body business. “We would not have known as a board where we needed to be spending money, because no one was giving us an indication that we had deficiencies where stuff needed to be addressed.”

Parkland finished its 2011 fiscal year with a surplus of $105 million — the seventh straight year with a margin of 5 percent or more. It even committed nearly $50 million more to construction. All of that despite having lowered the property-tax rate from 27.4 cents to 27.1 cents per $100 in assessed value.

Some county commissioners had questioned that cut, because of looming state and federal health-care overhauls that might change funding and patient volumes. But Dragovits had assured them during public discussions over the 2011 budget: “We’re not in a position of needing any kind of relief.”

Ongoing patient-safety breakdowns, meanwhile, prompted CMS to launch a massive, top-to-bottom inspection of Parkland.

Regulators found patients were in “immediate jeopardy” of harm or death and faulted the board’s oversight of the hospital. In September 2011, just weeks before the fiscal year ended, the government threatened to cancel more than $400 million in annual Medicare-Medicaid funding.

Continued federal funding was made contingent on Parkland hiring outside safety monitors to overhaul hospital operations, under CMS supervision. The board hired the Alvarez & Marsal Healthcare Industry Group, at a cost now exceeding $9 million, and accepted an April 2013 deadline to reform.

Alvarez & Marsal monitors found that Parkland was failing to meet about half of the government’s 100 or so safety standards and continuing to have an “extremely troubling” number of adverse patient events. Senior hospital managers also hadn’t kept board members “as informed as they should have been” and did not initially share “critical information and documents” during the government crackdown, the monitors wrote.

“Parkland faces regulatory, safety and patient care deficiencies in nearly every aspect of its organization and delivery system,” the monitors said in their February 2012 overview analysis. “If the deficiencies catalogued in this report are not addressed and fixed, Parkland could not pass a CMS hospital survey [inspection] and would not continue as a Medicare and Medicaid participating hospital.”

Some problems were attributed to past budget constraints that led to staff reductions and beds taken out of service. Others were the result of a lack of investment in operations and the existing building.

Parkland, for instance, hadn’t implemented rigorous methods to track the quality of care and performance of UTSW physicians and residents. Hospitals were required in 2008 by the Joint Commission and other accrediting groups to collect such data, monitors noted.

Other problems were in plain sight. In medical and surgical units, there wasn’t an “appropriate level of care-staffed inpatient beds” at key times. That translated into about 30 available but unstaffed beds a day.

“We were told that this was due to budgeted staffing constraints imposed last year,” monitors wrote.

In the ER, patients were forced to wait “longer than acceptable” to transfer. The backlog increased workloads for an already understaffed nursing team. It also “creates safety risks and creates delays for other persons presenting to the hospital for evaluation and stabilizing treatment,” monitors said.

Patients chose to leave without treatment at rates twice the national average in 2011, monitors found. The ER was so full Parkland diverted ambulances to other trauma centers during one-third of its hours each month.

In Parkland’s women’s and infants’ specialty hospital, known as WISH, two units were closed in 2011 and staff decreased by about 20 in anticipation of a decline in deliveries. But the number of patients increased in a few months’ time, monitors wrote.

That made beds scarce at peak times and forced women to recover in hallways or classrooms. Nursing-to-patient ratios in some areas became “unsafe.”

“While Parkland’s new hospital facility should be designed to resolve the inadequate size, proximity and model of care,” the monitors wrote, “Parkland must still make investments in the current hospital facility, specifically in WISH, to ensure a safe environment.”

The hospital itself was in such disrepair that some areas required immediate attention. Floors were soiled, paint chipped and furniture torn in WISH. An operating room had a hole covered by duct tape and a door that wouldn’t close completely. In another unit’s break room, large wet stains on ceiling tiles contributed to infection control risks.

“While Parkland’s current facility may show wear and tear due to its age, it does not have to be unclean,” monitors wrote. “Even the oldest facility can maintain an appearance and standard of cleanliness appropriate for patient care.”

Monitors warned that fixing the deficiencies by the April 2013 deadline was a “heroic challenge” that would require the focus of front-line staff, executives, the board and the community.

“The hospital is in the midst of a major construction project with the ongoing construction of a new hospital facility,” they wrote. “However, construction updates and discussions should not overwhelm or overtake the critical time necessary to oversee quality and safety functions and successful performance.”

The challenge also required money. Parkland estimated that it spent about $32 million in CMS-related expenses by fiscal 2012’s end in September. Just over half of that was on staff salaries, retention payments and benefits. Parkland projected adding roughly 250 full-time employees, including nurses, patient-care assistants and social workers.

The additions contributed to an 11 percent increase in nursing and other caregivers from 2011 to 2012, while patient volumes fell by about 1 percent. The growth rate was also the biggest since at least 2005, the earliest year-to-year comparison possible using the employment data Parkland provided The News. Despite the hires, another 400 nursing positions remained unfilled just before fiscal 2012’s end.

Another $45 million in CMS-related spending was estimated for fiscal 2013 year.

Among the specific investments made since the government’s intervention:

•New hires in the hospital’s medical and surgical units to accommodate more patients from the ER. Parkland also will create a 13-bed medical unit by converting space UTSW researchers were using and add 22 beds by remodeling offices that were once patient rooms.

•Renovations totaling up to $4.3 million in the main emergency department and psychiatric ER, and a redesign of the replacement hospital’s ER to meet safety standards. More than 100 caregiver positions were added in those short-staffed areas at nearly $6 million in fiscal 2012 alone. In early February, privately owned Green Oaks Hospital in Dallas was hired for about $1 million annually to manage the psych ER.

•An additional 28 beds in the women’s and infants’ hospital by reopening one of the closed units and filling 26 positions. Monitors also recommended studying how to use the second closed unit.

•At least $3 million on software systems to better manage patient cases, collect data, and measure clinical outcomes and physician performance. The monitors had urged Parkland’s board to “commit to the provision of financial support for the quality program.” They also recommended a patient rights and safety executive post, which is unfilled.

The expenses had Parkland executives worried publicly over their bottom line. Blaming the CMS-related improvements in part, they predicted fiscal 2012 would end in a loss for the first time in a decade.

“This is something we haven’t had to worry about since I got here,” Dragovits, the CFO who arrived in 2006, said during a March 2012 board meeting.

Dragovits retired last summer. He did not respond to requests from The News for an interview.

By the fiscal year’s end in September, Parkland reported making about $30 million more than it spent, according to its financial statement.

“We’re very financially healthy,” Shaw, Parkland’s interim CFO, said during December’s board meeting. “We continue to be well positioned.”

Nonetheless, there was some financial uncertainty.

Parkland forecast that it would close the fiscal year in September 2013 with a $6 million deficit because of the CMS-related spending, increased drug costs, more uninsured patients and Medicaid funding changes. Officials said balancing its budget would require using some of the $1 billion in “reserves.”

Parkland staff also told the board the replacement hospital would either need more funding to finish it as originally designed under the build-at-once plan or would need to be scaled back. And the 1-cent tax-rate increase it thought “operational improvements” could eliminate would be assessed starting in fiscal 2014, at a slightly higher rate of 1.4 cents.

If Parkland requires more money for construction and patient safety, the hospital could have its finances tested unlike in previous years, financial experts said. Dipping excessively into reserves would potentially make investors nervous, and asking for additional tax support is politically risky.

Already Standard & Poor’s has placed a “negative” outlook on Parkland’s bond rating. It did so after monitors released their critical analysis of Parkland’s problems. That meant a 1-in-3 chance Parkland’s rating could be downgraded, increasing future borrowing costs.

“We felt the risk is significant enough,” said Holloran, the S&P analyst, “that we owed it to the public to say they have a potential problem here.”

For former board member Shulkin, Parkland’s failures have left him “stunned and heartbroken.” He said he’s read the inspection reports and analyses and agreed with CMS’ mandates that the hospital spend millions on improvements.

Given the financial resources Parkland had at its disposal, Shulkin said, “It never should have come to this.”

“The problem with Parkland is, they forgot to take care of what they have to deal with every day,” he said. “They were so seemingly focused on what’s going on across the street that they’re forgetting about what’s going on inside these hallways.”

Staff writers Miles Moffeit and Sherry Jacobson contributed to this report.

http://res.dallasnews.com/graphics/2013_02/parkland/#day5main

Parkland Memorial Hospital is the nation’s largest healthcare facility ever forced into federal oversight to remedy patient-safety dangers. How did the landmark Dallas County public hospital reach this precipice? The problems have been years in the making.

By BROOKS EGERTON
Staff Writer
begerton@dallasnews.com

The nurse aide was accused of raping a grandmother who could barely walk. Doctors moved her from Parkland Memorial Hospital to another facility, where caregivers caught the man trying to track her down. Parkland fired him for “unsatisfactory work performance” and moved on.

Hospital police overlooked or ignored potential evidence and never filed charges. Hospital administrators failed to alert state regulators, as required by law. And Manuel Rodriguez went to work for a hospice company, caring for dying people in their homes. He denies wrongdoing, and Parkland said its police force found no evidence to support the rape allegation.

Parkland Memorial Hospital faces an April 2013 federal deadline to prove it is safe. How did Dallas’s landmark public hospital reach this precipice? Read First, do no harm, a compilation of The Dallas Morning News’ coverage of Parkland’s patient-safety crisis. The case is one of at least 25 in recent years in which patients accused Parkland caregivers of sexual abuse. Parkland’s in-house police force — which controls all criminal investigations of hospital staff — made no arrests. One caregiver was ticketed and fined.

Parkland has made it difficult to see how the cases were handled. The public hospital has sued the Texas attorney general in an effort to shield records. For a year, hospital officials refused to release any police investigative reports to The Dallas Morning News and would not answer most questions. Last month, they again declined interview requests, but did release a four-page statement and a selection of police records.

But the newspaper, using other sources, had already pieced together extensive details about several cases. All showed signs of poor police work, with one going officially uninvestigated for a year. Some patients and front-line workers involved in the cases alleged cover-ups.

Parkland adamantly disagrees. “To suggest that there has been a systemic or even inadvertent effort to suppress or overlook incidents of alleged assault at Parkland is to suggest a falsehood,” hospital leaders said in their Jan. 22 statement to The News.

Parkland Feb. 1, 2013 email statement to “opinion leaders and media” Parkland stressed that the Rodriguez case was “discussed with the Dallas County district attorney’s office.” It did not mention that the discussion occurred in December, nearly two years after the rape report. Parkland police officials met with prosecutors only after The News asked the district attorney’s office whether it had been consulted about any of the accused caregivers. It had not, and the DA’s office did not do any official investigations, its spokeswoman Debbie Denmon said.

Parkland’s statement also said the hospital now asks the district attorney’s office to review every sexual assault allegation, “regardless of whether the police believe it is substantiated.”

The investigative records that Parkland released last month show that detectives took logical steps in several cases and amply documented reasons for dropping them. For example, some accusers made vague, shifting allegations, and some seemed delirious.

But other cases were closed with little or no investigation, deemed to be medical procedures or bathing assistance that patients misunderstood. In the four cases about which The News had already pieced together the most information, the newly released investigative records raised further questions about police conduct.

PARKLAND AND CMS

Mike Malaise, senior vice president/external affairs, Parkland Memorial Hospital, in a Feb. 1 statement:

“In the normal course of regulatory oversight, the U.S. Centers for Medicare and Medicaid Services and the Texas State Department of Health Services investigate incidents such as those under review by the Morning News. In reviewing some of these cases, those agencies did find deficiencies in reporting, documentation or procedures surrounding the incidents. At no time did those agencies suggest that police handling of the incidents was insufficient or inappropriate.”

David Wright, deputy regional administrator, U.S. Centers for Medicare and Medicaid Services, in an email response to The News later that day:

“We have neither the authority nor expertise to review the adequacy of law enforcement investigations from any jurisdiction. Our investigations focus solely on the hospital’s compliance with the Medicare Conditions of Participation.” The Parkland statement did not address questions asked of hospital leaders: How many sexual abuse cases have come to light recently, since the newspaper last sought police records under the Public Information Act? What were the allegations? How did Parkland respond?

There has been at least one new case, the newspaper learned. Government regulators found in December that a psychiatric aide had been inappropriately touching a patient. Hospital police filed no charges.

These are the first accounts to emerge alleging deliberate mistreatment at Parkland, which collects about $425 million annually from Dallas County taxpayers. The News’ three-year investigation of the hospital previously documented harm stemming from error, under-staffing, lax supervision or, occasionally, psychiatric aides’ violent reaction to combative patients.

U.S. health officials intervened in 2011, putting Parkland under a rare form of probation that could force it to close unless systemic change is documented in the next three months. Federal monitors have reported significant progress by the hospital in some areas as well as ongoing patient-safety breakdowns. They have said nothing publicly about possible crimes committed by caregivers.

In late 2011, when the newspaper began researching sexual abuse allegations, Parkland said there had been 15 such complaints against employees in the previous four years. Abuse, as defined by Parkland, ranges from verbal or visual sexual harassment to rape — it’s “anything that forces a person into unwanted sexual contact or attention.”

Police substantiated no wrongdoing in 13 of the 15 cases, said Dr. Thomas Royer, who was Parkland’s interim chief executive at the time. The other two “were found to be assaults but not sexual,” he added. “Those people have been dealt with through the HR process.”

Records show that in one of those cases, the suspect was not a caregiver but a patient. In the other case, Parkland police accused a nurse aide of improperly touching a patient near her genitals and ticketed the man in 2011 for Class C misdemeanor assault. He was fined the maximum $500 penalty by a justice of the peace.

It’s a Class A misdemeanor to intentionally or knowingly make offensive physical contact with people who are “substantially unable” to protect themselves because of disease or injury, Austin criminal justice expert Eric Nichols said. It’s a first-degree felony if such contact causes serious mental or physical injury to a disabled person.

Three women recall their suffering at the hands of Manuel Rodriguez, a nurse aide accused of raping a patient at Parkland Memorial Hospital. In general, such misconduct “is judged very harshly by jurors and members of the community,” said Nichols, a former federal prosecutor and former Texas deputy attorney general. The maximum penalty for a Class A misdemeanor is a year in jail. The maximum for a first-degree felony is life in prison.

The aide resigned from Parkland — which failed, as it did in the Rodriguez case, to make a required report to regulators.

There’s no good way to compare the number of abuse cases at Parkland to those at other hospitals, most of which are private. In Dallas County, the DA’s office says it does not keep statistics on the types of cases filed by different police departments.

But sexual abuse of patients has been documented around the country since at least the 1970s. And predators in health-care settings, experts say, are the same as predators everywhere: They choose victims who are particularly vulnerable — physically or mentally or because their credibility can be questioned. They take advantage of institutions with a culture “of not paying attention,” said Boston College nursing professor Ann Wolbert Burgess, who co-edited a textbook on patient exploitation.

Patients are doubly vulnerable, she said. Predators have extraordinary access to their bodies. Hospital managers may assume that accusers — because of illness or medication — imagined or misunderstood a caregiver’s actions.

Burgess, a consultant on patient-abuse issues, said criminal prosecutions can be difficult or impossible because of limited evidence and victims’ disabilities. Another reason “is the hospital does not want negative publicity.”

Courtney Underwood Newsome, the Dallas area’s most prominent advocate for sex-crime victims, reviewed Parkland records obtained by The News and said she could not believe all the cases were unfounded. She cited research showing that most sexual abuse allegations are never reported to police and, of those that are, fewer than 10 percent are false.

“They [Parkland] are fighting to survive,” Underwood Newsome said, “and no one wants to see them fail.” But “there appears to be an egregious lack of action,” one that will “lead people to question what, in addition to criminal behavior, is being swept under the rug.”

Underwood Newsome co-founded the Dallas Area Rape Crisis Center and has led efforts to expand the number of hospitals offering victims full forensic examinations, which seek evidence such as an attacker’s bodily fluids. Until 2010, Parkland was the only place in Dallas County providing this service.

She questioned whether Parkland police should handle serious criminal allegations against their fellow employees. “There is always going to be a question regarding the conflict of interest,” she said.

In-house police forces like Parkland’s also face questions about whether they have the time and expertise for specialized investigations, former Dallas Police Chief Ben Click said. There are times when they should ask for outside help but don’t, he said, because “egos come into play.”

State records say Parkland has 59 licensed officers — more than some Dallas suburbs, such as Highland Park and University Park. The hospital’s force includes one veteran officer with his own history of sexual misconduct: Duane Stubbe, who served deferred-adjudication probation for exposing himself to a Collin County girl.
Parkland officials acknowledged knowing about Stubbe’s misdemeanor criminal case. Separately, they have praised their police department for preventing sex crime. In 2009, a magazine for Parkland employees said officers monitor “potentially dangerous individuals” who have medical appointments.

“Whether you’re running errands or going to your grocery store, predators can be anywhere,” the magazine quoted Lt. Rick Roebuck as saying. “I’m glad that at least while they’re here, we can make sure Parkland remains safe.”

Fred Price, who retired as a Parkland detective in 2005, said his fellow officers were generally “sincere.” But “you just knew you walked on eggshells” when investigating insiders.

Co-workers “would definitely try to cover up” for each other, said Price, who’s now a Dallas County courtroom bailiff. And management “would always believe any employee, especially a doctor, over any policeman.”

Here’s how Manuel Rodriguez got a nurse aide job in 2010 on Parkland’s eighth-floor neurology unit, according to hospital records:

He made the lowest possible passing score on a basic math test. No one else was considered for the position. Another male aide was in the process of being terminated — after being accused, for the third time in three years, of sexually abusing female patients.

Rodriguez’s personnel file shows no sign that he underwent a background check or provided any work history. He was 53 at the time and, after a career as a printer, had just spent a few weeks training at Parkland to become a certified aide.

His boss tried to fire him within 90 days, citing emails in which he complained about understaffing and accused nurses of not helping patients who’d lost control of their bowels. “Our unit’s patients and staff do not need an employee such as this,” the boss wrote to a personnel official. “I made a poor decision in hiring him.”

For reasons not explained in the personnel file, Rodriguez kept his job. And, in March 2011, the disabled grandmother was delivered to his care after fainting at a workers’ compensation hearing. A conveyor belt injury had left her in chronic pain and largely unable to use the right side of her body, including her dominant right hand. She lost her job, car, home and ability to live independently.

Rodriguez was her most helpful caregiver at first. “He brought me blankets,” said the woman, who is in her mid-50s. “He gave me a lot of attention.”

But the aide soon began to seem too familiar with his hands, “using lots of talcum powder.” And late one night, after she’d been in Parkland about a week, “he said he was going to give me a bath, and I told him, no, I didn’t want to.”

“He dragged me to the bathroom,” the woman told The News. Then, through sobs, she described how she refused when he “tried to put his thing in my mouth,” and how he went on to pin her down in bed and vaginally rape her.

Afterward, she said, he cleaned their genitals and put her bed sheets in the linen drop.

Police records say the woman tried to cry out during the attack but couldn’t make much noise, both because of her medical condition and because Rodriguez put his hand over her mouth. She remembered being restrained by terror, too: Rodriguez, she said, showed her that he had access to her medical records, so he knew where she lived with relatives. A Parkland detective verified that Rodriguez had looked up her address in the computer, a police report says.

“He threatened to kill not just me but them,” she said. “I didn’t know what to do.”

So at first, she told no one. Doctors sent her for therapy related to her workplace injury at UT Southwestern Medical Center’s Zale Lipshy hospital, next door to Parkland. There, she said, she finally felt safe enough to tell an employee what Rodriguez had done.

A Parkland police officer was summoned to her Zale room. It was the afternoon of March 29, 2011 — six days after the alleged rape, according to a Parkland police report.

KYE R. LEE/The Dallas Morning News

A disabled Dallas woman says she was raped last year by Manuel Rodriguez, a nurse aide at Parkland Memorial Hospital. Parkland fired the man, but its police force filed no charges. The woman’s daughter was present when a hospital police officer first responded to the rape complaint and described him as ‘really rude.’ She tried to get help from Dallas police instead, to no avail.“The policeman was really rude,” recalled one of the woman’s daughters, who was present for the interview. He raised his voice repeatedly, she said, demanding to know “why didn’t she say anything before.”

The daughter told him she was going to contact the Dallas Police Department, “and he said there’s no point in calling them because they have no jurisdiction over us.” She later called anyway and found out that Parkland was, indeed, a law force unto itself. DPD says it gets involved only if it responds first to a major crime in progress or if Parkland seeks help.

Hospital police did not immediately arrange for a physical examination of the woman, ask her to undergo a rape exam or refer her to a counselor. At the daughter’s insistence, Parkland agreed to see the woman two days after she reported being raped.

Two Parkland officers escorted her from Zale back to their hospital to have a rape exam done, police records say. But a Parkland nurse told them that “because of the extended time that had elapsed, the test could not be performed.” The hospital did test her for possible exposure to sexual diseases.

In its statement to The News, Parkland said a rape exam “only has clinical or evidentiary value within 96 hours after an alleged assault.” Underwood Newsome, the Rape Crisis Center’s co-founder, called that claim “completely unfounded.”

Texas law says police must request a rape exam when an accuser comes forward within 96 hours; after that, “the law enforcement agency may request” one. Experts say it often makes sense to perform rape exams beyond 96 hours, especially if the accuser, like the one in this case, has had limited physical activity.

“It is important to remember that evidence collection beyond the cutoff point is conceivable and may be warranted in particular cases,” says an evidence protocol published by the U.S. Justice Department.

A basic physical examination “should be performed in all cases of sexual assault, regardless of the length of time which may have elapsed,” says a Texas attorney general’s protocol. One reason is to check for internal injuries. Also, “evidence may still be gathered” — for example, by taking photographs of bruises.

While waiting for the two officers at Zale, the grandmother’s room phone rang. It was Rodriguez, taunting that he had been to court before and “nothing happened to him that time either,” a UTSW police report quoted the woman as saying. In the same call, she told The News, he also made the sound of a gun.

Nurses moved her to a different room and put her on the “no info” list, preventing anyone from knowing where she was unless she told them. She spoke with a Parkland counselor, whose notes describe her as tearful, fearful and intensely depressed.

Bruises on a Parkland patient’s arm, photographed in 2011 at a Parkland counseling center two weeks after the victim was allegedly raped by Parkland nurse aide Manuel Rodriguez. The photo comes from her medical records.“Don’t leave me,” she begged the counselor. “I feel like I’m dying.”

Parkland suspended Rodriguez the following day, April 1. On April 2, according to UTSW police records, he showed up at Zale, apparently unaware she had already been discharged. Dressed in street clothes and a white ball cap, he asked to see the woman and gave nurses his name. They refused to help him and alerted police, but Rodriguez left before officers arrived.

Marsha Newberry, who is a friend of Rodriguez’s and one of his ex-wives, said he called her about the suspension. He denied wrongdoing, described the patient as “crazy” and said “she claimed that he was trying to track her down in another building. He was like, ‘I’ve never even been in that building.’”

One example Rodriguez gave of the patient’s behavior: “She would just, like, not have any clothes on and open up the sheets and try to pull him down on her, and he was like, ‘I can’t do this. I’m here to take care of you.’” According to Newberry, Rodriguez said he also received a love letter from the patient but didn’t show it to anyone before destroying it.

Rodriguez, who has never been convicted of a crime, declined an interview request. He referred The News to his longtime lawyer, Dennis Croman, who said the patient had “mental problems” and might not be “altogether competent.” He did not elaborate.

For months before her hospitalization, the woman was treated by a psychiatrist at Parkland’s outpatient Victim Intervention Program. He diagnosed her with major depression and post-traumatic stress disorder, including nightmares and flashbacks, which he said stemmed from her work injury, disability and pain. He saw her again on April 7 and noted that she was “distraught” because of a sexual assault at Parkland that had “significantly exacerbated symptoms.”

Other therapists who later saw the woman briefly offered varying diagnoses, according to her medical records, which she let The News review. One said she talked about a childhood belief in “aliens.” Another said she described elaborate visions, but he thought she was faking mental and physical symptoms for financial gain. The woman told The News that doctors, generally working through translators, had asked her to visualize as part of stress-reduction therapy. She said she knew the difference between the imaginary and the reality of rape.

During the April 7 visit, Victim Intervention Program staff took photographs of the woman in a wheelchair — the only photos that appear in medical records she’s been able to obtain. Two weeks had passed since the alleged rape, but bruises were still visible on her calves and upper arms. Parkland also gave her a brochure from the Texas Association Against Sexual Assault that explains how vulnerable the disabled are to sexual abuse. The association offers a similar pamphlet for police that urges patience with the disabled, who are often reluctant to report abuse for fear of losing health care and may be “considered less credible.”

On April 8, intervention program staff contacted the detective assigned to the woman’s case. The detective wrote a report saying that she learned two things from the call: “The patient was being treated for a work-related shoulder injury that was traumatic,” and had previously been sexually assaulted without reporting it to police. There is no mention of her bruises in this report or any other police records released by Parkland.

The detective, Darlene Griffin, closed the case that day. “We have no physical evidence to support a sexual assault against the victim,” she wrote.

“Investigation believes that there are inconsistencies with the statement of the patient,” she added. “However, investigation cannot conclude that an offense did not occur.”

Griffin’s report gave no examples of inconsistencies and made no reference to the patient’s mental status. The News, in hours of interviews with the patient over several months, detected no inconsistencies. It found no sign in her medical records that caregivers doubted the truthfulness of her rape report.

The newspaper did find, deep in a box of her personal papers, hospital menus from the day after the alleged rape. “I am dirty,” says a note she scrawled near references to peach halves and grilled chicken breast. The note curses Rodriguez by name and adds, “He raped me.”

Griffin’s report noted that Rodriguez, during the week of the alleged rape, had accessed personal contact information for another of his female patients. He called her after she was discharged and said he was sorry “he couldn’t help her with her bath,” the report says.

An unsigned memo dated April 12 told Rodriguez to return to duty. “Although the allegations were determined to be unfounded, you are strongly cautioned to exercise prudent judgment so similar situations are avoided,” his boss wrote. “However, should we substantiate any of these allegations in the future or continue to receive additional complaints, further corrective action may be taken not to exclude termination.”

That week, the neurology boss also drafted a memo for all of her staff. It decreed that aides could no longer care for patients of the opposite sex unless another caregiver was present.

A nursing administrator responded by noting that problems could also arise when caregivers worked alone with patients of the same gender. Parkland’s patient relations department, the administrator wrote, “is currently investigating a complaint by a male patient against a male provider regarding inappropriate touching.”

Rodriguez was fired in late April, ending an 11-month tenure at Parkland. Records released by the hospital do not detail reasons for the firing beyond his “unsatisfactory” job performance.

“He said something about how they fired him because he wouldn’t write down a statement” admitting he violated a procedure, Newberry said. He told her he refused because “I did everything I was supposed to do.”

She said he was “heartbroken.” “He was just like, ‘I cannot believe I’ve lost my job because of some stupid woman.’”

Croman, Rodriguez’s lawyer, said he talked with two Parkland detectives during the criminal investigation.

“We tried to cooperate with them and give them what information we knew,” Croman said. “They just determined that it wasn’t worth pursuing.”

The detective’s report contradicts this. “The suspect has been non-cooperative,” Griffin wrote. “Investigation did not receive communication from the suspect attorney.”

The International Association of Chiefs of Police says sexual assault investigations should be treated not as “he said, she said” cases, but as “he said, they said” matters. Detectives should look for a pattern of unreported crimes “by interviewing the suspect’s social circles, current and former partners,” says the association’s list of recommended best practices.

OTHER PARKLAND ACCUSATIONS Here are other examples of sexual abuse allegations against Parkland Memorial Hospital caregivers. Parkland’s police force filed charges only in the first case.

KHASRO HASAN

Position: Nurse aide
Background: He told Parkland that he worked as a nurse in Iraq and as a translator for U.S. military officials.
Tenure at Parkland: Seven months in 2010-11
Accusations: In January 2011, a patient accused him of groping her breast and pubic areas “more than once.”
His response: He denied wrongdoing to Parkland police and The Dallas Morning News. He told the newspaper that a vindictive co-worker manufactured the accusations. According to police records, he admitted touching the patient’s abdomen and head without consent. He said he was trying to help her with pain. An aide’s duties don’t include treatment.
Outcome: Hasan quit his job. Parkland police later charged him with Class C misdemeanor assault. He was convicted in a justice of the peace court and assessed the maximum penalty: a $500 fine.
Today: Parkland did not make a required report to regulators. Hasan avoided being put on the state’s list of aides who are unemployable because of abuse. He said he is no longer working in health care.
PETER SARMIE

Position: Neurology unit nurse aide
Background: He told Parkland that he studied to be a mechanic in the West African nation of Liberia before becoming a certified aide in Texas.
Tenure at Parkland: 2007-10
Accusations: He put his hand in a patient’s vagina while bathing her in 2010. “This is the third complaint received for the same type of behavior,” Parkland told him.
His response: “All of it was investigated and employee was found not guilty,” he wrote to his superiors. Sarmie reiterated these denials in an interview with The Dallas Morning News. Male aides, he said, are vulnerable to false accusations when assigned to female patients who need assistance with bathing and dressing.
Outcome: He was fired for “repetitive at risk behavior/reckless conduct that jeopardizes the life and/or welfare of another individual.”
Today: He lives in Rhode Island and said he is working as a nurse aide.

ARLO TABADA

Position: Intensive care unit nurse
Background: His resume says he worked as a physician in his native Philippines before getting a U.S. nursing degree in 2008.
Tenure at Parkland: 2008-12
Accusations: In January 2012, a patient said, Tabada woke her in the middle of the night, while she was intubated, for bathing. “I felt a pinch on my nipple,” she told the nurse’s supervisor. Then he “started to rub my back” with a hot towel and “had his hand on my pubic area.” The patient added that she’d never been bathed by a male nurse before.
His response: Tabada and an aide, who helped with the bathing, denied wrongdoing to Parkland. He reiterated that denial to The News. Having female caregivers bathe female patients “might be the best scenario,” he added. But “sometimes it’s just not practical” given Parkland’s “heavy load” of patients.
Outcome: Both caregivers returned to work after a one-day investigation by Parkland police. A psychiatrist said the patient’s allegations were “likely due to delirium given that she was on propofol,” a sedative and hypnotic agent. Tabada told The News he agreed to take a polygraph test, but police “didn’t pursue it.”
Today:Parkland fired Tabada in July 2012 for seizing an emergency-call button from another ICU patient. He said the patient was repeatedly demanding painkillers ahead of schedule, disrupting care of others in the short-staffed unit. “I made a mistake,” Tabada told Parkland. He still has his Texas nursing license and would not say whether he is currently working as a caregiver elsewhere.

MORE INCIDENTS

Because Parkland withheld or blacked out large portions of many records, it’s impossible to identify most of the other accused caregivers and their jobs. Here are examples of patients’ accusations and how hospital police responded:
December 2010, second floor: A caregiver performed an invasive exam without consent. The patient grabbed the caregiver’s hand “and pulled it out.” Records released by Parkland show no sign that any police investigation resulted. Ten months later, the supervisor of criminal investigations created a report that declared, without elaboration: “This was a medical procedure not an assault.”
February 2012, emergency room: A clothed caregiver pressed his erect penis into the patient’s genital area during an exam. The patient was upset and terminated the exam. Here’s why a Parkland detective said he closed the case as unfounded: The caregiver “would have to slouch or get on his knees” to do what he was accused of, and the patient said he was standing.
March 2012, emergency room: A caregiver “fondled the nipple on her left breast three different times” while attaching testing equipment to her chest. The caregiver denied touching any part of the breast. Both parties agreed to take a polygraph. “After interviewing both parties and polygraphing one, we came to the conclusion that there was no assault,” a detective wrote. “The polygraph showed there was no deception.”

SOURCE: Parkland police and personnel records; Dallas Morning News research. Records released by Parkland don’t show whether its police followed this advice. But The News found a pattern of abuse allegations in Rodriguez’s past and support for what he allegedly told the disabled grandmother — that he’d been to court before.

Oralia “Lala” Boatright, a divorced mother of two, lived with Rodriguez in the early 1990s, in his hometown of Irving. Police there arrested him twice after she accused him of assault.

In 1991, according to a police report, he grabbed her by the throat when she tried to leave him. An officer took him to jail after she said she “was afraid if the police left, the assault would continue.” Municipal court records show the case was dismissed but don’t say why.

A 1992 police report said he pinned her down on a bed with his knees to keep her from leaving home, then pushed her into a glass table. Hospital records say she received treatment for a gash near her right eye, in the company of an unidentified man.

That man was Rodriguez, Boatright told The News. She recalled a nurse asking whether she’d been assaulted and being so afraid that she claimed it was just an accident. Three days later, after moving out of his house for good, she gave police a written statement. It said he had previously held her at gunpoint.

“He kept an old antique shotgun that his dad gave him behind the bedroom door,” Boatright said in an interview. “He pointed it at me and says, ‘You’re not going anywhere. Do you understand?’” Her response: “OK, OK, I promise. Don’t do anything — my son’s in the next room.”

She said he put the gun down and taunted her: “I broke you, didn’t I?”

Police deemed the 1992 case serious enough to send to the district attorney’s office for prosecution. A judge found Rodriguez innocent, for reasons that county records don’t explain. Boatright said she didn’t know the case went to trial, because she went into hiding and didn’t leave a forwarding address.

Rodriguez called Boatright a “maniac” who deliberately injured herself, according to his friend Newberry. “She told him she was going to get him put away” and “jumped into the glass coffee table,” Newberry said, recounting his story. “He said, ‘I didn’t touch the girl.’”

Newberry was married to Rodriguez for about eight years. When filing for divorce in 2004, she accused him of cruelty and adultery. The cruelty, she told The News, was strictly verbal. “He was never physical with me.”

Rodriguez was briefly married in the mid-1990s to Sandy Jackson, who accused him of harassment while their divorce was pending. When she contacted Irving police, she said he had called her about 25 times that day and knocked on her door, trying to get her to move back in with him.

An officer told him to leave Jackson alone, according to police records, prompting Rodriguez to reply: “But I want to talk to her.” He agreed to stop bothering her but did not, records say. Police then referred the matter to the city attorney, but Irving officials recently said there was no record of prosecution.

Jackson told officers that Rodriguez “was violent towards her during their marriage,” but she did not call police then. She told The News that she feared complaining would lead to more violence and that she spoke up only after securing a place of her own.

“One time I thought I was going to end up in the bottom of Grapevine Lake because he hit me so hard,” Jackson said in an interview. They were in his sailboat, she explained, and he was barking orders while doing no work. When she protested, “he hit me right on the pelvic bone,” and “half my body went over the railing.”

Jackson said Rodriguez sometimes bragged that his common names and lack of a middle name made him hard to track. “He was very bold about that,” she said. “He would just tell me, ‘How the hell is anybody ever going to catch up to me?’”

The News learned of the Parkland rape allegation in late 2011, about eight months after it was made. The newspaper sought information from the Texas Department of State Health Services, which licenses hospitals and which Parkland should have notified within 48 hours.

DSHS said it had never been notified and began investigating. It isn’t clear what steps the state agency took, but it did not interview Rodriguez and found no fault with Parkland.

Agency spokeswoman Carrie Williams said she could not discuss investigative details. But in general, she said, Parkland’s past failures to report abuse allegations made it difficult for DSHS to determine what happened and contributed to the agency’s decision to fine the hospital a record $1 million last year.

“They really protect the workers there,” Rodriguez’s accuser said of Parkland. “And the patients, where does that leave us? In their hands, where they can do what they want.”

Rodriguez went to work in early 2012 for a home-health firm based in Arlington. Officials there said he wanted more work than was available and quit after a few months. He gave no notice, they said, and simply failed to show up at a home where a patient was waiting for help.

Since then, he has been working for Hospice Plus, a Dallas-based company that cares for the terminally ill. Its chief executive, Dr. Bryan White, said he knew of no problems with Rodriguez. He declined to comment on whether the company received information from Parkland about the aide. “We followed our policies and procedures,” White added.

The Parkland patient who accused Rodriguez began to cry when told of his hospice work. She said she suspects the hospital views her as someone who just wants money.

“I don’t want money. I don’t want any of that. I want justice,” she said, sobbing. “I want justice so this doesn’t keep happening to so many other women.”

Police officer remains on Parkland’s force after sexual misconduct findings
He served probation for indecent exposure and was later fired, but the hospital hired him back.
By BROOKS EGERTON
Staff Writer
begerton@dallasnews.com

Parkland Memorial Hospital police officials promoted Officer Duane Stubbe after his first incident of sexual misconduct. They warned him after the second. They fired him after the third.

And two months later, they gave him back his gun, badge and previous salary. He remains on Parkland’s police force today, enforcing the law at primary-care clinics.

The troubles date to 1996, when Stubbe was arrested for being naked in front of three middle-school girls during a slumber party at his home. In 1998, he was found not guilty on two misdemeanor charges of indecent exposure and agreed to plead no contest to a third. A Collin County judge put him on six months of deferred-adjudication probation.

Parkland Memorial Hospital
Duane Mark Stubbe, a longtime Parkland Hospital police officer, is shown in a 1998 booking photo from Collin County. He was arrested in 1996 for indecent exposure, and again in 1998 for a probation violation.Stubbe was required to leave home, undergo sex-offender treatment and submit to polygraph testing. When tested, he “failed when asked his sexual intent during the commission of the offense,” court records say.

Prosecutors sought to revoke his probation. Stubbe sought to withdraw his plea, claiming he hadn’t understood its consequences or the evidence against him. He had always “maintained his innocence,” his lawyer argued.

A judge rejected both efforts in early 1999. Stubbe completed probation with no conviction record.

The Texas Commission on Law Enforcement Officer Standards and Education then moved to suspend Stubbe’s license. It got a late start because Stubbe had failed to make a required report of his arrest; he didn’t disclose the criminal case until after his probation began.

Parkland intervened on the officer’s behalf. Kenneth Cheatle — then his lieutenant and now Parkland’s police chief — wrote a letter praising Stubbe. So did CaSandra Williams, who was assistant chief at the time and now heads the police department at Texas Health Presbyterian Hospital Dallas.

Smith Lawrence, then Parkland’s chief and now retired, went to Austin and testified before an administrative law judge. He said he’d recently promoted Stubbe to a supervisory job “entirely based on merit.” The officer “enjoys the support of both his superiors and peers.”

The three supervisors did not respond to requests for comment.

Stubbe, who declined to comment for this story, also testified in Austin and gave this version of what happened at the slumber party: He was sleeping naked and unaware of the sleepover when a noise from his stepdaughter’s room woke him. He went to investigate, opened her door and saw the girls. “He immediately closed the door,” he said, and two of the three girls did not see him nude.

But two of the girls, who are now young women, told The Dallas Morning News that they did see full frontal nudity. They said Stubbe entered the room naked, told the girls to quiet down and then briefly lingered there. The two did not testify in Austin.

Parkland Memorial Hospital
Image from the Parkland Hospital newsletter, released in Sept. 2012, showing Officer Duane Stubbe, a member of Parkland Memorial Hospital’s police force, who has his own history of sex crime: He was sentenced to six months of probation in 1998 for indecent exposure, and state regulators later suspended his officer’s license. Stubbe has worked as an officer for the hospital since 1994.In his testimony, Stubbe said “he has learned his lesson and is truly remorseful,” the administrative judge wrote. The police officer said suspension would cost him his job and hurt his family.

It would also hurt Parkland, Stubbe asserted, because he was the hospital police force’s only member specially trained to deal with mentally ill people.

The law enforcement commission agreed to a six-month probated suspension, which began in early 2000 and allowed Stubbe to keep working.

By late 2000, he was in trouble again. Parkland supervisors cited Stubbe for refusing to help a patient who’d lost her purse. And in early 2001, he was written up for failures including an “unsatisfactory” report on the use of force and not telling the Secret Service when a psychiatric patient threatened President-elect George W. Bush.

Stubbe received a “final warning” in April 2001, for sexually harassing another officer. He grabbed the man, according to personnel records, and made comments such as “You need to quit looking at me like you want me to … [expletive] you.”

The records show that Stubbe was fired the following month for similar sexual comments. He told a fellow supervisor, for example, “I’ll do it if you [perform oral sex on me].”

Termination paperwork also cited “inappropriate incidents” with his Parkland-issued gun, such as taking it out during a meeting, sliding it across a table and telling a subordinate, “You shoot him.”

There is no sign in records Parkland released that Stubbe denied doing any of these things. Nor is there any explanation for why, two months after his firing, he was rehired. He appealed his firing, the hospital said in a statement to The News, and Lawrence “agreed to allow him back onto the police force.”

Stubbe, 48, has received excellent evaluations in recent years.

That is little consolation to the two young women who attended the slumber party. Both said they were upset to learn that Stubbe was still working as a police officer. One said she worked in health care and had considered getting additional training at Parkland.

Now, she said, she’s afraid to go there. “You don’t know you’re safe.”

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