Parkland Memorial Hospital blaming affiliated UT Southwestern Medical Center doctors for problems with patient care

A major factor behind Parkland Memorial’s patient care crisis is the hidden power struggle between the hospital and its medical school partner, UT Southwestern Medical Center.

Publicly, Parkland Memorial Hospital and its affiliated medical school, UT Southwestern Medical Center, present a united front. “We have a great relationship,” the hospital’s longtime leader told a group of aspiring UTSW doctors just last fall.

Behind the scenes, however, the reality has been far different. Dr. Ron Anderson, the former CEO, lamented the “vitriol” from UTSW faculty doctors, who supervise patient care at Parkland.

“They honestly don’t know how to work collaboratively with another (non-UTSW) physician who is demanding higher levels of performance and accountability,” he wrote in late 2011.

The tension between the two institutions reflects their tangled relationship. Parkland actually has little control over the doctors working under its own roof. Most are employed by, or answer to, UTSW. Parkland’s priority is supposed to be patient care. Yet UTSW lists its missions as medical education, research and patient care — in that order.

The organizations’ divergent missions, business interests and turf battles contributed to a dysfunctional culture at Parkland over the last decade, jeopardizing patient care, The Dallas Morning News has found.

Federal safety monitors have flagged the culture as a major factor in plunging Dallas County’s hospital for the poor and uninsured into its safety crisis.

Many times over the last decade, UTSW faculty physicians have failed to show up to care for Parkland’s patients. Instead, they see privately insured patients at the medical school’s separate system of hospitals, or focus on research. Resident doctors-in-training at Parkland often have been left with little or no faculty supervision. And front-line caregivers who report to the doctors, especially nurses, have felt powerless to resolve patient-care breakdowns.

Trust and transparency issues abound.

Welcome to the annual UTSW-Parkland cage match,” UTSW’s chief of internal medicine wrote in a September 2010 email to colleagues, describing contract talks with Parkland over the cost and scope of physician services.

“We can’t let them control faculty,” another UTSW chief said in an email to co-workers last March.

The problems between the two institutions run deep. Parkland’s ability to change depends in large part on UTSW. But few, if any, governmental or industry standards exist nationally to help responsibly manage such complex partnerships.

Since 2004, at least three separate consultant firms have urged Parkland, for the sake of better and more efficient patient care, to change its management model to take more control of clinical operations from UTSW. The Dallas County Commissioners Court, which approves Parkland’s budget and appoints its board of managers, also was put on notice. But the contractual relationship between Parkland and UTSW has remained fundamentally unchanged.

“That [relationship] has to be dealt with,” said former Parkland board member Chris Luna, who left in early 2011. “It’s daunting. The culture at Parkland can’t be fixed unless UTSW’s power is addressed.”

The institutions’ problems could worsen after Parkland and UTSW both open new, larger hospitals in the next few years.

Federal regulators and onsite safety monitors have prescribed 499 reforms to turn around Parkland by the end of April. By then the hospital must prove that the changes have taken root or lose massive government subsidies vital to staying open.

Doing that means transforming the culture, according to the monitoring team of Alvarez & Marsal Healthcare Industry Group. The monitors have warned of widespread divisiveness. They have said Parkland workers are lacking in personal accountability and could be desensitized to patients. They have cautioned that UTSW may put the “training and teaching of new doctors above a safe patient experience.”

Recently, the monitors said progress had been made toward a safer culture but warned that a “check-the-box” mentality, instead of sincere efforts at reform, persists. They also wrote of doctors’ lack of engagement in changing their practices, as well as their limited grasp of the government’s action plan for reform issued a year ago this month.

UTSW declined to discuss its relationship with Parkland or furnish details about the work its doctors provide at the hospital. In a statement to The News, it called the model “successful” and stressed the school’s commitment to improving health care through doctor training, biomedical research and patient care.

“UT Southwestern’s partnership with Parkland Hospital is structured to ensure outstanding patient care while fulfilling our responsibility as a state institution to educate and train future generations of physicians to care for the people of this community,” the statement said. “Based on the many hundreds of thousands of patients cared for under this arrangement, we believe the current model has been — and will continue to be — effective in achieving both of these mission-related goals.”

Current Parkland officials also have declined to answer most questions from The News about the alliance, including whether they would pursue a new staffing model.

Since 1943, the public has entrusted the two tax-funded institutions with balancing their different missions.

Parkland furnishes the grounds for UTSW’s doctor training and research pursuits. The medical school serves as the exclusive provider of care for Parkland’s mostly indigent patient population. For those services, UTSW is now paid about $160 million a year.

Their 10-year affiliation agreement, last renewed in 2006, touts the relationship as a national model and a “covenant of mutual responsibility.”

But UTSW’s influence inside Parkland is vast: Its physician force accounts for virtually all of the doctors at the hospital — about 1,000 residents and an estimated 700 faculty members who are supposed to supervise them. Doctors, with a few exceptions, don’t directly report to the hospital’s leadership.

The school has essentially acted as a shadow government over clinical care. Its department chairmen oversee Parkland’s clinical departments. Its faculty physicians serve as the direct chiefs over departments. Its faculty members serve as medical directors over units inside departments.

Parkland directly employs only a handful of attending physicians in its administration or on the main campus. It mainly provides the supporting cast for the UTSW physicians: about 2,500 nurses, hundreds of aides and techs, and directors who supervise them.

The patient safety spotlight has been on Parkland as the entity certified by the U.S. Centers for Medicare & Medicaid Services to receive government funding. But most of the serious patient care breakdowns that forced Parkland into a rare form of federal oversight last year were a shared responsibility with UTSW, which doesn’t answer to CMS.

Dr. Kern Wildenthal, president of UTSW from 1986 to 2008, said the “standard of physician care and supervision by UT Southwestern faculty in Parkland was judged to be high in each and every review by every accreditating agency during my tenure.”

Yet, Alvarez & Marsal outlined more than 50 violations — better than half of all regulations — in the comprehensive analysis of Parkland it completed a year ago. Parkland’s failures in infection control, emergency care, surgical services, resident supervision, physical medicine and rehabilitation, and psychiatric care, among other areas, also fell under UTSW oversight.

“We believe the current operation of Parkland’s resident training program is contributing to the hospital’s deficiencies in meeting all standards,” the monitors said, referring to the program jointly administered with UTSW.

In reality, there are two separate chains of command inside Parkland.

Parkland’s chief medical officer, for example, is supposed to provide leadership over clinical affairs and quality of care at the hospital. Yet the UTSW president “is actively involved in the selection, regular evaluation and decision to continue or terminate the employment of the CMO,” according to the affiliation pact. The current interim chief medical officer is a UTSW faculty member paid by the university, not Parkland.

Employees say the system — what some call the “two-headed beast” — fosters confusion and chaos.

UTSW medical directors, for example, are expected to collaborate with Parkland department directors on decisions. But the structure stymies cooperation.

“Ideally, they’re supposed to meet and discuss the best approach to provide the best of care for patients,” said a former Parkland nurse who has filed a legal claim against the hospital and requested anonymity for fear of retaliation. “What occurs is: they collide. Both have power and both want control.”

UTSW research projects — about 700 studies are currently under way at various stages at Parkland — also can derail patient care priorities.

“If the resident or attending is seeing a patient for medicine management, yet there is also a study on medicine management for which they need participants, during their appointment the resident may cover both,” the nurse said. “This will back up the patient load for the day. The residents get brownie points from their attending [faculty] doctor for signing up participants.”

Parkland’s longtime management structure failed to give the chief nursing officer direct oversight of nurses, despite the title. Many nurses have felt powerless because of the blurred lines of authority. Yet they are expected to backstop and monitor the very doctors who give them orders.

Safety monitors flagged that as a serious problem in their February 2012 report. Nurses, they said, are the “constant eyes and ears of hospital care,” adding that it was crucial to have a vigilant nursing service to monitor the residents.

As part of its reforms, Parkland has now given the chief nursing officer direct authority over the nursing staff.

Concerns about physician oversight kept surfacing over the years as UTSW embarked on an ambitious growth and profit-making strategy, opening its own hospitals.

In late 2000, the school purchased St. Paul Medical Center as a private-referral hospital for its faculty physicians. Five years later, it took formal ownership of Zale-Lipshy Hospital, a private facility adjacent to Parkland that UTSW had managed since 1989.

Some Parkland officials were alarmed.

“Up pops St. Paul, and we’re thinking, it’s a difficult situation for faculty doctors to be covering three different spots,” said a former Parkland board member.

Nurses were regularly noticing that faculty physicians weren’t showing up for work, leaving residents alone to deal with patients. A frequent comment was, “Where’s the doctor?” several caregivers told The News. Parkland employees weren’t always sure whether to take problems up their own chain of command because some of the hospital’s top executives were paid UTSW faculty members.

Anderson, for example, was a tenured professor at UTSW, his alma mater, for most of the 30 years he served as Parkland’s chief executive. He earned $100,000 total in supplemental salary from UTSW until payments stopped in 2007, records show. Parkland officials told The News that board members became concerned that state law prohibited such dual payments, and the practice was halted by UTSW. Parkland’s policy now is that “no one double dips,” according to a hospital statement.

Anderson was forced to resign as Parkland’s CEO more than a year ago after federal inspectors confirmed the hospital’s patient-safety breakdowns, though he was retained as a paid consultant through the end of 2012.

For years, there were concerns that Anderson had conflicting loyalties between the hospital and medical school. After Anderson resigned, a coalition of area churches and schools asked Parkland board members to find a new permanent CEO “free of any conflict of interest.” The group’s leaders, who had worked with Parkland for years on community health care issues, told The News that Anderson’s potential conflicts were behind the request.

Anderson told The News that his role with the school did not compromise his Parkland oversight. As for the payments from UTSW, they were “small” and were reported to the board, he said.

By late 2003, Parkland’s emergency room waits were averaging 13 hours. Women were going through labor in hospital hallways. Packed operating rooms were forcing delays.

Anderson believed a new larger hospital complex was the solution to those problems. So he and the Parkland board moved forward with a $1 billion strategy to build one.

But county commissioners, concerned about the hospital’s ability to manage costs amid government funding cuts, forced Parkland to put the plans on hold. Instead, they hired an outside firm, Health Management Associates, to do a comprehensive study of Parkland.

In 2004, the firm began pointing to the medical school as a major source of problems.

UTSW president Wildenthal was demanding that Parkland increase by $24 million what it paid for annual medical services, saying the school was being underpaid. In Texas, because of a lack of state funding, medical schools generally recover the costs for providing indigent care from the hospitals that contract for their services.

At Parkland, faculty doctors, Wildenthal contended, were working longer hours because of new national accreditation standards that capped residents’ work hours. At the time, Parkland paid UTSW $70 million for its doctors’ services, including supervision of residents and administrative overhead. (Parkland ultimately paid UTSW an additional $7 million for the next fiscal year, which began that fall.)

But the HMA consultants questioned the payments. UTSW had been unable to document much of what it was delivering to Parkland. Administrative costs were “extremely high.” UTSW was charging for “performance enhancements” to encourage more faculty members to supervise care at the hospital — behaviors that consultants said “shouldn’t need additional payments to assure.” And payments to more than 100 medical directors who “had no identified real authority” needed explanation, they said.

They also noted the contract had more than tripled since 1993, when it was $22 million, “despite the lack of any significant service volume increase over the past decade.” They called for more transparency in the partnership and suggested a third party verify costs.

Dr. Allan Shulkin, who served as a Parkland board member between 2004 and 2009, recalls that steps were taken to try to confirm UTSW’s physician costs. But he wasn’t sure how effective they were.

UTSW’s new focus on profits saddened Shulkin, now a pulmonary specialist at Medical City Dallas Hospital and a member of the Texas Medical Board. “You could see that there was another agenda evolving,” he said.

He remembered a different culture during his residency at Parkland in the 1970s.

“We viewed our mission as almost sacred to take care of the poor.”

The consultants also spent months evaluating Parkland’s clinical operations. They found a chaotic and fragmented structure.

UTSW’s academic mission was sidetracking care, they said. Parkland was a “resident-run” hospital.

“The foundation of the clinical care delivered at Parkland is built on the teaching model wherein the training needs of residents essentially guide policy and practice,” the HMA report said.

Trainee-doctors bottlenecked emergency care through unnecessary patient evaluations. Those “who need to experience certain kinds of surgeries in their training, will often look for the most interesting cases, leaving general surgeries behind.” In Parkland clinics, residents ran patient care while a faculty physician “personally never lays eyes or hands on the patient.”

“Most [UTSW] physicians work substantially in other venues and admit [patients] to other hospitals,” consultants said, referring to UTSW facilities.

A common complaint among doctors was that they didn’t know “who is in charge.’’

HMA urged Parkland to work with UTSW toward achieving a dedicated staff, where UTSW physicians — or doctors hired by Parkland — would spend most or all of their time at Parkland. It also urged the hospital to negotiate with UTSW to give the chief medical officer clear authority over the school’s doctors.

But Anderson hesitated.

“Our partnership with the medical school has been a wonderful asset,” he said, adding that he would explore the dedicated staff proposal.

At the time, Parkland’s board was operating without a patient quality committee — a common vehicle used by hospitals across the country to address problems. Such a panel wasn’t activated until after John Dragovits took over as chief financial officer in 2006.

Over the next few years, Anderson’s administration moved aggressively on the new construction front. Parkland hired PricewaterhouseCoopers to work on a strategic plan and master facility plan.

Parkland developed a campaign to replace its old hospital. “We will define the standards of excellence for public academic health systems,” the vision statement said. “The construction of this facility is an opportunity to maintain that vision.”

In 2007, PricewaterhouseCoopers supported plans for a new $1.2 billion hospital. But the firm also echoed some of HMA’s concerns, saying Parkland’s partnership with UTSW created “operational inefficiencies inherent in the teaching process.”

That draft report, obtained by The News, urged Parkland to seek partnerships with other health care services, with or without the support of UTSW, because it had “no substantial provider relationships beyond UT Southwestern.”

It also identified another weakness. It was imperative, the firm said, that Parkland develop quality metrics, as recommended by the national Institute of Medicine, to measure the clinical performance of doctors and to benchmark itself against other hospitals.

Parkland had been paying UTSW without rigorous methods for assessing the quality of doctor care.

By fall 2010, the hospital’s patient-care breakdowns had become widely known. The News had been investigating them since March after a UTSW surgeon alleged that lax resident supervision and absentee doctors were causing widespread harm at Parkland.

One case involved Jessie Mae Ned, a former Parkland employee whose leg was amputated after she was injured during a surgery by a UTSW resident. Following the surgery, Ned went three days without seeing a faculty doctor as she faced life-threatening complications.

Former board member Luna recalled board discussions in 2010 about changing the physician model out of fear that UTSW doctors were spending too much time at their own hospitals and transferring Parkland’s privately insured patients to the school’s hospitals.

“There was this growing concern: Are there two classes of care?” Luna said.

Anderson remained passive, he said. When such changes were discussed, Anderson would say, “It’s not provided for in the contract,” Luna recalled. “He used that a lot.”

Another board member, Alan Walne, once pressed Anderson on that point, Luna said. “We can change the contract. If it’s not right, if it’s not the best thing, we should fix it,” Luna recalled Walne saying. Walne declined to comment for this story.

Dr. Lauren McDonald, who resigned as chairwoman of Parkland’s board last year, said the board instructed Anderson to move toward developing a staff of doctors dedicated to Parkland. “The CEO did not follow through on this along with other important recommendations. You are aware of the outcome,” she told The News.

Anderson said it had been his intent to move toward a dedicated staff, with the help of UTSW. “I wanted to see it happen,” he told The News. “But it will take time to grow into that model.”

He noted that he had persuaded UTSW some time in the few years following the HMA study to agree to allow Parkland to employ and supervise a handful of its own medical directors, as well as have the chief medical officer report to Parkland instead of to both institutions.

In late 2010 a third group of experts, Chartis Management Consultants, issued a striking new finding: Roughly two-thirds of the 700 UTSW doctors assigned to Parkland were spending 50 percent or less of their time at the hospital.

The News obtained only a summary of the report, so it’s unclear whether the consultants offered any more details on the physician absences. Parkland has refused to release a copy of the full report. Chartis did not respond to inquiries.

Like previous consultants, Chartis did not say the Parkland-UTSW alliance is inherently bad. To the contrary, such hospital-school collaborations can be highly effective if both parties work more closely and openly, and ensure “a cadre of faculty physicians whose primary focus is the care of Parkland’s patients,” the firm said.

“Parkland needs a model where most of the care is provided by physicians practicing at Parkland 75 percent or more of their time rather than the current situations,” Chartis said.

Parkland “must be steadfast in its negotiations with UTSW due to the complexity and magnitude of change required,” and it must be prepared to hire its own doctors, the report said.

That fall, Parkland officials sought some changes in the contract with UTSW, though it is unclear whether the request was tied to the Chartis findings. The hospital asked for guarantees from UTSW to commit a group of hospitalists — specialists in acute hospital care — to Parkland 100 percent of the time, according to emails obtained from UTSW through an open-record request. The emails don’t make clear how many doctors would be involved.

Inside UTSW, administrators balked.

“The 100 percent dedicated Parkland hospitalist language is not something we can abide by, it’s not how we are structured, and not something we can be in 100 percent compliance on,” Dr. Ethan Halm, chief of internal medicine, wrote in an email to colleagues. “These are UTSW faculty, not Parkland employees.”

He called the negotiations a yearly “cage match” and insisted that “most of the people who split their time [between hospitals] spend the vast majority of their time at Parkland.”

It’s unclear what happened as a result of the hospitalist negotiations. But over the next two years, both sides continued to battle over staffing, revenue and control. One UTSW official said in an internal email that a “nuclear option” be considered to fire an employee appearing to side with Parkland’s effort to regain some control.

Dr. Claus Roehrborn, chairman of the UTSW urology department, emailed other school leaders in December 2010 expressing frustration over a proposal to provide additional urologists at the hospital. Parkland officials should “find themselves a urologist,” he wrote.

“None of our faculty is truly all that interested in working with a group of nurse practitioners thoroughly disinterested in their job, being reprimanded by the administrators around every turn, and having no patient of their own to follow,” Roehrborn wrote. “Plus, I really need them to all work at Aston [a UTSW ambulatory care center] and Zale. Far better for our enterprise.”

In December 2011, his last month in office, Anderson described “the vitriol of some of our medical colleagues” toward his chief medical officer. The criticism, he wrote in the CMO’s job evaluation, “is directly in proportion to [the CMO’s] pressure for needed change in supervision (amount and quality).” He also said that the current patient safety problems “have to be owned by Parkland, not blamed on UTSW.”

UTSW officials refused to disclose to The News exactly how many of their physicians work at Parkland. After they initially declined to answer a series of questions late last year, they sent a follow-up statement saying they “categorically reject” the findings of the Chartis study and did not have input into them.

In the statement they acknowledged, “While several hundred of our faculty contribute to patient care and teaching at Parkland to some degree, more than two-thirds of care is provided by a much smaller subset (about 30 percent) of our faculty.”

That subset of doctors, they said, is “essentially dedicated to Parkland and do not have appreciable practice responsibilities elsewhere.”

Wildenthal, who left his presidential post in 2008, also said in a statement that “there was a steady, progressive, and dramatic increase in the number of excellent faculty physicians rendering care and supervision at Parkland” over the last two decades. That was made possible, he said, because of the school’s ability to recruit physicians who care for both Parkland patients and UTSW patients.
n the comprehensive report last February in which federal safety monitors detailed Parkland’s many problems, including culture, they stopped short of calling for an end to the UTSW staffing model.

However, in addressing one of the most troubled areas of the hospital, the psychiatric emergency room, they wrote:

“The contractual and financial relationship between Parkland and UTSW cannot be a barrier to the imperative that there must be consistent physician coverage by doctors who are interested and committed to … promoting a new model of care. The Hospital [should] look to non-UTSW physicians for consistent coverage,” if necessary.

Federal regulators also have not directly called for an overhaul of Parkland’s relationship with UTSW. David Wright, deputy regional administrator for CMS, said that fixing Parkland’s most pressing problems — rampant unsafe practices — is the agency’s top priority.

“It’s like trying to walk through a building full of clutter,” Wright said when asked whether CMS or monitors would pursue such an overhaul. “You’ve got to get rid of all the clutter before you can see all the cracks in the foundation.”

Still, federal overseers have been helping Parkland regain control in a variety of ways.

Parkland has persuaded UTSW to commit full-time faculty doctors to the understaffed psych ER, the scene of a series of violent incidents including the death of patient George Cornell following illegal restraints two years ago Sunday. Last week, Parkland struck a deal with a private psychiatric firm to manage all mental-health services.

The hospital has developed a system to document and audit supervision of residents across the hospital but it is still being tested. And, recently, the hospital has contracted with a private company of physician-specialists to staff its urgent care center, which relieves pressure on the main ER.

The hospital also has greater authority over an influential medical executive committee responsible for evaluating doctors and developing proper clinical practices. Committee members were previously appointed by UTSW division chairmen and stacked with faculty doctors who worked primarily at other hospitals. The committee now consists of doctors who work at Parkland.

In addition, Parkland is developing a quality improvement program to measure and monitor patient outcomes and employee performance across the hospital, as required by federal regulations.

Dr. Marty Makary, associate professor of surgery and public health at Johns Hopkins University, said a safety-centered culture is fostered by an administration that measures outcomes, seeks employee input and moves aggressively to fix problems.

“Everyone agrees they know what a healthy culture looks like. But it takes time to change a culture and a business model,” Makary told The News. “In terms of a business model, you can’t fix something if you can’t measure it.”

Health care systems also must be transparent with the public about their breakdowns, said Makary, author of the new book Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care.

“What you don’t want is a situation where leaks to the press lead to embarrassment,” he said. “That’s a system where there is detached management, and people wait for things to blow up and they do patchwork fixes in response.”

Dr. Laurence McCullough of Baylor College of Medicine in Houston is among the few researchers nationally to study the complex power relationships between hospitals and medical schools. He says there is a need for uniform ethical standards to help oversee the partnerships across the nation. Fostering transparency between such organizations is a crucial element, he said.

Otherwise, the quality of care can be corrupted by other forces, he said.

“You have to be anticipating ethical challenges so you can manage them,” said McCullough, a professor of medicine and medical ethics. “When an organization focuses on the bottom line, it loses sight of care. That’s a formula for trouble.”

What it will take to fix Parkland’s problems, the federal monitors said, is a cultural transformation. Everyone, no matter the job, must be focused first and foremost on patient safety.

In retrospect, Dr. Shulkin said he wishes he and other Parkland board members would have taken stronger actions to protect the hospital’s mostly low-income patients.

“I would blame the skill of the medical school in being able to avoid what we were asking of them, and our not putting them to task for it,” he said. “I would demand a lot more accountability from UTSW. I would demand an investment from UTSW, an emotional investment for responsibility for patient care” at Parkland.

Dallas County Judge Clay Jenkins said Parkland needs to revisit the findings of past consultants calling for improved doctor coverage of patients and more openness.

“Parkland must require that doctors are sufficiently present at the hospital and focused on patient care,” Jenkins said after The News shared its findings with him. All contracts and internal rules “must include improving and maintaining transparent safeguards.”

Dallas Parkland Memorial Hospital caregivers accused of sexually abusing patients

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.

Staff Writer

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.


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.


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.

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.


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.


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.
Staff Writer

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.”