By Jonathan Nelson, The Columbian, Vancouver, Wash.
Sep. 9–The citrus smell of Nautica cologne swept over Troy Dreiling’s former girlfriend’s senses as the Vancouver chiropractor pushed her against his office wall and closed a fist around her throat.
The 30-year-old woman, who asked that her name not be used, said she came to Dreiling’s business that August day in 2001 “to talk about the fact that we were pregnant.” He told her to leave.
She refused, he began yelling and slammed her against the wall, she said.
Dreiling, now 37, pleaded guilty to fourth-degree assault, domestic violence, for the incident. Dreiling had entered the same plea in 1999 in connection with a similar case with another woman.
The Chiropractic Quality Assurance Commission fined Dreiling $2,000 and suspended his chiropractic license for two years after investigating. The punishment, however, came not because of the assaults or the fact that Dreiling was treating both women at the same time that he was sexually involved with them. He was disciplined because he didn’t notify the governing body about the convictions. An agreement with the state allowed Dreiling to continue working as a chiropractor and president of Absolute Life Chiropractic in Vancouver during the suspension.
John McDonald, a Vancouver attorney who represented Dreiling, said the chiropractor declined to comment for this story.
McDonald said the state has never questioned Dreiling’s chiropractic abilities.
“What they went into didn’t involve negligence or omission on his part as far as the standard of care that is expected of his chiropractic care,” McDonald said.
Dreiling’s appearance before the chiropractic board wasn’t an isolated case. In 2005, he agreed to pay a $4,000 fine and serve a two-year suspension for charges that amounted to sloppy record keeping. Dreiling, again, was able to practice while serving that suspension. And he was able to get a chiropractic license despite a 1990 felony conviction for forgery.
The chiropractic commission’s handling of the case isn’t out of the ordinary when compared to other disciplinary action against Clark County health care industry workers.
The state routinely lets people who stole money from patients, assaulted patients in their care and had sex with clients keep their licenses.
In fact, the state rarely pulls a health care provider’s license.
Columbian review
The Columbian reviewed 223 disciplinary cases the Washington Department of Health handled between 2000 and April 2007. Officials revoked 41 licenses during that span. All but one of those professionals were allowed to seek reinstatement once they completed a state-mandated suspension that ranged from a year to as many as 20 years without a license.
The Department of Health’s job of meting out punishment to those who violate state laws and regulations is a fractured affair.
Within the health department is the Health Professions Quality Assurance office, which regulates nearly 300,000 health care professionals statewide that fall into 57 licensing categories.
The HPQA relies on 16 commissions and boards to oversee 34 of those licenses. Fourteen of the commissions and boards hold the power to levy fines and suspend or revoke licenses.
There is a good chance that the people handing out the punishment know the person in trouble since most of the board and commission members are professionals. For instance, doctors sit on the Medical Quality Assurance Commission and chiropractors on the Chiropractic Quality Assurance Commission.
State audit
A recently completed state audit ordered by Gov. Chris Gregoire found the system rife with flaws that include weak internal controls, spotty oversight of disciplined professionals and inadequate criminal background checks of license holders. The 13 specific findings leave the public at risk.
Rep. Tom Campbell, R-Roy, who is a chiropractor, has fought for years to toughen state laws regarding licensing requirements and the autonomy of commissions and boards that wield health care worker disciplinary authority.
“The boards are designed to protect the public,” Campbell said. “I think it’s confused. They’re protecting the professions.”
In the legislative session this year, Campbell and colleagues pushed for three bills that would have:
Allowed the state to permanently reject some applications based on past bad behavior. The law currently allows a person to reapply.
Toughened license standards for counselors.
In cases of a patient’s death or sexual misconduct, the disciplinary authority would be stripped from commissions and boards and given to the Secretary of Health.
All three bills died.
Campbell said the legislation will resurface in the 2008 session, and pressure against rogue health care providers is mounting in part due to a 2006 Seattle Times series that uncovered a system with gaping deficiencies that harbored repeat offenders. It was that series that prompted Gregoire to call for the audit.
The Times’ investigation found that one-third of the sexual misconduct complaints the Department of Health received since 1995 were dismissed without any inquiry.
The paper also found that license holders were often allowed to edit disciplinary orders by removing incriminating comments.
The health department responded to The Times’ series by implementing a series of changes that included investigating all of the sexual misconduct complaints and using emergency suspensions more frequently.
Mary Selecky, secretary of the health department, acknowledged the report has added a sense of urgency to changes under way. But Selecky said the state was already working to improve patient safety when the Times’ story appeared.
“It’s a journey we’ve been on to make sure we improve on patient safety and we’ve been working on it for a couple of years.”
Thousands of complaints
Each year the state receives 14,000 complaints, 5,000 of which become active investigations. In Clark County, there were 227 complaints filed in 2006, with 150 of those resulting in investigations.
Campbell said the structure of the agency and the autonomy of the commissions and boards put patient safety at risk. He said board members and people coming before them often went to school together, belong to the same professional organizations, know each others’ kids.
“There’s an inherent bias,” Campbell said. “They (board members) think, ‘there but for the grace of God go I.’ “
The department has attempted to remove the appearance of favoritism and uneven handling of cases by creating sanctioning guidelines, similar to the sentencing benchmarks criminal courts use. Selecky said the intention is to bring uniformity to punishing similar conduct regardless of the profession.
But of the 14 commissions that have discipline authority, only 10 have adopted the guidelines. For instance, the Medical Quality Assurance Commission, the group that oversees doctors, is the highest profile commission not to embrace the standard.
Selecky said the department is also trying to work harder at the front end of cases through a program started in 2004 that teams an investigator with a department attorney and field operative to review complaints and move the most egregious, where imminent harm is a possibility, to the top of the list.
That triaging of cases resulted in 55 summary suspensions being issued through the first half of this year compared to only 14 in 2006, according to Selecky.
Local cases
Locally, there are a number of past cases that might have drawn that more urgent response.
Robert W. Goodwin was an emergency room physician at Southwest Washington Medical Center in 2005 when he was contacted by a pharmacist who wanted pain medication for a friend who reportedly was heading overseas, according to disciplinary records. The pharmacist persuaded Goodwin to call 35-year-old Scott Piva, a Washington state trooper who was suspended from work at the time. Piva said he worked for a private company that provided para-military services and was assigned overseas and needed a six-month supply of pain pills for a back injury.
Goodwin, who never examined or met Piva, prescribed 720 tablets of the pain medication Hydrocodone and 250 pills of Xanax, a tranquilizer prescribed to relieve anxiety, documents said.
The prescription was given to Piva on March 13, 2005. Two days later, Piva’s wife, Danyel, found her husband dead in the bedroom of their Amboy home. Investigators found that 21 of the Hydrocodone pills and 30 Xanax tablets were missing. The Clark County medical examiner ruled Piva died of a heart attack.
The Medical Quality Assurance Commission reprimanded Goodwin and fined him $2,500. He resigned from Southwest on Dec. 14, 2005 and declined to renew his medical license when it expired April 1. State officials continue to investigate the open case, the specifics of which they won’t discuss. When contacted, Goodwin’s wife refused to let her husband talk about the case.
Vancouver gynecologist
Lyubov Veselkov worked as a Russian interpreter in the Vancouver office of Dr. Huong Luu and was also a patient.
On June 5, 2001, Veselkov was in the patient role when she lay down on the exam table. Luu, a gynecologist, entered the room, but left quickly, saying he forgot something, documents said. He returned and began the procedure.
Veselkov and Luu’s assistant, who was also in the exam room, saw a flash of light and heard the whir of a small motor. A few seconds later it happened again.
The assistant concluded Luu was taking pictures of Veselkov.
A couple of months later, Vancouver police took the processing unit from Luu’s computer and found that despite attempts to erase data, the doctor’s computer contained 137 pictures of female genitalia, according to documents.
Luu declined to comment on the case.
The medical commission fined Luu $3,000, suspended his license for three years and required that he undertake several evaluations. Luu continued to practice during the suspension and in 2005 successfully lobbied to remove all restrictions on his license. He continues to work in Vancouver.
State legislator Campbell said those kinds of stories keep him pushing to toughen oversight.
“Some people just shouldn’t be health care providers,” he said. “It’s a trust, it’s not a right.”
Disciplinary actions against local providers
Here are a few of the disciplinary actions the Department of Health has taken against Clark County health providers since Jan. 1. The Department of Health does not provide where the person in question practiced:
–Dentist Charles J. West was charged with unprofessional conduct for allegedly improperly setting a post for a crown during root canal treatment. –Physician Rae Wisler was charged with unprofessional conduct for allegedly failing to consider a different diagnosis of a patient, failing to adequately monitor therapeutic effects of treatment and failing to reevaluate diagnosis and treatment. –Susan D. Miller, a pharmacy technician, was charged in May with stealing money from her employer. –Gari D. Stanley, a registered counselor, was charged with unprofessional conduct for allegedly failing to comply with previous terms and conditions set against his license. –Registered counselor Glenda A. Bigalky had charges amended in connection with allegations that she caused patient harm when she accepted a friend as a patient, failed to provide written disclosure information to the patient, used substandard treatment methods and failed to maintain professional boundaries. –Pharmacist Robert S. Kellar was charged with unprofessional conduct for allegedly incorrectly filling a prescription and declining to provide counseling to a patient. –Pharmacist Jasmine T. Nguyen had her license put on probation for five years because she misrepresented her professional status to a prospective employer to obtain a higher salary and sign-on bonus. –Christina L. Cannizzaro, a registered counselor, had her license revoked because she engaged in sexual misconduct with a client. –Scott F. Koyen, a registered nurse, had his license suspended because he diverted methadone for personal use, worked while impaired and was convicted of possession of a drug without a prescription. His Nevada license is on probation for diversion of controlled substances. –Physician Michael L. Workman was charged with unprofessional conduct for allegedly allowing an unlicensed person to perform medical procedures in his office and at a facility where he was the medical director. –Mary S. Benavides, a nursing assistant, was charged with unprofessional conduct for allegedly violating a domestic violence and protection order.
Jonathan Nelson is a Columbian business writer. He can be reached at 360-759-8013 or via e-mail at [email protected].
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Copyright (c) 2007, The Columbian, Vancouver, Wash.
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