The Politician and the Madman

In 2011, a new doctor came to the town of Kermit, Texas, in the remote, dusty reaches of West Texas to take a permanent position at the brand-new county hospital. Around the same time, another doctor came to the bright lights of Dallas to start a neurology practice.

Both men were charming, good-looking, fast-talking, and confident. And both would leave chaos and injury in their wake — exposing the deep flaws in Texas' medical system.

Part I

What Happened in Kermit

If you get hurt in Kermit, as in most small Texas towns, there is only one place to go. Car accidents, roughnecks with chemical burns, women in sudden labor—they all go to Winkler Memorial. It’s small, with 25 beds and two or three doctors on staff. But in the ultramodern, $13 million facility that opened in 2007 to replace the old hospital, Winkler Memorial provided basic care that a small community needs. Because few doctors wanted to devote their careers to a dusty flyspeck in West Texas, the community relied on foreign doctors who came in on a J1 Visa, served a few years in Kermit, and moved as soon as possible to bigger cities. 

But then in 2010, a new doctor came to Kermit. Rolando Arafiles was smooth-talking and good looking, and more than that: he was willing to settle in town. For the first time since the oil patch began to go dry, residents would have a doctor they could grow old with. He took up with the town's old families and power brokers, forming close friendships with the hospital administrator, the county district attorney, and the county sheriff, Robert Roberts. 

But Winkler Memorial's nurses watched Arafiles with concern that grew to panic.  When the medical care is excellent, Kermit residents’ lack of choice isn’t a problem. But in a facility with just two or three doctors, it doesn’t take much to change the quality of care from excellent to downright dangerous. And in 2011, as Arafiles began to grow increasingly unhinged, the nurses watched their hospital slipping, and determined that it was their job to save it.

As Dr. Arafiles began to conduct strange surgeries, Kermit's nurses turned to the one outside authority that could help: the Texas Medical Board. But when the town sheriff caught word of what was happening he acted decisively: by going after the nurses.

Narrative

Intent to Harm

The Texas Observer
March 17, 2011

The Texas nurses versus Arafiles. (This piece won an award for Best Longform Newswriting from the American Association of Alternative Newsweeklies, and was published in Longform.org's book Best Alternative Longform Journalism.)

RADIO

Old Boys Network

This American Life
June 3, 2011

Radio version of the Kermit story. 

INTERVIEW

How I Got that Story

Longform.org
Fall 2011

A Q&A in which I answer questions about the making of the Kermit story; reporting for This American Life; and the downside of having a mother that loves you.

Part II

Blood in the Hospital

As we worked on the Arafiles piece at the Texas Observer, we were haunted by a question: how had things gotten that far? How had a doctor like Arafiles — with a history of bad practice and bad judgment across Texas — managed to get another hospital job in the first place? How had the Medical Board lost track of him, and how had it taken them so long to sanction him for what happened in Kermit?

Another case in Dallas would answer these questions, revealing a Texas medical regulatory system that had been dangerously — and deliberately — stripped of effective regulation, leaving little shield standing between patients and predators. In 2013, about 18 months after the Arafiles affair, the Texas Medical Board convened to take emergency action on another doctor — an ambitious young neurosurgeon named Christopher Duntsch, who had left a trail of dead and crippled patients behind him as he moved from hospital to hospital.

The real tragedy of Duntsch's case was how preventable it was: for over a year, as the bodies piled up, the Medical Board and the hospitals he worked with received repeated complaints from his colleagues and patients' lawyers begging them to take action. And throughout 2012 and 2013, as evidence of his danger mounted, unsuspecting patients with nerve tingling and back pain continued to come into his well-appointed Plano office, put their insurance information on the table, and prepare themselves to go under his knife. This is the story of how that happened and how he was stopped.

Narrative

Anatomy of a Tragedy

The Texas Observer
August 28, 2014

In the gleaming hospitals of Dallas, a novice neurosurgeon leaves his patients maimed and dead during minor surgeries. But the real tragedy is that the Texas Medical Board couldn’t stop him.

Investigation

Licensed to Kill

The Texas Observer
May 1, 2014

As he left dead and crippled patients in his wake, Christopher Duntsch was quietly passed across Dallas from hospital to hospital. Which begs the question: what legal responsibility does a hospital have to keep a dangerous doctor from operating? In Texas, the answer is: none.

Reaction

Greg Abbott Strikes Back

The Texas Observer
August 1, 2014

In the wake of lawsuits against hospitals that allowed Dr. Duntsch to practice after killing his patients, Texas current governor takes a bold stance: by standing up for the hospitals that protected him.