Is There a Doctor in the House?
The Miami-Dade Department of Corrections and Rehabilitation. I like the sound of that. Such a hopeful name for such a severe agency. If you get into serious trouble, all is not lost. You can always be rehabilitated.
I'm talking about the staff, of course, not the inmates. At corrections, there are plenty of second chances. One example: Dr. Robert Gonzalez, the department's medical compliance officer. He doesn't practice medicine in the county's sprawling system of seven detention facilities; corrections contracts the Public Health Trust to handle that task. But Gonzalez, who earns $68,000 a year, is the department's top administrative medical officer. He inspects the facilities, reviews inmate medical records, and evaluates the medical needs of the jails.
Nonetheless, during the recent outbreak of an antibiotic-resistant strain of staph infection at one of the jails, it was the 59-year-old Dr. Gonzalez who got a call for help from the mother of the first inmate diagnosed with the problem. And after state health department officials inspected the jail, they sent Dr. Gonzalez a memo with information on how to deal with the problem. As you can see, a lot rests on his shoulders.
The staph outbreak was an embarrassment for the department's medical team. For more than two months they failed to properly diagnose that first inmate's infection as his condition grew worse, even though jails in Broward and Palm Beach counties were struggling to contain the very same outbreak of MRSA (methicillin-resistant Staphylococcus aureus). When the sick inmate and a second individual were at last correctly diagnosed with the highly contagious MRSA, they were quietly quarantined. Only after the episode was exposed in this column did the department announce it would send out notices to all facilities and have medical staff inform all corrections officers about the infection and its consequences. Some corrections officers reported that Gonzalez failed to promptly implement the health department's recommendations to contain MRSA. Even now the officers union has formally complained that staff lack adequate gear and equipment to protect them from infection.
The episode continues to be an embarrassment for a very different reason -- it has put Dr. Gonzalez in the spotlight, and he's shining bright as a poster boy for one of the most persistent problems at corrections: the craven political manipulations that have dogged the department for decades.
Long before Robert Gonzalez-Galban, Jr., M.D., went to work for the county, he had his license to practice medicine revoked for "gross or repeated malpractice" and "incompetency." It's never been reinstated. But with the right friends, even a disgraced doctor can land a job sucking at the public teat. For all his faults, Gonzalez had one thing going for him, at least in Miami-Dade County: He was a Cuban exile with staunch anti-Communist credentials -- credentials that went far beyond attending meetings of the Cuban Medical Association in Exile. He was a CIA contractor in war-torn Nicaragua.
On his résumé Gonzalez notes that from 1982 to 1987 he set up field hospitals for "war victims in Nicaragua." In 1987 his name popped up during the congressional inquiry into illegal funds channeled by U.S. military officials to Nicaraguan rebels, known as contras, fighting that country's socialist government. A front company for the CIA "was billed for the services of Dr. Robert Gonzalez Jr.," according to an Associated Press story.
When he wasn't patching up guerrillas for the spooks, Gonzalez was practicing medicine at Pembroke Pines General Hospital. That is, until the state's Department of Professional Regulation accused him of misdiagnosing seventeen patients. Regulators alleged that Gonzalez "exercised influence on patients for financial gain," because he routinely ordered batteries of redundant or useless, but expensive, tests. And he regularly ordered lengthy hospital stays when there was no evidence to support those orders.
Here's just one case from 1983: Gonzalez hospitalized for fourteen days a patient who had complained of abdominal pain and "biliary disorders." He performed a series of tests, including an EKG, cervical spine x-rays, gallbladder sonogram, chest x-ray, an echocardiogram, a barium enema, a sonogram of the thyroid gland, an air contrast barium enema, a urinalysis, platelet count, nine glucose-level tests (all normal), a glucose-tolerance test, two stool cultures, 24-hour monitoring of urine creatinine levels, and a parathyroid hormone study. That's only a partial list of the tests he ordered. In the end he diagnosed the patient with diverticulosis, an irritation of the sack at the end of the colon, and a form of diabetes (although state regulators said there was no evidence of diabetes).
The Florida Board of Medicine ultimately ruled that his misdiagnoses went beyond mere incompetence and rose to the level of a "trick or scheme ... for financial gain." (Ironically one of the cases studied by the board was a mistaken diagnosis of Staphylococcus aureus, a more aggressive strain of which would cause problems at the jail.)
Before revoking his license, the board tried to contact Gonzalez so he could attend a hearing, but his answering service responded that he was out of town. It wasn't until a few years later that Gonzalez made a bizarre appeal to have another hearing based on the fact that he'd been out of the country treating wounded contras for the CIA. He and his lawyer even had a retired DEA agent appear before the board to vouch for Gonzalez. The board agreed to hold another hearing, but Gonzalez never followed through.
Instead in 1993 then-county Commissioner Pedro Reboredo hired Gonzalez as a special assistant. Reboredo had longstanding political and business ties to Nicaragua. He was a major supporter of President Arnoldo Alemán, for whom he hosted election-campaign fundraisers. (Alemán has since been convicted of embezzling millions of public dollars. The Miami Herald has reported that Reboredo was the legal director of a company Alemán may have used to launder some of that money.)
Reboredo, you may remember, has had his own problems. In 2001 he pleaded no contest to exploiting his office for keeping two no-show employees on his payroll. He was forced to resign from the commission. But by then Reboredo had successfully placed Gonzalez at the county's Department of Corrections and Rehabilitation.
That hire boggles the mind. What kind of place would employ a doctor who misdiagnosed at least seventeen patients, when the position required him to "review inmate medical records"? And it wasn't easy. Reboredo had to lean on ex-county manager Armando Vidal, who in turn had to seek absolution from the county attorney's office -- which he got, sort of. In a December 19, 1997, memo, county attorney Robert Ginsburg responded to Vidal's question whether "a county employee possessing a revoked medical license may work as a medical contract compliance specialist." Ginsburg's conclusion: "Based upon the attached job description, and the legal authority reviewed, the employee technically appears to be able to work as a medical contract specialist since a valid medical license is not required by the job description."
That's all Vidal needed to please Reboredo, so it's possible the ex-manager never even read the last paragraph of the memo. It states, "The attached job description, however, ... is sufficiently general to permit acts that could require medical licensure.... In light of the fact that the subject employee has had his license revoked, the county would likely be liable if the employee were to be found negligent in the performance of his duties. Whether the county would want to incur this potential risk is an administrative decision, not a legal one."
In his seven years at corrections, Gonzalez has managed to avoid being sued for negligence. And if you believe his annual evaluation forms, he has done an "outstanding" job. I called him to discuss his colorful past and how it might affect his work. "I don't touch no inmate here, sir," he began defensively. "I don't have nothing to do with the practice of medicine."
But what about reviewing inmates' medical records?
"Just like at the insurance company when they review medical records, that's what I do," he said. Then, perhaps sensing that the conversation was headed toward the touchy subject of erroneously reviewed medical charts and misdiagnosed patients, he continued: "When I do that, I don't do that by myself. Usually a nurse is with me."
And that was about all he cared to offer on the subject. "I don't want to answer any more questions," he said.
I can understand why. The time for accountability has long passed. He is now a proud employee of the corrections and rehabilitation department, the home of second chances.
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