An El Paso Politics Special Report

This article was updated on October 5, 2020 at 10:07a.m. (ET) to clarify that as far as the El Paso Politics is aware, County Commissioner David Stout is not related to Cindy Stout. We also added a section headline for readability purposes.

[Author’s note: I had originally intended to publish this article as a multi-series piece over three days because of its length, but I soon realized that the sources would not be available until after the last article. Because of the importance of the information, I have decided to publish it as one article.]

Is El Paso Children’s Hospital A Danger to Children?

Are El Paso’s sick children in danger? A recent medical malpractice lawsuit seems to suggest that the El Paso Children’s Hospital is endangering El Paso’s children. As the El Paso Politics previously reported, David Saucedo and his wife filed a lawsuit in August alleging “grossly negligent care provided” at the El Paso Children’s Hospital in the death of their three-year-old daughter, Ivanna. Like in all lawsuits, the allegations are just that, allegations. However, once the article was published several individuals reached out to share their own stories. Some were former employees, others had first-hand knowledge of events and others lost loved ones. Their experiences and the documents reviewed by El Paso Politics paints a troubling picture of El Paso Children’s Hospital and the medical care they provide.

Today, El Paso Politics explores whether the El Paso Children’s Hospital is a danger to El Paso’s children. We will review court and other documents and share with the reader the information provided to us by several individuals through interviews and emails.

What we have seen shows a hospital where the CEO pushes “profits before patients,” as one former employee put it. [1] One lawsuit does not prove that something is wrong. Two lawsuits may raise some eyebrows. Three lawsuits may get more individuals to pay attention.

But when several documents, including court filings and individuals who begin to speak out about the troubling things they witnessed firsthand all suggesting that patient safety is not the priority, it is time to start taking a deeper look to see if El Paso’s children hospital is a danger to the children of El Paso.

Losing a child must be one of the most horrific experiences anyone can experience. Being a medical provider and being judged by laypeople, especially grieving ones, is likely also difficult as well.

Individuals should not draw conclusions from one bad experience nor from one problem.

But when several pieces of data come together suggesting something is wrong it is important to understand the implied problem, the reasons for it, and why they are happening. It is those pieces, formed together, that allows individuals to draw their own conclusions.

Doctor Presents a Real Danger To His Patients

The affidavit attached to the Saucedo malpractice lawsuit is clear and to the point, “Dr. Canales presents a real danger to his patients and should be removed from the practice of medicine.” [2] The sentence is concise and to the point.

Thomas C. Mayes is a graduate of Georgetown University and is a pediatrician accredited by the American Board of Pediatrics and Pediatric Critical Care Medicine. He is a board-certified pediatric intensivist. Mayes has practiced pediatric critical care medicine and held faculty positions in Texas medical schools for 30 years. For six years, Mayes “served as medical director of the Pediatric Intensive Care Unit (PICU) at University Hospital and Santa Rosa Children’s Hospital in San Antonio.” His duties included “appropriate credentialing of physicians and other providers based on training, experience and certification.” [2]

Thomas Mayes has extensive and verifiable experience in pediatric medicine including intensive care. According to his affidavit, Mayes began working “as a locum tenens pediatric intensivist at El Paso Children’s Hospital (TX) in January 2017.” [2] The Latin term locum tenens, which means “to hold the place of,” is used in the medical industry to refer to “temporary workers in the medical profession.” [4]

On April 1, 2018, Mayes was appointed as the interim Chair of the Department of Pediatrics for the Paul L. Foster School of Medicine at Texas Tech University. He served in that position until December 31, 2019. Mayes was also appointed “to the non-salaried medical staff position of Chair, Department of Pediatrics at El Paso Children’s Hospital.” One of his job duties “was to ensure that physicians were appropriately trained, certified, qualified, and could demonstrate appropriate experience in practicing pediatric medicine” at the children’s hospital. [2]

Thomas Mayes not only has the medical expertise to evaluate another doctor, but he was also required to do so as part of his job at the children’s hospital.

Mayes states in his affidavit that before Roberto Canales applied for medical staff privileges at El Paso Children’s Hospital, Mayes was already aware of him. According to Mayes, in reviewing the patient records of a Canales’ patient, Mayes was “startled to see the poor quality” of Canales’ medical records. Mayes had been retained as an expert witness in a case against Roberto Canales. [2]

Mayes, as part of his duties, “declined to signoff” on Canales’ application to practice pediatric critical care medicine at the El Paso Children’s Hospital. The reason Mayes provided was that Roberto Canales was “not certified,” and “unqualified” to practice pediatric critical care medicine. [2]

In 2018, there were at least eleven doctors in El Paso certified to deliver the pediatric medicine that Canales had applied for at the children’s hospital. [2]

“When EPCH hospital administration discovered my refusal to sign off on Dr. Canales’ pediatric intensive care privileges, I was ambushed by hospital administration, who repeatedly requested that I allow an exception for Dr. Canales,” wrote Mayes in his affidavit. [2]

Cindy Stout, CEO of El Paso Children’s Hospital, attempted to “brow beat,” Thomas Mayes into signing Canales’ waiver. Stout told Mayes that it was “very important” for the children’s hospital “to get Dr. Canales’ business”. [2]

Mayes adds that the “badgering” went on for weeks. Mayes added in the affidavit that Prashant Joshi, the El Paso Children’s Hospital PICU Medical Director also “declined to sign off” on Canales’ application. [2]

However, the El Paso Children’s Hospital Board of Directors overrode both Mayes and Joshi’s recommendation that Canales not be allowed to practice pediatric critical care medicine at children’s, and voted to “grant privileges” to Roberto Canales to practice pediatric critical care at the children’s hospital. [2]

Canales began admitting patients to the children’s hospital in March 2019. [2]
Although it was standard industry practice to have doctors peer reviewed by other doctors, according to the Mayes’ affidavit, the children’s hospital CEO, Cindy Stout, refused to institute a peer review process which was also required under the hospital’s bylaws. [2]

According to Mayes, Cindy Stout was telling him that Canales “could grade the quality of his own work without any accountability from his peers.” Mayes states that Stout explained her reasoning as Canales would not “get a fair shake” from the other physicians at the children’s hospital, “specifically those employed” by the Paul L. Foster School of Medicine. [2]

It was clear to Mayes that the children’s hospital “was doing everything in its power to appease Dr. Canales in order to continue to obtain his business,” declared Thomas Mayes in his affidavit. [2]

Thomas Mayes closes his affidavit with, “Dr. Canales presents a real danger to his patients and should be removed from the practice of medicine.” [2]

In response to the Thomas Mayes affidavit, rather than denying the facts that Canales “presents a real danger to his patients,” the doctor’s lawyers chose to argue that the Thomas May’s affidavit must be withdrawn from the public record. [14]

Canales’ lawyers did not dispute any of Mayes’ facts in his affidavit.

Troubling Malpractice Lawsuits

El Paso Children’s Hospital emerged from bankruptcy in January of 2016. Since then, at least five lawsuits alleging “injury,” and “damage” have been filed against the children’s the hospital.

On December 13, 2017, “a 12-year-old girl” who paramedics recognized as a “likely diagnosis of stroke” was flown to El Paso Children’s Hospital. According to a malpractice suit filed on June 10, 2019, although the “Emergency Department physician recognized that stroke” was the “likely diagnosis,” an “incorrect brain imaging study was done.” Dr. Rodolfo Fierro-Stevens, who had “not come into the hospital and see” the patient, “provided phone advice and reportedly thought that the patient might have had a migraine or a seizure.” [9]

In 2018, “on the day of her birth,” a child “was admitted to the Intensive Care Nursery (ICN) due to respiratory distress.” A severe infection developed on the child’s foot after an IV was improperly applied to the child. The medical records for the child misidentified the mother “and provided details of care for another individual who gave birth the same day.” The lawsuit narrative adds that “on various records,” the child, “is misidentified entirely” and there are records of a “bone break that never occurred” during her care at the children’s hospital. The child was released from the children’s hospital on January 21, 2018, “with her Grade IV wound present and open.” Eight days later the child was admitted to the emergency room at the children’s hospital “when it was clear” to the hospital that the child’s wound “was necrotic.” [11]

In another case in 2018 – this one on July 27, 2018 – one of a twin sister pair was taken to El Paso Children’s Hospital “in the custody of the El Paso Police Department.” The other twin sister along with their mother arrived later that day. “Upon seeing her sister in handcuffs,” the twin sister “became concerned and told her mother she wanted to leave.” A hospital staff member told the mother they could not leave. When the twin sister “became more agitated,” an El Paso police officer and “several” hospital “nurses threw” the twin sister “to the floor and physically restrained her.” The sister’s “arm was completely fractured in the process.” [10]

The three lawsuits above are in addition to the Saucedo lawsuit previously discussed and two other lawsuits that have been filed. Also, the El Paso Politics is aware of at least two other allegations of injured children where a lawsuit has not been filed as of October 4.

Money Before Patients

“Prior to Dr. Canales’ arrival, ECPH’s annually lost money,” wrote Thomas Mayes in his affidavit. Mayes, adds, “that changed once Dr. Canales began practicing” at the children’s hospital. [2]

Cindy Stout told Thomas Mayes that revenues from Canales’ patient load “was an important reason for accommodating Dr. Canales.” [2]

When El Paso Children’s Hospital filed for bankruptcy in 2015, then county judge, Veronica Escobar, who was critical of children’s for filing for bankruptcy instead of negotiating with UMC, told the El Paso, Inc. that meetings with local physicians “were intended to persuade local physicians to obtain privileges at Children’s and admitting their patients because more patients has been the main thing the struggling hospital needs.” [8]

El Paso Children’s Hospital has struggled to remain economically viable since it opened its doors.

Two feasibility studies looking into the viability of a children’s hospital in El Paso had determined a hospital was not financially sustainable.

A Financial House of Cards

Around May of 1999, a search committee was formed by Thomason and Texas Tech Health Sciences Center in El Paso to find a pediatric surgeon for El Paso. Thomason had lost Gerard Gollin, the pediatric surgeon serving at Thomason, who had left El Paso. Gollin had come to El Paso “with the understanding that a children’s hospital would be built.” Two primary reasons cited for the inability to attract a pediatric surgeon was the low-income levels in the city and the lack of a children’s hospital. “Some local medical professionals blame petty rivalries, politics and hospitals’ interest in protecting turf for the failure to unite behind a children’s hospital.” The El Paso Times quoted the Thomason chief of medical staff, Mathew Walsh, as stating that “there’s only enough money for one good children’s program among six hospital in El Paso, and no one wants to cede the operation to another hospital.” [6]

In 2002, the El Paso International Children’s Hospital Task Force was looking into the feasibility of creating a children’s hospital in the El Paso area. The driving force behind the initiative is that “El Paso remains the largest city in the nation without a children’s hospital.” Leading the effort was pediatrician Carlos Gutierrez. Another member of the task force was Sam Legate, who was also on the University Medical Center of El Paso board. At the time UMC was known as Thomason Hospital. The task force was organized by Thomason. While El Paso was looking to fund a children’s hospital, another group in New Mexico already had a commitment of $50 million of industrial revenue bonds from Sunland Park, New Mexico, “if a feasibility study” recommended the project. [7]

However, the El Paso leadership wanted the proposed hospital in El Paso. Gutierrez told the El Paso Times that “he would rather see the children’s hospital built in El Paso primarily because it could incorporate into a separate community plan to expand the medical and health care industry around Thomason Hospital.” [7]

Consultants hired by the El Paso task force said that they didn’t “see why the children’s hospital couldn’t be part of the BHI even if it was about 10 miles away.” However, former mayor Ray Caballero argued “repeatedly” that “all components of the new medical complex need to be physically grouped together.” “Gutierrez said another reason for building in El Paso is that most of the patients served by a children’s hospital would come from El Paso,” dismissing the New Mexico initiative. [7]

Prior to the 2002 task force, two studies looking into the feasibility of a children’s hospital in El Paso were created by two El Paso private hospitals. Both were generated by Ernst and Young in the 1990s. One for Columbia Medical Center and the other for Providence Hospital. The third feasibility study, by the El Paso International Children’s Hospital Foundation was created by The Katz Consulting Group in 2003. The Katz report found that “the number of patients admitted in recent years to the pediatric unit at Thomason Hospital would not be sufficient to support a stand-alone Children’s Hospital.” The Katz Study found that for a children’s hospital to “be financially feasible” required “the number of pediatric patients served” to “be increased”. The Katz Study recommended “that the Hospital and Texas Tech embark on an aggressive physician recruitment program centered on this Pediatric specialists (Medical and Surgical) where Thomason [UMC] does not currently enjoy at least a market share of 26 percent of El Paso General Pediatrics patients.” [14]

The two previous feasibility studies had determined that a children’s hospital was not feasible because there were not enough pediatric patients to fund a stand-alone pediatric hospital. The Katz Study agreed with the initial two studies and suggested siphoning patients from the existing medical facilities to make a children’s hospital financially feasible. The Katz Study also recommended tying the children’s hospital to Thomason, now UMC, to “construct the facilities and acquire the necessary equipment.” [14]

El Paso taxpayers were needed to make the project financially feasible.

El Paso pediatric physicians also needed to funnel their patients directly to the children’s hospital to make the hospital financially feasible. Without these two components, the El Paso Children’s Hospital would fail.

In 2007, El Paso voters approved $120 million in a bond election to fund building an El Paso Children’s Hospital. El Paso voters approved the bond 50.87% to 49.13% to fund the children’s hospital building. Children’s opened on February 14, 2012. On May 19, 2015, the hospital filed for bankruptcy owing more than $112 million, mainly to UMC. [8]

A point of contention between UMC and the children’s hospital was UMC’s demand for children’s to pay rent for the building they occupied. The El Paso Children’s Hospital argued that the 2007 bond money was for the children’s hospital “not for UMC to make money off of Children’s.” [8]

The Hospital Needs To Siphon Patients From The Other Hospitals

Once the taxpayer-funded building at UMC was ready, the children’s hospital needed the second component of the Katz Study to make it financially feasible, siphoning as many pediatric patients as it could get.

Then UMC Board Chairman, Steve DeGroat, testified at the bankruptcy hearing that for El Paso Children’s Hospital to be successful, “we need the community physicians, not directly associated with the Children’s Hospital, to encourage necessary admission,” into children’s, “versus other hospitals, primarily Providence that has a pediatric” practice. DeGroat added, “but for the future success of the hospital, you’ve got to have independent community physicians that will encourage admissions to the Children’s Hospital.” [13]

To accomplish the goal of recruiting as many local doctors as possible to send their patients to children’s, adult practice doctors were also credential to provide services at EPCH.

One of the problems observed by a former employee of the children’s hospital was the “credentialing of adult trajectory doctors” at El Paso Children’s Hospital. (El Paso Politics agreed to keep the individual confidential because they feared retaliation.) All that the adult doctors would do, is “take the call and refer the patient to children’s,” the former employee said. The former employee added, “very few adult doctors followed up” with the patients. [17]

There are a significant number of adult treating doctors with privileges at the children’s hospital, according to the former employee. [17]

Cindy Stout Created A Hostile Work Environment

According to a former doctor who worked at the children’s hospital, “things got significantly worse after Stout took over.” (The El Paso Politics has promised the doctor anonymity to protect them from retaliation.) The doctor stated that children’s uses “intimidation” to attack “hostile” doctors. The doctor stated they were subjected to various forms of intimidation. When the doctor wrote a letter to complain about the quality of care being delivered by another doctor, the doctor was told he “was NOT to get involved or write more letters,” [emphasis in original text message] by a medical director. [16]

In his resignation letter from the children’s hospital, Kimothy Sparks, wrote on August 30, 2018, that “the past eleven months have steadily and quickly become a living HELL.” [emphasis in original]

In his resignation letter, Kimothy Sparks added that “the rapid decline in staff, morale, and team culture is a true testament to a leadership style that DOES NOT WORK.” [emphasis in original]

Kimothy Sparks was the Director of Quality, Risk Management, Patient Safety and Accreditation at El Paso Children’s Hospital from January 2017 through his resignation on August 2018. Sparks said that prior to the arrival of Stout, the leadership team at the children’s hospital was “a good team to work with.” “Cindy arrived like a tornado,” Sparks said. [1]

In the first nine months of his arrival, “the hospital turned into a perfect well-oiled machine,” Sparks said.

According to a former employee who was in position to observe Cindy Stout, “Cindy went on about having community doctors send patients to children’s”. The Children’s Hospital created Fast Pass Track packets that were delivered to area pediatricians. The packets were designed to have the physicians easily send patients to children’s, instead of to Providence. “Literally, it was like going fishing,” the former employee described the packets. When asked, why? The former employee explained that “children’s was hurting for money.” They needed local doctors to refer their patients to El Paso Children’s Hospital instead of Providence. “Cindy was tasked,” by the UMC board “with bringing in all El Paso pediatric patients” to the hospital. [17]

When asked why the El Paso Children’s Hospital issued a credentialing waiver to Roberto Canales, although he was not qualified for it, the former employee replied, “easy, Canales had a big practice.” [17]

Canales’ patient load was what El Paso Children’s Hospital needed. Canales was credentialed at Providence and Stout wanted him at the children’s hospital.

The “Rocking Horse Hospital,” [17] [1], as Providence was referred to was Cindy Stout’s target. “Cindy needed to make money,” and to do so she needed to get as many referrals to the children’s hospital as she could. [17]

Mother Blames Hospital Politics For Death Of Her Child

A mother who lost her child at the children’s hospital blames the “politics of the hospitals” for the death of her daughter. Danira Chavez told the El Paso Politics that her daughter died because the nephrologist that Roberto Canales referred her daughter to was not allowed to practice at Providence. According to Chavez, Roberto Canales could not attend to her daughter at the El Paso Children’s Hospital because Canales was not credentialed at children’s at the time. Because the nephrologist could not provide services at Providence, Canales told her to take her child to El Paso Children’s Hospital, where the nephrologist could see her. [18]

Chavez describes Roberto Canales as “an excellent doctor”. [18]

“My daughter was killed because of the damn politics of the hospitals,” Danira Chavez told the El Paso Politics. [18]

Another child dies at the El Paso Children’s Hospital.

Joel Ojeda, who has “almost two decades working in the operating room” lost his daughter after she was treated at El Paso Children’s Hospital. Ojeda sent a letter of his concerns to the El Paso Children’s Hospital leadership after the death of his daughter. He has not received a reply to his letter, almost three years later. [19]

Ojeda took his daughter from El Paso Children’s Hospital to Cook Children’s Hospital in Ft. Worth Texas on November 2, 2017. At Cook, the parents learned “that a lot of things they did at El Paso Children’s Hospital should never have been done.” Ojeda describes how a second PICC line needed to be inserted into his daughter, after the first one had become infected. A PICC line is used for long-term intravenous antibiotics. [19]

The old PICC line was left inserted and the new one “was soaking wet” indicating that there was a problem. The medical staff was unable to resolve the problem with the PICC line and the child was “in horrific pain.” She was also “swollen up all over her body”. [19]

The next day, the child was taken to the operating room to deal with the PICC line. When the daughter stopped breathing after being sedated, the medical staff ordered a “code”. It was at this point that Joel Ojeda noted that the hospital did not have the proper equipment to deal with the emergency. According to Ojeda, someone had to get an AmbuBag from “bay two and take it to bay three,” where his daughter was being treated. According to Ojeda, an AmbuBag is required in each bay. [19]

At Cook Children’s Hospital, the Ojeda’s learned that their daughter was “grossly misdiagnosed” at El Paso Children’s Hospital. [19]

Joel Ojeda says he feels that the children’s hospital saw his daughter, Mia, “as a profit line and not a patient by refusing to transfer her to a higher-level care immediately.” He adds, “I also feel as if they wanted to use Mia on their resume to say they have treated a child with Neuroblastoma.” [19]

Ojeda says that the oncologist in Fort Worth told them, “with tears in her eyes, to please not go back” to El Paso Children’s Hospital. [19]

The Taxpayers Are Liable

Although there exists a notion that the El Paso Children’s Hospital is a separate hospital that is a non-profit who has its own Board of Managers, the fact remains that the 2015 Amended Bylaws of the hospital specifically acknowledges that the “Sole Member” is “El Paso County Hospital District d/b/a University Medical Center (the “Member” or “UMC”) shall be the sole corporate member of the Hospital.” [12]

El Paso taxpayers are ultimately responsible for the El Paso Children’s Hospital, including any malpractice payments the insurance does not cover.

Although the children’s hospital board governs the operations of the hospital, UMC has reserved 15 governing powers that only it can approve. Among them are the annual budget; the approval of strategic and business plans; “any material change to the Hospital Medical Staff bylaws”; and the “selection and removal of the Hospital CEO”. [12]

Cindy Stout, the current CEO at El Paso Children’s Hospital, serves directly at the pleasure of UMC, a taxpayer-funded entity, according to the bylaws.

UMC Board Members have argued that the El Paso Children’s Hospital is a separate entity with its own board. However, the bylaws are clear in that the UMC Board of Managers have the final authority to approve who the children’s hospital CEO is, and the business practices of the pediatric hospital.

Joel Ojeda says that El Paso Children’s Hospital “uses children as guinea pigs.” [19]

When asked what El Pasoans should know about the situation at El Paso Children’s Hospital, the former doctor responded that El Paso was “told that if it built it, highly trained specialists would come.” The former doctor added, “and they did, and they left, because EPCH was an administrative nightmare.” The doctor concluded, “El Paso needs to know their stories (departed doctors) because woven together it may yield the root cause of this terrible illness.” [16]

Footnotes:

1. Interviewee Sparks, Kimothy, JD, RN. (Director of Quality, Risk Management, Patient Safety and Accreditation, El Paso Children’s Hospital, January 2017 – August 2018), in telephone discussion with author, October 1, 2020.
2. Affiant Mayes Aff. Cause No: 2020DCV2549, Saucedo v. El Paso Children’s Hospital Corporation, et al.
3. David Edward Saucedo, II and Mariana Terrazas Saucedo, Individually and on Behalf of I.S., a Minor Child v. El Paso Children’s Hospital Corporation, Dr. Roberto Canales, M.D., and Dr. Rodolfo Fierro-Stevens, M.D., Cause No: 2020DCV2549, (171st District Court, El Paso, Texas. 2020).
4. Jane Ferguson and Kieran Walshe, “The quality and safety of locum doctors: a narrative review,” Journal of the Royal Society of Medicine, November 2019.
5. Documents received by the author under a Texas Public Information Act request on December 2, 2015. The FOIA request requested communications between the University Medical Center of El Paso and others regarding the appointments of the children’s hospital initial children’s Board of Managers. UMC File no: HM-15-089.
6. Gary Scharrer, “El Paso can’t hire a pediatric surgeon,” El Paso Times, October 24, 1999.
7. Tammy Fonce-Olivas, “2 groups map plans for children’s hospital,” El Paso Times May 24, 2002.
8. David Crowder, “Children’s docs say no to UMC takeover,” El Paso Inc., August 3, 2015.
9. Kevin Hensley, Individually and as natural parent, next friend and legal guardian of KH, a minor v. Steven Ross, MD and Rodolfo Fierro-Stevens, MD, Cause no: 2019DCV2190, (346th District Court, El Paso, Texas, 2019).
10. Rocio Hernandez de la Cruz v. El Paso Children’s Hospital Corporation, Cause no: 2020DCV2366, (171st District Court, El Paso, Texas, 2020).
11. Arturo C. Martinez and Erika Martinez As Next Friends of Frida Fernanda Martinez, a Minor Child v. El Paso Children’s Hospital Corporation, (41st District Court, El Paso, Texas, 2020).
12. Amended Bylaws of the El Paso Children’s Hospital Corporation, 3.1 Article III, Member, October 2015.
13. Oral Depositions of James Stephen DeGroat, taken on August 4, 2015 in the bankruptcy case of El Paso Children’s Hospital., Case no: 15-30784-HCM, Chapter 11.
14. “El Paso Children’s Hospital Feasibility Study, prepared for Thomason Hospital,” The Katz Consulting Group, March 13, 2007.
15. David Edward Saucedo, et al v. El Paso Children’s Hospital Corporation, et al, Cause No: 2020DCV2549, “Defendant Roberto Canales, M.D.’s Motion to Strike Affidavits, Opinions and Testimony, (171st District Court, El Paso, Texas. 2020).
16. Text messaging interview with former El Paso Children’s Hospital doctor with author, October 2, 2020.
17. Telephone interview with former El Paso Children’s Hospital employee with author, September 30, 2020.
18. Interviewee Chavez, Danira (child died at El Paso Children’s Hospital in 2016), in telephone discussion with author, September 27, 2020. The interview was conducted in Spanish.
19. Interviewee Ojeda, Joel (child died after treatment at El Paso Children’s Hospital), in telephone discussion with author, September 26, 2020.

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