On August 10, 2020, El Paso pediatrician Roberto Canales was sued by David and Mariana Saucedo over the death of their three-year-old daughter, Ivanna. The lawsuit alleges “grossly negligent care provided” by the doctor and El Paso Children’s Hospital’s staff.
Roberto Canales has built a reputation over the years as a “beloved” doctor working miracles with El Paso children. The leadership of the El Paso Children’s Hospital considers Canales’ pediatric practice necessary for the hospital’s financial stability, according to an affidavit attached to the Saucedo Lawsuit. 
Dr. Mayes is in the position to know and understand Canales’ medical expertise because Mayes – as the Chair of the Department of Pediatrics at El Paso Children’s Hospital – refused to allow Canales to practice pediatric critical care medicine because Canales was not qualified to do so.
The El Paso Children’s Hospital leadership overrode Mayes’ determination and in violation of the hospital’s own standards credentialed Canales to practice at the children’s hospital. 
When El Paso Politics started reporting on the lawsuit, several individuals reached out to us telling us that Canales is “well respected” in the community. Others noted that a community the size of El Paso “deserves” a children’s hospital of its own.
We were told that we are “maligning” a well-known doctor with one individual in particular complaining that we “defamed” the doctor by publishing an editorial describing how Canales become well known in the community.
A Record of Malpractice
Doctors argue that the number of malpractice lawsuits filed against them are a product of a litigious society rather than the quality of care they provide. Making a correlation between the quality of care and malpractice filings against doctors is difficult because of the muzzling of details often imposed on out-of-court settlements.
However, a 2008 study looking into twenty years of malpractice lawsuits show that the outcomes of the cases “bear a surprisingly good correlation with the quality of care provided to the patient as judged by other physicians.” 
More importantly, the investigators of the 2008 study found that “between 80% and 90% of the claims rated as defensible are dropped or dismissed without payment.”  The study concluded that there exists a “correlation between the odds of a settlement payment and the quality of care provided” to the patient. 
Among pediatricians, a 2013 study looking into malpractice risk among pediatricians determined that malpractice “payments among pediatricians are infrequent.”  The study also found that pediatricians face claims at a rate of 3.1% compared to other doctors who are sued around 7.4% of the cases they work on.
The studies into malpractice lawsuits have found that pediatricians are sued less than their counterparts and that malpractice lawsuit payments correlate to the quality of care provided by the doctor.
The Canales Lawsuits
The Saucedo lawsuit, as troublesome as the detailed facts are, may not be enough to question the quality of care provided by Roberto Canales and the El Paso Children’s Hospital. But what about a history of malpractice cases?
Between 1987 and 2020, Roberto Canales has faced at least nine lawsuits for malpractice. Six of the lawsuits have resulted in death. It is not known how many patients Canales treats and thus determining a factor of lawsuits filed to the number of patients treated is difficult to ascertain. The secrecy of the settlements makes this harder.
However, the studies into malpractice lawsuits noted above have determined that a correlation between the quality of care and malpractice lawsuits exists.
On April 4, 2007, Canales was sued by Horacio and Martha Ornelas. The Ornelas alleged in their lawsuit that Canales “failed to properly care” for their child, who later died. The case was dismissed. It is unclear if a settlement was reached. 
On May 29, 2003, Lorena Martinez sued Canales and others on behalf of Guillermo Alejandro Perea. Perea “went into cardiopulmonary arrest due to the chemotherapy” that Canales was treating Perea with. According to the lawsuit, Perea “developed an allergic reaction to chemotherapy” in July 1995. On November 27, 1995, Perea “suffered permanent brain damage” as the result of Canales prescribing him chemotherapy. The lawsuit was settled as a nonsuit on November 24, 2003. 
Often, court cases settled as “nonsuits” is the result of a settlement agreement reached between the parties. Texas’s public policy “favors the amicable settlement” of court cases. (Elbaor v, Smith, 845 S.W.2d 240, 250; Texas 1992.) As part of the settlement agreements, confidentiality agreements are normally included. This makes it difficult to ascertain the details of the evidence.
However, as discussed in the 2008 study about malpractice lawsuits above, “between 80% and 90% of the claims rated as defensible are dropped or dismissed without payment.” Generally the dismissal of cases rated as defensible results in dismissals “for want of prosecution,” instead of “nonsuits.”
In December of 2003, Clementine and Victor Rodriguez filed a lawsuit against Canales and others alleging that Canales failed to provide adequate medical care that resulted in the birth of a child with severe disabilities. According to the lawsuit, Canales and the others did not provide the results of an amniotic fluid test with enough time to give the parents time to make an informed decision on whether they should proceed with the pregnancy. The case was dismissed “for want of prosecution” on December 15, 2004.
In Texas, a case dismissed for want of prosecution is usually the result of the plaintiff – the individuals suing – missing deadlines or filings to allow the case to move forward.
On April 20, 1992, Ricardo Ornelas and Alejandra Ornelas sued Canales for the death of their child. According to the lawsuit, the child was hospitalized on August 18, 1991. “During the hospitalization her condition worsened, and on August 24, 1991, Naomi Ornelas died.” She was under the care of Canales. 
An autopsy revealed that the 14-year-old child died of Thrombotic Thrombocytopenic Purpura (TPP).  TPP is a rare blood disorder that results in blood clots throughout the body. It has a mortality rate less than 1% (0.4%) according to two studies published in the National Library of Medicine, one in 1995 and the second in 2020. The first study analyzed cases between 1968 and 1991.  The second study sampled patient records between 2003 and 2016. 
Both studies showed a mortality rate of under 1%.
On March 29, 1995, the case was dismissed by the plaintiffs after several court actions. It is unclear why the case was dismissed but the court activity on the case suggests that a settlement was reached to settle the case.
Another case was also dismissed on March 4, 1992. Like the 1995 case, the court activity suggests that the lawsuit filed on April 5, 1991 was also settled out of court. In that case, Jackie Abshagen alleges that on April 12, 1989 her child was taken off life support after suffering “permanent brain damage.” 
According to the lawsuit, Canales told the mother that her infant would not be able to function “as a normal human being,” while informing her of the brain damage. The lawsuit alleges that although the mother had been instructed on emergency resuscitation (CPR) and the need to ensure her infant was breathing and that the infant had a heartbeat upon being discharged from the hospital, Canales refused to connect the infant to a heart monitor upon returning to the hospital a month later. 
The lawsuit alleges that Canales refused to connect the infant to a monitor on April 7th, 8th and on the 9th even though the infant was ill. The mother woke up on April 10th at the infant’s hospital bedside to find her child “was not breathing and felt cool to the touch.” Canales informed her of the brain damage on the 12th. 
On October 3, 1990, another child, under the care of Canales and another doctor died at the hospital. The child was experiencing symptoms of asthma attacks that got worse over 18 days in July 1988. That case was also dismissed after much court activity on it.
An October 28, 1987 case, also resulting in death, was dismissed for “want of prosecution” after several court actions.
An August 25, 1989 case that also resulted in death was settled by the hospital in the lawsuit for $60,000. From the online records it is unclear what the deposition of the case against Canales is, as the online reporting tools shows that the case was dismissed on April 16, 1993 for “want of prosecution” but it also shows court activity in 1990, 1991 and several unknown motions filed in 2000.
Of the eight cases identified by El Paso Politics it appears that almost half of them were settled out of court with the assumption that the settlements included some form of compensation.
This suggests that Canales has a significantly higher rate than the studies into malpractice lawsuits have found. The studies found that 10% to 20% of the malpractice cases result in payments whereas Canales appears to be paying out in about 50% of the cases.
The Money Factor
The El Paso Children’s Hospital has been mired in financial controversies since its foundation. The hospital opened its doors in 2012. It filed for bankruptcy in 2015. The hospital emerged from bankruptcy at the end of 2015 as non-profit wholly owned by the University Medical Center of El Paso (UMC).
It took at least three feasibilities to find a financial model to fund the El Paso children’s hospital. The third feasibility study agreed with the first two that it is not financially sustainable for El Paso to have a children’s hospital. However, the Katz Study, the third study suggested that in addition to having El Paso taxpayers fund a hospital building, El Paso’s pediatric population needed to be siphoned away from all the other medical providers directly into the children’s hospital.
During the bankruptcy proceedings, UMC Board Chairman Steve DeGroat testified that for children’s to be financially viable it needed “the community physicians, not directly associated with the Children’s Hospital, to encourage” them to admit their patients into the hospital for treatment.
Hiding Behind Fake Facades
The El Paso Children’s Hospital argues it is a non-profit organization not subject to the Texas Public Information Act, notwithstanding the fact that it is owned by the taxpayers of the county through UMC. The hospital argues that it is not required to provide information under the freedom of information laws of Texas because it does not consider itself a public entity.
In 2014, the author filed a request for financial information about the salary paid to the individual handling the public relations of the hospital. On December 10, 2014, the children’s hospital’s Manager of Legal Services, Melissa Dugal, replied to the author that they do not release information about their contracts to the public. Dugal added that they “respectfully deny” the author’s public information request.
Defamation & Libel
Often litigation is used to distract away from holding professionals to account. One of the often-misused litigation tools are threats of suits over libel or defamation. Libel and defamation laws are important in a society that values free expression to protect innocent parties from abuse. But using the laws limiting free speech to protect malfeasance hurts free societies.
On February 25, 2020, Roberto Canales filed a lawsuit against the Buzbee Law Firm and Texas lawyer Anthony Buzbee. Buzbee represents the Saucedos in their malpractice lawsuit against Canales. According to Canales’ lawsuit, Buzbee ran advertisements in the El Paso Times and in El Diario. Canales is alleging that the Buzbee advertisements – asking for parents whose children were hurt by Canales to come forward, “are defamatory, false” and “misleading.”
The Buzbee advertisements asked parents to call the law firm if children were hurt by Canales.
Buzbee filed a motion to dismiss the Canales lawsuit arguing that the advertisements “were for investigative purposes”. The trial court denied Buzbee’s request to dismiss the Canales lawsuit. Buzbee appealed the court ruling. On March 9, 2021, the Court of Appeals in the Eight District of El Paso denied Buzbee’s request to dismiss the Canales lawsuit.
The court held that Buzbee’s advertisements were not protected free speech but rather client solicitations. The Canales lawsuit against Buzbee remains in the court to be litigated later.
However, it should be noted that the Canales lawyers have focused their legal efforts in keeping information about Roberto Canales out of the public realm while arguing libel and defamation and asking a judge to throw out the Mayes affidavit on a technicality of privacy instead of on the merits of its content.
Lawyers Asked Judge To Hide Damning Details
Earlier this month, lawyers for Roberto Canales and El Paso Children’s Hospital went to court asking a judge to throw out at the Thomas Mayes affidavit. Rather than arguing that Mayes was wrong in his assessment of Roberto Canales, they instead are asking a judge to keep the Mayes affidavit away from the jury.
The defense lawyers are arguing the technicality that because Mayes was a member of the credentialling committee and that deliberations of the credentialling committee are subject to confidentiality that Mayes cannot disclose his concerns about Canales and the motivations of money behind having Canales work at the children’s hospital.
Thomas Mayes was clear in his affidavit that the information he was disclosing was either already public information – like the lack of board certification – or that the information was disclosed outside of any official credentialing meetings.
Like El Paso Children’s Hospital arguing that it is not subject to disclosing information under the Texas Public Information Law because it is a non-profit, notwithstanding that it is owned by UMC, the defense lawyers are using technicalities to hide incriminating evidence from the juries.
Children Are Dying
Hiding incriminating information and protecting the reputations of individuals is common in American jurisprudence. It is the result of a litigious society and of individuals trying to protect lucrative money flows. However, at what price is this acceptable?
Is the death of one child an acceptable outcome to protect an institution or an individual? How about two dead children?
More important is what do the lawyers and suffering parents tell other parents who lose a child due to malpractice when asked the question – why didn’t you warn the community?
At what point does the reputation of a “beloved” doctor outweigh the death of a child?
El Paso Politics would like to thank the unsung heroes who provide endless hours of research and access to documents.
- Affiant Mayes Aff. Cause No: 2020DCV2549, Saucedo v. El Paso Children’s Hospital Corporation, et al.
- Martin Paredes’ letter to Susie Byrd and El Paso Children’s Hospital dated December 9, 2014.
- Philip G. Peters, “Twenty Years of Evidence on the Outcomes of Malpractice Claims,” US National Library of Medicine National Institute of Health, December 2, 2008.
- Anupam B. Jena, MD, PhD, Amitabh Chandra, PhD., and Seth A Seabury, PhD., “Malpractice Risk Among US Pediatricians,” US National Library of Medicine National Institute of Health, June 2013.
- Horacio Ornelas, And Martha Ornelas, Individually And On Behalf Of The Estate Of Andres Ornelas, Deceased, Cause no: 2006-1613, (168th District Court, El Paso, Texas, 2007).
- Lorena Martinez, as Next Friend for Guillermo Alejandro Perea, Cause no: 2003-2189, (County Court of Law 7, El Paso, Texas, 2003).
- T. J. Torok, R. C., and T. L. Chorba, “Increasing mortality from thrombotic thrombocytopenic purpura in the United States,” 1995.
- Krishna Kishore Umpathi, Aravind Thavamani and Mammen Puliyel, “Predictors of In-Hospital Mortality in Thrombotic Thrombocytopenic Purpura in Children in the United States: A Population Analysis,” 2020.
- Ricardo Ornelas and Alejandra Ornelas, Individually and on Behalf of all Statutory Wrongful Death Beneficiaries of Naomi Ornelas, a Minor Child, Deceased, Cause no: 92-4864, (210th District Court, El Paso, Texas, 1992).
- Jackie Abshagen individually as representative of the Estate of Christopher Mathews, Cause no: 91-3758, (County Court of Law 5, El Paso, Texas, 1991).
- Opinion – Court of Appeals, Eight District of Texas, El Paso, Anthony G. Buzbee and the Buzbee Law Firm v. Roberto Canales, M.D. and Roberto Canales, M. D., P. A., (TC#2020DCV0691, No. 08-20-00138-CV, 2021).