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February 14, 2010

Small-town "justice" run amok?

I have been intrigued by the attention national media have given this week to a criminal trial in West Texas.  Ann Mitchell, an administrative nurse at the community hospital in Winkler County, went on trial in state court charged with "misuse of official information," a third-degree felony that carried a possible fine of $10,000 and up to 10 years in prison.  The charges stemmed from an anonymous letter that Mitchell and another administrative nurse wrote to the Texas Medical Board.  In it, they called the Board's attention to irregularities in how Dr. Rolando G. Arafiles was practicing medicine at the hospital where they worked.  The nature of the irregularities and report are described in a New York Times story as "a pattern of improper prescribing and surgical procedures — including a failed skin graft that Dr. Arafiles performed in the emergency room, without surgical privileges. He also sutured a rubber tip to a patient’s crushed finger for protection, an unconventional remedy that was later flagged as inappropriate by the Texas Department of State Health Services."  The nurses believed they were under a professional obligation to make the report, but following it, the Winkler County Sheriff's Office seized their work computers and arrested them.  The local prosecutor subsequently charged the nurses with the third-degree felony, and the Winkler County Hospital fired them.  Those consequences apparently unfolded after the Medical Board notified Dr. Arafiles of the anonymous complaint and he told his "friend, the Winkler County sheriff, that he was being harassed. The sheriff, an admiring patient who credits the doctor with saving him after a heart attack, obtained a search warrant to seize the two nurses’ work computers and found the letter."  The prosecutor says that Mrs. Mitchell has a history of making "inflammatory" statements about Dr. Arafiles and that she did not make the report in good faith.  To establish the felony charged, however, the State must prove that she disseminated confidential information for a "nongovernmental purpose" with intent to harm Dr. Arafiles. 

The prosecutor dropped charges against Mrs. Mitchell's colleague just before the case went to trial.  A jury in neighboring Andrews County acquitted Mrs. Mitchell on Thursday.  The jury voted unanimously on the first ballot to acquit the nurse and questioned why she had ever been arrested.  Read more here.

New York Times reporter Kevin Sack observed that "seeming conflicts of interest are as abundant as the cattle grazing among the pump jacks and mesquite" in the small town of Kermit, population 5,714, where these events unfolded.  Indeed, subsequent reports reveal an additional conflict:  according to filings in a federal case the nurses have brought against Arafiles, the Sheriff, and Winkler County, the Sheriff is a partner in Dr. Arafiles' herbal supplement business, a business that Arafiles promoted in emails to patients.   

Despite the obscure locale of these events--or perhaps because of it--the New York Times published three items about them last week.  The paper reported last week-end on the impending trial of Mrs. Mitchell, and later in the week it reported the not-guilty verdict.  In between, it published an editorial commenting on apparent flaws in the prosecution and the chilling effect it might have on whistle-blowing.  

The first NYT story about these events inspired this blog post on my Legal Ruralism blog, and I was especially intrigued that the story attracted as much attention as it did.  On the day it appeared, it rose as high as number 2 on the "most emailed" list at nytimes.com, and it stayed on the top-10 list for nearly two days.  I attributed the high degree of interest to the broad headline, "Nurse to Stand Trial for Reporting Doctor."  Many doctors and nurses all over country were presumably taking note of this unusual event and sharing the news.  But the New York Times reporting and editorial suggest several ways in which this story is distinctly "rural" or "small-town." In addition to referring to the apparent conflicts of interest, Sack's reporting refers to the "stained reputations" of the nurses and how "heads turn when they walked into local lunch spots."  He also reports the practical difficulties that rural hospitals like that in Winkler County have in attracting and retaining physicians; indeed, Dr. Arafiles came to the hospital in 2008 with a restriction already on his medical license.  The trial was moved to neighboring Andrews County because it "polarized the community."  Finally, the New York Times editorial suggests that "small-town 'justice'" was the problem.  

So, is there really something distinctly "rural" about this story, or could it happen anywhere? Clearly, it could happen anywhere, though I tend to agree with the Times' suggestion that the rural context facilitated this unusual prosecution. 

Rural sociologists and other scholars who write about rural-urban difference have discussed a number of factors apparently at play in these West Texas events.  These include lack of anonymity and conflicts of interest that sometimes result from it; rural disadvantage in terms of access to services such as medical care; a lack of checks and balances in rural local government and a related failure of local government to protect civil rights.  In this case, heightened reputational injury associated with lack of anonymity and the inability of the dismissed nurses to find replacement jobs because of the limited labor market presumably increased the damages they suffered.  This little case out of Kermit, Texas thus illustrates how various characteristics of rural places can be legally relevant in a variety of ways.  Some of the challenges associated with rural lack of anonymity were apparently mitigated by the change of venue.  Whether law and legal actors adequately respond to other challenges associated with rural places--such as those that seem to have aggravated the nurses' damages--may be evident when their case against the various officials is tried or settled.

Cross-posted to Legal Ruralism Blog.