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Feeling the pain: A small town struggles to find doctors

Copyright © 2019 Albuquerque Journal

Editor’s note: This is part two of the Journal’s three-part series

Dr. Paul Willette served as the chief of staff, surgeon, hospitalist, primary care clinician and chair of the quality assurance committee at the Union County General Hospital in Clayton, N.M.

He has taken credit for upgrading the 25-bed hospital in northeastern New Mexico to a Level IV trauma center, advocating for rural critical access hospitals, and sponsoring the county rodeo.

Dr. Paul Willette is suing the New Mexico Medical Board to get his license back. (Courtesy of Panhandle Press)

But his stint at Union County General lasted only 14 months after he was deemed a “clear and immediate” danger to the public health and safety in a 2016 summary suspension by the New Mexico Medical Board, which ultimately revoked his medical license.

Willette, who no longer lives in New Mexico, blamed his many roles and workload for his alleged substandard care of patients, including an 81-year-old cancer patient who died of an alleged drug overdose after Willette upped the frequency of his medication.

“I’m someone who did multiple things. It was impossible to keep up with the work,” Willette said during a Medical Board hearing in 2017.

Willette, whose attorney didn’t return a request for comment last week, is suing the Medical Board in state district court to get back his license. He was also sued for medical negligence and wrongful death by the cancer patient’s estate.

While the circumstances of Willette’s departure may be unique, losing a physician is nothing new to Union County, which has seen a revolving door of doctors and, according to a 2016 hospital needs assessment, longs for “access to consistent, local primary care physicians.”

Union County General Hospital in Clayton has seen a revolving door of doctors. Residents says instability with primary care providers is the county’s biggest problem. (Source: Union County Chamber Of Commerce)

According to the assessment, those residents interviewed “overwhelmingly agreed that instability with primary care providers is the biggest problem for the county.”

While Albuquerque and its surrounding areas may experience health care access issues, “outside of the four or five county area (around the city) it is truly a crisis,” said Dr. John Cruickshank, CEO of Lovelace Medical Group, based in Albuquerque. “These smaller towns, the rural cities and frontier cities … are struggling to recruit providers.”

Doctor ‘worked himself to death’

Union County, with a population of about 4,187, is among seven New Mexico counties with fewer than four physicians, according to a recent state health workforce study. In 2017, there were federally designated health professional shortage areas in all of New Mexico’s 33 counties but one, Los Alamos County.

Larry Fluhman, president of Clayton’s Farmers & Stockmens Bank, said the community “really needs two doctors.”

“We had a second physician until a week ago. They kind of had it solved, but that would be the first time in 15 years,” said Fluhman, who grew up in Roy, some 88 miles away. “You get some of these guys to move to Clayton. But if they’re not born and raised in a rural community or have some ties, it’s extremely difficult to keep them.”

Sometime back, Fluhman said, the town had a popular homegrown physician/surgeon who worked 24/7 for 25 years.

“He passed away and he was pretty young. But I think that’s what happened to him. He worked himself to death. They wear those guys out. They’re pretty much doing everything all the time.”

Fluhman said his wife, Jessie, is a certified nurse practitioner in Clayton. Nurse practitioners, who can work independently from a doctor under New Mexico law, have “taken the pressure off (doctors) and helped a bunch,” he said.

“But it seems like the demand for medical care continues to increase,” he said. “I know my wife saw 28 patients yesterday and that’s almost unheard of to see that many people.”

Asked about Dr. Paul Willette, Fluhman said he knew him briefly.

“It just seems like the ones that we get, aside from this last doctor who just got frustrated with whatever (and left), it seems like if we get them to move to a rural community, they have some baggage or something that shows up later that we weren’t aware of.”

Or they can’t adjust to the low-key rural life, he added. Clayton has some amenities, such as a theater and an old hotel and dining room, but “you certainly can’t go to the opera or anything, I mean that’s for sure.”

Litany of complaints

While working at the nonprofit Union County hospital, Willette was paid up to $350,000 in yearly compensation and other benefits, according to hospital 990 tax filings for the years 2014 and 2015.

But he appeared at a Medical Board hearing in early 2017 representing himself because he said he had no money for an attorney.

The board’s investigation of Willette, who previously worked in Nebraska and the East Coast, involved a review of dozens of his patient files. According to board testimony, allegations and findings:

• A patient with diabetes and hypertension admitted to the emergency room at the Union County General Hospital waited nearly two hours one night while Willette, who had ER duty, failed to answer a nurse’s repeated calls.

The nurse finally alerted police, who found him down the road at the Days Inn Motel.

• Another patient was admitted to the ER in “severe distress,” needing help to even get out of the car. When told by hospital staff to “come now,” Willette instead gave treatment orders over the phone. He was criticized for the lack of more immediate and aggressive treatment and for failing to prepare the patient for a higher level of care.

The patient was moved six hours later to an Amarillo hospital at the insistence of his wife. He died the following day.

• One patient who had trauma to the head, bleeding and loss of consciousness arrived at the ER. A nurse called Willette’s cellphone five times. Each time, Willette “would immediately hang up without saying a thing.” He arrived 35 minutes later.

• Willette “injudiciously” prescribed controlled substances to at least one patient. The board focused on the elderly cancer patient who arrived at the hospital in January 2015 needing to have an artery repaired.

Willette testified at a Medical Board hearing that the patient’s wife came to him saying her husband’s condition had “deteriorated so poorly that she felt he was suffering.”

He changed the man’s medications after “she pleaded with me to make sure he was … comfortable.”

Willette upped his medication to every two hours, and the patient was found dead in bed 12 hours later.

Willette testified that he wasn’t intentionally trying to kill the man.

• Willette engaged in excessive and fraudulent billing practices and during an emergency medical procedure on a patient, slapped a nurse’s hand in anger.

Medical Board hearing officer Monica Ontiveros asked Willette during the hearing about his contention that he was overworked.

“Did you ever have a conversation with the hospital about the fact that you really couldn’t wear all those hats and see the patients in the time period that you were required to?” she asked.

“I think that – yes. But it seemed like it never really turned into action,” Willette said.

A Journal phone call to the hospital CEO wasn’t returned last week.

Colorado Medical Board files show that before he was hired in Union County, Willette had two malpractice settlements against him in 2005 and 2009 – one in Massachusetts and another in New Hampshire.

Willette said at the state Medical Board hearing that he “came to New Mexico to really help support the rural critical access hospitals. I have had opportunities to work at the bigger hospitals, and it’s completely different.”

While revoking his license to practice medicine, the Medical Board stated that he was eligible to apply again if he can prove clinical competency and submit to a neuropsychological evaluation.

And now?

As to the current Clayton hospital physician, the New Mexico Medical Board last August lifted a requirement set in 2015 that Dr. Mark Van Wormer practice under the observation of a worksite monitor.

However, by order of the board, Van Wormer is still barred from treating “cosmetic dermatologic conditions.”

U.S. District court records show Van Wormer, who didn’t return calls seeking comment, served a year in federal prison after he pleaded guilty in 2007 to federal felony charges that he sold anti-wrinkle injections at his Albuquerque clinic in 2004 and misbranded the drug as Botox.

Prosecutors found no evidence that anyone was injured by the injections of the fake Botox, which wasn’t approved for use on humans.

The Medical Board revoked his medical license after his plea, but allowed him to reapply.

Coming next Sunday: Reasons for New Mexico’s doctor shortage and possible solutions being considered by lawmakers, state officials.

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