Austin American-Statesman (Texas)

February 4, 2012 Saturday
Final Edition

Documents cast doubt on state doctor’s work history

BYLINE: Andrea Ball AMERICAN-STATESMAN STAFF

SECTION: METRO; Pg. B01

LENGTH: 1100 words

Despite assurances from officials that three state hospital psychiatrists once disciplined for sexual misconduct had “good work histories” at the facilities, public records show that one of those doctors was suspended last year for verbally and emotionally abusing a patient.
Dr. Gary Paul Kula , a psychiatrist at Rusk State Hospital in East Texas, received three days of unpaid suspension in January 2011 for demeaning an aggressive patient – which escalated the confrontation, led to the patient’s restraint and contributed to the injury of three staffers – according to documents provided to the Austin American-Statesman by the Department of State Health Services, which oversees state psychiatric hospitals.
Kula’s personnel records also indicate that he has been disciplined by the hospital multiple times for “volatile” behavior and refusing to evaluate several patients that needed medical attention.
Kula declined to comment for this story.
“We want very good, pleasant, careful doctors around our patients,” said Carrie Williams, spokeswoman for the Department of State Health Services. “When we see a problem with an employee, we try to address it, whether that’s through counseling, warnings or termination. We’ve put our policies under a microscope, and we’re reviewing the files of all of our doctors at this point.”
In December, a Statesman investigation revealed that the state employed three male psychiatrists who had been punished by the Texas Medical Board for inappropriate sexual relationships: Kula, Alejandro Munoz and Larry Hawkins. Kula and Munoz were sanctioned by the board in the 2000s, after they were accused of having sexual relations with adult patients they treated before working at the state hospitals. Hawkins had his license temporarily restricted after he pleaded no contest in a Blanco County court to sexual indecency with a child in the 1980s.
Hawkins declined to comment for this story. Munoz could not be reached.
At the time of the Statesman story in December, Williams said: “They were hired because they were qualified candidates whose licenses were in good standing at the time they were hired. They have good work histories with us.”
That statement was made because, at that point, the agency was focused on the Statesman’s questions about sexual misconduct in the doctors’ history, Williams said Friday. They were also dealing with allegations of sexual abuse levied against former Austin State Hospital psychiatrist Charles Fischer. Fischer, who allegedly abused teenage boys in his care, has not been criminally charged and has routinely denied the accusations through his attorney.
“Since then, we have been taking a much deeper look at the files of all of our doctors,” Williams said. “Most are excellent. Others require more scrutiny. Based on those reviews, we may need to take more action.”
This month , the Statesman reviewed the personnel records for all three doctors and found that two of them – Munoz and Hawkins – regularly received positive evaluations over the years. Neither of their files include any instances of disciplinary action.
Since being hired at Rusk State Hospital in 2002 , Hawkins has received glowing job evaluations. Supervisors regularly gave his work the highest rating of “distinguished,” praising him for his professionalism, leadership, work ethic, respect for others and problem-solving abilities.
“Dr. Hawkins is a highly knowledgeable psychiatrist and willing leader who would function well as clinical director of one of our facilities,” a supervisor wrote in one review.
Munoz, who was hired at Terrell State Hospital in North Texas in 2006 , also earned compliments from his bosses. Although supervisors occasionally noted problems with his ability to properly document patient charts and complete tasks in a timely manner, his most recent review in September rated his overall performance as “commendable,” the second-highest rating possible. In an email placed in Munoz’s personnel file, a co-worker praised the doctor’s
attitude as “professional, friendly, approachable and supportive.”
Munoz, however, was fired in December after the Department of State Health Services discovered that he had failed to disclose a decade-old legal settlement that banned him from ever working again at a state mental health facility.
According to the termination letter by hospital Superintendent Joe Finch, the settlement stemmed from a job dispute between Munoz and Rolling Plains State Operated Community Services, an outpatient mental health clinic in Graham, northwest of Fort Worth. According to the letter, Munoz was fired from the facility for undisclosed reasons in 1998. Munoz filed a grievance against Rolling Plains and later sued the Department of State Health Services.
The sides settled in 2001 . In exchange for a payment of $25,000, Munoz agreed “never to seek employment with TDMHMR or any of its component facilities or any community mental health and/or mental retardation center … in Texas,” according to a copy of the agreement.
When state officials discovered the agreement in December, they fired Munoz.
Unlike Munoz and Hawkins, Kula has been disciplined multiple times since his 2005 arrival at Rusk State Hospital.
Over the years, supervisors have regularly judged him as a “competent” employee who is good at evaluating patients and developing plans of care, records show. But since 2007, Kula’s supervisors have placed in his file eight notes about “unprofessional” or “volatile” behavior while discussing patient care. He was officially reprimanded in two of those cases, including one in which he was accused by a nurse of refusing to medically evaluate a patient who had just returned from the emergency room.
In January 2011, the Department of Family and Protective Services, which investigates abuse allegations at state psychiatric hospitals, concluded that Kula had emotionally and verbally abused an aggressive patient, state records show. Among other things, investigators said the psychiatrist had confronted the female patient by saying, “You think you are bad, don’t you?” Then, the report states, Kula ordered a shot to calm her and said, “I want her on the floor by the count of ten.”
Three staffers were injured while restraining the woman, the documents said.
In a written statement to the hospital administration, Kula denied saying those things. He said he was frustrated that the other staffers present had not controlled the situation.
“This patient wasn’t psychotic; she just wanted to pick a fight,” he wrote.
Kula was suspended and returned to work a few days later.