Physician at hospital’s AIDS clinic charged head of infectious diseases department with religious bigotry; problems continue for Amelia Court
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A Dallas County jury found UT Southwestern guilty of discrimination on Tuesday, May 25, and the following day awarded former Amelia Court physician Naiel Nassar $3.6 million.
Nassar had charged UT Southwestern with religious bigotry and said Dr. Beth Levine, head of infectious disease medicine, drove him to quit.
UT Southwestern said it would appeal the verdict.
Last week, UT Southwestern chose not to renew the contract of Michael Limerick who works at Amelia Court. Limerick is an assistant professor at UT Southwestern with R.N. and Ph.D. degrees in nursing. His duties are split between patient care at Amelia Court and clinical trials.
Limerick declined to comment. Although not a physician, he had experience in caring for patients with HIV.
When UT Southwestern was unable to find a doctor for the Amelia Court position, Limerick was hired to fill the void.
One doctor said they hired him when it was convenient because they were unable to find a physician with his experience in HIV care and getting rid of him is typical of the way doctors at Amelia Court are treated.
Amelia Court is the Parkland Hospital HIV/AIDS clinic. While it is part of Dallas County-owned UT Southwestern hospital, the medical school that is part of the University of Texas system hires the physicians.
The two remain separate organizations with different missions. While the relationship may work in other areas, patients and doctors complain that they clash in the operation of Amelia Court.
Spokesmen for both Parkland Hospital and UT Southwestern disagree.
"I think the mission of the two integrate well," said Josh Floren, senior vice president of medicine services. "They are all about clinical care in a teaching environment. We both support research. They have clinical trials available to our patients. We’re very complimentary."
UT Southwestern spokesman John Walls said, "It’s kind of like a family. There may be moments when we disagree, but Parkland wouldn’t be what it is for the community without UT Southwestern. UT Southwestern wouldn’t be what we are without Parkland."
Doctors who have worked at Amelia Court and some patients say the clinic is where the two systems clash.
One said that the reason Limerick’s contract is not being renewed is because he was not bringing in revenue for patient care. Although he is seeing patients, Parkland is not processing his patients for billing because he is not a medical doctor.
On paper, he appears to have no billings although he actually sees a large portion of the patients coming through Amelia Court.
Another reason cited for Limerick’s dismissal was failure to bring in enough clinical trials. He is, however, involved in clinical trials. One Amelia Court patient said he was part of an ongoing study on lipodystrophy. He said Limerick is his principle contact for the study.
Lipodystrophy involves either wasting syndrome caused by HIV or fatty deposits that have been linked to taking protease inhibitors and more lately linked to reverse transcriptase inhibitors.
Limerick is listed as the principal investigator for the study on the National Institute of Health website.
Another doctor still listed as sub-investigator in the lipodystrophy study is Dr. Gary Sinclair. He was the former medical director of Amelia Court.
Sinclair, who left UT Southwestern in April, contacted Dallas Voice from Pretoria, South Africa, where is now training nurse practitioners to administer HIV medications under the President’s Emergency Plan for AIDS Relief (PEPFAR) that is better known as the Bush AIDS Initiative.
He said that since Levine was put in charge of hiring for Amelia Court, about 23 doctors have come and gone. He said some were fired, some did not have contracts renewed, and others "quit under duress."
Sinclair said he left after hiring attorneys in a successful effort defend himself against personal charges made by Levine.
"The ongoing struggle between UT and Parkland is their differing missions. Patient care for HIV is caught in the middle," Sinclair said.
While Parkland is charged with caring for Dallas County’s indigent and uninsured population, UT Southwestern is more concerned with clinical research and training physicians, he said.
And some doctors practicing at the clinic have said they feel there is a disregard for patient care by UT Southwestern, at least when it come to patients at Amelia Court.
Meanwhile, Parkland has received quite a bit of Ryan White funding but has not used most of that funding for Amelia Court. Most of the money has been invested in their Community Oriented Primary Care facilities located around the county.
Dr. Ampro Bernal, formerly an Amelia Court physician, is now a Parkland employee working at the Irving COPC.
UT Southwestern only staffs Amelia Court. Physicians at the community clinics are Parkland employees.
Nassar and another physician wanted to transfer their employment from UT Southwestern to Parkland but remain at Amelia Court. Instead, they were offered positions at community clinics by Parkland. But to remain at Amelia Court, they would need to remain with UT Southwestern under Levine.
Sinclair said that most of the doctors at the COPCs do not have the experience to treat people with HIV effectively. He said that even those with some HIV experience didn’t have the facilities to treat those in need of higher levels of care.
He said that the COPCs do not provide the infusion services that Amelia Court has and have no emergency services.
Floren agreed that Amelia Court provides a higher level of critical care than the COPCs.
"If we have patients who are higher risk, there’s a larger support structure around you — labs, infusion, dental services," he said.
But for a large number of people with HIV, it has become a manageable chronic disease that can be handled effectively in a community clinic setting, Floren said.
He said three of Parkland’s 11 COPCs have HIV practices. One is Bluitt-Flowers Health Center on Overton Road off south I-35. Two are at Southeast Dallas Health Center on Elam Road in Pleasant Grove. One of those clinics specializes in HIV care for women.
This article appeared in the Dallas Voice print edition May 28, 2010.
Great article David. I just found about this yesterday when I got an email from the Prez of UTSW about the incident. Had no clue what was going and all the details on but it seems that the school is sticking with Dr. Levine.
For many of us who have watched this disgraceful conduct by UT Southwestern / Parkland Hospital, we were surprised at the outcome. Dr. Nassar was well know and liked by many of us. His leaving Texas was sad, but California will benefit from his service.
His is just the first of many cases of discrimination, retaliation and blacklisting by the UT Southwestern Faculty Members. For more information on this case and others more despicable, see https://dallashealthcare.blogspot.com/
When UT Southwestern Faculty Members insist that the Doctors double bill like this, it is a clear violation of the laws. This is not the first incident of this conduct and it’s a policy within the UT Southwestern / Parkland Hospital system.
Another example of this type of double billing is their “Resident Training Residents†that remove the Supervising Attending Doctor from the floor, but they still bill the Dallas and Medicaid for his services.
As for Dr Levine and many of the Faculty, the scandals that keep coming out requires some of them to step down for the sake of the school’s reputation. Discrimination, retaliation and blacklisting – Is this 1950 Texas all over again?
Let’s be frank, when the head of Parkland Hospital called UT Southwestern the “Taliban of Medical Schoolsâ€, then it is time for a change of leadership at UT Southwestern. How many more cases will it take like this before the UT Southwestern Faculty Members start acting like professional people again?
Amelia Court is a big accident waiting to happen…
Let’s be frank, when the head of Parkland Hospital called UT Southwestern the “Taliban of Medical Schoolsâ€, then it is time for a change of leadership at both Parkland and UT Southwestern. Unprofessional behavior is destructive, negative and counterproductive especially when the core goal is to provide healthcare for persons with AIDS, and especially when their employment is paid by the public.
For many of us who have watched this disgraceful conduct by UT Southwestern / Parkland Hospital, we were surprised at the outcome. Hopefully we did more than watch and complain on blogs. Parkland is county owned and UTSW is state owned which means we have the opportunity to bring attention to violations when they occur and not merely watch and complain later. The healthcare of persons with AIDs is too critical to not act.
It’s amazing that a foreign-born doctor intuitively knew that double billing, an American classic, stinks! I am not familiar with the Ryan White Funds, but not surprised much has been spent on non-HIV needs.
The Texas tobacco settlement did absolutely nothing to reduce upfront expenses for low income adults with smoking-related illnesses. Parkland still wants their last $10 or $15 upfront. Tobacco money was spent on stuff like CHIPS for children.
Yes, children are needly. But money taken from the tobacco companies, who kill and maim victims, should rightfully be spent on its victims.