Blind trust: Don’t assume you’re seeing a doctor — even at the Mayo Clinic

It's hard to fault Paul Phillips for assuming that a practitioner in a suit and tie, holding his chart at the Mayo Clinic, was qualified to give a diagnosis. After all, Phillips had gone to the best. He knew of Mayo's international reputation for leading the way in cancer research. And Mayo had just been named the number one choice of hospital by consumers in the Phoenix area for the third year in a row, according to the National Research Corporation.

But the standards in place at the Mayo Clinic's ophthalmology department when Paul Hughes was hired — standards clearly not reviewed as the years went on — were hardly golden.

As revealed in court testimony, Paul Hughes was more than just a non-doctor who had his own office located between the spaces of Mayo physicians. Hughes came to Mayo as a convicted felon; his offenses included forgery and cocaine possession.

Not that Hughes was qualified to practice medicine in the first place; he doesn't even have a college degree.

If Hughes wasn't pretending to be a doctor, he was clearly allowed to see and treat patients in a way other non-doctors were not. (And in a way not allowed by Arizona law.) That's because Hughes was working for a longtime friend, then Mayo's director of ophthalmology, Dr. John Creasman.

Contacted for this story, Creasman says he trusted Hughes, regardless of his lack of official training.

"All technicians in our department become pretty good diagnosticians. You could take any one of them, and 95 times out of 100, they could tell the doctors what the patients had. They were right most of the time, so that was part of their responsibility," Creasman says.

Neither Creasman nor Hughes works for the Mayo Clinic now.

Creasman says that Hughes, still a close friend, was devastated by the lawsuit and would not comment for this story. Other attempts to reach Hughes were not successful.

Mayo employees testified that Creasman's trust of Hughes resulted in Hughes' seeing six to 13 ophthalmology patients per day at the Mayo Clinic, usually without any physician supervision.

Hughes worked in that capacity at the Mayo Clinic for 18 years.

No other lawsuits against Creasman or Hughes surfaced in a search of lawsuits at the Maricopa County Superior Court and at Arizona's U.S. District Court. Creasman has a spotless record with the Arizona Medical Board, too. (At least, to the extent that the medical board keeps such records. For more information about the Arizona Board of Medical Examiners and other state-regulated boards, see the earlier stories in this series, "The Doctor is Out," March 6, and "Dr. Loophole," April 10).

Even if Creasman and Hughes aren't contrite, the Mayo Clinic certainly is.

Speaking publicly about the case, apparently for the first time, the CEO of the Mayo Clinic admits that Phillips' care was not ideal. He says it was a fluke that won't happen again.

"I've been in this position six years, and I've been with Mayo 31 years. Personally and representing the organization, I feel bad and take responsibility when things go bad. We see about 100,000 patients per year. We know this wasn't the optimal," Dr. Victor Trastek says.

"Today we have a lot more policies and procedures in place," he adds. "I hope the point comes out that these are different times, and we're all trying to give the best healthcare to every patient."

It goes without saying that a non-doctor shouldn't be seeing patients alone, says Katherine Hatwell, a spokeswoman for the American Medical Association. Hatwell says she's heard of optometrists (who fit patients for glasses) working as ophthalmologists (who operate on eyes), but she's never before heard of a non-doctor diagnosing patients in an ophthalmology department.

"We think people should practice to their education and training and not beyond it," Hatwell says. "If you don't have a medical license, you shouldn't be able to practice medicine."

Paul Hughes was officially trained to do one thing — fit people for lenses that an eye doctor has prescribed. That's equal to the guy at Costco who works the glasses counter filling prescriptions, not writing them. (In fact, even those salespeople at Costco are licensed by the Arizona State Board of Dispensing Opticians. Hughes has never been a licensed optician in Arizona, according to Lori Scott, that board's executive director.)

Even if Hughes were a licensed optician in Arizona, he couldn't treat or diagnose patients. He could only put their glasses together or order their contacts.

So why was Hughes allowed to see Paul Phillips? The answer starts about 40 years earlier, when Paul Hughes was convicted of his first crime.