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

Sometimes, however, they do. The state trusts physicians to be honest about the duties they give medical assistants, says Roger Downey, spokesman for the Arizona Medical Board.

"For elderly patients, most healthcare professionals recommend that an 'advocate' accompany them when they visit the doctor. An advocate in this sense is a relative or friend who can ask questions the patient doesn't think of asking. The advocate can also take note of the healthcare provider's instructions and information that the patient may not remember later."

That didn't help Paul Phillips.

Medical assistants sometimes go by the name "technician" in ophthalmology departments. The American Academy of Ophthalmology says technicians and assistants should never diagnose patients. Spokeswoman Christina Curas says ophthalmic assistants "are not licensed to practice medicine." Curas adds that it's a violation of the Academy's bylaws and ethics to let technicians diagnose patients alone.

Despite those known standards, Creasman assigned Hughes to triage. Creasman knew Hughes was a convicted felon with no formal medical training when he hired him. But in an interview for this story, Creasman still says Hughes is qualified to work at the Mayo Clinic.

"Paul was the only one that did triage when [doctor's] appointments weren't available. He was the only one that had the expertise," Creasman says. "It's absolutely okay for Hughes to be working triage because he has more experience. In our department we don't have P.A.s."

Dr. Creasman also says the Mayo receptionist told Phillips he'd only be seeing a technician. (Phillips says otherwise, so it's his word against Creasman's. There's no recording of the conversation.) Creasman says Phillips was the negligent one, by assuming a technician was a doctor.

"There's no way Mr. Phillips could have misunderstood who he was seeing, because the secretaries make that really clear. Maybe he hoped he could see a physician after triage," he says.

National advocates say patients should never assume they're seeing a doctor, and patients shouldn't be afraid to ask for practitioners' credentials. Technicians and medical assistants shouldn't ever diagnose patients.

"One of the best ways for patients to help ensure that they receive safe and appropriate care is to be informed, ask questions, and make sure that they understand what is going on," says Diane C. Pinakiewicz, president of the National Patient Safety Foundation. "Patients and their families need to be viewed by all as part of the healthcare team and, as such, should be encouraged to speak up and actively participate in the care process."

Exactly two years after Hughes diagnosed Phillips with dry eyes, Phillips filed a lawsuit against the Mayo Clinic. His March 13, 2003 complaint alleged that the clinic overlooked his detaching retina and that they did so because Paul Hughes — a non-doctor — diagnosed his problem.

The case dragged on for three years, at a cost of tens of thousands of dollars. It was shaping up to be a boring malpractice case, packed with medical terminology and detailed time lines, but ultimately, it came down to one man's word against another's.

Had Paul Phillips actually complained of retinal symptoms? Had Paul Hughes really held himself forth as a doctor?

During the trial, Paul Hughes retired from the Mayo Clinic. It was June 6, 2006 — exactly 18 years after he'd started. Days later, an anonymous tipster sent a mysterious fax to Phillips' attorneys.

The fax clearly tipped the scales. It came from a number inside Mayo and outlined the criminal past Hughes had hidden during his first depositions under oath. Judge Baca reviewed Hughes' sworn claims that he'd only been arrested for speeding.

"He clearly testified to the contrary, and it goes to his credibility. So he can be impeached with those," Baca ruled.

Baca called Hughes to the court, showed him the fax and told him to come clean. Hughes then said his first criminal conviction was for forgery. He explained that his eye education actually started in prison. Hughes then said his second criminal conviction was "a conviction for possession of cocaine, about 20 years ago."

Hughes was testifying in July 2006, making "20 years ago" about 1986 — roughly when Mayo hired him to work triage and see patients alone as a "technician." Hughes then said that, among other things, he learned how to spell the word "ophthalmology" while in prison. "He gave me a real good training," Hughes said of the infirmary doctor.

To make matters worse, Hughes was caught in a second inconsistency. The medical record from Phillips' appointment was a one-page form. Hughes testified multiple times that he never modified or added to that record.