Opinion

How did a General Pediatrician become the Most Powerful Force in El Paso For-Profit Healthcare?

Editor’s note: El Paso Politics is publishing this editorial as anonymous. The author is known to me and I have agreed to publish the editorial without revealing the author’s name to protect their job. I understand that there is controversy regarding the use of anonymous sources and authors on news publications and it is a fair debate to have. However, the intent of my publication is to provide information to the community to better inform them. I personally know what it is like to be blacklisted in El Paso for exposing community issues. Although my intent is not to publish anonymous pieces I will do so on occasions where I feel the information is important and anonymity is necessary. The editorial has been updated for readability purposes.

Before Hospitalists and Intensivists

Once upon a time in the 1990’s in places like El Paso, doctors took care of their hospitalized patients. Your doctor “rounded” on you in the morning and evening – leaving nurses with orders and calling in specialists when needed. Managed care took root in the early 2000’s and weary doctors were sold on the hospitalist concept. Their days had grown very long trying to see patients in their private practice clinics and twice daily rounds at the hospital. In addition, reimbursement rates started to change, and doctors had to ask themselves if going to the hospital was worth the time away from their clinics given the overhead. This scenario allowed a general pediatrician to begin building an El Paso healthcare empire that may be one of the most glaring examples of how decades of lack of oversight enabled a peculiar situation that is finally being exposed, because one father cannot accept the tragic death of his three-year-old daughter.

How It Started

Start with an economically disadvantaged, medically underserved, undereducated and uninsured population. Add a culturally competent physician who understood Mexican classism and American racism and you begin to see how Dr. Canales became very popular very quickly. Poorly trained nurses and mostly foreign trained (Mexican) general pediatricians testified to his clinical acumen and parents praised his bedside manner and dedication to his patients. More than anything, the community responded to his willingness to treat all children regardless of their ability to pay. At first the hospitals cooperated – one was the county hospital (RE Thomason now called University Medical Center), one was a Catholic Sisters of Charity Hospital (Hotel Dieu, no longer exists) and there was the community not-for-profit called Providence Memorial Hospital, now named Providence Memorial Campus. It is owned by Tenet.

Providence was sold in 1995. Woody Hunt, one of only two El Paso billionaires, helped to establish the Paso del Norte Health Foundation with the $200 million raised from the sale. The foundation’s original mission was to use evidence-based strategies to reduce 10 key health indicators. When none of their benchmarks were achieved, after ten years of funding, they lowered their expectations and took a more generic approach. The average El Pasoan would be hard-pressed to tell you what the Foundation has achieved, however, the Covid-19 pandemic has provided them with the opportunity to offer some valuable community resources.

Roberto Canales

Canales has built a reputation amongst his peers as more than a general pediatrician even though he did not possess any specialty board certifications. He has passed himself off as both a pediatric intensivist and hematology/oncologist. For decades he based this narrative on a two-year oncology fellowship (duration is 3 years and there is no evidence he completed a fellowship) at Boston Tufts Medical Center. The fellowship does not appear to have resulted in board eligibility or certification. Additionally, he completed a vaguely described one-year research oncology training course at the Baylor College of Medicine.

At the time, few in El Paso questioned Canales’ credentials because the city was so woefully underserved in general pediatrics and pediatric specialties and they trusted the hospitals to be astute gatekeepers. Many adult specialists stepped up and treated children even though they had not completed pediatric residencies. None of this mattered because families were desperate because at the time no children’s hospital existed in El Paso. Specialty care required transfers to faraway places like Dallas, Houston, and Phoenix.

This was the perfect storm for empire-building. Canales set out to establish the largest pediatric private practice in the region while simultaneously working as a hospitalist, pediatric intensivist and pediatric hematology/oncologist at Providence Hospital.

He could drive his enormous patient volume to a specific hospital, prevent those patients from leaving town by telling them he could provide the same level of care and subsequently drive tremendous profits for the hospital. It is speculated that he forced hospital administrators to agree to accept a percentage of his uninsured patients in exchange for the insured, which made him a community hero. While many children were “saved” by Dr. Canales, many were also hurt. It is alleged that several hundred medical malpractice cases have been settled with prejudice.

The Game Changer

Tenet purchased Providence Hospital in 1995 and an alliance between Canales and Tenet Healthcare Corporation has continued unabated since 1997. On Feb 14, 2012, the long awaited and fought-for El Paso Children’s Hospital opened its doors for business. It was expected to be the crown jewel in a complex called the Medical Center of the Americas. The MCA already included the county safety net and teaching hospital – the University Medical Center, Texas Tech University Health Sciences Center (TTUHSC), the Paul L. Foster School of Medicine (PLFSOM), Gayle Greve Hunt School of Nursing and a recently completed dental school.

Apart from delivering high quality pediatric care, the hope was that El Paso could solve its chronic shortage of well-trained medical professionals (especially pediatricians for this young population) by growing their own. There has been a great deal of criticism aimed at TTUHSC and PLFSOM for their low acceptance rate of El Paso students into both the medical school and residency programs – especially in pediatrics. At the time, the Texas Tech faculty was largely comprised of foreign medical school graduates that had completed their residencies at TTUHSC 20 years earlier. This led to a situation best described as an intellectual trailer park and a focus on recruiting foreign medical school graduates from faculty alma maters or home countries for the residency programs-especially in pediatrics.

The establishment of the brand-new Children’s Hospital attracted an impressive group of pediatric specialists from across the U.S., including several from some of the most prestigious medical schools in the country. These doctors immediately forced TTUHSC and PLFSOM to “play up”. This caused tension and conflict. TTUHSC was unaccustomed to doctors refusing to accept the status-quo or inadequate delivery of medical care – just because that’s the way it’s always been done. The Mays affidavit reflects this clash. Most of the disillusioned doctors were employed by TTUHSC and left within the first 5 years and TTUHSC replaced their Dean.

From the very beginning, the El Paso Children’s Hospital (EPCH) criteria for medical credentials required Board Certification (Mary Lacaze MD seems to have been the sole unexplained exception). This meant adult doctors (that had operated on children for years) like orthopedic surgeon Jacob Heydemann MD were not welcomed at the new children’s hospital.

However, these doctors were permitted to treat their pediatric patients at Providence where Dr. Canales was the Medical Director of the Pediatric ICU and the oncology program. A few years after EPCH opened, their oncology program achieved COG (Children’s Oncology Group) accreditation which should have put the Providence program out of business, but it did not because Canales propped it up with his own patients and failed to inform them the COG program existed.

Indeed, a pediatric surgeon named Tamara Fitzgerald MD was allegedly “fired” for telling a patient to take their child to the accredited program. Providence knew their pediatric business would remain robust as long as they had Canales. They would keep him by letting him run their PICU and Oncology programs because he did not want anyone else taking charge of his patients or potentially stealing them.

Immediately after Tenet bought Providence, they ended the Canales “deal” because of concerns over conflicts of interest. The Columbia HCA CEO (now HCA Las Palmas, Randall Rolf 1994-1997) knew he could quickly build up their fledgling pediatric service with Canales. He successfully recruited him for a period of about 18 months before Tenet acquiesced (the financial loss was notable) and got him back.

With this, Canales had proof that he was one of their most valuable assets, and it gave him tremendous leverage. Behind their backs, staff allegedly dubbed Dr. and Mrs. Canales as the hospital King and Queen. They have remained Tenet royalty ever since. John Harris served as Providence CEO from 2006-2013 and it is rumored that his departure from Tenet may have been related to Canales. He remained in the area and is currently the CEO at Memorial Medical Center in Las Cruces, NM.

While this was happening, Canales was expanding his private practice with physician extenders and foreign medical school graduates enrolled in the J1 VISA waiver program. He increased his volume by assigning routine care to his Nurse Practitioners and splitting his time between his 3 clinics and the two hospital-based programs. He trained hospital-based Nurse Practitioners to be his eyes and ears in his absence and when he landed the third-party contract to provide full PICU coverage, he brought in out-of-town doctors.

This is how he was able to evade any peer-to-peer evaluation of his clinical skills for so many years. However, the new and better trained doctors at EPCH knew that something was wrong when they treated former Canales patients and read their charts. For most it was a revelatory experience. Dr. Tom Mays, who is originally from El Paso, is the only MD that has gone on the record stating that Canales is a danger to his patients. Dr. Mays is shielded from the social/political consequences of his affidavit because of his professional stature. Dr. Canales has his local critics, but they are unwilling to make their views known; it is political and social suicide. They incorrectly believed a new Children’s Hospital would solve the Canales problem and their advocacy was not required. Unfortunately, Ivanna Saucedo’s death is forcing the El Paso medical community to choose sides or keep an awkward silence.

Incoming President of the El Paso Medical Society, pediatrician Allison Days MD does not seem to want to talk about it.

Political Alliances

Dr. Canales or rather Mrs. Canales, has played the politics astutely. It is as if she knew a day of reckoning would come and has ensured her husband’s case is bolstered by heavyweight political allies. El Paso billionaire Paul L. Foster (PLFSOM) is married to Alejandra De La Vega Foster, a wealthy Mexican businesswoman. Her mother, Guadalupe De la Vega is a noted Mexican humanitarian who founded FEMAP (Federacion Mexicana de Associaciones y Empresas Privadas) the entity behind two hospitals and a nursing school in Ciudad Juarez.

Guadalupe Canales took over as Chairman of the FEMAP Board when Guadalupe De la Vega suffered a stroke. The current mayor of El Paso is Dee Margo and his wife Adair formed the FEMAP Foundation-El Paso to help her dear friend Guadalupe De la Vega raise money in El Paso for her Juarez projects. Adair Margo now assists Guadalupe Canales with that endeavor.

One of the biggest contributors to Dee Margo’s reelection campaign is Paul L. Foster. The Canales’s have friends in high places and that makes it difficult for people to speak out. This explains the lack of whistleblowers.

The Juarez/Chihuahua doctor mafia is how the Anglo, South Asian and Mexican American doctors describe the Mexican-trained physicians that completed residencies at TTUHSC and subsequently established private practices in El Paso. It is a brotherhood bound by language (Spanish), education, family alliances and a common history in Mexico. They are collegial with the Anglo and Mexican American doctors but there is no love lost between them and the South Asians. The mafia was here first and they resent the Asian invasion perpetrated by TTUHSC. Providence and Canales have given the mafia a safe place away from the South Asians at the Medical Center of the Americas campus. The mafia is loyal and covers for each other because they are all familia. The El Paso Pediatric Society is heavily influenced by the mafia and they will rally in support of Canales.

The Folklore

The mafia doctors will tell you Canales is a hero. He did the hard work when no one else would and is undeserving of criticism because he is such a nice guy. Hospital administrators will tell you he is a nightmare – but so profitable that he is worth the headache. Parents will say he slept on the hospital floor beside their child as if it was a good thing and not an admission of sleep deprivation and no backup help. Long gone physician recruiters will say that Canales made it difficult to attract more pediatric specialists. They were dependent on a solid PICU because no one wants to operate and then lose the patient to inadequate PICU care. In addition, it was known that Canales did not welcome anyone he perceived as competition.

He ran off more than a few good prospects. Ben Carcamo MD (Pediatric Oncologist at EPCH) and Mustafa Moazzam MD (Pediatric Oncology) might be considered two of those casualties. Canales’ critics claim this is how he avoided scrutiny along with the Tenet legal team keeping the number of medical malpractice settlements a secret.

Supporters will say it is impossible for Dr. Canales to be everywhere all the time and while Ivanna Saucedo’s death is tragic, it is the price the community pays for having a doctor of such renown. Critics have asked, “how does he do it?” Doctors know he rounds late at night, takes cat naps during the day and his wife allegedly speeds him around town (while he naps) to his various clinics. But who sees the patients when he in not present?

He recently suffered a detached retina and was hospitalized for Covid-19 while Srinivas Badugu MD, possibly a J1 Visa holder, covered for him as well as the doctors he brings from Dallas.

Allegedly a large Medicaid fraud settlement was paid in cash. Given the lack of documentation typical of his charts and large patient volume, it would not be surprising if there has been a Canales’ Medicaid fraud investigation at some point during his long career.

EPCH Throws a Hail Mary Pass

Three different feasibility studies warned that El Paso could support a children’s hospital with one caveat – ALL the pediatric business needed to be concentrated in one place. Tenet’s support of Canales was always going to be a destabilizing force for the new Children’s Hospital. That, in combination with financial shenanigans at UMC and incompetent EPCH leadership plunged the new hospital into bankruptcy.

As soon as the current UMC CEO, Jacob Cintron, arrived from a professional lifetime of working for HCA, he started to make overtures to Canales. Two years prior to striking a deal with him, allegedly Cintron asked a society matron at an EPCH fundraising gala for Canales’s private cell phone number. EPCH CEO Cindy Stout arrived shortly after the overtures began and she took up the cause for luring Dr. Canales to EPCH.

Both administrators were graduates of the school of hospital profits at all costs. Shareholder profits were not at risk, but their bonus payouts were tied to financial metrics. Changing the hospital by-laws to accommodate Dr. Canales is well documented in the Dr. Mays affidavit.

When the announcement came that Canales would be admitting patients to EPCH and permitted to personally treat his PICU patients (historically a closed unit) it was a shock to the existing PICU staff. The most egregious policy implemented was the one that forbid any intensivist or hospitalist to care for a Canales patient in his absence. Staff knew his patients would arrive and he would not be there. Caring for a Canales patient became subject to disciplinary action. It also posed an ethical dilemma for the doctors on service. One departing doctor predicted children would die if the policy were enforced and three weeks after he left, Ivanna Saucedo became its first victim.

13 replies »

  1. @david: an editorial is an editorial and cannot be alleged, bull or otherwise. It’s the prerogative of an editorial writer to express a point of view. On the other hand, if only just an iota of what is written is fact, shame on the leadership at University Medical Center, El Paso Children’s and Providence Hospitals.

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  2. Sorry David but this is pure gold, not pure bull. There may be a few minor errors but it is amazingly accurate. So unsubscribe if you like–you probably won’t be missed since you aren’t paying anything anyway.

    The anonymous editorialist left out a few interesting tidbits:

    When EPCH emerged from the bankruptcy, they hired a new CEO. Cindy Stout wanted that job but the outgoing Board did not consider her to be qualified. It should be noted that she is Jacob Cintron’s lackey, both at Del Sol and UMC. Once Jacob Cintron was established at UMC, it should come as no surprise that the EPCH CEO was soon terminated by the new Board and his puppet Ms. Stout was the replacement despite having no meaningful experience. My bet is that, as an outsider, he wouldn’t “play ball” with Cintron and the Board and suck up to Dr. Canales to get his business. Ms. Stout was more than eager to jump in and do their bidding. It is a shame that Cintron and the EPCH Board will probably hang all of this around her neck to save their own hides and protect their own positions.

    Another part he/she left out is that Dr. Canales actively steals patients from other pediatricians. If they are admitted under him at Providence (and presumably at EPCH too) he tells them to follow up with him in his own clinic instead of sending them back to their own doctor. That is universally considered to be unethical and unprofessional. That is another way he has built up his practice.

    There are many other things but you get the idea.

    It is true that Dr. Canales stepped up when there was a need although one might cast doubt on his motives. However there are now far more qualified practitioners and it is time he returned to doing general outpatient pediatrics and left the rest to experts before he causes another bad outcome because of his lack of knowledge.

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  3. You are a LOCO with motives…LOL more bull. Dr. Canales has served our children community with great talent and is one of the best pedi doctors in El Paso.

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  4. David now you are just demonstrating your ignorance of what good pediatric care is. Time to stop commenting on things you obviously know nothing about.

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  5. This would be more believable if this “anonymous person” identified themselves. You really want to help the city of El Paso, show yourself and show you have no other motive to write this. This is obviously another pediatrician who has been very much involved or sidelined in this whole drama. Those who work within the hospitals, definitely know about the particular pediatricians or icu pediatricians that cry because they are not part of the “popular crowd.” The true sadness is that many other children’s lives have been lost by incompetent pediatric icu doctors yet their names haven’t been brought to light nor remembered and those ICU doctors are still working in said hospitals.

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  6. The 2 people who want the writer to reveal his/her identity don’t put their real name on their comments. Oh the irony!

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  7. I totally agree with David and @El Pasoan! Show your face!! This article it’s very unprofessional. It sounds like a very jealous child wrote it. We have a pretty good idea which person the Author got his info from. 😉

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  8. My argument is this.

    In publishing this article, the owner of this site (or whatever you want to call them) states that they know who the author is and knows them but won’t reveal their name because they fear loosing their job.

    However, whistle-blower laws exist. If the person who wrote the article actually had a leg to stand on, and not trumped up accusations, (mind you that tragic death happened at that so called *stellar facility* EPCH where even if Canales was at fault all the nurses and doctors there that day or night should be held accountable for just standing by and doing *nothing*) then he/she would have posted their name.

    The fact of the matter is this sounds like a political attack against a man who has dedicated his life to the city of El Paso. Dr. Canales has been here for decades, and I doubt he’s going anywhere because of this “expose” on a site most people have never heard of before. Should a man who has helped so many have enemies to this caliber? Well yes. All great men are hated by people with weak egos.

    Move along disgruntled child. Move along.

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  9. Those writing in support of Canales are like abused spouses. failing to accept the toxic relationship and abusive relationship that they are in; coming back for more. The CMS investigation will find something and it will lead to the potential loss of Medicare funding for EPCH without corrective action. hopefully, it doesnt bring down the hospital. there should also be an investigation into Tebet’s hospitals. the company got hit with fines for kickbacks 15 years ago. im sure that is still happening in El Paso.

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  10. BRAVO Anonymous, your editorial jives with decades of stories told by three generations of healthcare workers sitting around my kitchen table. I thought the first EPCH Board were tonto; the second are MAS TONTO. I mean they did a background check, right? They knew about the malpractice cases and that he was already spread too thin. Maybe he didn’t show up for Ivana because he didn’t know enough to realize how sick she was because he didn’t train as an intensivist. To “Another El Pasoan”the complaint says he didn’t show up for like 12 HOURS and did you read the part about THREATS of disciplinary action against EPCH staff? The peso stops with the mas tonto Board and the two Dead Souls Alumni and this will cost nuestros pobres taxpayers mucho dinero. Time for a third Board and eighth CEO. Bend over El Paso, here it comes… OTRA VEZ!!!

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