Laredo Pediatrician Dr. Rebecca Uribe Garza has signed an Agreed Order of the Texas State Board of Medical Examiners (TSBME) that restricts her medical license to certain terms and conditions "due to failure to practice medicine in an acceptable professional manner consistent with public health and welfare." According to an April 9, 2002 press release from the TSBME, Uribe Garza signed the order on April 5. She will no longer practice neonatal medicine or admit patients to or treat them in any neonatal intensive care unit.

Among the Findings of Fact in the April 5 order, Uribe Garza failed to maintain adequate patient medical records; failed to document her advice and discussion with parents regarding end of life issues for neonatology patients; failed to properly document treatment care plans; failed to timely and appropriately respond to neonatal emergencies; failed to identify worsening conditions of neonates; and failed to intubate in a timely manner and properly manage ventilation assistance. The findings of that order state that Uribe Garza prescribed inappropriate medication dosages.

The TSBME's April 5 order requires Uribe Garza to transfer patients requiring neonatal care to a neonatologist. The order allows her to continue the practice of pediatric medicine, but calls for a monitoring physician for Uribe Garza's office and surgical practice. According to the order, the monitoring physician will conduct a monthly on-site inspection of Uribe Garza's practice, personally review at least 10% of the charts of patients seen during the review period, counsel her regarding any perceived deficiencies, and provide written quarterly reports to the TSBME through its compliance office.

The order stipulates that Uribe Garza shall maintain adequate patient records on all patient office visits, consultations, surgeries performed, drugs provided, and treatment rendered. The board orders her at a minimum to include on records the patient's name and address, vital signs and statistics, chief complaints, history and physical findings, diagnosis and basis for diagnosis, and treatment plan including dosages, rationale for providing the medications, and detailed records for follow-up visits.

Uribe Garza is required to appear before the board once a year for a period of three years and is also required to take 10 hours of continuing education classes. She is required to provide a copy of the Agreed Order to all hospitals and treatment facilities at which she has privileges and is also required to make accurate reference to the Agreed Order to inquiries regarding her licensure as a physician.

The order warns that Uribe Garza's failure to comply with the terms, conditions, or requirements of the order "may constitute unprofessional conduct likely to deceive or defraud the public, and to injure the public, and may constitute a basis for disciplinary action by the Board…"

In order for Uribe Garza to practice neonatology in Texas she will have to receive an American Board of Medical Specialties certification in neonatology; complete the Post Licensure Assessment System evaluation sponsored by the Colorado Personalized Education for Physicians in neonatology; or complete a mini-fellowship in neonatology at an accredited medical school. Such a fellowship would have to address the specific educational needs identified by the TSBME's Finding of Facts.

According to Martha Cigarroa de Llano, Garza Uribe's local counsel and her cousin, "Dr. Garza was reported to the Board by her competitors, including a former chief of pediatrics who probably violated hospital policy that may have resulted in the Texas Department of Health's investigation. No one would have or could have had access to the information to provide to the Board." Cigarroa de Llano referred to an investigation that also reduced the care status of Mercy Regional Hospital's neonatal intensive care unit from a Level III to a Level II trauma center.

In a written statement to LareDOS, Cigarroa de Llano called the TSBME's investigation "inadequate." "They did not even realize that three of the babies they thought had died were very much alive thanks to the skill and efforts of Dr. Garza. There were many mistakes in the Board's unidentified 'expert's' reports."

Cigarroa de Llano continued, "The babies in the cases that were reviewed by the Board were extremely premature or had low weights or had serious health problems. Two were 21-22 weeks at birth, three were 23-24 weeks, two were 27-28 weeks. One baby was born at 32 weeks but only weighed 815 gms. All of the babies had serious health problems."

Though Cigarroa de Llano took issue with the TSBME's experts, she said that an independent expert opined "that Dr. Garza's care met the standard of care in all the cases reviewed by the Board. The expert summarized that 'in these cases, Dr. Garza has generally approached her patients with reasonable diagnostic and therapeutic approaches. She also appears to be available and conscientious in her responsibility toward her patients and their families. Neonatologists deal with a population of patients who are at most risk of dying. It is difficult therefore to examine any small number of fatal cases and make comprehensive statements about a physician’s body of work, particularly when by virtue of the medical specialty, the physician assumes care of almost exclusively patients who are at high risk of mortality.'"

According to Cigarroa de Llano, "Many of the physicians who provided consults for these babies complimented her on her care."

Cigarroa de Llano said, "From the period July 1999 through June 2001, Dr. Garza’s mortality/transfer rate at Mercy

Hospital was .63% (13 deaths/transfers out of 2032 cases). The national average is 2-3%. Conditions in Laredo are worse than most of the nation. Dr. Garza’s mortality transfer rate was well below the national average."

It is Cigarroa de Llano's opinion that, "Dr. Garza enjoys the support of the community. Many nurses and physicians take their children to her for treatment. Most of the NICU nurses take their children to her for treatment. Most of the pediatricians refer patients to her.

"Mercy Hospital reduced its status from a Level III to a Level II trauma center because of the poor conditions in the NICU, including staffing issues," she continued. "TDH threatened to take Mercy’s license because of a failure to have policies in place. Dr. Garza petitioned Mercy to help with neonatology coverage and advised Mercy of the inadequate conditions. Dr. Garza voluntarily relinquished her neonatal privileges because the hospital could not support a neonatology practice.

"Of significance is that the BME conducted its investigation of Dr. Garza and her medical practice for almost eighteen (18) months, yet the result was that her license was unrestricted with regard to her current practice," Cigarroa de Llano said.

On a personal note, Cigarroa de Llano said, "For many months Dr. Garza took care of my premature (32 weeks) twin girls, Meg and Cristi, each weighing less than a sack of sugar at birth. As a parent of premature infants, I cannot express the fear, anxiety, and helplessness one feels in preparing for the birth of babies you know are not designed by God to come into this world at such a premature time. The stress is unbearable. My husband Matias and I owe the lives of our twins to Dr. Garza who provided quality care and treatment to them and was with them at all times of the day and night. She was tireless and knowledgeable and committed to their growth and physical well-being. As much as she exhibited this care to our precious children she did so with all the other babies she cared for in the unit. As a parent, I was there at least 24 hours a day and my memory is that she was too. When I count my blessings, Dr. Becky is always at the top of my 'Thank-you God' list. I stand by Dr. Becky and know for a fact that thousands of similarly situated families do the same."