'Red flag' process failed on Anthony Garcia - Omaha.com
Published Sunday, August 4, 2013 at 1:30 am / Updated at 9:37 pm
Creighton slayings
'Red flag' process failed on Anthony Garcia

When Anthony Garcia applied for a medical license in Illinois in 2003, Creighton University officials indicated he had “satisfactorily completed” one year of pathology training at the school.

That despite the fact that Creighton had moved to terminate him in 2001 less than 11 months into his troubled residency. Had Creighton indicated to the State of Illinois that Garcia had failed to complete a year of residency, that likely would have raised a “red flag” for his license application, according to Illinois' medical licensing authority.

“There is nothing on here that suggests there was a problem,” Susan Hofer, a spokeswoman for the Illinois Department of Financial & Professional Regulation, said of the documentation Creighton submitted.

Illinois suspended Garcia's medical license recently in the aftermath of the doctor's arrest in a pair of double homicides: the 2008 deaths of 11-year-old Thomas Hunter and Shirlee Sherman, and the May deaths of Dr. Roger Brumback and his wife, Mary. Police have said the four killings were motivated by a simmering grudge Garcia held against Creighton pathologists Brumback and Dr. William Hunter, Thomas' father, for firing Garcia in 2001.

Questions have now been raised on how Garcia was able to obtain a physician's license in Illinois, particularly given that he was subsequently rejected for licenses in at least three other states. While many of the questions have focused on Illinois' actions, it also appears Creighton contributed to Garcia's ability to gain the license in at least two ways.

Not only did the university indicate that Garcia had satisfactorily completed one year of residency, the school did not report its termination of Garcia to the State of Nebraska. Had it done so, state officials likely would have revoked the temporary permit issued to Garcia to practice medicine as a Creighton resident.

The state would also have notified two national practitioner databases about the permit termination, an action that could have created a red flag for Garcia's subsequent Illinois license application.

Creighton officials declined last week to answer questions for this article, citing the current police investigation into Garcia.

“At this time, we simply can't elaborate — even generally — about our process for releasing resident information to state licensing boards due to the ongoing investigation and to protect the integrity of the case,” said Jennifer Homann, a Creighton spokeswoman.

But she said Creighton follows accepted standards in graduate medical education in what it reports to state licensing boards.

For many residency programs, it appears standard to provide limited information on past residents when state licensing boards seek to verify their training.

Garcia, a California native and a 1999 graduate of the University of Utah's medical school, began a pathology residency at Creighton in July 2000. Indications are that his time at the school and affiliated teaching hospital was tumultuous.

A Creighton faculty member has said that Garcia's work in the lab and classroom was inadequate and that he was often rude and insolent. The last straw was an incident on May 17, 2001, in which Garcia was accused of attempting to sabotage another resident who was taking a high-stakes national exam.

Creighton officials decided the incident constituted unprofessional behavior and, on May 22, 2001, asked Garcia to resign or face termination proceedings. On June 26, an appeals committee unanimously supported the termination. Hunter, the pathology residency director, and Brumback, the department chairman, argued for Garcia's termination.

Garcia appealed to the dean of the medical school, who upheld the termination on July 12.

Yet Hunter and Brumback later signed documents requested from state licensing boards in Illinois, Indiana and California, verifying that Garcia's residency lasted one full year, from July 1, 2000, to June 30, 2001.

The fact that Garcia's appeals extended his tenure at Creighton past June 30 might explain why the university gave him credit for completing a full year.

Remaining unclear is what definition the school used in determining that his training had been completed “satisfactorily” — the term Hunter and Brumback used in the three verification letters.

Garcia also had abbreviated stays in two other residencies. He resigned six months into his residency at a New York hospital in 1999 after yelling at a radiology technician. The University of Illinois-Chicago ended his contract in 2004 after 19 months because of several long absences from the program, apparently because of health problems, and his failure to communicate with the staff about the absences.

Garcia applied for full medical licenses in Illinois, California, twice in Indiana, and Louisiana. Only Illinois granted him a license.

When he applied for a license in Indiana in 2008, officials from the residency programs in Omaha, New York and Chicago provided verification letters that gave only the length of time of his service.

But Illinois does not routinely take one step that some state licensing authorities do: ask applicants to sign a release authorizing residency programs to provide more information on the applicants' residencies.

When Indiana obtained such a signed release from Garcia in 2012, Brumback disclosed that Garcia had been fired from the Creighton program. It has been speculated that the letter in late 2012 might be the motive for Garcia allegedly killing Brumback.

Hofer, the spokeswoman for the Illinois licensing authority, said the state sometimes asks license candidates to sign such releases. But she said it's not standard and is usually requested only when other red flags have been raised on a candidate.

The state didn't see red flags with Garcia in 2003, she said. According to the records provided by Creighton and the University of Illinois, Garcia met the state's requirements for licensure because he had satisfactorily completed at least two years of residency.

He subsequently used his Illinois license to work at two clinics in Chicago, from 2009 to 2012.

Garcia's firing also could have come to the attention of Illinois if Creighton had reported it to the State of Nebraska, which had granted him a temporary permit to practice medicine as a Creighton resident.

Under state law, when a health care facility takes an action “adversely affecting the privileges or membership” of a credential holder due to alleged “unprofessional conduct,” the facility must report the action to the state within 30 days.

Helen Meeks, administrator of the licensure unit in the Nebraska Department of Health and Human Services, said she could not comment on particulars of Garcia's case because the state has no official information on what happened during Garcia's residency.

She said, however, that the firing of a resident for unprofessional conduct in general should be reported to the state.

“They are required to report that to us,” she said.

Once a health care facility reports the firing or suspension of a permit holder, the state would treat it as a complaint, which could lead to disciplinary action. If the permit holder is disciplined, the state would typically report that to two national databases. One is operated by the federal government and the other by a consortium of state medical licensing boards.

In some instances, the federal government requires hospitals to report adverse actions against a staff member directly to the federal databank. However, that direct reporting requirement does not apply in the case of medical residents.

Hofer said Illinois checked both national databanks before issuing a license to Garcia.

Illinois officials have faced criticism for issuing Garcia a license, particularly given the fact that he was rejected by at least three other states.

Hofer said those other states had more information to go on than Illinois, the first state in which Garcia sought a full license. By the time Garcia applied for his license in Indiana in 2008, he disclosed his firing by Creighton — something he did not do on his Illinois application.

He also disclosed to Indiana the incident in New York, a residency he had completely left off his Illinois application.

Hofer said she could not say for sure how Illinois would have responded to Garcia's license request had his residency problems been disclosed a decade ago.

But there's no question his application would have been subjected to far more scrutiny. Today, in all likelihood, he would have been called to appear before the board.

“People have said 'Why did you issue him a license when no one else did?'” she said. “We knew a lot more (about Garcia) in 2012 than we did in 2001.”

Contact the writer: Henry J. Cordes

henry.cordes@owh.com    |   402-444-1130    |  

Henry's a general assignment reporter, so he could end up writing just about anything, though he usually focuses on public policy matters affecting the state, region or nation.

17 senators in Nebraska Legislature hit their (term) limits
Convicted killer Nikko Jenkins might await his sentence in prison
Crews working to subdue brush fire that may spread to Fontenelle Forest
It's a pursuit of pastel at Spring Lake Park's Easter egg hunt
Financial picture improving for city-owned Mid-America Center
No injuries after fire at midtown's old Mercer Mansion
29-year-old Omahan arrested for 22nd time in Lincoln
Police: Slaying of woman in Ralston apartment likely over drugs
Explosion near 29th, Woolworth damages vehicles
Omaha police arrest man, 19, accused in March shooting
Earth gets its day in the sun at Elmwood Park
Beau McCoy strikes Obama doll in TV ad; Democrats are not happy
Keystone XL pipeline backers blast 'political expediency' as foes hail ruling to delay decision
Nebraska senators to study tax issues over break
Portion of Saddle Creek Road closed after water main break
Teenager arrested after woman's purse is snatched outside Omaha store
Police identify 21-year-old shot in ankle near 30th, W Streets
Cult murderer's death row appeal denied, but execution in limbo
Interstate construction to cause lane shifts, closings in Omaha area
Kelly: A California university president returns to her Nebraska roots on Ivy Day
Omahan charged in fatal shooting in Benson neighborhood
Friday's attendance dips at Millard West after bathroom threat
High school slam poets don't just recite verses, 'they leave their hearts beating on the stage'
Crack ring's leaders join others in prison as a result of Operation Purple Haze
Haze in area comes from Kansas, Oklahoma
< >
Dickson’s Week in Review, April 13-19
On Twitter some guy tweeted that the spring game isn’t taken as seriously as a regular-season contest. What was your first clue? When the head coach entered waving a cat aloft?
Kelly: A California university president returns to her Nebraska roots on Ivy Day
The main speaker at today's Ivy Day celebration at the University of Nebraska-Lincoln is a college president who grew up roping calves and earned her Ph.D. at the prestigious Oxford University in England.
Breaking Brad: Stuck in a claw machine? You get no Easter candy
I know of one kid in Lincoln who will be receiving a lump of coal from the Easter Bunny, just as soon as he's extricated from that bowling alley claw machine.
Breaking Brad: Mountain lion season's over, but the bunny's fair game!
Thursday was the last day of a Nebraska Legislature session. Before leaving town, legislators passed a bill to hold a lottery to hunt the Easter Bunny.
Breaking Brad: At least my kid never got stuck inside a claw machine
We need a new rule in Lincoln. If your kid is discovered inside the claw machine at a bowling alley, you are forever barred from being nominated for "Mother of the Year."
Deadline Deal thumbnail
The Jaipur in Rockbrook Village
Half Off Fine Indian Cuisine & Drinks! $15 for Dinner, or $7 for Lunch
Buy Now
< >
Omaha World-Herald Contests
Enter for a chance to win great prizes.
OWH Store: Buy photos, books and articles
Buy photos, books and articles
Travel Snaps Photo
Going on Vacation? Take the Omaha World-Herald with you and you could the next Travel Snaps winner.
Click here to donate to Goodfellows
The 2011 Goodfellows fund drive provided holiday meals to nearly 5,000 families and their children, and raised more than $500,000 to help families in crisis year round.
Want to get World-Herald stories sent directly to your home or work computer? Sign up for Omaha.com's News Alerts and you will receive e-mails with the day's top stories.
Can't find what you need? Click here for site map »