REPORT: ESCOBEDO WARRANTS DISCIPLINE

JEFFERSON CITY - A state administrative hearing commissioner released a report Friday for the Missouri Board of Registration for the Healing Arts, concluding that it should consider disciplinary action against Dr. Bolivar M. Escobedo.

The conclusion was formed by Commissioner Edward F. Downey, more than three years after a complaint charged Escobedo was guilty of misconduct and neglect with regard to abortion clinics he operated in Cape Girardeau and Manchester.

The seven count complaint filed against Escobedo, also charged that the St. Louis doctor misused controlled drugs; operated an abortion clinic without a license; performed surgical procedures without a registered nurse, blood bank or adequate equipment on hand; and performed abortions without having surgical privileges at any Missouri hospital.

Although the hearing commissioner has concluded that "Escobedo's license is subject to discipline," any punishment rests with the healing arts board that regulates physicians in the state.

Punishment could range from a reprimand to revocation of his medical license.

Escobedo was issued a license in 1977 and was the president and sole shareholder of the Women's Health Center, Inc. which operated in Manchester and Cape Girardeau. More than half of the health center's revenues came from performing abortions.

The center in Cape Girardeau has been closed for several years, and Escobedo indicated in June of 1991 that he was no longer performing any abortions.

In the first two counts filed against the doctor, he is accused of being "grossly negligent" in performing abortions - one in St. Louisa and one in Manchester.

In the first instance, a woman went to the Cape Girardeau facility in 1983 for an abortion when she was 10 weeks pregnant. Shortly after the procedure, the patient experienced stomach cramps and six weeks later another doctor said she was still pregnant. She returned to the clinic for another abortion.

The complaint charges that the manner used by Escobedo to attempt the abortion was "contrary to accepted standards of the medical profession."

In the second instance, a woman from Carbondale attempted to have an abortion several times unsuccessfully. Eventually the procedure was completed at a Carbondale hospital when the woman was suffering from severe bleeding.

But the hearing commissioner concluded that Escobedo was not at fault in these instances to any degree that would provide for disciplinary action. The commissioner concluded: "there is no evidence that Escobedo committed any act with wrongful intent."

The commissioner did find that Escobedo signed prescriptions without patients names, in effect delegating his authority to write prescriptions. "That conduct constitutes the signing of blank prescription forms and is cause for discipline," the commissioner said.

But he also noted: "We cannot say whether such conduct is also incompetency, gross negligence or repeated negligence because this record lacks the necessary expert medical testimony."

On a fourth count concerning violations of controlled substances, the commissioner found only minor violations.

The healing arts board also charged that Escobedo's operation of the Cape Girardeau and Manchester facilities without ambulatory surgical center licenses is cause for discipline. The commissioner said that because they were abortion facilities, they were ambulatory surgical centers and should have been licensed, which is cause for disciplinary action.

The commissioner concluded: "... Escobedo's failure to have the Department of Health's abortion facility licenses constitutes misconduct in his practice of medicine as it was in knowing violation of the department's regulations in that regard. In spite of the department's repeated notice to Escobedo of the requirements, he took no action to obtain such a license. This conduct shows wrongful intent. His argument that the law required no license for his facilities because he charged for ancillary abortion services a la carte is imaginative but disingenuous. His conduct in this regard was also unethical and unprofessional ... "

However, the commissioner makes it clear that there is no evidence the failure to have the licenses jeopardized the health of anyone.

In another count, the commissioner determined Escobedo could be disciplined for not always using registered nurses, but not for inadequate equipment or lack of a ready blood supply.

A final count charged that Escobedo performed abortions without privileges at a Missouri hospital and signed insurance forms as the treating physician when he was not.

The commissioner points out there is no dispute that Escobedo performed abortions between Aug. 13, 1986 and Jan. 12, 1987 when he failed to have hospital privileges, which violates a law that became effective Aug. 13, 1986. It states that a physician at an ambulatory surgical center shall not perform surgery without surgical privileges or a transfer agreement at a hospital in the same community.

The violation is considered unprofessional conduct and grounds for license revocation.

A charge that Escobedo attempted to collect fees by fraud, deception or misrepresentation was determined unfounded.

The original complaint from the State Board of Registration for the Healing Arts was filed on Feb. 23, 1990. A corrected second amendment complaint was filed on April 9, 1992.

A hearing was held on Oct. 13-16, 1992 and again on Jan. 4-5. The board filed its last written argument July 21 and Downey's decision was issued Friday.