Editor’s Note: Before Parkland Memorial Hospital came under national scrutiny, before it was one of the largest hospitals ever put on probation by the Centers for Medicare and Medicaid Services, it recruited Larry Gentilello, M.D., to be the distinguished chair in surgery for trauma and critical care. This decision would irrevocably change the hospital’s standing and the course of Gentilello’s career.

In 2002, Gentilello was a world-renowned trauma surgeon and academic at Harvard Medical School and its teaching hospital, Beth Israel Deaconess Medical Center. In 2003, he left that post for a prestigious chairmanship and tenured position at UT Southwestern and a surgical appointment at Parkland.

It’s a long fall from the top, and Gentilello has taken quite a tumble. Demoted at UTSW and barred from operating at Parkland in 2008, Gentilello now works at a low-level private hospital in Northern California. Although he's been quoted as a corroborating source in a number of articles, this is the first time Gentilello is speaking publicly about his journey from the height of academic medicine to virtual obscurity after filing a slew of lawsuits against his former employer.

A spokesman for UTSW declined to be interviewed for this series, citing a policy against discussing pending litigation. However, the medical school’s voice is represented through internal documents, sworn statements and depositions obtained by CultureMap.

Chief among his complaints, Gentilello alleges UTSW committed billing fraud and endangered patients’ lives by failing to properly supervise residents in the emergency room at Parkland.

In state whistleblower litigation that went before the Texas Supreme Court on September 12, Gentilello claims UTSW retaliated against him for reporting the alleged fraud. UTSW is trying to get the case thrown out on the grounds that Gentilello had a legal burden to contact law enforcement, not his supervisor at UTSW. The case is still pending.

The federal whistleblower lawsuit was dismissed in August on legal grounds before ever going to trial. The billing fraud lawsuit, filed in July 2007 and sealed until September 2011, was settled for $1.4 million last year. For a billing fraud lawsuit, $1.4 million is rather paltry. Similar suits at other institutions have drawn upward of $30 million.

Although the monetary damage is minimal, Parkland’s standing has suffered greatly as numerous state and federal agencies have found fault with the storied medical center. In August, Parkland reached an unprecedented $1 million settlement with the Department of State Health Services for patient safety claims. The largest hospital fine previously levied by the entity was $50,000.

Parkland is in the midst of a stringent improvement agreement with the Centers for Medicare and Medicaid Services. If it fails to meet standards, the hospital could lose significant funding in April 2013 and effectively be forced to shut down. All of this can be traced back to one man: Dr. Larry Gentilello.

This is the first installment in a four-part series on the rise and fall of Larry Gentilello. Read the full series.

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Trouble in the ER
Larry Gentilello peered at his unconscious patient. Days ago, the man had blown off his own jaw with a single shot to the face. He’d been rushed into surgery at Parkland Memorial Hospital and given a breathing tube before being sent to the intensive care unit. Gentilello appraised his patient once more and prepared to remove the breathing tube. He hesitated.

“I need to know that you fixed his jaw, and he’s not going to swallow his tongue,” Gentilello said to the UT Southwestern residents who had operated on the man in the emergency room.

They assured him it had been fixed, but the doctor, knowing the gravity of the situation, asked for more proof. If Gentilello had been the one in the ER, he would have performed a tracheostomy and placed the tube directly into the patient’s airway. But Gentilello hadn’t operated on the man.

The residents grew impatient with the thorough doctor, as they often did, and insisted there would be no complication. Gentilello, previously a professor at Harvard Medical School and the chief of trauma at its teaching hospital, thought otherwise.

The team removed his breathing tube, and immediately the man began choking on his tongue. The patient, weighing in at around 300 pounds, thrashed in his hospital bed. Pus poured out from the opening in his throat, and screws popped through his skin.

But Gentilello, a world-renowned surgeon, didn’t wheel him into the operating room. He called for help.

“This guy has lost his airway. He needs a tracheostomy right now,” Gentilello told the trauma surgeon on call.

Next, he ordered an anesthesiologist to the operating room. Gentilello, who had 20 years of trauma surgery experience, stood helplessly next to the convulsing patient.

“They wouldn’t give me a knife,” he says. “They’d rather him die to prove their point.”

Four years after that botched surgery, Gentilello grows red in the face as he recalls the details. The patient lived, yes, but this was just one case.

“I saw horror story after horror story,” Gentilello says.

A contested reputation
Depending on whom you talk to, Larry Gentilello is described as rigid and argumentative or brilliant and compassionate. But no one can argue with the man’s results.

Fresh out of medical school, he literally rewrote the book on hypothermia treatment in the 1990s. Since then, Gentilello has left an indelible mark on substance abuse treatment and indigent medicine, earning commendations, awards and grants from institutions across the country, including the U.S. House of Representatives.

It’s a pretty impressive résumé for a guy whose post-high school employment included driving a cab in Spanish Harlem and a merchandise truck for Carlos Santana.

“I knew I didn’t want a desk job,” Gentilello says. “And driving paid very well.”

If not for a bit of divine intervention, Gentilello might have stayed behind the wheel forever.

From cab driver to college student
At 20 years old, Gentilello hadn’t given college much thought when he found himself at Boston University. He was there as a hired hand, moving a student from a dorm room to an apartment, but something about the campus intrigued him.

A theology professor approached Gentilello and asked him if he was lost. He then ushered the future doctor into his office and told him about night school, financial aid and work-study opportunities.

A month later, Gentilello was a Boston University student, working at the library during the day and a convenience store at night.

Although he appreciated getting in the door at BU, the price of education in the Northeast was too high. After a few semesters, Gentilello set off for UT El Paso, where he’d been offered a full scholarship.

Growing up, he’d always had a knack for science. A bright child with an unstable home life, Gentilello graduated from high school with no immediate career plans.

As it turns out, he was never meant to graduate from college. He was accepted to medical school after his junior year at UTEP.

“I showed up in El Paso without even a toothbrush,” Gentilello says, recalling how his car had been robbed the night before he moved. “I left with a wife and an admission ticket to medical school back in New York City.”

With such a meteoric rise, perhaps Gentilello’s career was destined to come crashing down.