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.

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.

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.

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 approvement 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 second installment in a four-part series on the rise and fall of Larry Gentilello. Read the full series.

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The doctor's formative years
When Larry Gentilello graduated from Albert Einstein College of Medicine in 1982, he was the first person in his family to go to college, let alone complete it. His matriculation was followed by several internships and fellowships around the country, as well as a residency at UC San Diego.

Accolades started pouring in around 1990, when Gentilello discovered a new treatment for hypothermia. That same year, he landed a job as an attending surgeon at Harborview Medical Center, the teaching hospital of the University of Washington. He also served as an assistant professor in the department of surgery.

As Gentilello was gaining notoriety as a doctor and researcher, the world of academic medicine was undergoing major changes.

In 1992, the federal government created laws that dictated how residents and accredited doctors at university hospitals had to operate in order to bill for Medicare and Medicaid — specifically the need for a teaching physician to be physically present at services performed by residents.

Though they were articulated four years prior, the Physicians at Teaching Hospitals Laws, commonly referred to as PATH Laws, became effective in 1996. Around that time, the government began conducting audits of large teaching hospitals.

The PATH Laws were not without controversy. The Association of American Medical Colleges as well as other medical associations and specialty societies filed official complaints and lawsuits with district and federal courts. To date, none has been successful in overturning the laws or stopping the audits.

In 1999, when Gentilello had risen to co-director of the trauma and critical care fellowship, Harborview was hit with a massive lawsuit for Medicare and Medicaid billing fraud. The whistleblower case, brought by the university’s billing compliance officer Mark Erickson, drug on for five years before the university ultimately settled for $35 million. Erickson’s lawsuit also led to two doctors being convicted of felonies: obstruction of justice and fraud.

“I become acutely aware of how the law must be followed in order to prevent illegal billing,” Gentilello says. “It really disrupted the university in a terrible way.”

With this knowledge intact, Gentilello headed to Harvard University and its teaching hospital, Beth Israel Deaconess Medical Center, in 2002.

There, Gentilello says, the staff strictly adhered to the letter of the law.

“The resident wouldn’t put a needle into a patient in the operating room without you standing there,” Gentilello says. “Anesthesiologists wouldn’t even think of putting the patient to sleep without you there. No nurses would hand a surgical instrument to a resident unless the attending surgeon was there.”

A homecoming of sorts
Gentilello’s reputation for publishing papers, garnering high-profile speaking gigs and generally influencing medicine got the attention of Parkland Memorial Hospital and UT Southwestern. Shortly after arriving at Harvard, Gentilello was recruited for a prestigious chairmanship in Texas.

“It felt like coming home in a way,” says the UTEP grad.

At the time, the C. James Carrico Distinguished Chair in Surgery for Trauma and Critical Care was one of only a few such prestigious positions in academic medicine.

“It was something that most people were very interested in. It was sort of a big honor,” Gentilello says of being selected after a nationwide search.

Of course, Gentilello knew the appointment would include its fair share of headaches. Not unusual for a large county hospital, Parkland had fallen on hard times. Its residents weren’t publishing. The trauma center got few grants or applications for fellowships.

But Gentilello couldn’t have imagined what was going on behind the operating room door.

“There was no reason to assume Parkland didn’t make the changes that everyone else had to in order to obey the law,” he says. “It’s a famous institution. No one would have thought that they were really a criminal organization — that would be beyond a reasonable belief.”