Patient, doctor refute diagnosis, practices in healthcare fraud trial

Another one of Dr. Jorge Zamora Quezada’s patients took the stand Wednesday to talk about her experience with the rheumatologist whose diagnosis of her was later refuted.

Giovanni Hernandez resumed her testimony Wednesday morning that had begun on Tuesday afternoon during which she stated she had gone to see Zamora Quezada a few times in 2014.

The doctor, his wife Meisy Zamora and two of their employees — Estella Santos Natera and Felix Ramos — are currently on trial on allegations that they participated in an alleged scheme to defraud health insurers by misdiagnosing and over-treating patients seen at Zamora Quezada’s clinic, the Center for Arthritis and Osteoporosis.

The federal indictment also alleges the scheme included tampering with medical records and money laundering to conceal the source of the funds they made from the alleged scheme.

While questioned by one of the attorneys for the government, Emily McLogan Gurskis, Hernandez testified that she went to see Zamora Quezada after an episode of severe pain led her to the emergency room. After following up with her primary care physician, she went to see Zamora Quezada.

On that first visit, Hernandez said, Zamora Quezada diagnosed her with rheumatoid arthritis and fibromyalgia and later began administering methotrexate injections.

However, Hernandez said the injections made her feel worse and, eventually stopped taking them.

Her last visit with Zamora Quezada was in September 2014. Hernandez explained she stopped going when the doctor told her she had erosions which she said she knew was incorrect because her primary care doctor had taken an MRI that showed she did not have them.

In 2015, she went to another rheumatologist, Dr. Melissa Mizesko, who told her that she did not have rheumatoid arthritis.

During questioning by Zamora Quezada’s defense attorney, Trey Martinez, Hernandez acknowledged she had a long history of pain long before going to Zamora Quezada.

Martinez reviewed her medical records from her primary care physician — ranging from 2010 to 2016 — from Zamora Quezada in 2014 and from Mizesko who treated her from 2015 to 2017. From the records, Martinez established that Hernandez had complained of various pain for many years before seeing Zamora and after seeing him.

Some of that pain, Hernandez pointed out, stemmed from injuries playing soccer.

Mizesko, a rheumatologist based in Corpus Christi, testified Wednesday afternoon about treating Hernandez and said that she did not find any evidence of chronic arthritis.

She testified that she did not find signs of erosions in Hernandez’s physical exam nor in Hernandez’s radiograph which, Hernandez pointed out, do not go away once they begin to form.

Mizesko also testified that Hernandez did not have joint swelling, stating that without joint swelling, it would not be reasonable to diagnose rheumatoid arthritis.

When Martinez had pointed to Hernandez’s records showing she had joint pain on and off for seven years, Mizesko said that was not relevant to her because that could have been caused by many different things.

The doctor acknowledged that Hernandez complained of joint pain when she came to see her so she prescribed medication to help alleviate that but she did waiver in her position that Hernandez did not have rheumatoid arthritis.

Following Mizesko’s testimony, a San Antonio-based rheumatologist who worked at Zamora Quezada’s Edinburg clinic temporarily, testified about practices that caused him concern.

Dr. Robert Persellin worked at the clinic for two and a half months in 2003, filling in for another doctor who was on maternity leave.

While there, he said he saw about 26 to 28 patients a day when he was only used to seeing about 14 to 16 patients per day.

Persellin said the most extraordinary thing he observed there was that the patients would come to him with  pre-printed histories and physicals that were all identical.

He stressed that no two people are alike and believed those documents were prefabricated.

The last line of the document, he said, had a list of several diagnoses that “didn’t make sense” because they couldn’t all possibly coexist.

He said he also believed patients were administered tests he didn’t think were warranted and that the treatment was more excessive than he would have prescribed. Therefore, he would often change their medication and have them return when appropriate and thus less frequently.

He was so concerned about how patients were treated at the clinic that he called Medicare to complain but they were not receptive. When he called Medicaid, they told him they no longer had a fraud desk.

He also called the Texas State Board of Medical Examiners but was told they only took complaints from patients, not from doctors.

Under questioning by Zamora Quezada’s other defense attorney, Stephen Lee, Persellin said he did not work full time at the clinic but would fly in from San Antonio and work for two days at a time.

When asked about patients’ histories and physicals, Persellin said he never received copies of those, didn’t have any patient files from that time, and couldn’t remember any of the names of those patients.

Persellin was excused from the witness stand shortly after.

Testimony in the case is scheduled to resume Thursday morning.