Chapter Five
RITA AUCLAIR’S OFFICE is on the third floor of a building off Broadway, near the Pearl, and she has a framed diploma from St. Mary’s Law School hung slightly crooked on the wall behind her desk.
I’ve been sitting across from her for twelve minutes, and she hasn’t offered me water, coffee, or sympathy, which is how I know she’s the right attorney.
“Walk me through the prescriptive authority agreement,” she says.
She’s in her mid-fifties, reading glasses pushed up on her head, a legal pad in front of her with handwriting so small it looks like code.
A Keurig machine sits on her credenza, and she doesn’t offer me coffee.
“You said Dr. Fossi is your primary supervising physician.”
“She’s the physician on my PAA filed with the Texas Medical Board.
She’s been my supervisor for twelve years.
She signs the agreement that gives me authority to prescribe medications, order diagnostics, and manage controlled substances.
Without it, I can see patients, but I can’t prescribe.
In primary care, that makes me functionally useless. ”
“And you can’t just switch to another physician at the practice.”
“Ridgeline has four physicians. Sharon is the senior partner. She built the referral network, she recruited three of the four doctors, and she’s the highest-producing provider in the group.
The other physicians defer to her on everything from scheduling to hire decisions.
If I walked into Dr. Pham’s office tomorrow and asked him to take over my PAA, he’d go to Sharon first. He wouldn’t say yes without her approval, and if Sharon’s already anticipating problems, she’ll frame any internal switch as a professional concern about my judgment. ”
Rita writes something on the pad without looking up. She writes left-handed, her wrist hooked around the pen in a way that should make the handwriting worse but somehow makes it faster. “Can she increase the level of oversight she requires of you?”
“Yes. Under the current rules, the supervising physician determines chart review requirements in the prescriptive authority agreement. She has discretion. She can decide she needs to review more charts, audit more of my clinical decisions. She can frame it as quality improvement and it’ll hold up, because the regulations give the supervising physician that authority. ”
“So she can tighten the screws without ever saying the word ‘affair.’”
“She can make my workday twice as long, bottleneck my billing, and make me look incompetent to the practice manager, and all of it would be defensible as clinical oversight.”
“What happens if she terminates the agreement entirely?”
“I stop prescribing. I notify the Texas Board of Nursing within fifteen days that my practice situation has changed. I find a new supervising physician willing to execute a new PAA and register with the Medical Board. Until that happens, I don’t prescribe.”
“How long does that process take?”
“Finding a willing physician could take weeks. The registration paperwork with the TMB takes additional time. I’ve heard of it going through in ten days if the physician is already registered as a supervisor. I’ve heard of it taking six weeks.”
“And during that time?”
“During that time I don’t practice. I don’t earn income.
I don’t see patients. My six hundred patients get redistributed to the other providers at Ridgeline, who are already overloaded, and the ones who don’t want to see someone else leave the practice.
Some of them I’ve treated for a decade. I lose them because a woman decided to sleep with my husband. ”
Rita puts her pen down and looks at me over the legal pad. Her expression is direct, unpadded. Twenty-five years of delivering bad news has taught her that softening it doesn’t help.
“Here’s what you’re looking at,” she says.
“Your husband’s affair is a personal matter that the court will handle through the divorce.
Property division, spousal support, and custody if applicable.
Texas is a community property state, so everything acquired during the marriage gets split, and his commission income is part of that calculation. That’s the straightforward piece.”
She leans forward. “The complicated piece is that the woman he’s sleeping with holds your professional authority.
She didn’t just take your husband. She holds the document that lets you work, and under Texas regulations, she has discretion over how closely she supervises you.
If she decides to weaponize that authority, she can make your professional life very difficult before she ever terminates the agreement.
The tightened oversight, the billing delays, and the chart reviews.
All defensible. All procedurally clean. All designed to push you out without leaving her fingerprints. ”
“So what are my options?”
“Three, as I see it. One, you try to switch supervisors internally. You’ve already told me why that’s unlikely to work.
Two, you stay and document. If she tightens the screws, you keep a record of every chart review, every delayed signature, and every reassigned patient.
If she terminates the agreement, you file a complaint with the Medical Board arguing that she abused her supervisory authority for personal reasons.
That’s a real argument, but it’s slow, and while it’s pending, you’re not working. ”
“And three?”
“You find a supervising physician outside the practice. Someone willing to execute a new PAA with you before Sharon makes her move. You file the new agreement with the Board, you give notice at Ridgeline, and you walk out with your prescriptive authority intact. She can’t terminate an agreement you’ve already replaced. ”
I sit with that. The office is quiet. Traffic hums three stories below. Rita’s crooked diploma catches a slant of light from the window, and the brass frame needs polishing, and my brain grabs at these details because it’s looking for anywhere else to be.
“You’re telling me the cleanest way out of this might be leaving the practice I’ve been at for twelve years.”
“I’m telling you Sharon holds the thing you spent eighteen years building, and the cleanest way to protect it may be a door that isn’t in her building.” She picks up her pen again. “Do you have a relationship with any physicians outside Ridgeline who might be willing to supervise?”
Dawson Cruz. The name surfaces before I’m ready for it. The occupational medicine physician with the clean charts, the open NP position, and the direct voice on the phone that didn’t waste my time or his.
“Maybe,” I say. “I might.”
“Then I’d start there. Quietly. Before Sharon knows you’re looking.”
I nod. Rita tears a sheet from the legal pad and hands it to me, her handwriting listing the three options in that unreadable script, with option three circled twice.
“One more thing,” she says. “Your husband told you that Sharon knows things are ending. That means they’ve been coordinating.
Keep a record of that too. If the affair and the professional retaliation are connected, and if you can show the connection, that changes the math for both the divorce and any Board complaint you might file. ”
I fold the paper and put it in my bag. I thank her. I pay the consultation fee at the front desk, $350 on a credit card that is mine and not shared, and I drive back to Ridgeline for my afternoon clinic with the list in my bag and the name in my head.
Dawson Cruz. The door that isn’t in Sharon’s building.