After Kimberly Ray’s tragic death, her family found out just how hard it is to hold Texas medical providers to account.
For as long as anyone could remember, Kimberly Ray had shown a soft spot for animals. When she was five years old, she discovered a newly hatched starling that had tumbled from its nest and was distraught when she couldn’t nurse it back to health. Years later, while visiting a shelter to help a friend pick out a dog, she saw a pit bull puppy and adopted her on the spot because she was afraid no one else would. So it was no surprise when Kimberly, a brunette with apple cheeks and a giggly laugh, landed a job at a pet supply store in her early twenties. She happily spent her days bathing dogs, but just a few months into the gig, she tweaked something in her lower back. Soon, hoisting animals in and out of the grooming tub became too painful, and she was forced to quit.
A military brat, Kimberly had a nomadic childhood—her father served in the Air Force and was stationed in Hawaii, California, and a half dozen other states. Her mother, Dee Cook, liked to brag that their daughter spoke in complete sentences as a toddler and could read before kindergarten. Kimberly made friends easily, some for a lifetime. When she was in middle school, her father, Mike Woodworth, joined the Texas Air National Guard, and the family settled in Arlington, between Dallas and Fort Worth. Even after she graduated from high school and her parents divorced, Kimberly never strayed far from home.
After leaving the pet store, she began waiting tables at the restaurant inside a nearby Marriott, where she befriended a barkeep named Brandon Ray. He made her laugh, and they were both fans of the Dallas Cowboys and Dave Matthews Band. The two remained friends even after they both moved on to better jobs. Then they were more than friends. One day in the spring of 2012, Kimberly invited her mother to lunch at a local Cheesecake Factory. Over pasta and salad, she announced she was pregnant. “Are you happy about this?” Dee asked. Kimberly was—very.
She moved in with Brandon and gave birth to a baby girl. Four years later, Brandon and Kimberly married at a Tarrant County courthouse. A small group of family and friends attended and took snapshots on their phones. As the couple recited their vows, their daughter, wearing a pink dress and polka-dot bow, began dancing. They struggled to finish their “I dos” with straight faces.
Brandon had secured a good job with UPS, and the newlyweds bought a three-bedroom house with a fenced yard about fifteen minutes from her mother’s place in Arlington. A few years went by, and when their daughter reached elementary school age, Kimberly decided to start classes to become a cosmetic laser technician. But before she could embark on a career that would require her to stoop over clients all day, she needed to do something about her back.
More than a decade had passed since her injury, and the pain still came in excruciating waves. At times, Kimberly would call Dee over to babysit so she could stretch out on the sofa, waiting for the agony to subside. She struggled off and on with alcohol and prescription pain medication, which Dee believes was collateral damage from living with chronic pain. Eventually, Kimberly sought relief at Mansfield Pain Services, a clinic located a short drive from her home. There she received injections in her lower lumbar region. The shots worked—until they didn’t.
Kimberly’s medical provider asked her, in early 2021, to begin seeing him at a different location, an ambulatory surgical center called Integrity Wellness Center, located thirty miles north, in Coppell. “She just said that’s the clinic the insurance okayed her to go to,” said Dee, who accompanied Kimberly to appointments. “I don’t think she really thought, ‘Maybe I should check into this. Maybe I should get second opinions.’ ”
After a few visits, Kimberly’s provider suggested a rhizotomy, in which the nerves responsible for the pain are severed or burned. If the nerve is damaged, pain signals can’t get through to the brain, at least in theory. It’s a common procedure, typically quick and low-risk.
Kimberly was upbeat. She’d stopped taking pain meds and had been sober for more than a year, and she was excited about the possibility of ending her pain once and for all. Late on the morning of April 19, 2021, Brandon drove her to Integrity Wellness, with their eight-year-old daughter in the back seat. He’d taken time off work to finish home renovations and celebrate his wife’s birthday—Kimberly was turning 42. Because of COVID-19 precautions, no one was allowed to accompany her inside for her appointment. So when they arrived at the clinic, housed in a brick veneer strip mall across from a Domino’s, Kimberly kissed her family goodbye and walked in alone.
More than an hour passed. Brandon, who waited outside with their daughter, didn’t suspect anything was wrong. Then he saw an ambulance turn into the parking lot, sirens wailing.
There was a lot Kimberly didn’t know about Integrity Wellness. That wasn’t her fault—it’s often hard in Texas to discover much about the people and institutions you entrust with your life. The first place many patients turn to is Google, scrolling through websites and online reviews as if they were searching for dinner reservations or selecting a new refrigerator. These ratings can be notoriously incomplete and misleading. One infamous Texas doctor, the neurosurgeon Christopher Duntsch, left such an astonishing trail of fatalities and paralyzed patients as he moved from hospital to hospital that he later became known as Dr. Death. He eventually went to prison, in 2017, yet up until the moment his license was suspended, his rating at Healthgrades, a sort of Yelp for physicians, was 4.5 out of 5 stars.
Duntsch’s case attracted global attention, but Texas patients can still find themselves in the dark. The website for Integrity Wellness, which recently changed its name to Cedarwood Surgical Center, didn’t list any staff under the “About Us” tab. The only photograph of a person showed what appeared to be a handsome doctor in scrubs but was in fact a stock image of a male model pasted onto dozens of sites around the world. Kimberly couldn’t have known there were legitimate concerns about substance abuse among some who worked at Integrity Wellness and that the doctor on duty the day of her appointment had been dropped from previous hospitals over worries about patient safety. Dee didn’t even realize that the specialist Kimberly was seeing wasn’t a doctor. When she and Kimberly saw him, he wore a white coat or scrubs, so Dee gave it no further thought.
“He never identified himself, specifically,” Dee told me one day last spring. “But I just always assumed if you’re treating somebody with the procedures she was being treated with that you would be a medical doctor.” We sat in her living room, where a wall of bookshelves held framed family photos, including a portrait of Kimberly with her brother and another of Kimberly’s little girl proudly riding a camel at a renaissance festival.
When Kimberly filled out the consent form for her rhizotomy, the blank space for her provider was labeled with “Dr.” Another line on the form indicated “surgeon.” Her provider wrote in his name and signed above the blank designated “physician.” In scrawled handwriting, the signature says, “Scott Houghton, CRNA.”
Houghton is a certified registered nurse anesthetist. CRNAs are trained to provide general anesthesia and perform many of the same services as an anesthesiologist—including putting you under during surgeries and monitoring your breathing and heartbeat. Some, such as Houghton, are also trained in pain management, which is generally considered beneficial for the health-care system. CRNAs make medical care more accessible and affordable, especially in areas with doctor shortages. Texas law says CRNAs must practice under the guidance of a physician, only seeing patients referred by a physician. That doesn’t mean a doctor is looking over their shoulder, keeping tabs every day. Kimberly, for example, never saw anyone other than Houghton for her pain.
When I spoke to Houghton recently, he said he has never represented himself as a doctor and did not think Kimberly mistook him for one. In Mansfield, he said, his bio hung beneath his photo on the clinic wall. He graduated with CRNA credentials in 2004 and completed a pain management fellowship at Hamline University, in Minnesota, in May 2014. Four years later, he opened Mansfield Pain Services, which is where Kimberly first met him. The business stalled. He told me claims were often denied because he’s not a physician, though in a deposition entered into court records, he said that he knew other CRNAs were “making good money, getting really good reimbursement” and that he attributed his troubles to “a lack of understanding about how to play the insurance game.”
An anesthesiologist in Frisco named Baber Younas took over the operation of Mansfield Pain Services in 2020. Whereas Houghton struggled to keep the clinic solvent, Younas was a more experienced businessman. He has owned or partially owned roughly seventy limited liability companies, or LLCs, on file with the Texas Secretary of State’s office, about thirty of which are listed as active.
Younas had already become a majority owner of Integrity Wellness and served as its medical director. Despite what Kimberly told her mother, none of the charges billed by Integrity Wellness were covered in network by her insurer. At Mansfield Pain Services, the insurance company was billed around $2,000 for each injection she received. Kimberly had two appointments for injections prior to her rhizotomy at Integrity Wellness. The surgery center billed her insurance $139,625 for those visits, including $920 for an adhesive bandage and $288 for Hibiclens antiseptic cleanser, which sells for around $10 per 8-ounce bottle on Amazon.
On Yelp, the most recent reviews of Integrity Wellness complain of eye-popping charges. “What is the deal with the billing nightmare?” one person wrote. Said another: “They continue to bill insurance for $200,000 for an hour appt and a spinal injection.” One patient describes “over $125,000 to my insurance for two dates of service, for roughly 40 min of work each.” (Younas told me that the bills at Integrity Wellness were higher than at Mansfield because the Coppell clinic is a surgical center with steeper overhead, and, according to Houghton, “everybody jacks up the way they bill” because it’s impossible to determine what percentage insurance companies will cover.)
Shortly after acquiring Integrity Wellness, Younas recruited his sister-in-law, a registered nurse who had worked part-time at a pediatric practice, in an assisted living center, and at a psychiatric hospital—but never at an ambulatory surgical center. This was her first full-time job. She was quickly promoted to be director of nursing. Shortly after she was hired, another nurse texted an administrator, “Y’all are asking me to put her in there without knowing anything. She doesn’t have her ACLS [advanced
cardiovascular life support]. She doesn’t know what has to be on paperwork to go into surgery. Putting her in there without some kind of training, mistakes will happen.”
Once inside the surgery center, Kimberly began preparing for her procedure. She signed the final consent form for the rhizotomy at 12:41 p.m. on April 19, 2021. A short time later, as she lay on her stomach in the operating room, she was given general anesthesia—a cocktail of fentanyl and propofol—by a CRNA named Mauro Molina, who was working alongside Houghton. Houghton finished the rhizotomy around 1:30, and that’s when Molina, who was responsible for monitoring Kimberly’s vital signs, first noticed that she wasn’t breathing and had no pulse. They then flipped her over. In sworn testimony, a paramedic who arrived later said the staff told him Kimberly “appeared to be blue when she was rolled over and found not to be breathing.” (Houghton later disputed that Kimberly had turned blue.)
Molina and Houghton sounded a code blue, and Houghton began trying to resuscitate her. At 1:40 p.m. the staff called an ambulance. Paramedics arrived within five minutes and found a scene that was “chaotic and unorganized,” according to the EMS report. “The staff did not appear to know how to deal with the code situation. They were having trouble finding the necessary drugs and instruments,” the paramedic later testified. After successfully restarting Kimberly’s heart, the paramedics loaded her into an ambulance and rushed her to a nearby hospital.
That afternoon, Dee was waiting for a call from Kimberly, who’d promised to let her know how the procedure went. Then Brandon’s name lit up her phone. “Dee, something went wrong,” he told her. Paramedics had taken Kimberly to Medical City Las Colinas Hospital. “You need to get over there.” Dee felt herself trembling. “My gut just told me it was bad.”
She raced to the hospital, unprepared for what she would find—her daughter lying on a gurney, racked with almost constant seizures. That evening Kimberly was moved to a neurology unit in Fort Worth. Dee had planned to make Kimberly’s favorite pistachio cake for her birthday. Instead, she sat by her daughter’s side, holding her hand and talking to her, finally going home for a fitful night of sleep.
Two days later, doctors told Kimberly’s family that brain scans showed she would not recover from the prolonged oxygen deprivation she’d suffered at Integrity Wellness. From the moment she’d been placed under anesthesia, she never regained consciousness. On April 23, 2021, her family gathered around her bedside. Brandon softly played recordings of Dave Matthews Band next to his wife’s ear as doctors withdrew life support.
Kimberly’s family held a small celebration of life and made plans to scatter her ashes in places that had been dear to her, including Hawaii, where she’d made some of her happiest childhood memories, and Australia, where her brother lives. Before her cremation, though, Brandon and Dee, desperate to comprehend what had gone wrong, requested an autopsy. They received the results four months later. The pathologist’s report stated that Kimberly “died as a result of complications following injection procedure for pain.” A medical expert who later reviewed the case cited the “distinct possibility” that Kimberly’s heart had stopped because Houghton accidentally injected a local anesthetic in such a way that it caused “muscle paralysis that would prevent the recipient from breathing.”
Houghton has denied this, and his attorney suggested that Kimberly’s death might have had something to do with a previously undetected heart condition. The pathologist strongly rebutted that claim during her sworn testimony, explaining that immediately after the injection of local anesthesia Kimberly “had a drop in her blood pressure, and when they turned her over she was in cardiac arrest.” (No one at Integrity Wellness has been found liable for causing Kimberly’s death.)
After receiving the pathologist’s report, Kimberly’s father began looking for a lawyer. He eventually found himself on the phone with Dallas malpractice attorney Mike Sawicki, who would spend more than two years following a trail of evidence that revealed an almost unimaginable dearth of accountability in Texas’s health-care system.
A former newspaper reporter, Sawicki has rimless glasses, a round face, and a penchant for gallows humor. He once worked at the Dallas Times Herald, but he abandoned journalism for law school in the late eighties. “The two jobs have a lot of similarities,” he says. “One is that you are not usually welcome when you’re talking to anybody. And they’re usually annoyed at you after you’ve done your job.”
Like many who grew up in the Watergate era, Sawicki aspired to be an investigative journalist who exposed abuses of trust and power. While in college at the University of Missouri, he envisioned himself as a future Woodward or Bernstein. He ended up working the graveyard shift, chasing police dispatches at a newspaper in financial decline. He decided there were other ways to hold wrongdoers to account.
It turned out that representing plaintiffs suited him, providing an outlet for the kind of obsessive tendencies common among investigative reporters. Piles of research tend to collect on his desk during big cases. He often wakes in the middle of the night, his brain a feedback loop mulling some new hunch, and turns on his computer. Friends know not to ask him what he’s working on because he’ll inevitably tell them. And tell them. And tell them again.
An amateur pilot, Sawicki began his career in aviation law at Dallas’s Turley Law Firm. Then the firm’s malpractice attorney left, and Sawicki says he drew the short straw to replace him. He eventually started his own practice and cemented his reputation in 2005 after a historic $606 million judgment for a case involving a man who had been overdosed with chemotherapy drugs. A framed copy of a news report about the case hangs in his office, a monument to the kind of stratospheric payouts that are unlikely to happen again in Texas. “I inherited a great medical-malpractice reputation at a time when medical malpractice in Texas was going away,” he says. “So it’s like being the best buggy-whip maker in America.”
When you have a conversation about patient safety in Texas, especially with a plaintiff’s attorney, it’s not long before they’ll bring up House Bill 4, passed in 2003. The law imposed a $250,000 cap on pain and suffering claims against medical providers, regardless of how many providers are found liable, which almost overnight rendered most civil malpractice litigation not worth the cost of going to court. The stated purpose was to prevent frivolous suits that were driving up insurance costs and scaring doctors out of Texas.
To be sure, baseless lawsuits exert an economic and mental toll on physicians, even if they are ultimately cleared. The Texas Medical Association, which represents doctors, has hailed the legislation as “the single most effective known cure for health care lawsuit abuse.” The number of malpractice judgments and settlements in the state has plummeted by more than half in the twenty years since, to just 574 payouts in 2023, even as the state’s population grew from 22 million to about 30 million.
The benefit to patients is not so clear, though. The favorable malpractice climate hasn’t done enough to attract urgently needed doctors to Texas. Almost three dozen rural counties do not have a single primary care doctor, and Texas currently ranks forty-first in the number of active physicians per capita. (New York, commonly cited as a malpractice hellscape, is number three.) What’s more, Texas ranks among the top five states with the largest percentage of people with medical debt and the largest number of residents who say they skip medical care because they can’t afford it.
What is not in dispute is that the law has throttled the malpractice business. In the late aughts, Sawicki’s wife, a financial planner, visited him at work and said, “You’ve got a huge office with a lot of books you don’t look at that are very impressive. And a lot of space you don’t actually do anything in.” Sawicki shrunk his malpractice firm from five people to two and moved into a lower-rent suite with no receptionist and a lobby the size of a large walk-in closet. And like most other plaintiff’s attorneys in the state, he got picky about clients.
Sawicki would eventually take on Kimberly’s case, but before deciding whether to sue on behalf of her family, he needed her medical records. After weeks of making unanswered requests to Integrity Wellness, Sawicki drove up to Coppell. No patients were there, and the place was locked, but he knocked and a woman answered. He explained what he was there for, and she started to close the door. But, he says, he blocked the threshold with his foot and calmly told her he wasn’t leaving until he got what he needed. As he stood waiting, a lawyer for Integrity Wellness—an acquaintance of Sawicki’s, it turned out—called and told Sawicki he would have the records that afternoon.
When the files arrived, Sawicki got right to work. “We start running the names,” he says, investigating the clinic’s medical staffers. The first he checked out was Mauro Molina, one of the two CRNAs caring for Kimberly. The records he found on him were lengthy.
Molina knew Younas, Integrity Wellness’s principal owner, from when they both worked at the Dallas branch of Forest Park Medical Center, a hospital chain owned by a group of physician investors. Forest Park’s Frisco location opened in 2012, catering to patients who wanted “the ambiance of a resort spa,” the project manager told a trade publication at the time. Four years later, the U.S. Department of Justice announced charges against 21 people at the Forest Park hospital in Dallas, including nine physicians, for health-care fraud, specifically a bribery scam “designed to induce doctors to steer lucrative patients—particularly those with high-reimbursing, out-of-network private insurance.” Fourteen of the accused were eventually sent to prison. (Younas and Molina were never accused of any involvement in the Forest Park case.)
Amid the hospital’s implosion, Molina began working as an independent contractor at medical facilities around North Texas. In November 2019, while he was tending to a patient at Methodist Southlake Medical Center, colleagues became alarmed by Molina’s unusual behavior. They reported “slurred speech, unsteady equilibrium, slow speech, wandering the halls,” according to records I obtained through a public information request from the Texas Board of Nursing. A colleague referred Molina to a peer assistance program specializing in alcohol and drug abuse and various mental health conditions, and the hospital stopped contracting with him. Molina declined to be interviewed, but in a deposition he told Sawicki he had been friends with the person who referred him to the program. He said he didn’t know why the friend thought Molina needed treatment. When asked why he no longer worked at the hospital, Molina replied, “I just assumed they had other providers.”
Seven months later, in June 2020, Molina was administering anesthesia to a patient at Baylor Medical Center at Trophy Club, north of Fort Worth, when Molina sank into a chair “with a blank stare and [was] unable to communicate,” according to a witness affidavit. The staff feared that Molina was suffering from low blood sugar or a stroke and whisked him to the ER in a wheelchair. He was transferred to another hospital for evaluation, but by the time he arrived, his condition had resolved.
In an affidavit submitted to the Texas Board of Nursing, a supervising physician said he found dirty needles in the room, along with discrepancies in the quantities of ketamine and hydromorphone. Molina later said he had treated two patients back-to-back and did not have time to document use of the drugs for the second case before his symptoms appeared.
Molina told Sawicki during the deposition that he could not explain the cause of the two episodes. After the second incident, his doctor “couldn’t come up with a diagnosis, but she gave me a release to go back to work.” (Molina had a history of back pain. Records indicate that in February 2020 he filed suit against his insurance company over its denial of a disability claim. The company countersued, alleging that Molina had misrepresented his health history on his insurance application.)
After the incident in Trophy Club, the Texas Board of Nursing, which does not comment on individual cases, notified Molina that his license was subject to temporary suspension based on the two incidents. But publicly available information on his license does not indicate that any kind of suspension or official action ever happened.
Historically, a malpractice lawsuit has been one of the most potent avenues for a patient, or a patient’s family, to hold health-care providers to account. Civil cases not only offer the possibility of justice for those who suffer harm but also create a public record that serves as a warning to potential patients and employers. “Our courts were empowered to be a check and balance and to make sure that wrongdoing was brought to light,” says Ware Wendell, the executive director of the patient-safety nonprofit Texas Watch.
When the Legislature imposed its $250,000 malpractice cap in 2003, a separate bill seemed to acknowledge a greater need for patient protection, creating an office expressly for that purpose. The state provided funding for a small staff. In addition, the Texas Medical Board, the Texas Board of Nursing, and other medical-licensing boards began dedicating a few dollars from every fee they collected to sponsor the newly created office.
In its first year of existence, 2004, the Office of Patient Protection’s annual report explained its role as “a vehicle for the consumer’s voice into the regulatory process (particularly the enforcement process).” The report noted that 40 percent of survey respondents who said they or someone they cared for received substandard treatment didn’t know how or where to file a complaint, so one of its jobs was to increase awareness and create a portal for patient complaints. The office’s newly created role was “unprecedented in other states,” boasted the report. The presiding officer, Harry Whittington, soon gained brief national fame when he was accidentally shot by then–Vice President Dick Cheney during a hunting trip in South Texas. (Whittington died in 2023 at the age of 95.)
A year and a half after opening its doors, the Office of Patient Protection abruptly closed. During the 2005 legislative session, Tommy Williams, a Republican state senator from the Woodlands, near Houston, said the agency was “duplicative” and recommended to the Senate Finance Committee that it be defunded in a budget that eventually passed both houses. Williams now works as a lobbyist in Austin and told me that, given the amount of time that had passed, he could not recall further details about the decision.
Yet while the Office of Patient Protection hasn’t existed for twenty years, the fees that funded it have never gone away. The nursing board alone collected almost $700,000 on behalf of the phantom office last year. The Texas Medical Board collected another $231,000. Contributions also continue to come from dentists, optometrists, and other health professionals. A longtime state employee told me no one had ever asked where the money was going. The answer: Rather than supporting patient safety, it is now channeled into the state’s general coffer.
In practical terms, this means that the burden of overseeing the state’s approximately 98,000 licensed physicians and more than 230,000 nurses has fallen almost entirely to Texas’s medical-licensing agencies. Compounding the challenge, according to Wendell, the patient advocate, is that in the age of malpractice reform, the threat of lawsuits has been turned on its head: Hospitals, administrators, and even other doctors are now loath to report patient harm because they are afraid of getting sued by those they are calling out. A medical provider could allege that a mere accusation affects their ability to make a living. “The fear is of doctors suing hospitals, not patients suing doctors or patients suing hospitals,” Wendell says. “Patients have been downgraded completely.”
Wendell is quick to add that he doesn’t believe complaints against medical providers should be made public before they are vetted—the accused deserve due process. But he worries about egregious behavior that never gets reported to a medical board, never results in a public reprimand if it is reported, or ends up so buried in bureaucratic kudzu that it’s all but hidden. Investigative reporters at the Austin television station KXAN recently highlighted this risk, finding dozens of doctors who had fled from other states to Texas and escaped a paper trail of dangerous behavior, including suspended or revoked licenses, but still managed to get approved to practice here. In response, state lawmakers passed a bill to try to make it harder for problematic doctors to slip through the cracks. Still, Wendell says, “the issue is how much information actually reaches the public at the end of the day.”
Sawicki had seen a lot of tragic mishaps during his career, but he found Kimberly’s case especially disturbing. After discovering the troubled history of Molina, the CRNA who was tasked with monitoring Kimberly’s vital signs during her procedure, Sawicki next turned his focus to the lone doctor on duty at Integrity Wellness that day: Venkateswara Rao Mandava, an anesthesiologist. As it turned out, his history also raised concerns.
Mandava, now in his late seventies, received his board certification in anesthesiology in 1987. Prior to Kimberly’s procedure at Integrity Wellness, doctors at two hospitals had complained that Mandava’s actions posed a potential threat to patient safety. In the late eighties, administrators of a hospital in Maryland, where Mandava lives, revoked his right to practice there. According to a federal district judge’s opinion filed at the time, a hospital committee found that Mandava’s behavior was “disruptive and damaging to the Hospital” and “posed a potential threat to the quality of patient care.” Mandava told Sawicki during a deposition that the termination was the result of an internal political struggle.
About a decade ago, Mandava began practicing in North Texas. He had worked for Younas since 2015, but he was a contract employee elsewhere, too, through an agency that provides temporary medical staffing. He ended up assigned to a hospital in Longview, two hours east of Dallas, in 2017. It canceled his services after one month. A recruiter for the staffing company sent Mandava an email saying doctors had reported that one of his patients sat up during surgery and that others were twitching and moving on the operating table. “The facility does not feel safe having you work with them,” the email said, and went on to note that “several surgeons have requested not to have you in their OR, and the facility let us know that they had to send in another Anesthesiologist to rescue you from a couple of cases because your skill set did not match up with the cases they were performing.” In the legal battle that followed, Mandava said there was never a formal investigation into the Longview doctors’ allegations, and he never lost privileges to work at the hospital. The case was eventually settled out of court.
If Mandava was ever reported to the Texas Medical Board over his abrupt dismissal in Longview, there is no public record of it. Look up his license, and nothing seems amiss, other than that he stopped paying his fees in 2024, three years after Kimberly’s death.
After Kimberly stopped breathing, Molina intubated her to open her airways. Then Mandava, as the doctor in charge, led the effort to resuscitate her. The EMS records say that when the ambulance arrived there was no monitoring in place to measure how much carbon dioxide she was exhaling, which meant paramedics couldn’t tell if she was intubated properly. “We offered to take over care and re-intubate Mrs. Ray. The doctor refused our offer and said he wanted to re-intubate Mrs. Ray instead.” The paramedic wrote that Mandava was yelling at the staff and “seemed confused about what to do.” In a deposition with Sawicki, Mandava accused the paramedic of lying. “I am not going to respond for an illiterate guy . . . writing notes,” Mandava said. “He’s a professional firefighter on duty. He’s not a doctor. He’s not supposed to be commenting about what doctors do.”
Sawicki, stunned by what he’d turned up thus far, felt compelled to keep pressing. “There are all sorts of red flags,” he says. “It may be the old reporter thing that convinced me—if I just look behind curtain number three, I’m going to find more.”
He decided to pull the records on every 911 call made from Integrity Wellness. That’s how he learned that a CRNA named Michael Howington had been giving himself alcohol breath tests while on the job.
On September 3, 2020, Howington arrived late for his shift at Integrity Wellness, having been driven there by his girlfriend. He remained in the car until others at the clinic helped him inside. A receptionist called 911 and told the dispatchers Howington was “talking nonsense.” An ambulance arrived and took him to a hospital, where he was given a brain scan and later released.
Howington later told Sawicki that the episode was the result of an electrolyte imbalance and “elevated ammonia levels.” A colleague who was present that day believed he was possibly suffering from a ministroke. Howington admitted to Sawicki that he drank habitually at the time—no hard liquor, just red wine.
“Were you ever hungover at Integrity?” Sawicki asked.
“It’s hard to tell,” Howington answered, saying that at times he didn’t feel well because he was stressed or sleep-deprived.
Like Molina and Younas, Howington had previously worked at Forest Park Medical Center. He was an independent contractor who now worked at various locations around Dallas, sometimes with Houghton. For a time, he also ran his own clinic. Howington told Sawicki he would never have cared for patients while intoxicated. He said he purchased an alcohol breath test from CVS that he would use outside the clinic, in the parking lot. “I would cancel if I didn’t feel comfortable enough to take care of patients,” he said. He explained that he would send screenshots of the test results to the administrator of Integrity Wellness, and he texted an example to Sawicki: The photo shows a blood alcohol level of 0.0.
There is no evidence that Howington ever worked while impaired; Houghton told me he never suspected his former colleague of heavy drinking. Though Howington wasn’t involved or even present for Kimberly’s case, he nonetheless bothered Sawicki the most. “It means people knew he had an issue, and the workaround for what could be a potentially life-threatening issue is to rely on the person to give themselves a Breathalyzer test,” Sawicki says.
Howington initially told Sawicki he had discussed the use of the breath test with Younas, whom he considers a friend, then later said he wasn’t sure they’d ever talked about it. (Younas told me that he did not, in fact, know about the tests at the time.) “If I had an employee that I suspected had a drinking problem, and my workaround was that before I let them handle a case they would blow into the Breathalyzer—no one would do that,” Sawicki said. “Here’s a guy that’s about to put people under anesthesia and perform medical procedures.”
Given all he had learned, Sawicki decided in November 2021 to proceed with a lawsuit against Integrity Wellness on behalf of Kimberly’s family. He quickly ran into a conundrum, though: No one directly involved in her case actually worked there. They were all contractors employed through various LLCs.
Take Molina, the CRNA who administered Kimberly’s anesthesia. After Sawicki discovered Molina’s incident at Baylor Trophy Club, he requested the hospital’s employment file. “The response comes back, ‘We don’t have one. He’s never been an employee here,’ ” Sawicki said. Yet he held in his hands documentation of Molina’s history at the hospital. “How can you tell me he doesn’t work there?”
Technically, he didn’t. The hospital contracted with a company that provides CRNAs to health-care facilities. Mandava, the anesthesiologist, didn’t work for Integrity Wellness either. He was hired on contract by Northeast Anesthesia Associates, an LLC owned by Younas. Sawicki searched for all the business entities he could find connected to Integrity Wellness. “They’re all over the place, and I’m trying to figure out how they’re all interrelated. The one common denominator is Baber Younas.”
Sawicki ultimately filed a suit that named Younas, the medical providers involved in Kimberly’s care, five LLCs that contracted with Integrity Wellness, and Integrity Wellness itself. Part of Sawicki’s argument was that behind all the interlocking LLCs, there are actual people who oversee the care of patients and make hiring decisions. Younas conducted an interview with Mandava, for example.
When I asked Younas about the structure of his businesses, he told me that working through multiple LLCs helps reduce legal exposure. “It’s like a bunch of grapes” that are kept “separate from each other for liability,” he says. That proved effective in Kimberly’s case, as Sawicki “was only able to sue a smaller company versus a bigger company,” Younas told me.
Younas said he did not know Molina’s history—that he’d been reported to the nursing board—until the day after Kimberly’s rhizotomy, when Molina informed him. “I’m a doctor,” Younas told me. “I’m seeing patients. I’m not an administrator, so I have to rely on the data given to me.”
Younas wasn’t the only one involved in personnel decisions at Integrity Wellness. Another Forest Park alum named Michael Gallagher, the chief of anesthesia at a physician group that Younas owned, interviewed Mandava as well. Gallagher was also involved in interviewing Molina, though he wasn’t aware of past issues with Molina or Mandava, he said, because neither of them had disclosed anything on their credentialing applications and both had clean records in the official databases.
Gallagher was aware, however, that Howington was using an alcohol breath test on the job. He’d once seen Howington with one in a preoperative area at another clinic.
Sawicki conducted Gallagher’s deposition in January 2023. Nine months later, Sawicki was reading the news on his computer when he came across a story about the shocking death of a local radio personality. As he scrolled down, he spotted Gallagher’s name.
In the summer of 2023, Jenifer Cleveland visited Luxe Med Spa, in Wortham, about an hour southeast of Dallas, for an IV drip of vitamins and electrolytes. Shortly after her IV treatment was completed, the staff found her unresponsive. Cleveland died later that day at a hospital, apparently of cardiac arrest, likely caused by the flood of potassium chloride in the IV, according to the Texas Medical Board. The spa’s medical director, whose name was plastered on the building’s front window, was Michael Gallagher.
Sawicki called a Central Texas television station to report Gallagher’s connection to Kimberly, and he agreed to go on camera. He wanted to go public, believing that what had happened to these two women wasn’t just a catastrophic fluke but a systemic breakdown of the medical system that could have been prevented. For the interview, he wore a navy blue polo and, at first, spoke with some remove. “In the past, you would go to a major hospital where you could rely on credentialing,” he said. “Now you really are on a roulette wheel, not knowing what you’re gonna get when you walk in.”
When the anchor asked him about the human toll of these events, his voice caught, and he paused to gather himself. “The image that I have a hard time even thinking about is [Kimberly’s] eight-year-old daughter sitting in the parking lot and watching the ambulances, and never seeing her mother again. That’s what keeps me up at night.”
When I spoke with Gallagher, he said there was more to the story. He had agreed to become medical director of the spa, he said, as a favor to the owner, to get the business up and running. But certain activities had been hidden from him, he said, and he didn’t know anyone was administering IVs with anything other than saline and B12 vitamins. “No physician in their right mind would ever authorize potassium,” he said.
Gallagher accused Sawicki of using the med spa tragedy to get publicity for Kimberly’s case and insisted that the two incidents were unrelated.
The Texas Medical Board temporarily suspended Gallagher’s license three months after Cleveland’s death, saying he had “failed to properly supervise” the employee administering the IV, which led to “complications that the Luxe staff were not trained or prepared to manage, resulting in the Patient’s death.” He had visited the spa during its grand opening and once again a month later but did not return until the day of Cleveland’s death. (He says he texted the owner regularly.) In December 2023 the board prohibited Gallagher from supervising anyone, including physician assistants and advanced practice nurses. He reached an agreement with the board last summer, allowing him to supervise CRNAs but also mandating that he receive extra training in “medical supervision and delegation and risk mitigation.”
Gallagher told me that at Integrity Wellness, he never had any supervisory role to begin with. He maintained that his leadership consisted mostly of making out work schedules and approving vacation time.
The way Gallagher explained it, supervision at Integrity Wellness fell to an administrator named Andre Henderson. When I reached Henderson, he suggested Younas was ultimately responsible for personnel. For example, although Henderson told me he was aware that Howington used an alcohol breath test, “Dr. Younas made that call.” He also said the role of hiring and vetting physicians and CRNAs fell to Younas, not him.
Henderson is a registered nurse who faced scrutiny from the Texas Board of Nursing after he was accused of sexually assaulting a female coworker at a Fort Worth–area hospital in 2012.
According to news coverage of that case, a criminal grand jury declined to indict Henderson, citing insufficient evidence. But the woman’s attorney told the Fort Worth Star-Telegram that neither she nor the police detective who investigated the case was ever given a chance to testify. She then filed a civil suit and won a settlement of almost $2 million against Henderson, in 2019. In his ruling, Donald Cosby, a district judge in Tarrant County, wrote that the nurse had been called to the hospital late one night to assist in an emergency surgery. While there, the judge stated, Henderson trapped the woman in a bathroom and assaulted her. She continues to suffer “severe mental anguish and pain and suffering.”
Henderson disputes this account and sent me a psychologist’s evaluation that concluded he did not commit a sexual offense. “He did, however, kiss a coworker while on duty,” the psychologist wrote. In 2022 his license was temporarily suspended for “abusive conduct toward staff.” It has since been reinstated. That year, he was also fired from Integrity Wellness after an employee reported that he had sexually harassed her, an accusation he denies.
Early in his investigation into Kimberly’s case, Sawicki had begun pinning notes, photos, and key documents onto a giant corkboard in his office, drawing lines among the various actors and their histories. Over time it started to resemble something out of a cop show. The practice administrator had been found liable for sexual assault. The doctor on duty had a history of being removed from hospitals. The CRNA who delivered Kimberly’s anesthesia had been the subject of two complaints regarding unexplained neurological behavior in the operating room. And today they are all cleared to practice.
In May 2022, a year after Kimberly’s death, Molina faced the prospect of discipline over his two operating room incidents and Kimberly’s case, including a possible revocation of his license, from the nursing board. As part of his defense, he submitted four letters of support. One was from Younas, who wrote, “I have known and worked with Mr. Molina since July of 2011 and can attest to never seeing him under the influence of any substance.” Molina has “demonstrated excellent character and judgment,” he continued. “I am glad to have Mr. Molina on staff and quite frankly have been trying to recruit him in a leadership role for our group.” Younas remains so confident in Molina’s skills as a CRNA that he says he has requested Molina when he has needed general anesthesia himself.
An expert with the Texas Board of Nursing who reviewed Kimberly’s case determined that Molina did not adequately check Kimberly’s airway before the procedure and did not properly resuscitate her. Yet in November 2022 the board dismissed the case against him, stating, “This matter was handled informally.” I looked up Molina’s license on the nursing board’s public portal, clicked on a few screens, and downloaded the results. His license is listed as “current,” and there is no mention that he has ever faced any disciplinary action or even any complaints.
The nursing board did later charge Houghton with possibly contributing to Kimberly’s death because of a delay in resuscitating her. According to board documents I obtained through a public information request, he “failed to intervene to prevent complications for patient K.R. in that he did not have a crash cart present containing drugs and equipment necessary to carry out ACLS [advanced cardiovascular life support] protocols.” (Houghton told me the crash cart was there.)
The case was resolved in 2023, when the board sent Houghton a letter stating that “the information received indicates that you may have failed to timely initiate emergency measures after patient was unresponsive and had stopped breathing. However, based upon the information reviewed during our investigation, it has been determined that the reported conduct does not warrant action by the Texas Board of Nursing at this time.”
Kimberly’s death marks a dark moment in the careers of both Younas and Houghton. “I can’t do anything for the family, and it’s devastating,” Younas says. “It’s heartbreaking for us too.” In a written statement, Molina also expressed sympathy for Kimberly’s loved ones. “I am sorry for their great loss, and the family is in my thoughts and prayers.” He added, “I maintain that I acted reasonably and that nothing I did or failed to do caused Mrs. Ray’s heartbreaking demise.”
For his part, Mandava appears to have returned to Maryland, where he retains his medical license. Look it up, and under the headings for disciplinary actions, pending disciplinary charges, or malpractice judgments, the answer is the same: none, none, and none.
One spring day six years ago, Kimberly and her daughter showed up at her mom’s door carrying an Easter basket. Inside was a puppy with thick brown fur that Kimberly had adopted from a rescue organization. His name was Romeo. Kimberly knew that Dee’s elderly dog was ailing and wouldn’t live much longer. She hoped the new puppy would soften the heartbreak. She told her mother that she couldn’t bear the thought of Dee coming home to an empty house.
The day I met Dee, she was on the verge of settling the civil suit against Kimberly’s providers for an undisclosed amount. She’s not able to comment on the medical care Kimberly received, though she did explain that she originally wanted to sue Integrity Wellness to give Kimberly a voice in her own tragedy. Now that she’s achieved that—the case is public record in the court system, there for anyone to find—Dee is hoping to finally find some measure of peace.
While we talked, Romeo, who has brown eyes and floppy ears, lay at Dee’s feet. “He is the gentlest, sweetest dog ever,” she told me. “They couldn’t have given us a better dog.” But there is an emptiness in the house too large for him to fill.
https://www.texasmonthly.com/news-politics/kimberly-ray-death-texas-broken-medical-malpractice-system/?utm_source=texasmonthly&utm_medium=email&user_email_address=0846a80b9b8ad458408a4c4746c512b8e0b0bb44d0214ee03b851f76e080b63c&utm_campaign=TM%20Today%2012-9-24&utm_term=TM%20Today
