February 15, 2013 Recent Legal News





Peer Review and Employment




Friedman (US) v Wasserman

Dr. Friedman, a pathologist in Tampa, filed a whistleblower suit against Dr. Wasserman and the US intervened.  Dr. Wasserman, a dermatologist. settled with the feds for $26.1 million.  Out of that Dr. Friedman will get $4 million.  Dr. Wasserman took kickbacks from Tampa Pathology Laboratory and did thousands of medically unnecessary skin biopsies to increase the business at the pathologists. The pathology company previously settled for $950,000.  Dr. Friedman used to work for the Tampa Pathology Laboratory.  He can now retire gracefully.  

US v Thoen

John Thoen, RN., of Miami was seentenced to 111 months in prison for his part in the illegal kickback scheme of doing unnecessary PHP by Health Care Solutions Network.  

US v Ralabate

Dr. James Ralabate of Stratford, Connecticut, agreed to settle a false billing action for $700,000.  He was accused of billing patients in nursing homes a high service when it was not or not even medically necessary.  Some nursing notes never said the physician even visited the patient.  

US v Schwartz

Dr. Irving Schwartz and his associate Jose Melendez both pled guilty of fraud in the giving prescriptions and selling unneeded wheelchairs.  They are both of Southern California.  The physician admitted to wring about 186 fraudulent prescriptions for wheelchairs in exchange for kickbacks.  The physician was really stupid as he would get only $350 per false prescription and his co-conspirator would sell the fake prescriptions for $1000 each. 

 US v Deguzman

Dr. Daisy Deguzman of Newark, New Jersey, was sentenced to 6 months in prison and another 6 months in home detention for her part in a Medicare fraud.  She is another dumb physician who accepted bribes from a local MRI facility to refer patients.  She made a grand total of about $5000 for these referrals.  Her sentence includes a $20,000 fine and a forfeit of an additional $23,000. 

US v St. Joseph Medical Center

 The hospital in Maryland admitted patients for several days who did not need hospitalization.  They did this to increase reimbursement while under the ownership of Catholic Health.  This case was self reported when the University of Maryland took over the hospital.  Compare this settlement to the one below when the hospital was warned to self report but refused.  (See more about St. Joseph in Recent News)

US v Broward Health
$100 million Fine

Broward Health was warned by its previous attorney that its action in paying physicians were illegal and they should self report it.  The Board not only did not listen to the attorney but fired him and paid a settlement of $100,000 for wrongful termination.  This is an example of the attorney doing right and the replacement attorney and Board screwing up.

US v St. Luke's Roosevelt Hosp
Filed and Settled

The Government filed and settled the case against the hospital at the same time.  The hospital will pay $2.325 million to settle claims for fraudulent billing in their psych department.  The hospital admitted double billing for services in their outpatient department.  The payment is to be made within ten days.

US v Rand

Dr.Dov Rand was also caught accepting kickbacks from the New Jersey MRI.  He was sentenced to five months in prison and a fine of $30,000 and home confinement for five months.        Top



SEIU v Prime Healthcare
To be Filed

Prime Healthcare of California is now at the forefront of labor law.  After the courts threw out Obama's NLRB appointments as illegal, it made the call that an illegal body may not make laws or rulings.  They have notified the unions that they will no longer collect the blood money due unions from their employees nor will they provide unions with certain material during internal investigations.  The union said they will not comply with Prime but since Prime holds the cards the unions have little say unless they sue.  It is expected that more employers will follow suit since Obama packed the Board with anti-business people.  The Board continues to sit and says the ruling only applies to one case.  They are legally wrong.  They have asked the full court to re-hear the ruling which is legitimate.  

Methodist Hospital v OSF St. Francis Med Ctr

Methodist Hospital in my hometown to Peoria, Illinois, is suing it's across the street competitor hospital St. Francis for antitrust violations.  Methodist wants $300 million for St. Francis' alleged violation of laws regarding its contracting with insurers.  They allege that St. Francis, the large hospital, will pull out of contracts if the insurer contracts with the competitors.  This type of suit is becoming more common.         Top       


Center for Medicare Advocacy v CMS

The patient's have won a battle but not the war.  There is a one year only Congressional moratorium on the CMS policy to limit payments to $1900 for physical, occupational or speech therapy in any one year. The law allows many exceptions to the policy.  

Also there will no longer be a denial of payment if a patient reaches a plateau in a nursing home, home health or outpatient therapy as long as the physician states there is a need to continue the therapy.  This means people in home care can continue to receive this for possibly years without going to a medical facility.  This does not change the three day hospital stay prior to admission to a skilled nursing home nor the 100 day limit of benefits.        Top


France v Physicians
Prison Sentences

France has send several physicians to prison for severely over radiating prostate cancer patients.  This occurred at the Jean Monnet Hospital in Epinal, France, between the years 2001 t0 2006.  There were 450 patients affected and 12 deaths.  Many had sever urinary, bowel and or sexual problems.  The machines were not calibrated resulting in a 24% overdose.  Human error was also present leading to an additional almost 10% over radiation.  Two cancer physicians were banned from the practice of medicine, fined $27,000 and given a four year suspended prison sentence.  A third physician, a radiologist, admitted negligence in calibration and teaching others how to calibrate.  He was given a three year suspended prison sentence, sent to prison for 18 months, fined $13,000 and banned from medicine for five years.  

In Germany, a patient following radical prostate surgery complained of abdominal pain.  He was found to have 16 foreign bodies left in him that may have contributed to his death.        Top

Peer Review and Employment

Ex Parte Moulton
Alabama Supreme Court

The state high court did what it was supposed to due in denying a physian the ability to sue a state university or his supervisor acting in his capacity as an employee of the university.  The physician who was at will and had a handbook that stated layoffs were exempt from due process appeal nevertheless found an attorney who could not read and took this case of a laid off physician who got no due process to the state supreme court.

Warfield v Beth Israel Deaconess Med Ctr

Dr. Carol Warfield received a $7 million settlement from the hospital for gender discrimination.  She was the former anesthesia chief who contends she was forced out of the Harvard school by the chief of surgery and the chief executive.  The hospital and the individual defendants did not admit wrongdoing but give me a break. The hospital also must give an annual lecture on women's health and the contribution of women in medicine and change its policies and procedures on process and retaliation. The chief executive lost his job for fooling around with an employee which was against policies even though he late married her. 

Haley v Community Mercy Health Partners
SD Ohio

A nurse had multiple write ups against her because she took a lot of FMLA leave.  She was terminated and sued.  The hospital asked for summary judgment and was denied in all aspects of the case.  The nurse met her burden in age and disability discrimination and the hospital did not meet its in the legitimacy of her dismissal.

Cardiologists v Renown Health

The two sides settled on payment to the cardiologists of $1 million which included over $800,000 in attorney fees for their illegal attempt at monopolize the cardiology in the area.  The FTC said their actions were illegal and partially voided the cardiologists non compete clause.  This should end this case.  When one looks at the above four cases they all involve very poor advise from attorneys.  Another case in the fraud section above involving Broward Health in Florida is in the same category. 

Johnson v SSM Healthcare
ED Mo.

Dr. Johnson was reported to the VPMA and CEO of the hospital for abusive conduct toward a nurse and a patient's mom.  He was placed on a suspension and invited to a MEC meeting.  He did not go but sent a letter telling his side.  A nurse witness testified.  His suspension was continued until he was evaluated by the Missouri Physicians Health Program.  This needed to be done in 30 days or he would be reported to the NPDB.  He did not comply and he did not pay his med mal premium which led to the state revoking his license.  He then requested a hearing and got one.  The peer review panel recommended his suspension be continued until evaluated by a psychiatrist.  The MEC gave him three names none of which he used.  He never had the evaluation and the MEC revoked his privileges.  He was given a chance to appeal to the Board and did not.  The Board affirmed and the data bank report was updated.  He sued and lost under HCQIA as the court found that the hospital acted righteously in all four aspects of the law.        Top


Gonsalves v Sharp Healthcare
Ca Ct App

In a convoluted case a patient had a cardiac bypass at the hospital and later developed a pleural effusion.  The pulmonologist ordered a tube to be inserted to drain the fluid but did not get consent from the patient.  The nurses called a relative to get consent since the patient had dementia.  The physician who did the insertion did not get consent.  He punctured the aorta.  Several years later the patient died and the family filed suit for malpractice, wrongful death and battery.  The lower court granted summary judgment to the hospital due to the lack of causation and the independent physician's duty to get consent.  The court of appeal disagreed stating there was an issue of fact as to causation that need to be resolved.  Battery in this context in California comes under medical malpractice.

Ruday v Shore Memorial Hospital
NJ Superior Ct

  An elderly later patient was a risk of falling out of bed.  She was placed on an alarmed bed.  The patient fell and was injured.  There was nothing wrong with the alarm.  The hospital had a written policy about high risk patients and this provided the hospital's duty.  When the employees did not follow the policy the hospital was potentially liable.  The summary judgment issued by the lower court was reversed and the case is to go to trial or settlement.

Patients v Duke University
4th Circuit

Several years ago Duke washed their surgical instruments in hydraulic elevator fluid by mistake.  They were sued by many patients and counter sued Mitsui Elevator company, a now defunct business.  Mitsui drained fluid from the elevators and left it in containers not marked as hydraulic fluid.  The court ruled that the entire suits were one incident and the elevator company only had to pay out once $1 million.  The decision was split in favor of the elevator company.

Reckis v J&J
Trial Ct. Mass.

Seven year old Reckis took ibuprofen and developed a severe case of Stevens-Johnson Syndrome.   She lost 90% of her skin and was blinded.  She also now has only 20% lung capacity and short term memory loss.  The patient won $64 million and of course this will be reduced drastically.  In a similar case in Pennsylvania a year ago a girl with the same injuries won $10 million.          Top


DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.