Christus Health v Aetna
The Texas high court has stated that hospitals and physicians may sue Medicare HMOs in state court for non payment of bills. The allows the hospitals and physicians to skip the Medicare administrative appeals. This means that the matter will head back to the low court where the hospitals are suing for $13 million due them under contract. The hospitals had contracted with NAMM, a subsidy of Aetna. NAMM went bankrupt so the hospitals turned to Aetna for payment. Aetna said they have already paid NAMM for the services. This is similar to the suit in California where the insurers were held not to be liable for the bankruptcy of IPAs and the non payment by the bankrupt IPAs for services rendered. There is a similar suit by Texas physicians against PacifiCare, a subsidy of UnitedHealth. The physicians have won the lower court battle but it is up on appeal.
Meacham v United Healthcare
Meacham was a patient who had significant back problems. He interviewed all the relevant surgeons in his plan. They all advised him that the surgery would by significantly invasive and require long hospitalization. He opted to go to Tampa, Florida for a series of outpatient procedures. United paid the out of network rate and he sued stating they had agreed to pay for the procedures. They denied making the statements and the court stated that as long as they used the arbitrary and capricious standard they were in compliance. Top
Riegel v Medtronic
The court kept alive a suit by the widow of a patient who died after an angioplasty catheter burst. The issue is whether or not a person who is injured by a FDA approved device may sue as a matter of fed/state preemption.
Kreppner v Physicians
The court tossed a case where a patient developed HIV after a blood transfusion. Canada, in its usual socialistic way, decided it was cheaper not to test for HIV or Hepatitis in its blood supply than to defend the cases in court. They were right. The court said that there was no marked departure from the standards of a reasonable person. I guess the reasonable person is a Canadian who is pliable. The blood product came from the US Armour Pharmaceutical Company. The Canadian Red Cross was so bad that it had its responsibility for blood supply removed. They were also fined the grand total of $5000. The Canadian government has said they are paying a total of $1 Billion for all those infected with Hepatitis C from the tainted blood. Top
Hollins v Mt. Sinai Hosp.
Hollins won a $30 million judgment from the hospital and the physician for oxygen deprivation due to a delayed C- Section. The Ohio Supreme Court tossed the judgment due to the behavior of the plaintiff's attorney in court. The behavior was so outrageous it threatened the jury. There will be a new trial.
Eason v CBLPath
The pathology group is being sued for mixing up samples and making an erroneous diagnosis due to the mistake.
Illinois v Veizaga-Mendez
Dr. Jose Veizaga-Mendez, a surgeon at the Marion VA hospital has lost his Illinois and Massachusetts licenses. He is also under investigation by the VA for nine deaths at the hospital.
Stewart v Gibson
Dr. Stewart was sued for prescribing Stadol to a patient and not explaining the addictive effects. Dr. Stewart had never seen the patient and was part of shoddy lawyering by Gibson in a rush to beat the Mississippi tort reform laws. Dr. Stewart was not dropped from the case even after he had shown he had not treated the patient. He had to defend and pay money to defend. He sued and won a verdict ordering the attorney to pay his legal fees. The shyster is appealing the decision to the 5th Circ.
Jones v UCLA
Christopher Jones, age 33, came to Olive View-UCLA Hospital ED with chest pains. He was not triaged and sat in the waiting room for three hours and then went outside and died. The hospital has already been cited five times this year for problems. Suit will come soon. The hospital has fired a nurse in this case. Top
Eist v Maryland Med Board
In the continuation of the antics of the state reported in Recent News, the Medical Board of Maryland sued a psychiatrist for not turning over medical records to the state after the patients objected. The Court stated the Board does not have unfettered right to patient records when they are investigating a third party complaint. The Board must prove good reason for overriding patient privacy which could harm patient care. This could reach to other aspects of medical privacy such as HIV, alcoholism, abortion records and cancer tests. It may also affect other states.
Potomac Ortho v Maryland Med Board
In the continuing saga of shabby treatment of physicians, Maryland has banned the ownership and referral of all CT and MRI scanners by orthopedic physicians in the state. This is much stricter than the Fed rule. Top
US v Brown
Dr. Zack Brown and his biller in Detroit have been sentenced to 16 years and three years respectively in prison for billing fraud. They submitted 19,000 false claims. for over $2.5 million. The pair also has to pay $1.13 million in restitution. That speaks volumes on how much a physician gets paid versus what he bills. Top
Wilkey v McCullough-Hyde Hosp
Dr. Wilkey, an Orthopod, was hired by the hospital and soon after started to complain about the equipment an scheduling. He also had persona run-ins with several competing physicians who held high positions. One of his cases was reviewed internally and the externally and found to be substandard. The problem was the reviewer was not qualified to review the case. A second reviewer stated the case passed muster but this report was never given to Dr. Wilkey nor the medical committee overseeing the case. Dr. Wilkey was eventually charged with disruptive conduct. He resigned and sued. The Court refused to give a summary judgment to the hospital nor the physicians involved since there was a dispute as to whether or not quality of healthcare was an issue and whether or not there was a reasonable effort to obtain all the facts in the matter, both requirements under HCQIA. It sounds like another case of poor judgment on the part of the hospital and its attorney. I wonder how much this will cost the hospital and physicians. Remember Polliner.
Crow v Penrose St, Francis
In a decision that defies reason the Colorado Supreme Court overturned a lower court decision. The physician was summarily suspended over the treatment of an emergency room patient. Three years later the case was still in peer review due to a dispute as to whether or not the hospital had to give certain information to the physician. The physician then sued for a permanent injunction and damages. The hospital moved to dismiss since full administrative remedies had not been completed. The lower court denied the hospital motion. The Supreme Court allowed it stating that the peer review committee was an extension of the Board of Medical Examiners and the peer review hearing needed to be completed prior to suit.
Fox v Good Samaritan Hosp
Dr. Fox is a well qualified pediatric pulmonologist. The hospital put a rule in place that those pediatricians holding privileges in the PICU identify coverage with identical privileges. Fox did not and was removed from the PICU. He challanged the process in the hospital and state court and lost on all occasions. He then sued in federal court on antitrust claims that there was a decrease in the quality of care due to his suspension by the collaboration of the hospital and the medical staff. The defendants asked for and were refused summary judgment under the rule of reason. The Court stated that their could be a conspiracy between the hospital and the medical staff due to the timing of the matter after Fox complained about patient rights. The Court also found possible monopoly power under Section 2.
Johnson v Riverside Health
Dr. Johnson had been on the staff of the hospital for over three years and did not timely pay his dues so was removed from the staff. He reapplied and was denied due to 14 complaints about his behavior by nurses. He requested a hearing and the committee stated that his conduct was so disruptive as to constitute a risk to patient care. The Board agreed and he sued. Guess what? He lost. Top
Dabney v HCA
Dabney went to the hospital with a neurosurgical condition. The on call neurosurgeon was unavailable due to illness. The hospital attempted to transfer the patient to three other hospitals but all three refused. The patient sued and lost since there is nothing in EMTALA that requires a backup plan if the on call is sick and the hospital did try to transfer the patient. The plaintiff did not allege the hospital could have transferred him but failed to do so. 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.