September 15, 2005 Recent Legal News

Fraud and Abuse

Deaf

Medical Malpractice

Employment

Peer Review

Criminal

Insurance

Fraud and Abuse

US v Eisenhower Hospital
Settlement

Eisenhower Hospital in Palm Desert, California, has agreed to pay $8 million to the feds to settle fraud overbilling charges during the 1990s.  The US states the hospital had an accounting scheme to upgrade the costs to get a higher reimbursement.  This was initiated by one the hospital's consultants as a whistleblower charge.  This is part of the same whistleblower charges that led to the payment of $24 million by Lovelace Health Systems and $750,000 by HealthSouth.  The hospital of course stated the admit no wrongdoing but they did. 

US v Caremark
Settlement

 Caremark paid the government $137 million for a whistleblower lawsuit settlement.  The blower accused Caremark of taking kickbacks from drug manufacturers to give their products favorable treatment and to sign contracts.  There are still ten states that have cases against Caremark for the same illegal acts.  The illegal acts happened by AdvancePCS Inc. prior to being purchased by Caremark.      Top

Deaf 

Webb v St. Francis Med Ctr.
Filed Calif.

Webb, who is deaf, had a baby at the hospital.  She states that she had a "fearful and frustrating experience because she didn't understand what was happening to her or her child".  Her attorney from the Western Law Center for Disability Rights said that in a hospital "silence is not golden".   The suit asks for training by the hospital and its parent Daughters of Charity in communication with the deaf.  The suit states the patient notified the hospital a week in advance that she was deaf and requested an interpreter.  She got one just prior to her C-Section but not during or for the three days after, according to the suit.  She did get one once a day from day 4-7.        Top

Medical Malpractice

Patients v Hospitals
To Be Filed

The Dallas News reports that the scum filled trial attorneys are already busy attempting to line up patient families to sue HCA, Tenet and other hospitals for the loss of their family members during Katrina.  Some of the two faced trial attorneys state the hospitals did an admirable job but they should have been better prepared.  It seems unlikely that any jury would find a hospital guilty due to a levee break and flooding.

Boyle v Laurelli
RI Trail Ct.

Dr. Laurelli was found by a jury to be not negligent in his care of the plaintiff.  The case was a routine malpractice case until a neurosurgeon who was supposed to testify against the defendant backed out presumably due to peer pressure.  The plaintiffs attorneys have fired their client. 

Richardson v HealthSouth
Filed

Although not a true malpractice case, Richardson is suing under the ADA for refusing to operate on his foot because he was HIV positive.  The surgical center stated that the scrub techs refused to scrub and it was the policy of the center not to accept HIV positive patients. 

McClinton v Virginia Mason
Settlement

There was no question of fault.  Virginia Mason negligently injected Ms. McClinton with an unlabeled and deadly fluid during a procedure.  The settlement was for an undisclosed amount of money to the family, money to charities, an apology, and the use of the case to teach medical staff the importance of proper labeling of meds.  Since the case started, the late acting and poorly performing Joint Commission also got on the bandwagon to have all meds labeled in procedural areas.  This is to start in 2006.      Top

Employment

Physicians v WHA

Wilmington Health Associates (WHA) became independent from Phycor in 1996.  They have 60 physicians.  There was a liquidated damages clause in the contract that allowed payment to the group of a specified amount determined by contract if anyone practiced in any of the surrounding counties after leaving the group.  Five cardiologists left and were sued by WHA.  The liquidated damage clause was found to be legal and the physicians were told to pay $1.6 million plus $238,000 in WHA's legal fees. The case will be appealed.  

Fessel v Yale
Filed

Dr. Fessel, the former head of internal medicine at the health center at Yale claims age and health discrimination.  The 68 year old internist was removed following a heart attack and replaced by a 38 year old.  Yale contends that he wrote two prescriptions that he shouldn't have but Dr. Fessel states others have done the same without termination.  It is interesting that the same year he was nominated for physician of the year by his peers was when he was asked to leave by the university.  Dr. Fessel also is suing for med malpractice in his own case.        Top

Peer Review

Adeduntan v Hosp. Auth. 
MD GA

The hospital surgical review committee reviewed the physician's work and recommended he undergo further training and/or proctoring.  The physician apealed the decision and filed a EEOC claim against the hospital.  A settlement was reached where the physician would be monitored by direct observation of another surgeon to determine his competency.  In return the physician would withdraw his suit, there would be no peer review hearing and both sides release the other from all claims which were in any way directly or indirectly related to the peer review investigation.  The physician did not follow the monitoring and was not reappointed.  He sued and lost in summary judgment since he had signed the agreement and this related to the peer review matter.   This shows how important good a forward thinking attorney is in these matters.    

Feldman v Hunterdon Radiology
NJ Superior Ct.

 Feldman was part of the Hunterdon group as well as Chair of Radiology at one of the hospitals.  She instituted a peer review action against one of the partners f the group after complaints had been made.  Following the peer review she underwent a hostile work environment.  She stated this caused a constructive discharge.  The group stated she was not an employee so she could not have the  protection of the state statute.  The court stated that since she could only work where the group stated she could work, she had to follow the group rules, she had to devote all her time to the group and could be terminated by the group she indeed was an employee of the group and had the protections of the state law and could sue.      Top

Criminal

US v Hurwitz
Appealed

In a case that deserved to be appealed and overturned, the convicted pain physician is appealing his coviction.  This is the case that made the DEA change their web site since the physician showed that he was practicing according to the government's standards.  This case has had the biggest chilling effect in the country on the physician adequately treating pain for patients.  All pain physicians were testifying in favor of the physician.  Most of the charges the government made up against him were either dismissed outright or declared mistrials.  He was finally convicted of conspiracy to distribute controlled substances and charges related to drug trafficking that resulted in one death and serious bodily injury to others. 

La. v Mangano
Filed

 Criminal negligence charges have been filed by Louisiana against the owners of a nursing home that did not evacuate during Katrina.  The owners state they were afraid of patients dying during an evacuation unless the evacuation was mandatory, which the state did not do until it was too late.       Top

Insurance

Aurora Health v Centene HMO
Settlement

Centene, the owner of Wisconsin's largest Medicaid HMO agreed to pay Aurora, the owner of outpatient surgical centers, $9.5 million.  The two also agreed to another five year contract.  It seems that if they didn't pay what they owed Centene would be in a hole without outpatient services and a poor reputation.  

Physicians v Blues
Illinois Filed

Multiple physicians have filed against Illinois Blue Cross and Blue Shield for their bundling, downcoding or rejecting medically necessary claims.  This is said to be over $1million in two years.  This sounds like other Illinois lawsuits in the past several years and the RICO claims now in the Florida Court against the HMOs.        Top 

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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.