Shrager v Magellan Health
Dr. Shrager, a psychiatrist, refused to give Magellan five complete medical records for their quality assurance. He felt privacy took precedence. He also felt that since the insurance company wanted the records, they should ask the patients for the authorization. Magellan attempted to terminate him. The judge ordered Shrager reinstated and that the insurers had gone too far. The judge stated that it was the physicians duty to send the records to the insurer but with a substantial amount of information redacted. This would include all identifying identification. After Shrager filed suit, the insurer called and wrote to patients informing them that Shrager was no longer an active provider and advising them to seek other physicians. This was not decided. Top
The Ohio Supreme Court reduced a $40 million denial of claim award to a mere $30 million plus interest which is now $11 million. The patient was being treated for a brain cancer which Anthem said was experimental and denied treatment. The patient appealed and the final notice of denial came on the day of the funeral. The damage award goes part to the widower and part to a Cancer Institute. Top
Haltom v Bayer
In one of the first trial against Bayer, a jury cleared the manufacturer of Baycol, an anticholesterol drug. The patient had sought $560 million, a ridiculous sum even for tort crazy Texas. Bayer's Baycol was taken off the market after if was found to be linked to a severe muscle disease and may cause death. There are about 8000 more cases to go but Bayer is attempting to settle most of them with serious side effects. The problem was mainly with the high dose Baycol. Bayer had offered to settle this case but the idiot attorney refused and instead tried to strong arm Bayer to settle the other 1400 cases he represented. Bayer told him to stuff it. The attorney didn't believe there was a good faith effort to settle. Top
SEC v HealthSouth
HealthSouth has been charged along with it's CEO with accounting fraud. The SEC accused HealthSouth of overstating its earning by $1.4 Billion since 1999. Trading in HealthSouth has been halted. Top
US v Spinella,
Dr. Spinella, a Urologist in Connecticut has been convicted of fraud for selling free Lupron samples. The sentence was one year probation and $5000 fine.
Dr. Wm. Couser, one of the country's top nephrologists has pled guilty of one count of mail fraud for submitting a $124 bill to a private health insurer for a treatment where he wasn't present. He also admitted to submitting $100,000 in bills to the government for dialysis treatment when he wasn't present. The University of Washington has agreed to pay the money but is now stuck in a hard place. They want Dr. Couser out but the doctor doesn't want to leave quietly. He has a petition signed by national and local doctors urging the university to keep him on. Top
Ching v Methodist
A surgeon had his privileges suspended at two hospitals. he sued under various state claims. the court ruled that the suspensions had fair hearings and under HCQIA, there could be no damages. He lost not so much under the HCQIA but equally under the specific Texas statutes. Top
The Court of Appeal reversed a lower courts dismissal of a physician from a malpractice suit. The facts showed that Hudson was admitted for probable appendicitis. he was not operated for two days and died post-op appendectomy. Dr. Wali contended that when he was called about the patient on the day of admission he was at another hospital taking care of patients. he asked the nurse to call the on-call physician. He states he never met Hudson and had no duty of care. However at the time of the above declaration, no discovery had been performed. The hospital had listed Dr. Wali as the on-call doctor for the following day. The lower court ruled that there needed no discovery for Dr. Wali since as a matter of law thee was no duty. The appeals court stated that discovery should proceed to determine if there was a duty of care. The statement by Dr. Wali that he was not on call on the day following the patient's admission to the hospital was conclusionary and not backed up by any facts. There was nothing to state he wasn't on call and had a duty on the other two days.
A family practitioner took care of the plaintiff for four years. A routine PSA on this 58 year old man was 4.48, elevated. The doctor did not refer the patient to a urologist for evaluation. The following year the PSA hd moved to 7.68. The patient was then referred and had the appropriate tests done. This showed cancer of the prostate. He was treated with radical prostectectomy and was found to have local extension into the seminal vesicles. He underwent postoperative radiation and soon after was found to have spread to the bone. He was placed on androgen deprivation. The case was settled after unsuccessful mediation for $550,000. This shows that family practitioners must refer suspicious cases to the specialists for appropriate early care. Top
v Phillip Morris
The California Court of Appeals held for the second time that the $26.5 million award to the plaintiff for lung cancer after smoking cigarettes was legal. The issue in this case was due to a state supreme court ruling last year that precluded evidence between 1988 and 1998 due to a law protecting tobacco companies from law suits. The Court of appeals stated that since this issue had not been raised in the trial, it could not be raised here. This verdict will again go tot the Supreme Court.
In Illinois Phillip Morris has been ordered by a judge to pay $10.1 BILLION for misleading people regarding light cigarettes. This is a class action suit by Illinois smokers. This was $7.1 BILLION in compensatory and $ 3 BILLION in punis. This will be appealed since the judge is giving money to people who were not harmed and who smoked cigarettes that had the requisite warnings. Top
The US and Imler reached a settlement by Imler pleading guilty to criminal charges of maintaining a drug establishment in Los Angeles. The other two defendants are not affected by this settlement. This may lead to the loss via a civil claim by the feds of a $1.2 million dollar building in downtown LA and $58,000 previously seized by the feds. This case has been pending since 2001. Imler faces up to 20 years in prison. All he did was follow the California marijuana rule and worked closely with the city officials setting up the medical marijuana program. Top
The trial court ruled that the non compete clause between a previously employed physician and the University was not valid. The University appealed and the Appeals court agreed. The rationale was that the University could not show any patients had left to join the new practice, that the physician had given any care to any former patient or that the University had any decrease in its patient population after the physician joined the new group. The University had not met its burden that the physician had interfered with specific prospective patients. 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.