February 15, 2009 Recent Legal News







Peer Review


Mountain State Ins v Jamie
W. Va Superior Ct.

 Mountain State Insurance sued Dr. Sharooz Jamie of Clay County, West Virginia for fraud.  They contended he billed and collected for tests never performed.  The judge awarded the insurer $180,000 plus $94,000 in interest since the case started in 2005.  The physician tried to state that his job was to see patients and not do the billing.  That argument did not fly.  He also tried to blame it on being underpaid as a rural physician.  That went nowhere as well. The doctor also worked as a day trader in securities from 2000-2002 and was ordered to pay $163,372 in penalties for under reporting income on his federal return.   

New York v Aetna

Aetna has agreed to pay $5.1 million it has underpaid college students and physicians for out of network care.  This is a continuation against the poor reimbursement settlement against United and Aetna for their general underpayment of physicians because for the faulty computer program being used.  

New York v MVP Healthcare

MVP Health has also agreed to stop using the flawed Ingenix data system and pay $525,000 to the state.

US v Bourseau

Mr. Robert Bourseau and Dante Nicholson the former co-owner and Vice-president respectively of City of Angel Hospital in Los Angeles have been arraigned for recruiting homeless people for unnecessary medical procedures at the hospital.  The former CEO Rudra Sabaratham has already pled guilty to the same fraud.  He has agreed to pay $4.1 million and is up for a ten year sentence .

US v Sheth

Drs. Sushi Sheth and Otto Montenegro, both of Chicago, have been accused of Medicare fraud for billing for procedures never performed.  Also, Stephen Pam and Shavon Williams both of a DME company have been accused of false claims for power wheelchairs that were not medically necessary.         Top 


Hynes v Holmes Med Ctr

In an unusual case the chief of the medical staff has filed suit as the medical staff representative against the hospital for defects in quality of care.  The suit asks for custody of the medical staff minutes (the hospital says anyone can read them but not have them), barring Hynes' attorney from the hospital grounds (hospital denies this), establishing shadow committees of medical staff members hand picked by the hospital (hospital states that it is not against the bylaws) and not allowing the vice chief of staff to attend Board meetings in place of the chief of staff who has been barred after he filed an antitrust suit against the hospital (the hospital states that the vice chief may attend).  It matters not who is right in this the hospital will come out terribly in the court of public opinion.

Also Hynes had four trauma surgeons summarily dismissed for what they say is quality of care concerns.  The hospital successfully won a temporary injunction against the physicians and this is now being heard in court.  Dr. Hynes is testifying that if there is an bad outcome no one would know about it.  That is why he and the chief of surgery did a midnight suspension of privileges.  He also stated that the medical staff had been trying for over a year to get information regarding the trauma service with no success.  As I stated above, the hospital will come out of this looking terrible.

Patients v NHS
British Court of Appeals

A judge has ruled patients who had put their sperm in a hospital sperm bank prior to chemo could sue the NHS for damages because of the ruination of the sperm when the hospital's freezer stopped working.  The men can sue for emotional distress over the incident.  

Christie Clinic v MediPlan
CD Ill

Christie Clinic sued MediPlan for being a silent PPO.  They charged that MediPlan allowed access to United Health without they having to offer to steer patients to the PPO.  The Clinic wanted this to become a class action suit to include members and physicians as well as all facilities with contracts with MediPlan.  The court would not allow the class action for the class not having typicality and other problems.  This should cost the attorneys alot of money. The members will need to file individual suits.          Top


Australia v Patel

Dr. Jayant Patel is finally getting his time in court.  Dr. Patel was originally in America practicing surgery in New York and Oregon.  He was chastised by the New York Board for failing to examine patients preop.  He then went to Oregon where he worked at the Portland Kaiser.  Kaiser does not report their physicians after 79 complaints he was put on internal removal of privileges for liver and pancreatic surgery plus having to have a second opinion on other surgeries.  Instead of putting up with this and the Oregon Board citing him for gross or repeated acts of negligence he took off for Australia.  He omitted and Australia did not check his background.  He is now up for manslaughter after being extradited from Oregon back to Australia.  He is linked to 13 patient deaths and has not yet entered a plea.

Consumer Checkbook v Medicare
DC Circuit Court

Consumer Checkbook attempted to get Medicare data on all physicians to determine quality.  This was allowed by the district court but overruled by the circuit court.  The freedom of information act is to shed light on the federal government and not private businesses. 

Florida v Sanchez

Dr. Benjamin Sanchez of Clearwater, Florida, has been arrested and charged with threats and damage to the people and property at Morton Plant Hospital.  He has been previously fired from an anesthesiology group due to being a risk of violence.  

King v Rollo

 He's at it again.  Dr. John King originally of West Virginia continues to sue people.  This time he is doing it pro per.  He is currently suing his last attorney who he used to sue his prior attorneys for $50 million.  He has lost all cases.  Originally he was removed from Putnam General Hospital for quality of care concerns and afterwards had 124 med mal cases filed against him. These suits were settled by the hospital for $100 million.  Dr. King has a long history of suing hospitals that have terminated him, lawyers that have defended him and state boards that have removed his medical licenses. King states that the failure of his attorneys have caused him to claim bankruptcy and that claim is now in litigation. 

Pardo v Regents
CA Ct App

 Dr. Pardo was an associate adjunct professor at the University of California.  He believed he was something else.  The University can no re-appoint a person for no reason and this is what happened to Dr. Pardo.  He sued and as one can imagine lost the case.  One has to wonder about the attorney not knowing or learning the truth before the first trial and especially before an appeal.  

Berndt v Goshen Hosp
ND Ind

An anesthesiologist was removed from a hospital staff.  The group stopped scheduling cases for the doctor due to lack of board certification and quality issues.  He sued under the Rehabilitation Act and the ADA.  He lost on all points.  He was not an employee of the hospital so the ADA did not apply and his attorney screwed up by not showing that the hospital received any federal financial assistance.  One wonders where these physicians find these attorneys.   

Calif v Doe
California Medical Board

The Medical Board and the Board of Reproductive Physicians have started the investigation into the fertility physician who allowed the  patient with 6 children who he implanted previously to receive fertility drugs and IVF to deliver eight more infants.  The woman is out of a job and all will be on the taxpayers backs.  Kaiser Hospital who delivered the children is after Medicaid for payment.

Pou v Louisiana

 Dr. Pou, who was wrongfully accused of the deaths at a hospital during Katrina, has going after her legal fees.  Louisiana has a law that state employees who have to defend themselves if the action arises out of official duties, as this did, may get reimbursed for legal fees.  

Physicians v MCAT
Ca Supreme Ct

Dyslexic students who take the MCATs will not be offered additional time to finish the exam.  The lower court ruled for the students but this was overturned by the California Court of appeals. The California Supreme Court refused to hear the case allowing the Appellate decision to stand.       Top


Jones v HealthSouth
Idaho Supreme Court

Jones needed back surgery and was given a choice between a hospital and an outpatient surgical hospital.  She chose the later.  The facility was responsible for obtaining the non disposable material for the independent contractor blood technician for auto transfusion and also the anesthesiologist was an independent contractor.  The surgical garb did not differentiate between employees and independent contractors.  The original anesthesiologist went for a break after hanging a bag of auto transfused blood.  The replacement anesthesiologist put a pump bag around the transfusion bag even though the transfusion bag stated that this was a no no.  The pressure bag pumped air into the patient and she died.  The patient sued the people and the facility.  The original court gave summary judgment to the facility but this was reversed by the Supreme Court.  Back for trial.

Patients v St. Joseph 

A case was filed against the Tampa, Florida hospital for the deaths of three children with cancer from mold.  The mold was released when the hospital was undergoing a renovation.  The children were one floor above the construction project.  The hospital states it followed all the necessary requirements for containment of dust and other contaminants.  All three children died of Aspergillus, a fungus commonly found in construction dust as well as other places.  

Patients v Grady Hosp
To Be Filed

Grady hospital has announced that four people hospitalized at their hospital in the past month have come down with Legionnaire's Disease.  The hospital is now attempting to find the source.  

Patients v Mass General
To Be Filed

The Republic of Massachusetts has begun monitoring the cardiac programs at Mass General and St. Vincent hospitals after a survey showed they had high death rates post cardiac catheterizations.  The hospital state that they have found, using outside consultants that they paid, that the deaths were due to underlying diseases and not the quality of their care.  There may be a problem of too aggressively performing stent procedures.   

Rodas v Swedish American Hospital
ND Ill

Rodas had prenatal care in a clinic and had no physician on the staff of the hospital.  She was cared for by two physicians who performed a C-Section.  Several weeks later the infant died.  The mother sued however even though the hospital employed the physicians, the physicians could have but did not bill the patient.  This protected the physicians under the Good Samaritan Statute.  There is precedent on both sides whether the physicians should be protected.       Top


Texas v Jones

Texas has filed felony injury to a minor.  She allowed her diabetic daughter to die by not monitoring her condition.  The mother and father also allowed the daughter to eat food high in glucose.          Top


California v Health Net

Health Net illegally terminated the health insurance of many individual insureds and were sued for this by the state.  They have now agreed to pay all the costs they should have paid originally plus $2 million to the LA District Attorney who filed the class action plus another $500,000 to charity.  The insured will just submit their claims and the claims will be paid.  This may cost over $14 million.

California v Blue Cross

Blue Cross has agreed to take back all the people it illegally terminated, pay all their claims and pay a $1 Million fine to the state.  This is for their PPO patients.  Last year they paid $10 million to settle claims for their HMO patients.  Personal  suits may still be filed against both Health Net and Blue Cross for emotional damages and the worsening of their medical conditions.

Physicians v Aetna and Cigna

The AMA has agreed to enter the suit by physicians against the insurers for using the disgraced United Health's Igenex system to determine payments for out of network patients.  Of course, the AMA has done nothing until this point which is usual for them.        Top

Peer Review

Wilkey v Hull
SD Ohio

Dr. Wilkey sued Mr. Hull, the attorney for the medical staff, for legal malpractice.  The attorney did not disclose to the MEC an external reviewers exculpatory report.  The Court was favorably inclined on the merits to the physician but the physician lost on the statute of limitations and lack of privity.        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.