Merrill v Agnesian Health
In a case to show the lack of reading of bylaws and the bias of medical staffs, the hospital lost a summary judgment for not allowing a qualified practitioner on its staff because he was not certified by the American Board of Ob/Gyn. She was certified by the equivalent board of the Osteopaths. The hospital relented later but by that time the physician had already left town and had incurred expenses. The court also found that the hospital's form didn't disallow suit against the hospital. The hospital should now cut its losses and just pay. Top
US ex rel Fry v Christ Hosp
In another hospital blunder they offered better times at the heart station to cardiologists that had the highest referral of cases to the hospital. The hospital lost a summary judgment motion for an immediate appeal here. This may involve the review of 11,000 claims. They should have been better informed by their attorney. Top
Bhama v State Medical Board Ohio
In the "what was she thinking" mode, Dr. Savin Bahma had her application for an Ohio license permanently denied when it was found that she lied extensively on her application. She did not reveal multiple resignations and terminations from private or public medical practices, a question on the application. She also affirmed that her application answers were true. Top
US v Castellanos
Yosdan Castellanos, a owner of a sham DME outfit was sentenced to 63 months in jail. He fraudulently billed for but did not supply vents to patients. He is also to pay $738,000 in restitution.
US v Scott
Varian Scott and Herzon Collie were indicted by the feds for fraud. They were accused of forging prescriptions for HIV and cancer meds in Atlanta.
US v Galichia
Dr. Joseph Galichia agreed to pay $1.3 million to the feds and enter a corporate integrity agreement. This was to settle allegations of false claims over a five year period. This was for services not provided and claims lacking proper documentation.
US v Strutsovskly
Dr. Mikhall Strutsovskly of Williamsville, NY, pled guilty of working for an unlicensed clinic and falsifying information that unneeded tests done by the clinic were medically necessary. Top
Elmer v Southland Corp
Elmer and his physician requested on several occasions a referral to a pain management specialist. The company never responded to any of the requests. Elmer sued under Florida law for authorization, attorney fees and palliative care. The lower court agreed with the insurer and denied any payments. The higher court reversed stating under Florida law if an insurer does not respond to a request for authorization in three business days agrees to the authorization. There is another law that makes this a 10 day rule but the insurer failed in either case. The court gave attorney fees and costs as well as authorization. They denied the requested palliative care.
NY v Group Health
Group Health of NYC and HIP Health Plan have both agreed to discontinue the faulty Ingenix database. This finishes the entire state from use of this database. Hopefully, the rest of the country soon will follow suit.
Healthy SF v Restaurants
The 9th Circuit agreed with the San
Francisco that ERISA did not interfere with the city's employer spending
requirement. The decision was split as to a rehearing en banc so the case
will go to the US Supreme Court. In the meantime the restaurants are
continuing to add money to each bill notifying customers that it is for the SF
health care ordinance. This will continue to cost both sides mucho dinero
for the appeal. Top
Nurses v Northeast Health
The hospital network in Albany, New York, has agreed to pay $1.25 million to settle the class action suit that the hospitals conspired to hold down nurse's wages. The hospital called the accusation false and then paid the money. Nurses have filed like suits in Chicago, Detroit, Memphis and San Antonio. Top
Guzman v Memorial Hosp.
The case had both state claims and EMTALA claims. The court did now allow peer review documents in the trial since they would only be relevant for the state and not the fed claims. The plaintiff tried and failed to get the information admitted stating that fed law (HCQIA) applied. It was a good try at an end around but of course lost.
Arunasalam v St. Mary's Med Ctr
The physician was summarily suspended from the hospital due to a pattern of problems and one sentinel case that led to patient harm. He asked for and received a peer review hearing but before it was actually started it was stopped due to the physician filing suit. This was against the hospital bylaws. California has a law called the anti-SLAPP law (Strategic Lawsuit Against Public Participation). This effects "harassing lawsuits". The trial court stated the suit was against the suspension of the privileges and not a peer review decision which is protected under the anti-SLAPP. The appeals court did not agree and stated that the defendant hospital must show that the action was a protected activity since mandated by law and if that occurred then the plaintiff physician had to show a probability of winning or the case is over. The case was then remanded back to the trial court to see if the plaintiff physician could show that he might win on the merits. In California the deck is slightly more stacked against the physician with this rule. However, on the other side, California also has protection for medical staff members not just employees that are "whistleblowers". Top
Phillips v Bramlett
The state high court opined that the
state law that allowed exceptions to the damages cap when the claim was
negligently not settled only applied to insurers and not physicians. The
case revolved around a post operative death. The hospital settled and the
physician went to trial. The judgment was against the physicians for $11
million and apportioned 75% to the physician and 25% to the hospital. The
jury added gross negligence and an additional $3 million against the
physician. The high court ruled that here the physician damages may not
exceed the damage cap. 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.