DeAnna v Aetna
The DeAnnas have filed suit against Aetna for failure to pay for about 10 weeks of their daughter's inpatient treatment for anorexia. The insurer states that anorexia does not have a physiological basis. They did pay for 35 days. The New Jersey state law mandates insurers pay the same coverage for mental and physiological diseases. The suit will seek class action status for the others who were not covered. A prior case in New York the plaintiff won coverage and in Minnesota there was a $8.2 million settlement on the same issues.
CarolinaCare Plan v McKenzie
The patient had profound sesnorneural hearing loss in both ears. She was covered by an ERISA plan and asked them to cover the physician recommended cochlear implants. The request was denied. The patient then sued in district court and the plan was rebuffed since it acted as both the insurer and the administrator. The 4th Circuit agreed since the plan did not explicitly exclude the devices. The plan was ordered to pay for the devices. The patient also sought attorney fees and was rebuffed by the 4th Circuit. This is only to benefit the person and there was no bad faith evident. The trial court's award of the attorney fees was overturned.
AARP v Highmark
The AARP sued as a class action Highmark for their failure to provide plan members with adequate information about claim denials. The AARP argued that the EOB forms did not comply with ERISA. The settlement gives the enrollees a choice of re-opening previously denied claims and potentially have them paid by Highmark. Top
LA v Hospitals
There have been 10 hospital in the Los Angeles area that have been identified by the LA city attorney as suspects in patient skid row dumping. The attorney has attempted to negotiate a no dumping with the hospitals but the talks have failed to date. He is now preparing civil litigation against several of the hospitals for unfair business practices and is considering criminal charges as well. There are about 15 incidents of skid row dumping against the wishes of the patients that are now under investigation. Three of the known hospitals are Kaiser, Drew/King and Los Angeles Metropolitan.
Patients v Virginia Mason
The hospital has agreed to refund faculty fees to about 3200 patients that had outpatient procedures at the hospital based clinics. The hospital's non hospital based clinics do not charge the fees and the patients were not told that they had the option to go there instead. Top
Patients v Sisters of St. Francis
The good Sisters took the same time as the Vatican talking about priest abuse to tell its patients that their records had been stolen. Months after the fact the cat got out of the bag. Days later the first of many law suits was filed for potential violations of HIPAA and privacy in general. In July, an employee accidentally left several CDs with identity information at a store. The CDs were recovered and it seems that although the dear Sisters were negligent no harm was done. The attorney is looking for a fast buck by wanting this to be a class action and each of the 260,000 people affected get $5000. The dear cheap Sisters have not offered any credit protection or money to allow the people to check their credit reports.
Patients v Intermountain
A TV station in Salt Lake City aired a story on the laptop computer with the names and SSN of 6244 patients of Intermountain Health had been put up for sale for $20. The person who purchased the lap top was not happy when he found all the names and numbers. He complained and found that all the names were people who were employed at Intermountain. Intermountain purchased the computer from the buyer and proceeded to smash the hard drive.
Patients v VA
A computer with 1600 military veterans was stolen from a VA. One month later the VA notified the people that their information had been stolen. The VA is at least, as opposed to the cheap Sisters mentioned above, are offering free credit monitoring.
Patients v VA
In yet another VA, this one in Oklahoma, the information on 1400 patients on disks was lost. These were lost in the mail. The loss was in May, June and July. The VA didn't notify anyone until now since they had to wait for the scrubbed form letter from Washington. Top
Stansfield v Summit Quest
The guardian of a mentally retarded minor sued mental health professionals and a MCO organization for negligence in the sexual abuse of the patient. As part of discovery they wanted credentialing information from all parties. The Court stated that the mental health people were protected under the state peer review statutes but that did not apply to the MCO. The MCO did have to comply but with only limited information.
Harris v Bradley Mem. Hospital
Dr. Harris sued the hospital after being suspended. He contended that the peer review failed to comply with HCQIA. The trial court allowed summary judgment to the hospital. The Superior Court reversed the findings of the trial court stating that the trial court did not decide if the hospital's method of investigation when deciding to suspend the physician was in compliance with HCQIA.
CA Podiatric v Kaiser
Dr. Weinraub worked for Kaiser in Southern California and sued Kaiser for not having any podiatrists on any committee and to give different privileges to podiatrists than others similarly situated. After a trial the court entered judgment for Kaiser stating there was no private right of action , injunctive relief would be inappropriate since an administrative agency had primary jurisdiction and Weinrub failed to prove his case. The appellate court affirmed. The reasons were the trial court had exclusive rights to grant an injunction, Health and Safety Code 1316 states that the People of California may bring a cause of action (not an individual) and Weinraub did not show by the preponderance of evidence that Kaiser made adequate decisions. This was an unpublished opinion so it may not be used for precedence.
Gateway Cardiology v Wright
The plaintiff sued the physician director of the hospital cardiac cath lab after he accused a cardiologist of doing medically unnecessary procedures. The cardiology group which employed the cardiologist stated the writing of letters by the director to the medical staff and hospital executives impaired their business. A ad hoc committee was formed to look into the allegations and concluded that none of the procedures were medically unnecessary. The committee then asked for other information from the cardiologist and referred the entire matter to another committee. The director sent a letter to the other committee suggesting they look at 15 additional cases. The committee looked at one of the cases and found no fault. They dropped the investigation. Then the suit came. The court granted summary judgment to the director under HCQIA. The court dismissed the exception to HCQIA that fee disputes are not protected. The court stated that the actions were based on competency. The court also found the ad hoc committee was a professional review committee since it was formed by the CEO on the advice of the attorney/compliance officer. HCQIA applied even if there was no underlying adverse action.
Shelton v Knox
The plaintiff physician sued the police for forcibly removing her from the hospital. She had been fired for disruptive conduct and then returned to serve a subpoena. The hospital had her arrested for trespass. The courts tossed the physician's claim stating that the police had probable cause to make the arrest and the physician had no privilege to be on the grounds.
Mehta v HCA
Mehta sued for discrimination after the hospital did not renew the exclusive contract with the radiology partnership of which Mehta was a partner. The discrimination did not apply since Mehta was a partner and not an employee or the group. Also the contract had an automatic dismissal from the medical staff that had been signed and therefore no fair hearing was necessary. Top
Castle v Lester
Lester sued Castle, an OB for med mal for neurological injuries to the child and to individual injuries to the patient. Castle settled regarding the child and admitted liability in regard to the mother. The trial was over damages. During the trial Castle asked that all mention of the son's injury be excluded as prejudicial. The trial court said they would allow testimony regarding the shortened life expectancy and the injuries. The jury instruction at the end of trial stated that an injury to an unborn child in the womb of a mother is to be considered as a physical injury to the mother. The jury awarded the mother $1.6 million and an appeal followed. The Supreme Court affirmed the jury instructions.
Riverside Hospital v Johnson
In another med mal case decided four days after the above, the Virginia Supreme Court again upheld a med mal decision. This was a case of Johnson, a 79 year old female with lymphoma, who died following a fall. The patient had severe problems with disorientation which was noted on the intake form but no high risk of falling status was given the patient. There was no bell alarm on the bed but the patient was given a bell at the bedside to ring. Apparently Riverside was aware of multiple falls at the institution but did not implement restrains or any other precautions on the patient. The jury awarded $1 million to the estate. The appeal centered on the admission of evidence. The hospital idiot attorney failed to object at trial to evidence being introduced so lost the ability to appeal that introduction. The Supreme Court also allowed the introduction of incident reports made in the normal course of business as evidence of other falls at the hospital.
Haynes v Beceiro
The patient sued the second physician for battery. She signed a consent form stating that the physician and such associates as deemed necessary would treat her condition. The two physicians in the same group performed the procedure and there was an injury. The court rightly said the signature gave the consent for both surgeons to be present.
Monostori v Murphy
The plaintiff sued the hospital under vicarious liability for the acts of an unemployed physician. The patient came to the ED with a crushed hand. He was examined by the on call physician and released to have surgery in two days. After the surgery the patient sued the surgeon and the hospital. The court ruled that the hospital may be sued if a patient has reasonably relied upon the appearance of the hospital having authority over the physician as created by words or deeds of the hospital. Summary judgment denied. Top
Restaurant v San Francisco
It took about one week after the election for the most important group in the city, the restaurants to sue to stop the healthcare for all law. The group claims the law is anti ERISA which has exclusivity. The suit seeks an injunction for business paying into the plan. This is the same argument used successfully in Maryland to strike down their law. 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.