November 15, 2011 Recent Legal News

Peer Review and Employment





Peer Review and Employment

Zawislak v Memorial Hermann Syst.
SD Texas

The physician was terminated from the hospital for allegedly complaining regarding an EMTALA violation.  He sued and the hospital wanted a summary judgment.  They did not get it.  They were told they were not immune from suit under HCQIA.  This hospital has had several suits against it by physicians for terminations.  It is a hospital that should be avoided by physicians coming into practice.

Miller v Hospital Care Consultants
ED Okl.

Judy Miller was retained by Hospital Care to be a hospitalist at McAlester Hospital for three years.  She was asked according to her contract to be a hospitalist from time to time at another hospital.  She did this for a year and then accused Hospital Care of breach of contract.  The court ruled that the case can go forward as there is an issue of interpretation of "from time to time".

Awwad v Largo Med Ctr
MD Fla

The physician was terminated after peer review and sued for a breach of the bylaws and discrimination.  He lost the breach of bylaws since he did not show any intentional fraud as required by the Florida statutes. He claimed he was terminated due to his heritage but the hospital said he was disruptive.  The discrimination part will be allowed to go forward.

Rajamannan v Northwestern University
To Be Filed

Dr. Nalini Rajamannan, associate professor of Medicine, has been fired from her position by the University.  She states it is because she accused the Chief of Cardiology Dr. Patrick McCarthy of implanting an experimental annuloplasty ring without informed consent and the patient had a post operative MI.  The University states she was dismissed because she was denied tenure.  

MRI Associates v St. Alphonsus Hospital

The hospital has been ordered to pay the MRI group $52 million for breach of contract.  This is the second time this has gone to trial.  The first one led to a $62 million verdict which was overturned by the state supreme court.  They had a contract with the group which they cancelled mid stream in favor of the hospital radiologists who opened a competing outpatient clinic.  The hospital again plans to appeal.

Iasis Healthcare v Apollo Physicians of Texas
Tex App Ct

In the trial court the physician group won a $10.5 million judgment for interference with contract and other claims.  On appeal the court reversed and said that there was no legal basis for the decision.  The physicians get nada.   

Fahlan v Memorial Hospital of Modesto 

Lawsuits have been filed against California's Memorial Hospital and Kaiser Permanente for lack of due process.  The suit claims that California is the only state that allows the hospital administration to accuse, name the judge and jury to decide the fate of the physician.  In the case of Dr. Fahlan, he has complained bitterly of the poor care at the hospital and has been dismissed as disorderly.  He is currently the Chair of the Department of Medicine at a nearby Modesto hospital.  When he went through peer review the committee agreed with Dr. Fahlan but the Board terminated him.  Dr. Safari of Kaiser was investigated by the Medical Board of California and was found by an ALJ not to be responsible.  Kaiser will not let him practice at the hospital.  Federal regulators investigated and said that Kaiser was responsible for the deaths of the two newborns due to not monitoring Safari closely enough.  Sounds like completely different cases that should not be related.   

Texas v Arafiles

Dr. Arafiles pled guilty of third degree felony of misuse of information.  He was the physician who was turned in to the Texas Medical board by two nurses at his hospital.  The nurses were criminally charged for their actions and exonerated.  All those involved with the case against the nurses have paid money to them and/or served jail time.   

Fleming Hospital v Fleming Regional Medical Imaging
Ky Ct App

The philanthropic hospital did not like competition and sued the imaging company for failure to get a CON.  The court said that the company qualified for a private physician office exemption from the CON process.  Hard Cheese!!   

Sweidan v Fountain Valley Hosp. 
Ca Ct App.

A new pediatric group entered into an exclusive contract with the hospital.  The new group hired some of the old group who soon went behind their backs to attempt to steal the contract.  The CEO gave the contract to the sneaky group and the new group sued the CEO.  The CEO attempted to get arbitration and this was denied by both the lower and the court of appeals probably due to the actions of the hospital as well as the contract arbitration not applying to all the defendants.

Mir v San Antonio Hospital 
CA Ct App

Mir who had no medical license and had been declared a vexatious litigant in law suits against another hospital was denied the ability to sue San Antonio Hospital for the same reason.  He needed to get permission of the court to file a suit and did not do so.     

Feinstein v St. Luke's Hosp.

Two employed physicians were participants in the hospital's pension plan.  The two physicians would not be entitled to any benefits if they quit but would be if they involuntarily left.  The physicians were terminated and sued for their benefits.  The courts said they quit and were counseled that if they quit they would get nothing.  There other claims were also dismissed.    Top


States v US
US Supreme Court

The high court hey will take the case from the 11th Circuit that tosses out all of Obamacare in this session.  The Court will look at the individual mandate and if unconstitutional should the entire bill be also unconstitutional.

Seven-Sky v Holder
 DC Ct App

The Court of appeals of the District of Columbia upheld Obamacare by a 2-0 vote.  The third justice would not consider the case as he felt it was not ripe for decision.  The two justices that upheld the law were one appointed by each party.  The losers have not decided whether or not to appeal to the entire Appellate Court or to the Supreme Court. 

Williams v Mission Viejo Emergency Med Assoc.
Ca Ct App

Williams went to the ED of the Mission Viejo Hospital and was seen by a physician.  The hospital was on her insurance plan but the physician group was not.  she was charged the out of network rate and sued for multiple claims.  The court dismissed the case with prejudice.  The court of appeal upheld since the patient's attorney did not state a viable claim and that any leave to amend would cure the problem.

Allen v Clarian Health Partners
Ind ct app

Allen, an uninsured patient , entered the hospital for treatment.  He signed their standard contract upon entering the hospital promising to pay the charged fees.  The hospital charged him the chargemaster fees, much higher than those charged insured patients.  He sued and lost in the lower court but won in the court of appeal.  The contract was silent as to the amount to be charged therefore a reasonable rate is assumed.   

CMA v California

The California Medical Association has filed a second suit against California after the US Supreme Court denied the first suit.  The issue is basically the same, will lowering the payment by 10% hurt access and is that legal.  I will assume that the CMA will again lose and the state will pay alot more than the reduced 10%.  Providers not in county hospitals will refuse to see the patients and they will end up in the expensive EDs.  Another example of government stupidity and ending up costing more money.  

Glaser v Kaiser Healthcare
9th Circuit

 The Circuit Court agreed that Kaiser did not have to pay for the surgery on Mr. Glaser.   The patient had liver cancer and wanted surgical removal.  The Kaiser tumor board found that surgery would leave him with too little liver to survive and recommended chemotherapy.  He went outside Kaiser and had the surgery and sued Kaiser for payment for the treatment.  They found that Kaiser only denied payment not the ability to go outside the plan and therefore was not liable for damages. Top 


Nissen v Johnson

The patient had neck spine surgery and ended up with pain and numbness in one arm.  She sued for malpractice and punitive damages.  The court stated that there was no malice therefore no punis were allowed.

Maillaro v New York Presbyterian Hosp.

The patient while in the hospital got a Staph infection in his surgical wound.  He sued the hospital and asked for the medical records of the person he shared a room with.  He did this to show that he got the infection from the roommate.  The court said without the consent of the roommate the medical records could not be given and the roommate would not consent.

Hale v Norteastern Vt. Hosp.
D Vt

Hale went to the ED complaining of severe neck ache and pain radiating to her temples and back.  She was seen and diagnosed with torticollis.  Three days later she returned and was seen by the same ED physician who did a spinal tap and CT.  A diagnosis of an intercranial bleed was made and she was transferred for surgical intervention.  The brain aneurysm broke leaving the patient with severe neurological deficits.  She sued for negligence and EMTALA breach.  The court found on summary judgment that the EMTALA screening claim and negligence could go forward but not the EMTALA stabilization claim.

State Bar of Texas v Rosenthal
Admin Hearing

The hearing to be held is to determine what if anything should be done to an attorney who stiffed an expert witness.  The article talked about the disbarment in other states for the same offense.

McCade v Wills Eye Hospital
Philadelphia Court 

McCade underwent a colonoscopy and had his colon over inflated with air which caused several perforations.  The repair was also with complications.  The jury awarded $2 million for the continuing problems.

Jeffery v Methodist Hospital
Ind Ct App

A couple adopted a son from the hospital.  Prior to the adoption the couple asked if the boy had any mental or physical problems.  The hospital said there were no problems when in fact the boy has severe mental retardation.  The court ruled that the hospital could be liable if their employees made material misrepresentations, which occurred here.  The court overruled the summary judgment for the hospital in the lower court.

Jeffers v Methodist Hospital of Sacramento

Jeffers was two years old when she went to the Sacramento hospital with fever, skin discoloration and weakness.  She had to wait in the ED before being seen by anyone.  She then began to have body bruising while still in the waiting room.  When she was finally seen five hours later she was flown to Children's Hospital at Stanford where she was diagnosed with Strept A septicemia.  She needed amputations of her feet, left hand and part of her right hand.  She settled for $10 million.

Bausch v Stryker
US Supreme Court

The Supreme Court let stand a lower court ruling that allowed the suit against Stryker to go forward.  The court refused to enforce the limit on patient lawsuits against medical device makers.

VanSlembrouck v Beaumont Hospital
Michigan Trial Court

In the largest med mal verdict ever in the state of Michigan the mother had gestational diabetes and went into labor.  Instead of a C-Section she had an induced vaginal delivery.  The child was born with brain damage, a broken clavicle and requires around the clock care.  The hospital claims the defects were genetic.  The complaint states the doctor did not find out the size of the baby and therefore plan accordingly.  The judgment was for $130 million in economic damages for care and loss of earning until 2077.     

Cinoman v Univ. North Carolina
NC Ct App

 The patient sued a physician who was an employee of another hospital but was temporarily working in the pediatric intensive care unit at UNC.  The suit was for more than the physician was covered for under his original employer and he sued UNC for indemnification.  The trial court ruled on summary judgment for the University.  This was overturned by the court of appeals.  There were areas of material fact that need to be settled since the University provided coverage for attending physicians employed full time and whether he provided details of his med mal coverage at the time of the hiring at UNC. 

Lord v Central Coast Health Dist.

This poor person had chemotherapy and gastric resection for a misdiagnosis of stomach cancer.  The original pathologist who screwed up has apologized to the patient and is not being sued.  The patient wants an apology from the district and compensation.         Top


Community Memorial Hospital v Goldenring
Ca Trial Ct

The hospital sued their prior attorney and CPA for covering up the prior CEO's alleged financial impropriety.  This is the same hospital attorney and CEO who caused such a stir several years ago leading to a new law protecting medical staffs against the hospital.  The hospital had to pay $1.5 million and the CEO, Mr. Bakst, paid $64,000 to the feds for illegal kickbacks.  This case was beyond the statute of limitations so the allegations were never heard.  The hospital will appeal.

US vs 12 

Twelve people including three physicians were indicted in a New York Medicare fraud roundup.  Six were in Flushing and accused of submitting $11.5 million in false billing for services not rendered.  They also offered inducements to patients for Medicare account numbers.

US v 17

In Los Angeles, seventeen people were indicted as runners for Dr. Kenneth Johnson of Glendale who would give prescriptions for drugs to the runners who would take them to pharmacies to be filled.  The pharmacies would bill Medicare for the meds that were never used.  The pharmacies would then repackage and resell the same drugs over again.

US v Kernan Hospital

Kernan Hospital of Baltimore has been sued by the feds for improper billing at the rehab hospital.  They changed their billing system so their patients had Kwashiorkor and were paid higher rates.  The hospital is owned by the University of Maryland.  

Bryden v Wyoming Medical Ctr.

The Medical Center was sued by a whistleblower for false billing.  She charged the admitting clerks changed the admission status without physician input.  She claims she went to the now CEO about the problem and nothing was done.  The CEO doesn't remember any meetings.  The feds have not yet decided whether or not to intervene.   

Texas v DeMaio
Texas Medical Board

 Dr. Samuel DeMaio formerly a Austin Cardiologist was ordered by the Board to pay $10,000 plus taking courses on ethics, stenting and medical record-keeping.  They found that he placed stents in patients that did not need them and used overly long stents.  He had just renewed his board certification in 2009.  

US v BCBS of Montana

Blue Cross/Shield of Montana and five hospitals have agreed to settle antitrust complaints against them.  The allegation is that the insurer paid the hospitals $26 million to purchase insurance for their employees from BCBS instead of the insurance company owned by the hospitals.  The hospitals are Bozeman Deaconess, Community Hospital, St. Peter's Hospital, Northern Montana and Billings Hospital.    

Maryland v McLean

Dr. John McLean was found guilty earlier this year of healthcare fraud for unnecessary cardiac stenting was sentenced to eight years in jail.  He is also to pay $579,070 restitution to Medicare and other insurance companies.  

Kansas v Planned Parenthood
Kansas Trial Ct.

 The case of fraud against Planned Parenthood has run into a bit of a snag.  the State had destroyed all the evidence against the Clinic.   Many of the charges against the Clinic will need to be dropped but many such as misdemeanor charges of performing illegal abortions can go forward.      

US v Chavez

Dr. Armando Chavez of Houston was sentenced to 70 months in prison for mail fraud.  He is also to pay $3,821,082 in restitution.  The fraud stemmed from unbundling medical codes to increase the amount he was paid.  He has already voluntarily surrendered his medical license.  

US v Johnson

Dr. Antoine Johnson and his mother Lawanda were convicted of healthcare fraud in the Western district of Washington.  They were dispersing narcotics without exams and not paying income tax.  The two closed their practice and fled the United States after the investigation started.  They were found in Madagascar and extradited back to the United states.      Top


Patients v Nemours
To Be Filed

Nemours Children's System has lost computer tapes with the patient billing information not encrypted.  Bad people.  Stupid people.  

Patients v Adult and Pediatric Dematology
To Be Filed

The medical group in Concord, Massachusetts, lost 2000 patient records when a flash drive was stolen from a car or home owned by an employee.  The clinic was not forthcoming about whether or not the information was encrypted.  Poor oversight by the Clinic and bad judgment by the employee.

Patients v Spectrum
Not filed

Not filed since it was in Great Britain.  Spectrum is a mental health facility.  The files were not encrypted.  

People v UCLA
To Be Filed

UCLA has 16,000 patient records missing after a break in at a physician home.  The information was encrypted but the password was also taken.  I do not know what the University or physician were thinking when the records were at the house and the password was on a piece of paper next to the computer.        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.