April 15, 2008 Recent Legal News






Peer Review



Lefever v Santilla Health
Ga Ct. App.

Santilla Hospital has an exclusive cardiology contract with Baptist Specialty Physicians (BSP).  Lefever and another cardiologist who are not members of BSP applied for the staff of the hospital.  They were denied due to the exclusive contract.  They sued for an injunction against the hospital.  The trial court ruled for the hospital and the court of appeals ruled for the physicians.  The reasoning was that both public and private hospitals must have bylaws and must follow those bylaws.  Santilla's bylaws allow even those dismissed for cause to reapply for hospital membership.  Since the bylaws are silent on the application of new members who are not members of the exclusive club, the physicians should be allowed all the protections of the bylaws.  This means they are to be considered by the medical staff and then final approval by the hospital board.  If not allowed in they are allowed to have a hearing on the matter.

Madonna v Santilla
Ga Ct App

The court ruled at the same time as the above that Madonna, a prior member of BSP, was rightfully terminated when he quit BSP per his contract.  He then reapplied to the staff as a non member of BSP and was refused.  Again, he sued for an injunction and using the same reasoning as above the appellate court ruled for the physician.  The court stated that the hospital has to follow its bylaws and the medical staff could change the bylaws if they wished.   

Wal-Mart v Shank

Wal-Mart sued and won a case from Mrs. Shank after she was injured in an accident.  They sued to recover the money they spent on her medical bills.  They had the legal right to sue but the publicity made them back down and have now agreed not to come after the money they won.         

Cairns v Ventura Urgent Care
Ca Ct App

Cairns sued Ventura for wrongful termination.  Dr. Cairns believed that Ventura's physical therapy unit was receiving illegal kickbacks and told Ventura he would no longer refer patients to the facility.  The next day he was fired.  Dr. Cairns then sued for multiple torts and breach of contract.  Ventura wanted to arbitrate and sued to compel arbitration.  The problem was that Ventura's attorneys left out the arbitration agreement on the new contract.  Ventura lost its argument and the case will go to court for all to hear the evidence.  This case is a great for teaching all attorneys how not to do something.  The attorney should not have allowed the firing of the physician.  The attorney should not have allowed the kickbacks or the perception of kickbacks.  The attorney should not have left off the arbitration agreement from any new contract.        

Salamon v Our Lady of Victory Hosp
2nd Circ

Dr. Salamon sued the hospital for discrimination.  The lower court ruled for the hospital in summary judgment since Dr. Salamon was not an employee.  The definition of employee has become more muddled with the hospital interfering with medical care.  Here the lower court ruling was overturned because there is a genuine issue of material fact as to the control the hospital had over the physician with the hospital's quality control program.  This needed to be resolved prior to any summary judgment.  

Mendiondo v Tenet
9th Circ

Nurse Marie Mendiondo complained about the cardiovascular procedures in her department as only being done to increase reimbursement.  She was fired and sued.  Hospital lost on appeal.  Hospital should fire attorney that allowed the firing.      Top


US v Sultan

Dr. Guishan Sultan, a psychiatrist in Cleveland, Tennessee, will pay $1.1 million for submitting over 6000 false claims to Medicare and TennCare. Allegedly the physician billed for services actually performed by a nurse.

US v Ignasiak

Dr. Robert Ignasiak Jr. of Freeport, Florida, was arrested and faces a 54 count indictment which include healthcare fraud.  He is accused of writing prescriptions not based on medical necessity and dispensing controlled substances to two patients one of which resulted in a death.

US v Casteneda
Guilty Plea

 In Miami, Florida, two people are going to jail for Medicare fraud.  Juan Carlos Casteneda, a pharmacy operator, is going away for 63 months for paying kickbacks to 72 DME owners.  Jorge Novoa, the owner of a DME company is going away for 56 months for submitting fraudulent claims using false information.    

US v Christ Hospital

The US has intervened in a whistleblower case against Christ Hospital in Cincinnati and the Ohio Heart & Vascular Center.  They are accused of illegal kickbacks by the hospital giving preferential times in the hospital outpatient cardiac testing areas based on revenue to the hospital.  The original suit was filed by Dr. Harry Fry, a cardiologist.  The hospital and cardiology group deny the charges but will settle later "to avoid the expense of litigation".  An article in the paper the next day stated that Christ states it acted properly.  The article will not help since the hospital has been trying to reach a settlement with the government for the last four years on this issue and is not willing to pay enough.  If the suit goes to court the hospital could lose all its assets.        

US v Lockridge 
Guilty Plea

Dr. William Lockridge of Florida has pled guilty of participating in an internet pharmacy in Pennsylvania.  He was in a Pennsylvania Federal Court.  He wrote prescriptions for millions of Vicodin, Xanax and Valium.  He never reviewed medical records or saw any patients.          Top


Oregon v Worthington

Mr. and Mrs. Worthington of Oregon City, Oregon, were indicted for manslaughter after their daughter died from an infection.  The couple preach against medical care and so their daughter got none.  She had pneumonia and a blood infection.  If convicted they will serve six years.        Top


Bay Care Health v Medical Saving Ins
MD Fla

Bay Care is a five hospital system under contract with National Preferred Provider Network.  The Network was a consortium of insurers that were to promptly pay for a discount in fees.  Medical Saving was also under contract with National but paid on its own fee schedule and not on National's fees as per the contract.  Medical left National and continued not to pay Bay for its full charges.  Bay sued and Medical asked for a nonsuit.  The court ruled that Bay had enough for the full case to go forward.  This will never see trial since the award would be huge.

Boca Raton Hosp v Great-West
SD Fla

In a like case to the above the hospial sued for underpayments by an HMO.  The hospital entered into a contract with Private Health Care Systems and Great-West became part of the system.  Great West later delegated some administrative functions from Private to its own subsidy.  Shortly after Private stated that Great West was out of the organization.  Neither Private nor Great West told Bay and Bay continued to accept patients from Great West but was not paid its non discounted rate.  Bay is suing for the difference.  The Court allowed the hospital to continue the suit.  This also will not go to trial due to the costs and bad publicity for the HMO.

Riverside Hospital v DC Dept. of Health
DC Ct. Appeals

The hospital sued the DC Department of Health for their retroactively denying Medicaid benefits to the hospital's patients.  The Medicaid benefits were denied as not medically necessary.  Since the patients were no longer receiving care at the hospital, the hospital had no right to assert third party jurisdiction.  The hospital had not completed all its administrative remedies prior to suing.          Top


Patients v Baxter Labs
Multiple Filed

Baxter is the distributor of Heparin which caused deaths in many people due to a contaminant from a Chinese manufacturer.  Baxter states that the allergy caused by the contaminant that led to a massive recall was not the as yet known cause of the deaths.   

Tomlian v Westside Regional Med Ctr
Fla Superior Ct

The suit was over an alleged late C-Section.  This caused mental retardation and partial deafness.  The Plantation hospital was found 85% at fault and the physician, Dr. Grentz the remaining 15%. This case is just coming to trial but the incident occurred in 1991.  The reason is the original suit 10 years ago was for the defendants and this was overturned by the court of appeals and sent back for a new trial.  The jury now awarded the family $30 million.  And one wonders why there needs to be limits.   

Patients v Wyeth

In the I don't understand it category, a USDC judge has awarded the attorneys that sued Wyeth in the Fen-Phen litigation the mammoth sum of $412 million.  He stated that the attorneys had billed over 578,000 hours which is equivalent to 24/7 sixty-six years.  I wonder how much padding was done here?  That obscene amount should mostly have gone to the plaintiffs.       Top

Peer Review

Johnson v Grays Harbor Hosp
WD Washington

Dr. Johnson was suspended and had his privileges removed by the medical staff and administration of the hospital for not completing his records on many occasions.  Many physicians have their privileges suspended for non completion of records but they are reinstated once the records are completed.  Dr. Johnson also did not do his medical records when asked and did not reapply for hospital admitting privileges in a timely basis.  Dr. Johnson then stated the hospital was singling him out since he was the only Black physician on staff.  The Court ruled for the hospital on all counts.   

Yancey v AAO
DC Minn

 Dr. Yancey, an ophthalmologist, testified as an expert witness in court against two other ophthalmologists, Dr. Weis and Hardten.  These physicians accused Dr. Yancey of giving misleading testimony.  Dr. Yancey sued the two physicians and the AAO for defamation.  The Court tossed the case against the AAO but allowed it proceed against the two physicians. The AAO had a peer review set up to monitor problem expert witness testimony.    

Gerkas v Seton 
Tenn Ct App

 Dr. Gerkas sued the Seton Corporation and Baptist Hospital for breach of contract for not promoting him to the full medical staff due to multiple episodes of disruptive conduct.  He claimed the bylaws were part of his contract and the hospital breached their bylaws.  The trial court gave summary judgment to the hospital and the court of appeal agreed.  The higher court stated that the bylaws were a part of his contract but the hospital had complied with the bylaws so there was no problem.  He had received due process according to the bylaws with notice and a hearing attended by counsel.  It should be noted that the physician represented himself.  The court was asked but refused to award attorney fees to the hospital.      Top


California v US

California sued the US Government over the Weldon Amendment which allows the feds to withhold payments to anyone who discriminates against any medical provider who refuses to not to offer or provide abortion services.  California lost.  This means that a physician who does not believe in abortion and is on call at a hospital who refuses an emergency abortion under EMTALA may not only be prosecuted under EMTALA but may cost the hospital federal funding if the hospital does a peer review on the physician.  The future should be interesting.        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.