August 15, 2005 Recent Legal News
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Nichols v Lowes
Filed
Every once in a while I find a story not in the medical field that is so outrageous and funny that all deserve to know about it. This is one. Lowes in Southern Illinois is being sued by a woman who claims she suffered cognitive impairment after being attacked by a wild bird outside the store. Yes, I said outside the store in the garden supply area. Nichols claims the bird attack caused cervical disc herniations and brain disease that has reduced her earning capacity by $3000. She was back at work soon after the hideous attack and is suing for at least $100,000. I hope the attorney for Nichols spends alot of money to get experts and loses all. Top
TennCare
The federal judge who has made the legal quagmire that TennCare has become will now rule on any lingering questions about his bad past rulings. The questions include what is meant by medical necessity and how appeals of denied drugs or services take place.
The judge gave the state enough leeway to be able to keep most if not all the 97,000 most needy on the rolls. However, the state must allow some exceptions to the changes that it wanted.
Tennessee has enough money due to the suits to continue coverage for the 97,000 people who originally would need to tossed due to the advocacy attorneys wanting everything for everybody.
Patients v Tenet
Settlement
Tenet has settled a class action law suit filed in 2002 alleging that Tenet was overcharging patients who were either uninsured or under insured. Tenet had put aside $30 million for settlement of the suit.
US v Blue Cross/Shield
Mass. Dist. Ct.
The District Court in Massachusetts ruled that Blue Cross did not have to turn over confidential peer review documents sought by the government. The court ruled the government failed in its attempt to show the benefits of the information would be more than the harm to the peer review process. This came from a case the government is attempting to make about a single physician suspected of healthcare fraud for false billing. Top
Arnett Clinic v Greater Lafayette
Health
Indiana Court
A judge has tossed a suit by the clinic against the health system for antitrust. The clinic had accused the system of placing roadblocks in the way of its building a new hospital. The judge stated that none of the individual actions were illegal and he would not put them together to divine some overall wrongdoing.
Physicians v Oxford & United
Filed
Four physician have sued the two plans for violation of unfair trade and insurance practices as well as antitrust. The suit claims the newly combined company is using its power to decrease payments to the physicians as well as place new administrative burdens on them. The physicians must see both plan's members or be terminated. The suing physicians only want to take care of the one plan's patients. The suit also state that Oxford keeps physicians on telephone hold for 30 minutes when they call for pre approval and have denied emergency care on weekends when the offices are closed. The Oxford spokesperson states that they have not had alot of complaints regarding the phone lines (which means they have) and that ER or urgent care visits don't need pre authorization providing they are medically necessary. This means they will not be paid. The antitrust aspect is an illegal tying of forcing the physicians to take care of both sets of patients when the companies are not putting them under one roof. Top
Cruz-Queipo v Hosp. Espanol
1st Circ.
Finally a patient won something in an EMTALA action in Puerto Rico, an overturn of a summary judgment. The patient sued for not following the hospital's own protocol for screening. He came to the hospital with chest pain and was discharged. he returned the next day with a myocardial infraction. He was originally screened with a protocol for back pain and muscle pain and not chest pain. The 1st Circ. stated it was a question of fact and therefore a jury decision whether the patients original complaint included chest pain and whether or not he had been stabilized prior to discharge.
Three other hospitals have agreed to pay money to settle EMTALA allegations. Dominican Hospital in Santa Cruz, California, has agreed to pay $33,000 when it failed to stabilize a patient and failed to perform an adequate screening in another. Lakeside Hospital in Metairie, Louisiana paid $20,000 for patient dumping in two patients. Hickman Community Hospital, a critical access hospital in Centerville, Tennessee, paid $5000 for asking patients regarding insurance prior to a screening and failure to conduct two screenings. Top
Patients v Duke
To be Filed
Duke University has set up a program to follow the patients who accidentally had surgery with surgical instruments washed in hydraulic fluid. Since this is an unknown area, it will be an interesting study. It is expected that more than one of the patients will sue to keep their options open.
The judge has also ruled that the patients may sue for punitive damages. Punitive damages are usually not covered under most policies.
Patients v Jewish Hospital
Filed
To date 69 patients have filed suit against Jewish Hospital in Louisville for getting methicillin resistant Staph infections. The cases center on the knowledge by the hospital of the problem and not warning the patients in order to give them a choice to have the surgery at the hospital. The hospital has been cited by the state in 2000 and 2002 for infection control problems.
Sullivan v UCSF & AMN
Settlement
Sullivan entered the University of California at San Francisco Hospital for elective neck surgery. Post operatively he was overmedicated and not watch closed enough by a temporary nurse from AMN. The combination led to a neurologically impaired individual who will need life long care. The hospital will pay $3.6 million and the AMN employer of the nurse the additional $2.4 million. This case shows one of the potential problems with the nurse ratio law and the need to get nurses from agencies just to fulfill a quota. Top
Granek v Texas Board
Texas Appellate Ct.
The Texas Board of Medical Examiners, already known as one of the worst in the nation, got another black eye. The Courts through out the Board's ruling on Granek as arbitrary and capricious. They tried to use an allegation from 13 years prior and made other mistakes in their language. 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.