August 1, 2003 Recent Legal News

Price Fixing

Physician Relocation 

Peer Review



Fraud and Abuse


Price Fixing

US v Washington Univ. Network

The two parties agreed to settle their disagreement.  They will no longer be able to negotiate agreements between its physicians and health plans.  The FTC stated that the group negotiated the contracts without enough clinical integration of the physicians.        Top

Physician Relocation 

US v Tenet

The Government has subpoenaed Tenet Corporate and all seven California hospitals for information regarding payment for relocation since 1995.  There will be criminal as well as civil charges on this issue.  Following the subpoena a federal grand jury has indicted Alvarado Hospital in San Diego of illegal payments to doctors to send their patients to the hospital.  This come one month after the CEO of the hospital was separately indicted on the same criminal offenses.         Top

Peer review

Gordon v Lewistown Hospital

The lower federal court through out another antitrust case against a hospital by a physician who got booted off the staff.  The physician. who by anyone's standard, was disruptive was given a second chance by the hospital.  The physician screwed it up and was tossed.         

Fox v Good Samaritan Hospital
Cal Ct. App

In this case that the Court say should not be published in the official reports. the medical staff adopted a rule for designation of coverage.  A pediatrician did not follow the rule and was removed from the staff.  He was not given a hearing since the removal was for administrative reasons and not having to do with quality of care by Dr. Fox.  Fox sued and lost on all points.  The physician should follow the Medical Staff Bylaws as long as they are not unilaterally changed by the hospital.

Chao v Kewah Delta Hospital
Ca. App. Ct.

Dr. Chao was summarily suspended from the hospital by the MEC.  He requested and was granted a judicial review hearing.  Following the hearing the JRC ruled that Dr. Chao was below the standard of practice on some cases but did not deserve removal from the staff or his privileges.  The MEC did not agree with the JRC and it went to a sub committee of the Board who sent it back to the JRC for reconsideration.  The JRC refused to reconsider their recommendation of monitoring the practice.  The Board then adopted the MEC position and tossed the physician. I am almost always on the side of the physician and believe strongly that the MEC should abide by the JRC recommendation.  This medical staff has a twist.  The bylaws state that the Board shall affirm the JRC recommendations if the JRC's decision is based on substantial evidence, following fair procedure.  In this case the Board did not fault the procedure nor the facts of the cases just that the JRC decision was not based on substantial evidence.  This is a great case to show why an attorney paid by the hospital should not be allowed to write or amend bylaws unless the medical staff has its own attorney to keep the hospital attorney in check.        Top

Richman v Rideout Hospital

Dr. Richman, a cardiac surgeon, has filed a suit against the hospital and four cardiologists.  The hospital had cancelled his privileges after the physician pled no contest in being under the influence of cocaine.  He is accusing the hospital and the physicians of interfering with open heart procedures so they could make money on their invasive cardiology.  Sounds like he may still be using.

Parker v St. Mary's Health
Nev. Superior Ct.

The jury found that St. Mary's had performed a malicious peer review against Dr. Parker and had awarded her $500,000.  When they returned to court to determine punitive damages, the judge stated the case was over.  He through out the verdict and ruled as a matter of law that the hospital and physicians could not be sued under HCQIA. The judge really goofed, not necessarily on the ruling, but letting the case go three weeks prior to making the ruling. On three separate occasions he ruled the case should go to trial.  This has cost Dr. Parker about $400,000.  The case is to appealed.          Top


Gier v CGF Health

The physician was on call and in the lower court won a summary judgment since he showed he had no patient physician relationship since he was never notified of the patient's admission.  The upper court turned it around to send it to trial when the plaintiff showed affidavits showing the hospital had a routine procedure to notify physicians of admissions and the chart showing that the physician was the one to be notified.  Like hospitals always follow their procedures. This should be an easy case for the physician.        

Conrad-Hutsell v Colturi
Ohio Ct. App. (From the August, 2002 Legal News

The plaintiff with Crohn's Disease sued for prescribing addictive drugs and failed to recognize she was becoming addicted.  The trial court ruled for a summary judgment for the defendant due to the patient assumed the risk of addiction.  The Court of Appeal reversed and remanded the case for trial.  Their rationale was the physician may or may not have considered the possibility of the patient becoming addicted when he prescribed the medicine and this is a question for the jury.  Just because the plaintiff knew of the risk and took excess narcotics and lied to the physician and lied to obtain more drugs, the physician still has a duty to monitor his patients for signs of abuse.  Is it any wonder why Ohio has a malpractice premium problem?  

I just received a response from the plaintiff.  It follows verbatim:

 I am that Crohn's patient that became addicted due to excessive prescribing. I saw your opinion and now that I've settled I can speak freely. The one important issue you did not comment on is the amount of narcotics my Dr. prescribed...3,800 in an 8 month period and he finally obtained my records from the Cleveland Clinic at the end of my treatment (after prescribing thousands of pills). In court, he claimed that I forged them, but we later obtained all the original prescriptions and they were proven to be his. As a physician, I would think you'd understand that addiction is not an overnight occurance. My Dr. knew I was taking more than what was prescribed, he mentioned it in his notes after 3 months of treatment (yet he continued to prescribe narcotics). He told me that sometimes "all we can do is medicate". That message played a large role in me being able to justify my use. He also didn't document many Schedule II narcotics, and on many occasions prescribed without an examination which is a criminal offense. I was healthy, no disease and no need to treat with narcotics.  Actually, after treatment at the Cleveland Clinic Pain Management Department I learned that opiods can actually cause abdominal pain. It would have been nice for a physician specializing in Gastroenterology to know that. Don't you think? My life was destroyed by drugs but I am sober today and have been for 5 years now. I know I have my part of blame in all of this but I didn't have the medical training nor the life experience to understand addiction, my Dr. did. I wasn't looking to get rich. Honestly, I wanted my medical bills paid... that's it. I feel my case will help protect the patients who unwittingly become dependant and addicted. There is also an article on Medscape to support my view. "The Gastroenterologists Side of the Story".
      I think I am most proud of the effects it had on the law in the state of Ohio. As the medical community is handing out anti-depressants and various drugs  to patients of all ages it worries me that we are becoming a nation dependant upon pills, that is such a wrong message to send. Drug companies are marketing straight to the consumer. Physicians are literally wined and dined so they can prescribe these drugs. I managed a fine dining resturant and saw Dr.'s enjoy the bottles of 1999 Far Niente and 2 Lb lobster tails. I don't see them standing up for the patient that struggles to pay for their $200.00 heart medication. The medical community can't demand respect because they have turned medicine into big business. They don't hold each other accountable actually they bend over backwards to cover each others asses. The medical community has many issues and a little self reflection couldn't hurt.  If they would examine why these cases are filed perhaps they could educate to minimize their mistakes. Instead they would rather mame, injure and kill patients and have no consequences. Treatment at the patients risk.
      My advise to you is don't be ignorant by commenting on cases if you don't have all the facts. This physician violated FEDERAL LAW. He could have his license revoked! My issue was to protect others and to stop this physician from addicting another patients! By the way PIE the insurance company went bankrupt because executives were lining their pockets by inflating earnings and assets! Are you familiar with what damages are? It's not a dollar amount you pull out of the sky!  J.  Hutsell  

Simmons v Arnold Palmer Hosp.
Case not yet filed

A nurse was cutting the name tag off a newborns ankle when she inadvertently snipped off part of a toe distal to the nail.  The area was reattached but it remains to be seen how much takes.           

Iriondo v Hartford Hospital
Conn. Superior Ct.

A twelve year old boy was diagnosed with a benign spinal tumor and admitted to the hospital.  He was scheduled for surgery 3-4 days later.  While in the hospital the tumor swelling became worse.  He lost control lost movement of his arms and legs.  This was noted and recorded in the chart by a medical student but no one paid attention. The remainder of a team never saw the child. The boy is now permanently quadriplegic with a permanent tracheostomy.  The jury awarded $9.8 million in economic loss and an additional $2.7 million for pain and suffering.          Top


HealthAmerica v Susquehannna

A judge ruled for the health system against the HMO.  The HMO originally sued since a merger creating a strong health system led to better bargaining for the system.  The judge said that the system is a solitary system and can not conspire against itself.        Top

Fraud and Abuse

US v Pennock Hospital

Pennock Hospital in Hastings, Michigan will pay the feds $850,000 to settle charges that they upcoded pneumonia charges.  The hospital could not substantiate their coding for the more severe form of pneumonia.  They blamed an inanimate old computer system not the people who entered the data into the inanimate old computer system.   

US v Chicago Hospitals

The University of Chicago and Northwestern University have settled a claim by the government in a whistleblower suit regarding doing transplants on patients who were not appropriate candidates.  The fines were $1115,000 and $23,587 respectively.  The University of Illinois is being sued for triple damages for over $3 million.  It was accused by a transplant surgeon of inflating the numbers of eligible liver transplant patients to make sure it would continue to receive federal and state funding.          Top


Belavilas v Weller
Nev. Small Claims Ct.

The plaintiff waited to see the physician for three hours and then left.  He sued the physician in small claims court for $5000.  He won $250.  The physician never explained to the patient why he was late nor even offered an apology.  Bad manners deserve to be punished.  The physician plans to make matters worse by appealing the decision.  I truly hope he loses.        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.