December 15, 2006 Recent Legal News
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Muehrcke v Housel
Filed
Dr. Muehrcke of Ohio was involved in an auto accident. He hired Housel to represent him in the suit against the other auto. Dr. Muehrke was awarded $10 million in damages. The problem is that the physician claims the attorney did not advise them of court procedures thereby prolonging the case and increasing the attorney fees to the physician's detriment. The physician is complaining that he actually took in only about 50% of the award. After the award the physician was told that the cap is $3 million and then a settlement was effected. If he had know about the cap earlier, an earlier settlement would have occurred. The total amount the physician collected from all defendants was $7.5 million and he paid the attorney $2.9 million. Then the attorney told the physician that there would need to be a guardianship for the eight year old daughter and the probate court would have to approve the attorney fees. The court ruled that the physician would have to pay into a guardianship account $250,000 since she was one of the original plaintiffs. The trial is ongoing. Top
Physician v PPO
Arbitration
In a confidential arbitration a ENT physician has been ordered reinstated into an un-named PPO and his NPDB report and Medical Board report ordered terminated. The ENT had been accused of performing too many endoscopic procedures and keeping insufficient records on four patients. This is an unusual result.
AMA v Blue Shield
Filed
The AMA has entered a prior lawsuit by the Washington State Medical Society against Blue Shield for limiting its provider network. The insurer is accused of using faulty methodology and outdated information in their exclusion of physicians. The original suit claimed defamation of the physicians in the letters sent to the patients. The insurer stated in the letter that the physicians left out of the network lacked "quality and efficiency in their practices."
After the AMA entered the suit, Blue Shield dropped its limited provider network. They then spoke out of the corner of their mouth and stated that their change had nothing to do with the lawsuit. The suit will continue for damages to the reputation of the physicians.
Rosenberg v Blue Cross of Tenn.
Tenn. app. Ct.
In a case that goes against precedent in other jurisdictions, the Tennessee Court of Appeal has ruled that physicians can not sue in a class action the insurers for arbitrarily denying them their rightful payments. The court stated that the issue must be arbitrated on a case by case basis. The court felt that the cost of individual arbitrations would not be cost prohibitive for the individual physicians.
Ciamaichelo v Independence Blue
Cross
Penn. Supreme Ct.
The Pennsylvania Supreme Court ruled against the insurer who was being sued for keeping too much money in reserve. Independence had over $438 million in reserve. They were sued by a member who believed that large amount of money could have been used for subsidizing coverage for the uninsured or to expand coverage for its subscribers. The insurer is non profit. The case now either goes to trial or to the Insurance Department for a look at the insurer's rates.
St. Luke's v Health Alliance
Filed
St. Luke's in the Cincinnati area is suing for $540,000 in legal fees for its attempt to withdraw from the Alliance.
Patients v Aetna
To Be Filed
Somebody stole backup data tapes from a lockbox of Concentra Preferred Systems. The company is a subcontractor to insurers including Aetna and Wellpoint. The tapes cannot be used on any personal computer without specific software. The chance of misuse is small but present. Aetna has notified about 130,000 members, Wellpoint and United have still not notified anyone. Aetna has offered to have credit monitoring for its affected members. The theft was in late October but the insurers were not notified for several weeks.
Patients v Geisinger Health
To Be Filed
In the continuing string of loss of patient identification, a computer containing information on Geisinger patients was stolen. The health system has offered 12 months of free credit checks in a letter sent out. The system then states that they don't know how many will need the protection and how much it will cost. Top
Kentucky v Conti
Indicted
Victoria Conti, the vice president of Conti Medical Concepts in Louisville has been indicted for altering medical records, and giving a $4500 television set to a physician for inducing referrals. Ms. Conti states the physician is a family friend and the set was a housewarming present not connected to business. Top
Kern County v Kern Woman's Health
To Be Filed
The county wrote a contract for the services of the physicians to the Kern County Hospital in California. The county now states that the physicians owe the county $317,000 due to the physicians claiming expenses for their private practice. If the county continues to pursue the matter they will lose their physicians but they may get back at least some of their money to use for other things. Of course, the citizens will not have the healthcare they now have and will remember that at election time.
US v Forcada
11th Circ.
A Florida physician Jose Forcada was found guilty of fraud and sentenced to 39 months in prison. The physician appealed and the 11th Circuit upheld the conviction. The physician was accused of diluting HIV drugs and charging for the full dose.
Murrah v Fender
Ga. Ct. App.
The patient came to the hospital for cardiac disease and learned he needed cardiac surgery. He wanted to go to a nearby hospital with better physicians and equipment. He was told by his physician that the surgery could be performed safely at the local hospital. He had the surgery at the local hospital and had a complication which forced the transfer to the other hospital. He ended up with permanent visual impairment. He sued the local physician for misrepresentation but did not have an expert witness. The court correctly ruled that since there was no standard of care and only misrepresentation that no expert was needed. To trial.
Sandu v Mercy Med Ctr
NY App. Ct.
In a case that I don't know why it was filed the physician was released from the emergency care group that had an exclusive contract with the hospital. He sued to get a hearing from the hospital. In fact when he lost his ED privileges he lost his hospital privileges as well. Top
Patients v Sutter
Settlement
The Court has given its blessing on the past summer's settlement by Sutter for overcharging uninsured patients. The settlement is worth about $275 million but the vast majority is forgiveness of debt and not payout. Sutter also agreed to give the uninsured discount prices for the next three years.
Botvinik v Rush Med. Ctr.
ND Ill.
Botvinik was an anesthesiology resident when he was accused of sending a porno package to a female resident. He proved it was not him and eventually graduated from the program. When he applied for a job he was informed he would need letters of recommendations from the anesthesiology program. The hospital had forwarded the accusation to the physician's prospective employer. The physician dropped his application and took a job for less money and then sued the hospital for conspiracy, and malicious interference with business expectancy. The court dropped the conspiracy charge but let the remaining charge go forward to trial. Top
San Diego v California
To Be Filed
San Diego must be rich as they are finding ways to waste taxpayers money. They lost in superior court on the merits of their case to toss out California's medical marijuana law as against federal law. The voters overwhelmingly passed the law many years ago and the state has now stated the counties should issue appropriate ID cards. The county is now appealing the ruling of the superior court. Why because they are only using their own salaried attorneys and not paying any outside counsel or experts. This may 1qualify them as another Board of Stupes. 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.