January 1, 2007 Recent Legal News
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Weber v Conn.
Filed
Dr. Weber, an ophthalmologist, is suing the state Department of Social Services. He was referred for fraud for using a particular billing code. Dr. Weber is suing for retribution, due process violations and malicious prosecution. He states his problems started when he wrote to a state legislator criticizing the Department of Social Services. The legislator sent the letter to the department for investigation. The main complaint was he used a code he had used in the past that the Department had said to use and which had was ok in four audits. The Department accounting manager drafted the response to the legislator and stated that Weber had failed to cooperate in an audit. Weber has a thank you letter from the manager regarding the audit. The manager then recommended that criminal charges be filed against Dr. Weber. The manager failed to forward the entire file to the supervisor who stated that if he had seen the entire file he would not have recommended any charges be filed. Dr. Weber was eventually arrested for larceny and after the manager testified that he had withheld information regarding other providers that used the same number and were not prosecuted the state prosecutor wanted to dismiss the charges and when that was refused by his supervisor requested to be removed. The case was eventually dropped.
Physicians v Blue Cross
Filed
The California Medical Assn. has asked to join the patients in suing Blue Cross for their illegal retro denial of payment for care. This makes all three segments suing Blue Cross at the same time. The Hospital Association filed its own class action suit a week prior. Blue Cross' action is doing more than anything else to bring expansion of health care to all Californians at the expense of the insurers and employers. Blue Cross has already been fined $200,000 for its practice of retroactive denials of approved care on those with individual policies.
US v Physicians
Filed
The FTC has accused and filed a consent order on some Chicago medical groups for price fixing and refusing to deal with certain health plans. The main offender, according to the FTC, is Advocate Health Partners (AHP). The feds state that the group negotiated fees with health insurers without any efficiency enhancing integration. After AHP negotiated a contract, the individual physician could opt in or out. AHP also terminated a contract that would not agree to its terms. The others named are Advocate Bethany Health Partners, Advocate Christ Hospital Health Partners, Advocate Good Samaritan Health Partners, Advocate Good Shepherd Health Partners, Advocate Illinois Masonic Health Partners, Advocate Bethany Health Partners, Advocate Health Centers and Dreyer Clinic. After a thirty day hiatus, the order will be final. The fine is $11,000 per incident. Top
Mann v Memorial Hosp.
Filed
Mann, the father of an infant who died at White Memorial Hospital in Los Angeles after contracting Pseudomonas has filed suit against the hospital. In the meantime the same day as a second infant passed away, the hospital made the announcement that it is re-opening the neonatal unit. It was shut down after the bacterial outbreak that affected the babies and then spread to the Peds unit. The infection was traced to laryngoscope blades. It appears that the blades were not sterilized correctly. The hospital changed its policy of having the sterilization department doing the cleaning to the respiratory department doing it. Since the outbreak the sterilization department is back doing what it does best.
Phillips v Eckard
Penn. Superior Ct.
A jury gave a woman $8 million due to the negligence of a pharmacy mixing up a prescription. She was supposed to get prednisone at 250 mg. per day but got 1250 mg. instead. The computer caught the error but a manual override was used to fill the prescription. The patient had only one kidney, a transplant, for which she was taking the anti rejection drug. She lost the transplant. She was told that due to the high steroid dose she could not get another (third) transplant and could not be put on dialysis. The jury decision was moot since Eckart Drugs settled while the jury was out.
Schroeder v Northwest Hosp
Ill. Ct. App.
The physicians involved gave a patient a contraindicated drug and the patient died. The family sued the physicians and the hospital. The hospital requested and received in the trial court summary judgment for independent contractor status of the physicians. The court of appeal reversed stating the consent form that stated the physicians were independent contractors was confusing and could be interpreted several ways. It will be up to the jury to decide if the hospital could be considered as vicariously liable because of the consent form. Top
Silva v Hoag Hosp.
Cal Ct. App.
Silva, a neurosurgeon, had his privileges restricted by the MEC. Silva requested a hearing but left the hospital to take a new job in another state. The MEC then changed its recommendation to a letter of censure and placed him on indefinite suspension. These are non-reportable actions and do not initiate a hearing. Silva then sued for damage to his reputation. He lost since it was considered under California law a Strategic Lawsuit Against Public Policy (SLAPP). The California Supreme Court had already decided that peer review was a public item and that the claims fell under the scope of the statute. The trial court now has to decide if all the elements of SLAPP have been met.
Reed v Franklin Hosp
WD La.
The hospital had suspended a physician based solely on an ad hoc committee report. The physician then requested a hearing and immediately filed suit for violation of due process and breach of contract. The court awaited the outcome of the hearing which recommended the Board rescind its suspension and deleting the report form the Bank. The Board did the right thing and reinstated the physician. The law suit then went on and the hospital requested HCQIA protection. The court said no since one of the claims was discrimination. The breach of contract claim went to the hospital. The court stated that ill will was immaterial as HCQIA only asks if the action was objectionably reasonable. The court actually was wrong. HCQIA requires all four points of the rule to be in place not just one. Ill will breaks the rule. Top
Kansas v Tiller
Superior Ct.
The judge dropped the charges against Dr. Tiller, a provider of late term abortions, after a request by the local prosecutor. The Kansas attorney general Kline had the case filed without consulting with the local DA. Kline had already lost his bid for re-election and wants the charges reinstated prior to leaving office. Kline had filed 30 misdemeanor charges relating to 15 abortions including one on a ten year old. None were late term abortions. Top
Mannick v Kaiser
Contempt of Court
Mannick was a patient at Kaiser Oakland and confined to a wheelchair. He found that there were no ADA compliant bathrooms nor anything else for the disabled. He sued and the judge told Kaiser to get its act together and build ADA compliant facilities. This was several years ago. Kaiser as usual did nothing. They were found in contempt of court and ordered to appear every three months to detail the progress of the original order. The plaintiff won money as well but will not discuss the case until the entire project is finished. The contemptible Kaiser asked for and received more time to comply. Top
US v U. of Miami
Settlement
The University of Miami has agreed to pay to settle an old PATH dispute. Per usual, they paid but admitted no wrongdoing, but they did. 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.