January 15, 2007 Recent Legal News
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Patients v Emory University
To Be Filed
Emory has joined the growing ranks of institutions that have lost patient data. This time it is 36,000 patients. A computer with the names and information was stolen from a contractor in Ohio. Emory has advised the people affected to place a fraud alert on their credit reports. There was no indication that the University would pay for this to be done. Top
Tenet v Kaiser
Filed
Multiple Tenet hospitals have joined together to sue Kaiser for not paying about $16 million in medical bills. The suit claims that Kaiser did not pay contracted rates between 2000 and 2004. Kaiser has refused to pay some bills since the condition was not life threatening. If the patient believed the condition required immediate attention, retroactive denials are an easy road not only to a law suit but to the Department of Managed Care levying fines. It is a good thing that Kaiser keeps a stable of attorneys otherwise they would be paying a fortune for their defense. Another waste of healthcare dollars.
Patients v Catholic Health West
Settlement
A judge has approved a settlement between Catholic Healthcare West and uninsured patients. The hospital chain will pay up to $423 million for overcharging the uninsured. The patients in the class action may file for a refund or a reduction of up to 35% from their bills.
Simkins v Conner
Or. Ct. App.
In 1996 Simkins had a stress test by an employed physician of Willamette Falls Hospital. The cardiologist told Simkins the test was normal when it wasn't and did not tell the patient's physicians about the test. Simkins died of an MI in 1998. The plaintiff requested all medical records and the records regarding the stress test were intentionally omitted. These records were not given until 2002 , after the statute of limitations had expired. The trial court ruled for the hospital but the Appeals Court overruled and discussed the economic loss suffered by the plaintiff due to the defendant hospital's negligence. Top
Strini v Edwards Lifesciences
NDNY
Strini had heart valve surgery and then needed to have the valve removed due to mycoplasma infection. He sued the valve manufacturer and both the patient and the manufacturer requested hospital information generated by the infection control and quality control committees. The court stated that the information was protected since the information had been prepared as part of the programs.
Doe v Dept. Health
Fla. App. Ct.
A physician attempted to quash the Department from obtaining a hospital peer review records. The hospital had reported that the physician had resigned under investigation. The physician argued that the information was protected under the peer review laws but the court stated that the Department could get the records since the records were part of the state's disciplinary process and not malpractice.
Haas v Wyoming Valley Health
ND Pa.
Haas, an orthopedic surgeon had a mental disorder and relinquished his privileges. After treatment he requested his privileges again and the hospital stated he had to monitored for all cases for six months. The physician sued stating that this could not be done. The hospital stated that without the monitoring the physician would constitute a direct threat to patients. The hospital lost the summary judgment motion since two psychiatrists testified that Haas was able to practice and the issue that he was more of a direct threat than other orthopedic surgeons without the disease was an issue for the jury.
US ex rel. Conners v Salina Health
D. Kans
Conners was removed from the staff and then filed a false claim action against the hospital along with retaliatory discharge. The retaliatory discharge were past the statute of limitations. and the False Claims Actions were summarily dismissed. Top
Barrios v Sherman Hosp.
ND Ill.
The patient entered the hospital and claimed she was not screened when she was in labor. She miscarried and was discharged prior to the placenta being delivered. Doesn't take a genius to know that this went against the hospital and the patient had filed a legitimate EMTALA claim. Top
Zembach v HealthNet
Ca. Ct. App.
Zembach, a city employee, signed himself and his family up with HealthNet HMO in 2002. He signed the enrollment form which had no arbitration agreement. He later sued HealthNet for disallowing his child to see an out of network specialist for a rare illness. The HMO went to court to block the suit stating that arbitration was necessary. The courts looked at the contracts and there was an added arbitration clause in 2005 but the only signature was on the 2002 form. The 220 arbitration form was against the Health & Safety Code by not being prominently displayed. The patient could sue. Another issue of spending much more than required to satisfy the patient.
AMA v United Healthcare
SDNY
The AMA filed an amendment to its complaint to add RICO and antitrust complaints against United for its claims reimbursements policies. The plaintiffs claim the defendants manipulated a data base that was faulty. This case has been going on for the past 6 years and is still in the pleading stage. The Court allowed the amended complaint. Top
Sarka v Univ. Calif.
Cal. Ct. App.
Sarka, a primary care physician, was ordered by his superior to not order so many tests. Sarka disobeyed. This had been stressed to Sarka over his 14 years of employment. The final was the University had a right to fire the physician. Sarka attempted to use Business and Professional Code 2056 in his defense. the code states that a physician may not be removed for advocating for his patients.
US v East Tennessee Heart
Consultants
Settlement
The medical group was turned in by former employees for retaining overpayments and intentionally concealing the credit balances. The practice will pay $1.5 million to the feds, $200,000 to the state, $44,000 to Blue Cross, $123,000 to private insurers and $1 million to thousands of patients. They are also being placed on a five year CIA. So much for any bonuses.
Mohanty v St. John Heart
Ill. Supreme Ct.
Two physician employees of the Clinic resigned after they alleged that hte Clinic was not paying them what they had promised. Both had non-compete clauses in their contracts. The pair sued to have the non-Competes deleted as against public policy and because of the breach of contract by the Clinic. An interesting side is the covenants prohibited practicing medicine in the defined area but the clinic only practiced cardiology. The Courts went for the broader medicine definition. and stated the covenants were enforceable. This decision by the Supreme Court finding that covenants were okay for physicians went against a prior decision stating the covenants were not enforceable against attorneys. For the attorneys the use of restrictive covenants goes against the Illinois Rules of Professional Conduct. There is no such thing in Illinois for physicians and the AMA's statements carry no weight. The high court also stated that there was no breach of contract and the temporal conditions were ok, even up to five years in duration since it took the Clinic about 10 years to get firmly established. Top
US v SSCI
Settlement
SSCI health Services and SSCI Hospital will pay the government seven figures for paying physicians for referrals. SSCI denies any wrongdoing but all who do no wrongdoing pay seven figures. Top
US v Zakharia
Indicted
A Miami cardiac surgeon, Dr. Alex Zakaria, has been indicted for lying under oath while giving a deposition in a med mal case. He overstated his qualifications. Since the case was a Veteran case,, the defense was the US Attorney's office in the Eastern District of Michigan. This is the same office that is prosecuting the physician. Prosecutional malpractice ?? Top
Simon v Biddle
La. Ct. App.
The plaintiff was pregnant and had a C-Section. She was supposed to have a Section and a tubal ligation but the consent form had no tubal on it so it was not performed. the patient was never notified and became pregnant again. The trial court ruled for the physician on summary judgment. the Appellate Court overruled. There was a genuine issue of fact as to whether the standard of the physician telling or not telling the patient was breached. 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.