September 15, 2007 Recent Legal News
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US v Federation of Physicians
& Dentists
Settlement
The feds alleged the Union illegally drove up prices for 120 OBs in the Cincinnati area. The union to settle the case agreed to not coordinate negotiations anywhere in the country. They can not even train physicians about contracts and negotiating with payers.
Physicians v Memorial Hermann
Filed
The physician owners of Town and Country Hospital which opened in Houston, Texas, in 2005 is suing Memorial Hermann a 8 hospital chain for their pressuring of insurers not to contract with Town and Country. The allegation states that Hermann told insures that they would terminate their contracts with them and demand an additional 25% rate increase if they contracted with the physician hospital. Hermann holds a 25% market share in the area. After several years of attempting to stay open Town and Country was purchased by Hermann for $70 million and then closed it down. The physician investors lost their invested money and are still on the hook for an additional bank loan of $3.5 million. Hermann is currently under investigation by the Texas Attorney General for antitrust.
After filing the above suit in both Federal and State Courts the plaintiff agreed to drop the antitrust Federal action and only sue on the State actions. This was in response to Memorials counter suit seeking declaratory relief.
Hetz v Aurora Med Ctr
ED Wisc
Dr. Hetz was denied privileges at the hospital due to bipolar disorder and sleep apnea. He sued and won in summary judgment and appeal the right to sue the hospital under the ADA even though he was not an employee. The physician could sue under the concept of the hospital being a place of public accommodation which may not discriminate against anyone seeking to use the full facilities. Top
Williamette v PeaceHealth
9th Circ
The 9th circuit overturned a jury verdict in favor of Williamette for over $16 million. The Court stated the jury instructions were wrong. The 9th ruled that PeaceHealth did act anti-competively when it offered deep discounts on tertiary care if insurers made it their exclusive hospital for all services. The court denied the summary judgment for PeaceHealth on the tying claim.
Lacoste v Pendleton Methodist
La Supreme Ct
The Louisiana high court ruled that lack of an evacuation plan in hospitals accused of negligence in the deaths of patients during Katrina is not medical malpractice. This allows the suits to go directly to court and not have to go to med mal panels first.
Illinois v Provena
Appeal
Illinois has decided to appeal the verdict in a low court that stated the Urbana, Illinois, hospital did enough to justify its tax exemption. Provena spent under 1% of its revenue on charity care. To date, since it lost its exemption, Provena has spent about $5 million on property tax. The hospital will need to continue to pay the tax while the appeal is decided. There will probably be an appeal after this one, no matter who wins to the state supreme court.
MRI Assoc v St. Alphonsus
Jury Verdict
The federal jury in Ada County, Idaho, found that Saint Alphonsus Medical Center illegally cancelled the contract with MRI Associates in favor of another medical group. The jury awarded $63.5 million to the radiology group. The original plaintiff was the hospital suing to get the group to pay back the hospital after it withdrew from a partnership. This led to a counter suit stating the hospital withdrew without proper cause. The suit accused the hospital of partnering with Intermountain Medical Imaging and then doing anticompetitive things to MRI. The partnership stated that any partner could pull out if one of four conditions occurred. These were anything that jeopardized the hospital tax exempt status, jeopardized the Medicare or Medicaid status, violated state or federal laws or was contrary to the ethical principles of the Catholic Church. I guess breaking a contract isn't against Catholic teachings. Top
States v UnitedHealth
Settled
UnitedHealth has agreed to pay a fine of $12 million to settle claims by 36 states against them for poor handling of claims. They also must reprocess claims and pay interest per each state's laws. UnitedHealth is embarrassed by this incident as well it should be. The fines should also have been much higher. If UnitedHealth does not perform what they are supposed to do more fines will be imposed. Top
Webb v Smart Document Solns
9th Circ
In another attorney stupid move designed only to make money and harass the defendant, a law firm sued as a class action a document firm. The basis is that the firm charged the law firm more than the reasonable cost of duplicating the medical record as required under HIPAA. HIPAA only states this about individuals and not their representatives. Therefore, the law firm spend a large amount of money and time for a small amount of damages and tried to make it up by using the class action method. I might add that there is no private right to sue under HIPAA. Stupid is as stupid does. Top
Mileikowsky v West Hills Hosp
Ca Ct App
The physician, an OB/GYN, had previous been removed from two hospital staffs and was about to be removed from the third. The hospital had asked in discovery for the transcripts of the hearing at Cedar Sinai Hospital. The physician failed to comply after almost one year. The hearing officer then terminated the hearings after only a voir dire due to the non cooperation of the physician and stated that the MEC recommendation was then in effect. The hospital Board affirmed. The underlying court agreed with the hospital after the physician appealed. The Court of Appeal overruled the underlying court stating that the hearing officer had no statutory right to prematurely close the hearing and declare that a decision by the MEC should stand. The hearing officer can only rule on procedural matters and can not be the decider of the matter. The Court of Appeals did err by not understanding what is meant by "courtesy" privileges. They order the underlying court to see if the physician had an injunctive right to retain his privileges during the continuation of the hearings. He should not have that right. It should be noted that the hospital attorney in this case made several procedural errors which led to the decision.
Ennix v Stanton
ND Ca
The court have summary judgment to the hospital on all state claims by a physician who lost his surgical privileges. He claimed he did not have to exhaust all his administrative remedies before suing. The court disagreed. The physician was given a choice of either accepting a total suspension of his surgical privileges or being proctored. He chose the later and no reporting. Therefore it was his decision and not the hospitals not to have a internal peer review hearing. Top
Louisiana v Magano
Jury Verdict
The Maganos, a husband and wife, that owned a nursing home in Louisiana had been charged with negligent homicide in not evacuating the patients ahead of Katrina. The jury found them innocent of all 24 counts of cruelty to the infirmed. The state is now 0 for 2 in attempting to pawn off their ineptness to individuals. The jurors said the Maganos were not perfect but they were not criminals either. One juror put the blame squarely on the government of the state. The state attorney general is suing the US government for the disaster and then turned around and came after the Maganos for the deaths of the people in their nursing homes.
Kansas v Tiller
Charged
Kansas has charged Dr. George Tiller of violation of a 1998 statute that prohibits late term abortions without independent second opinions. The state believes that the second opinion given by Dr. Ann Neuhaus in 19 cases. The accused physician states the law is unconstitutional under the 1973 case of Doe v Bolton. The two physicians were not affiliated in any way.
US v Srivastava
Settlement
Dr. Pradeep Srivastava a Maryland cardiologist has agreed to pay $476,000 to settle claims that he fraudulently billed for services not rendered and unbundling. The physician will also have to undergo a monitored integrity agreement for five years. 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.