Gonzalez-Morales v. Presbyterian Cmty. Hosp., Inc. — Nov. 2015 (Summary)

EMTALA

Gonzalez-Morales v. Presbyterian Cmty. Hosp., Inc., Civ. No. 13-1906 (PG) (D. P.R. Nov. 17, 2015)

The United States District Court for the District of Puerto Rico granted in part and denied in part a hospital’s motion to dismiss EMTALA-related claims made by a patient.

The patient was taken to the hospital’s emergency room presenting with symptoms of swelling and redness of the left arm, a recent insect bite to the left hand, and severe right hip pain. The patient was prescribed intravenous antibiotics and pain medication, and was discharged. However, she claimed that although the pain in her left arm had subsided, she had continued to complain of right hip pain and difficulty walking prior to being discharged. One day later she returned to the hospital but was discharged without being admitted. The patient then returned to the hospital three days later but was once again discharged without being admitted. As a result of her condition, she claimed to have suffered destruction of her right hip bone, chronic pain, and difficulty walking.

The first claim brought by the patient was a failure to screen claim. The court was unwilling to dismiss this claim because the patient had sufficiently articulated her cause of action. Also, the hospital had failed to counter the allegation that the screening she was provided during her three visits was not uniform to the level of screening the hospital provides other patients presenting with similar complaints. The second claim brought by the patient was a failure to stabilize claim. The court dismissed this claim because the patient never alleged that she was suffering from or was diagnosed with an emergency medical condition before her discharge.

Troilo v. Michner — Nov. 2015 (Summary)

APPARENT AUTHORITY

Troilo v. Michner
Civil Action No. 13-2012 (D.N.J. Nov. 13, 2015)

The District Court of New Jersey denied a medical center’s motion for summary judgment with regard to a medical malpractice action brought by a patient who claimed the medical center was liable for a physician’s negligent stillbirth of the patient’s child.

The patient had received medical care from the physician at the medical center on two occasions, the first after falling on her stomach, and the second for the delivery of her stillborn child. Although the medical center had provided a “conspicuous disclaimer” of the independent status of the physician, the court explained such a disclaimer was only one factor among many that must be considered to determine whether the physician was acting under the apparent authority of the medical center. The court held a jury could find the medical center failed to take sufficient measures to provide notice of the doctor’s independence because of the patient’s difficulty with reading. Additionally, the court noted the patient was not provided an opportunity to reject the care of the physician, further supporting the decision to dismiss the motion.

Malanga v. NYU Langone Med. Ctr. — Nov. 2015 (Summary)

FALSE CLAIMS ACT – RETALIATION

Malanga v. NYU Langone Med. Ctr.
No. 14cv9681 (S.D. N.Y. Nov. 12, 2015)

The District Court for the Southern District of New York denied a motion to dismiss a claim brought by a former director of research against a university and her supervisor regarding retaliation under the False Claims Act (“FCA”), among other things.

The director alleged university employees were unlawfully billing the federal government for blood tests, overcharging federal grants for patient visits, and paying the salary of a post-doctorate employee out of an unrelated federal grant. Furthermore, the director reported the university to the Department of Defense for allegedly failing to adhere to study protocols by failing to follow up with 300 patients, at least one of whom died. The study was suspended as a result. In alleged retaliation, the director claimed her supervisor corroborated false complaints to the university human resources department made by another employee.

The district court upheld the director’s retaliation claim under the FCA, holding that if the court accepted the director’s allegation that the university’s billing practices were outside the scope of her job duties, the court could not determine whether she was subject to a heightened pleading standard as a “fraud alert” employee. Additionally, the district court held it was “inappropriate” to consider performance evaluations that alleged the director altered medical records and exhibited unprofessional conduct at an early stage of litigation. The district court also held the director did not waive her right to a federal retaliation claim by bringing a claim under a New York Labor Law prohibiting retaliatory conduct against employees who report improper patient care because the Supremacy Clause trumped any waiver of rights and remedies contained in the state law.

Molleston v. River Oaks Hosp., Inc. — Nov. 2015 (Summary)

Molleston v. River Oaks Hosp., Inc.
No. 2014-CA-00421-COA (Miss. Ct. App. Nov. 10, 2015)

The Mississippi Court of Appeals reversed a decision of a trial court, holding a hospital violated the due process rights of a neurosurgeon by failing to comply with the hospital’s own bylaws during the credentialing process. The neurosurgeon applied for medical staff privileges at the hospital, which were denied by the MEC upon recommendation of the Credentials Committee. The neurosurgeon requested a hearing before the hospital’s Fair Hearing panel, in accordance with the hospital’s bylaws. With regard to the composition of the committee, the hospital bylaws stated, “No Staff member or Board member who has actively participated in the consideration of the adverse recommendation or decision shall be appointed a member of this hearing committee.” However, the chair of the Credentials Committee was appointed to the Fair Hearing panel, where he participated in the panel’s deliberations, vote, and decision. After the Fair Hearing panel and Board both voted to uphold the denial of appointment and privileges, the neurosurgeon brought suit. While the trial court found that the hospital had shown “substantial compliance with its bylaws and procedural due process,” the appeals court disagreed, holding that the hospital failed to provide the neurosurgeon with an opportunity to be heard at a “meaningful time and in a meaningful manner” because the chair of the Credentials Committee served on the Fair Hearing panel.

Chattanooga-Hamilton Cnty. Hosp. Auth. v. UnitedHealthcare Plan of the River Valley, Inc. — Nov. 2015 (Summary)

Chattanooga-Hamilton Cnty. Hosp. Auth. v. UnitedHealthcare Plan of the River Valley, Inc.
No. M2013-00942-SC-R11-CV (Tenn. Nov. 5, 2015)

A hospital that was a non-contract provider for a Tenncare MCO’s beneficiaries claimed the MCO was underpaying the hospital for emergency services. The hospital claimed that, under the Deficit Reduction Act of 2005, the MCO was obliged to pay the hospitals which rates were negotiated by contract “the average contract rate that would apply under the State plan for general acute care hospitals or the average contract rate that would apply under such plan for tertiary hospitals” for emergency services. Tenncare had submitted two amendments to the state Medicaid plan to CMS, requesting the reimbursement for emergency outpatient services provided by non-contract providers to be set at “74% of the 2006 Medicare rates for those services,” and reimbursement regarding inpatient hospital admissions at non-contract provider hospitals required as a result of emergency outpatient services to be set at “57% of the 2008 Medicare Diagnostic Related Groups (DRG) rates.” CMS approved both of these amendments, and Tenncare promulgated regulations consistent with these amendment plans.

The hospital filed a complaint with the Chancery Court requesting declaratory judgment that the MCO was required by Tennessee law to pay the hospital “at the rate equal to the prevailing average contract rate payable by TennCare MCOs” for EMTALA-mandated services and “at a reasonable rate of reimbursement for” services provided to patients not mandated by EMTALA. The hospital also brought claims of unjust enrichment and breach of contract in relation to the underpayments. The MCO contended that because the hospital was challenging the applicability of the Tenncare regulations, the hospital’s complaint must be dismissed because the hospital failed to obtain a declaratory judgment from Tenncare, thereby failing to exhaust its administrative remedies as required by the Uniform Administrative Procedures Act (“UAPA”). Additionally, the MCO asserted a defense of set-off and recoupment, arguing it had paid the hospital for non-contract EMTALA-mandated services in excess of $6 million. The trial court dismissed all of the claims, holding the court was without jurisdiction until the hospital exhausted its administrative remedies. The Court of Appeals reversed, holding the dispute between the hospital and the MCO was “merely a disagreement over the interpretation of the regulations,” and that the hospital was not required to exhaust its administrative remedies. The MCO appealed the decision to the Tennessee Supreme Court.

On appeal, the Tennessee Supreme Court held that the resolution of the hospital’s claim would “necessarily require” the trial court to render a declaratory judgment concerning the validity of the Tenncare regulations, and the court was unable to do so until the hospital had exhausted its administrative remedies with Tenncare. The hospital was required to exhaust its administrative remedies despite Tenncare not being a party to the suit between the hospital and MCO. The court did reverse the trial court’s decision to dismiss the hospital’s claims for money damages and the MCO’s counterclaim for recoupment, noting the validity of the Tenncare regulations is implicit in each of these claims. Therefore, the court remanded these claims to the trial court to be held in abeyance pending the resolution of the Tenncare proceedings.

Miller v. Huron Reg’l Med. Ctr. Inc. — Nov. 2015 (Summary)

Miller v. Huron Reg’l Med. Ctr. Inc.
No. 4:12-CV-04138-KES (D.S.D. Nov. 5, 2015)

A physician who was subject to a report in the National Practitioner Data Bank filed claims against a hospital alleging breach of express contract, breach of implied contract, negligence, and defamation. The claims arose from a dispute between the hospital and a general surgeon who voluntarily reduced her surgical privileges after a request from the MEC to do so. While the surgeon was told that her voluntary reduction in privileges was not a reportable event, the hospital ended up reporting her reduction in privileges to the National Practitioner Data Bank after determining that she was under investigation.

The court denied the hospital’s motion pertaining to the breach of express contract, finding that the surgeon did not receive a hearing as required by the Medical Staff bylaws. While the hospital sought immunity under the Health Care Quality Improvement Act for the surgeon’s negligence claim, the court denied immunity, finding that a reasonable jury could hold that the surgeon was not under an official investigation – and thus not subject to reporting – at the time she agreed to reduce her privileges. Further, because the hospital and medical staff leaders knew the surgeon was not under investigation at that time, the court found that a reasonable jury could find that the hospital was aware of the false information contained in the adverse action report. Finally, the court did not dismiss the surgeon’s claim for defamation against the hospital because a reasonable jury could find that the hospital knew that false information was in the adverse action report filed with the National Practitioner Data Bank.

In re Matter Under Investigation — Nov. 2015 (Summary)

In re Matter Under Investigation
No. 15-509 (La. Ct. App. Nov. 4, 2015)

A nurse anesthetist applied for privileges at a hospital and as a part of the process was required to submit references. Peer review references are to be confidential according to statute. After the applicant was denied privileges at the hospital, he sought to obtain a review letter from a reference at the anesthesia program where he attended school. The applicant thought he received a bad reference after being involved in a lawsuit against the school. He was denied access to the letter, as the peer references were deemed confidential under the state’s peer review statute. He then filed a complaint with the sheriff’s office for criminal defamation.

The sheriff’s office sought a search warrant to obtain the letter. A temporary judge granted the search warrant but placed the seized documents under seal based on his own concerns about the legality of the warrant. When the regular trial judge returned, he held a hearing and granted the hospital’s motion to quash the warrant and ordered that the letter be returned to the hospital.

The sheriff’s office appealed, but the Court of Appeals affirmed the trial court’s holding that the letter be returned, as the information sought was clearly protected by law.

Tate v. Univ. Med. Ctr. of S. Nev. — Nov. 2015 (Summary)

Tate v. Univ. Med. Ctr. of S. Nev.
Case No. 2:09-cv-01748-LDG (NJK) (D. Nev. Nov. 4, 2015)

UPDATE:  reconsideration denied, 2:09-cv-01748-JAD-NJK (D. Nev. May 4, 2016)

The United States District Court for the District of Nevada granted in part and denied in part summary judgment on a physician’s Section 1983 civil rights action, breach of contract, and breach of the covenant of good faith and fair dealing. The court held that the Health Care Quality Improvement Act of 1986 (“HCQIA”) did not provide immunity for the hospital from monetary damages to the physician’s claim alleging a violation of procedural due process rights under Section 1983. However, the court granted the hospital immunity as to the remaining contract claims. It reasoned that the language of HCQIA precluded application of immunity for damages brought “under any law of the United States relating to the civil rights of any persons or persons”; and a claim brought pursuant to Section 1983 was consistent with this portion of the statute. The court also determined that the medical staff could not be held liable for the contract claims.

Scott v. Sarasota Doctors Hospital, Inc. — Nov. 2015 (Summary)

Scott v. Sarasota Doctors Hospital, Inc.
No. 8:14-cv-1762-T-30TBM (M.D. Fla. Nov. 5,  2015)

The United States District Court for the Middle District of Florida denied a hospital’s motion for summary judgment on a hospitalist’s gender discrimination and retaliation claims. The hospitalist was employed by a physician services provider who assigned her to work at the hospital full time. While she was subject to a number of informal complaints about her “abrupt” and “curt” behavior, none of the concerns regarding the hospitalist’s behavior were ever reviewed through formal channels. She was, however, being encouraged to consider positions at other hospitals by her medical director, and the hospital was actively seeking a replacement for her. Feeling she was being treated differently than her male colleagues, who she alleged were given opportunities to respond to complaints and correct their behavior, the hospitalist filed a charge of gender discrimination against the hospital. Then, after having a confrontation with the hospital’s human resources generalist, the hospitalist was escorted from the hospital. The hospital then informed the physician services provider that it wanted the hospitalist permanently removed from the hospital because of her ongoing behavioral issues. The hospitalist was later terminated by her employer.

The hospital argued it was entitled to summary judgment on the hospitalist’s discrimination claims because it was not her employer. However, utilizing various legal theories, the district court determined that the hospital was a joint employer of the hospitalist. Next, the hospital argued that even if it were found to be an employer during the relevant time, the hospitalist’s gender discrimination claim failed because she failed to show that the hospital treated similarly-situated males more favorably. The court disagreed with this reasoning as well, citing the fact that a male physician who had exhibited similar behavior had been offered counseling, anger management classes, etc. before he was terminated. Therefore, there was sufficient evidence to make the issue of discriminatory intent one for a jury.

 

U.S. ex rel. Jajeh v. John J. Stroger Hosp. of Cook Cnty. — Oct. 2015 (Summary)

FALSE CLAIMS ACT

U.S. ex rel. Jajeh v. John J. Stroger Hosp. of Cook Cnty.
No. 13-cv-4728 (N.D. Ill. Oct. 30,  2015)

The United States District Court, Northern District of Illinois dismissed a physician’s claims under the False Claims Act for fraud and retaliation brought against a hospital that previously employed the physician. The physician alleged that his former supervisor at the hospital disbursed funds from NIH issued research grants in an illegal manner and in violation of NIH policy. The physician also alleged that after he made complaints to the hospital and the FBI about the alleged improprieties, his former supervisor retaliated against him by suspending the physician’s nurse practitioner and restricting the physician’s job duties. The hospital contended that the physician’s claims were barred by the False Claims Act statute of limitations. The court agreed, holding that the physician had not filed either his fraud or retaliation claims within the applicable statute of limitations period.