Singularity Health Law Blog

SHAM PEER REVIEW BOOK AVAILABLE

SHAM PEER REVIEW: THE POWER OF IMMUNTY AND THE ABUSE OF TRUST BY Gregory R Piche' is now available free by email to any of the readers of this blog. Simply provide your name, address and email address and it will be sent to you.

PRO-SE DOCTOR WINS SUMMARY JUDGMENT OVERCOMING HCQIA IMMUNITY .

An Albuquerque Obstetrician/Gynecologist, filed a pro-se lawsuit in Federal District Court in New Mexico claiming that a hospital which permanently suspended his privileges deprived him of his civil rights overcame the hospital’s defense of immunity under the Health Care Quality Improvement Act of 1986 (“HCQIA”). In Chinonyerem Osuagwu v. Gila Regional Medical Center, (No. 1:11 -cv-1 3/27/12), Dr. Osuagwu presented evidence that Gila Regional failed to follow its own bylaws and failed to provide him due process in permanently suspending his privileges without meeting the requirements of HCQIA for immunity.  One of the defendants, Dr. Romillard, a non -practicing gynecologist advised the hospital’s peer review committee as to why Dr. O’s privileges should be suspended.

 

Gun Rights Trumps Hospital/School Property Rights in Kentucky.

Michael Mitchell was a anesthesia technician at the University of Kentucky Chandler Medical Center when he was discovered to have possession of a loaded semi-automatic pistol in his automobile.  The gun was licensed and he had a concealed weapons permit. In April of 2009, the University fired him for violation of its no guns on campus policy. Mitchell, an at-will employee, brought an action for “wrongful termination” for violation of his constitutional rights to bear arms and his rights under Kentucky statutes. Kentucky, like most states recognizes an exception to an “at will” firing where the firing has been the result of a violation of the clearly expressed public policy of a state. Mr. Mitchell’s suit was dismissed on summary judgment and he appealed to the Kentucky Supreme Court which reversed.

HEALTH INSURANCE EXECUTIVE COMPENSATION - A CASE IN POINT

Wendell Potter is a former health care PR Director for Cigna who quit in disgust following CIGNA’s refusal to timely agree to provide a liver  transplant for a 17 year old girl in 2007, Nataline Sarkisyan, who died without the procedure. He now works for the Center for Public Integrity as an analyst. Yesterday, in his blog, he called out the objection by one of the shareholders of CIGNA to the company’s increasing his compensation by 25% to an annual total compensation of about $20,000.  The 46 year old, David Cordani, who looks a lot like the Russian New Jersey Nets owner Mikhail Prokhorov, is frequently sought out on the speaking circuit including Davos, Switzerland where he rails against rising health care costs as being unsustainable. On his departure earlier in the year the Hartford Courant quoted him as saying “ when you take the cost of sickness, its at an elevated level and its growing.”

 

BACK TO THE FUTURE IF THE INSURANCE MANDATE FAILS.

 

If the Supreme Court decides to tank the Affordable Care Act and returns us to the past system, James Carville may just be right that it will be a long term boon for Democrats.   Health Care costs rose from 12% to 17% of GNP from the 1970s to the present.  An estimated 45,000 uninsured die each year over inadequate health care.  The uninsured population is approaching 50,000,000.  People with pre-existing conditions will continue to be uninsurable.  Insurance companies will continue to make money but denying coverage to keep their medical loss  ratios low and their stock prices and bonuses high. 

 Cost shifting will continue to be the major financing vehicle for hospitals and physicians to cover deficits in service shortfalls in funding from Medicare, Medicaid and the uninsured care.  Medical bankruptcy’s will continue to grow from the current 60% of bankruptcy’s.  The cost of private insurance will continue to climb as the consolidation of hospitals exercise increasing leverage to cover their costs and gain a tidy profit. The number of uninsured will continue to rise as employers continue their effort to shift the cost increases to individual employees.

IDAHO SELF ABORTION PROSECUTION REVERBERATES

Jennie Linn McCormack of Pocatello, Idaho has a messy life.  She is the single mother of three children living on a $250.00 per month child support payment for one of her children.  She is unemployed, poverty stricken and desperate. Adding to her troubles she became pregnant again and the father is now serving time in prison for robbery.

WHAT HEALTH INSURANCE COMPANIES DO FOR US.

The writer and curmudgeon Ambrose Bierce once described a banker as a person who wants to sell you an umbrella on a sunny day.  A former judge and friend recently described an insurance company in similar terms as selling you coverage for everything except loss. One of the strange anomaly's of health insurance companies is that they make their money by not providing you the coverage you think that you are paying for. Health insurance companies have grown so big and powerful that in about half of the states there is little or no competition beyond two major providers. They make billions of dollars a year, but they do little for the price beyond providing a largely unnecessary financial load on the most expensive health care system by half in the world.

 

CHILD NOT A “CHILD” UNDER SOCIAL SECURITY ACT?

Modern biotechnology now makes possible issues that were not contemplated by Congress in the adoption of the Social Security Act.  One of those issues is whether a child conceived by artificial insemination a year after her father’s death is a “child” of her father entitled to survivor benefits under the Social Security Act.  The 9th U.S. Circuit Court of appeals earlier ruled “yes.”  In the recent ruling in Beeler v. Astrue,  the 8th U.S. Circuit Court of Appeals ruled “no”, overturning a lower, trial court decisions and affirming the final decision of the Commissioner of Social Security.

UTAH PRESCRIBES NEW PRESCRIBER LIABILITY DUTY

The Utah Supreme Court last month held that a prescriber of drugs has a duty to third parties injured by the conduct of the patient following the consumption of the medication.  In the case of B.R., a Minor Child and C.R., a Minor Child, through their Conservator, William M. Jeffs v. Trina West, Hugo Rodier and John Does I-X, (Utah, 2012), the Court overturned a lower court dismissal of a case for lack of duty.  The Plaintiffs are the two surviving children of David Ragsdale, who killed their mother after taking the medication prescribed by Ms. West, a nurse practitioner.  The drugs prescribed were Concerta, Valium, Doxepin, Paxil, pregnenelone and testosterone.

HIPAA SECURITY BREACH SETTLEMENT

The Office of Civil Rights of the Department of Health and Human Services (“OCR”) announced a settlement with Blue Cross and Blue Shield of Tennessee  this month a compliant alleging a security leak, in violation of HIPAA. The case is interesting factually and resulted in the payment by Blue Cross of a $1,500,000.00 penalty and the imposition of a Corrective Action Plan.

 

Proposed Overpayment Rule Expands Exposure.

On February 16, 2012, the Secretary of Health and Human Services, Katherine Sebelius published a proposed new rule to implement Section 6402(a) of the Accountable Care Act that requires Medicare providers to report and repay government overpayments within the later of 60 days of being “identified” or of the date of submission of a required cost report.  The term “identified” is not defined in the Act and is the critical trigger for commencing the running of the 60 day period and the exposure for False Claims and Civil Monetary Penalty liability.