Jones-McNamara v. Holzer Health Sys., Inc. (Summary)

FALSE CLAIMS ACT

Jones-McNamara v. Holzer Health Sys., Inc., No. 2:13–cv–616 (S.D. Ohio Jan. 23, 2015)

The U.S. District Court for the Southern District of Ohio granted a hospital’s motion for summary judgment against a lawsuit filed by its former Vice President of Corporate Compliance. The compliance officer sued the hospital for retaliatory discharge under the federal False Claims Act, plus five other state law claims.

In assessing her retaliatory discharge claim, the court explained that the compliance officer would have to show not only that she engaged in an activity protected under the law, but also that the hospital knew she had engaged in the activity and then “discharged or otherwise discriminated against her as a result of the protected activity.” The hospital argued that the compliance officer could not establish any of the required elements of retaliatory discharge, but the compliance officer insisted that she had evidence of retaliation.

To support her claim, the compliance officer introduced four different types of direct evidence. Most of this evidence consisted of e-mail chains from various administrators over the compliance officer’s investigation of a potential anti-kickback statute violation. Specifically, the compliance officer had been investigating whether an ambulance company improperly provided hot dogs to hospital employees.

The court sided with the hospital. First, it concluded that none of the compliance officer’s evidence directly supported her claim of retaliation. Next, it explained that even if it gave her the benefit of the doubt and decided there was at least a prima facie case of retaliation, there existed ample reasons why the hospital might have legitimately terminated her employment instead. For example, she had failed to disclose that she had a brother who also worked for the hospital, she had actively sought to conceal that she now lived in Ohio so that she could continue serving on a committee as Virginia’s representative, and she had repeatedly called the CEO “Brett” instead of his actual name, “Brent.” Moreover, she often sent out e-mails indicating that an anti-kickback violation existed, but then admit that she had issued this opinion before completing her investigation of the matter. When the CEO instructed her to complete her investigation before putting a conclusion in writing, she disregarded his advice and continued to send out e-mails announcing that she had found a violation.

The court stated that it had reached a simple conclusion. The court explained that the hospital claimed it had fired the compliance officer because she was a “difficult flake” and noted that the compliance officer had failed to provide evidence that would discredit this rationale. Consequently, she could not establish that the hospital had discharged her for engaging in a protected activity.

Furthermore, the court concluded that no reasonable juror could possibly find that the hospital’s reasons for firing her were mere pretext. It granted the hospital’s motion for summary judgment against the retaliation claim and denied the compliance officer’s motion for partial summary judgment. Since the retaliatory discharge claim was the only federal cause of action, the court declined to hear her state law claims and dismissed them without prejudice.

Murphy v. Goss – Jan. 2015 (Summary)

HCQIA

Murphy v. Goss, No. 3:14-cv-01135-SI (D. Or. Jan. 26, 2015)

The United States District Court for the District of Oregon dismissed a cardiac anesthesiologist’s substantive due process claim against several members of a state medical board, holding that the medical board was shielded by immunity pursuant to the Health Care Quality Improvement Act of 1986 (“HCQIA”).

Plaintiff, a cardiac anesthesiologist, was found by the state medical board to have engaged in unprofessional conduct by consuming alcohol while on cardiac call. The state medical board reported the cardiac anesthesiologist to the National Practitioner Data Bank. The cardiac anesthesiologist, while not challenging the validity of the state medical board’s determination, alleged that the board violated his due process rights when it reported to the National Practitioner Data Bank that his conduct adversely affected, or could have adversely affected, the health or welfare of a patient.

The court held that members of the state medical board were protected by HCQIA immunity. The court explained that the defendants were entitled to HCQIA immunity unless they knew the report contained false information. Here, the cardiac anesthesiologist failed to allege that the state medical board members had actual knowledge of any false information contained in the report.

Omni Healthcare, Inc. v. Health First, Inc. (Summary)

ANTITRUST

Omni Healthcare, Inc. v. Health First, Inc., No. 6:13-cv-1509-Orl-37DAB (M.D. Fla. Jan. 22, 2015)

The U.S. District Court for the Middle District of Florida denied a health system’s motion to dismiss in an antitrust suit brought by a number of physicians and practice groups. The plaintiff physicians alleged that the defendant system, which was described in the complaint as a “fully integrated” healthcare corporation consisting of a hospital, an insurance company and a physician group, engaged in an anti-competitive scheme to monopolize health care markets in Southern Brevard County, Florida.

The court held that the physicians had sufficiently alleged antitrust injury because they claimed to have suffered a competitive injury due to the actions of the defendants. The court rejected the defendants’ arguments that plaintiffs had to be “consumers or competitors” to allege antitrust injury. The court also found that the physician groups adequately defined the relevant product and geographic markets, ruling that they sufficiently alleged the product dimensions and geographical boundaries of the service market. Finally, the court found that the plaintiffs stated a plausible claim for conspiracy when they alleged that physicians who refused to join the system or enter into an exclusive referral arrangement with it were blacklisted.

Stein v. McGowan (Summary)

DEFAMATION

Stein v. McGowan, No. 1:12-cv-605 (S.D. Ohio Jan. 21, 2015)

The United States District Court for the Southern District of Ohio denied a defendant physician’s motion for summary judgment in a defamation suit brought by another physician.

The plaintiff was a director and officer of a cholesterol treatment center (“CTC”) and a metabolic and atherosclerosis research center (“MARC”). When he began to plan for his retirement, he brought in the defendant physician to begin taking over his responsibilities at both the CTC and MARC. After beginning her work at the CTC and MARC, the defendant claimed that the plaintiff prescribed pills in high amounts, and directed patients to cut the pills in half. She also claimed that the plaintiff reported different doses on the patient’s chart than he actually prescribed. The defendant said she did not approve with the practice of containing the patients’ CTC charts with the MARC clinical trial charts, as she believed it was a violation of HIPAA. After working at CTC and MARC for several months, the defendant met with staff members, where she accused the plaintiff of engaging in insurance fraud and posing a threat to patient safety. The defendant also expressed her concerns to her nephew and the Ohio Board of Pharmacy. She was fired soon after that.

The court held that the defendant was not entitled to summary judgment because factual disputes existed as to whether she was entitled to a qualified privilege to shield statements made in the scope of employment. Also, the court determined that there was a dispute over whether the defendant acted in good faith, and whether she discussed her concerns about plaintiff with third parties without legitimate reasons.

Baptist Mem’l Hosp.-N. Miss., Inc. v. Lambert (Summary)

EMPLOYMENT CONTRACT

Baptist Mem’l Hosp.-N. Miss., Inc. v. Lambert, No. 2013–CA–01002–COA (Miss. Ct. App. Jan. 27, 2015)

The Court of Appeals of Mississippi affirmed a lower court’s grant of summary judgment in favor of a physician against a hospital’s counterclaim for breach of contract. The dispute between the physician and the hospital arose when the hospital began to receive complaints from staff and patients about the physician’s angry and abusive behavior. Some of these complaints alleged that the physician had problems with his hands shaking and would sometimes become so insecure and hesitant that he would “freeze up” during surgery.

The CEO of the hospital requested that the physician attend an interview. During this interview, the physician agreed to enter the Mississippi Professional Health Program (“MPHP”), which eventually referred him for treatment at a recovery center. The recovery center evaluator recommended that the hospital place the physician in a monitoring contract with the MPHP for at least five years, and also warned that the physician was currently unfit to practice medicine with reasonable skill and safety.

The hospital suspended the physician’s clinical privileges once it received this evaluation. It then exercised an option to terminate his employment contract. The physician sued the hospital and the recovery center after he lost his job, but the claims were dismissed for failure to comply with the Mississippi Tort Claims Act.

Following this dismissal, the hospital brought its own lawsuit against the physician, claiming that he had failed to perform in accordance with the terms of his employment contract. The lower court granted summary judgment in favor of the physician, concluding that the physician’s obsessive-compulsive personality disorder made it impossible for him to perform in accordance with the contract.

On appeal, the hospital argued that the lower court had erroneously granted summary judgment. The Court of Appeals sided with the physician. It explained that even though the hospital was technically correct about the failure to plead the appropriate legal defenses, the practical impact of this was minimal – the physician could correct it simply by filing another motion in the lower court.

Two of the judges dissented from this ruling. In the dissenting opinion, they explained that the court had failed to distinguish the difference between a mental impairment and an actual disability resulting from a mental impairment. They argued that the mere existence of this mental disorder would not be enough to excuse the physician from his obligation to perform under the contract, and emphasized that the hospital’s claim should have been heard on the merits instead of dismissed through summary judgment.

Virk v. Maple-Gate Anesthesiologists, P.C. (Summary)

ARBITRATION

Virk v. Maple-Gate Anesthesiologists, P.C., No. 14-CV-381S (W.D. N.Y. Jan. 19, 2015)

The United States District Court for the Western District of New York enforced an arbitration clause against an anesthesiologist and his anesthesiologist group, holding that the clause was valid and controlled the parties’ dispute. Plaintiff, an anesthesiologist, was a shareholder and employee of defendant, an anesthesiologist group. The anesthesiologist group terminated the anesthesiologist after he was precautionarily suspended from the primary hospital at which the group practiced. The anesthesiologist sued the hospital and got the precautionary suspension annulled and expunged from his personal file. The anesthesiologist group still upheld the anesthesiologist’s termination. The anesthesiologist brought suit against the group. The group moved to compel arbitration pursuant to the anesthesiologist’s employment agreement. The anesthesiologist argued that the arbitration claim was superseded by a subsequent employment agreement, the dispute was not covered by the arbitration clause, and the arbitration clause conflicted with statutory pre-litigation requirements.

The court held that the anesthesiologist’s arbitration clause was valid and governed his dispute with the anesthesiologist group. The court explained that the arbitration clause was unambiguous and never expressly superseded by a subsequent employment agreement, so it must be enforced. Additionally, the dispute did not fall into any “exclusion from arbitration” explicitly stated within the employment agreement. Furthermore, the employment agreement waived any statutory pre-litigation requirements.

Woods v. State ex rel. Mont. State Hosp. (Summary)

DUTY TO WARN

Woods v. State ex rel. Mont. State Hosp., No. DA 14-0054 (Mont. Jan. 13, 2015)

The Supreme Court of Montana affirmed a lower court’s grant of summary judgment in favor of a state hospital on a “failure to warn” claim by the estate of a woman who was shot to death by a former mental patient of the hospital. The court held that no actual threat of violence was made to trigger a mental health professional’s statutory duty to warn. A patient with a history of self-harm was involuntarily committed to a state mental hospital after he was found unconscious in his house due to heavy drinking and ingesting pain medication. During a counseling session with a mental health professional of the hospital, the patient admitted to having an alcohol dependency problem. The patient said that when he was intoxicated he would become aggressive towards his then girlfriend. After continued sessions over a two-week period, the mental health professional observed that the patient had realized the seriousness of his alcohol problem and was planning to follow through with outpatient treatment. The patient was released. Four months later, at a bar, he saw his ex-girlfriend with a male companion. The patient followed the two as they left. Outside, the patient assaulted the male companion, and fired multiple gunshots at his ex-girlfriend’s vehicle, killing her. The patient then shot himself. Plaintiff, patient’s ex-girlfriend’s estate, brought suit against the hospital claiming that the hospital failed to warn the patient’s ex-girlfriend of the risk of violent behavior by the patient pursuant to a state statute.

The court affirmed the lower court’s dismissal of the claim, holding that there was no actual threat of physical violence by specific means to trigger the statutory duty to warn. The court explained that the patient must have made a specific expression or gesture against the ex-girlfriend to trigger the duty to warn. The fact that the patient may have presented a potential danger to the ex-girlfriend under certain circumstances, including his continued alcohol abuse and the end of their intimate relationship, was not sufficient, in the court’s opinion, to trigger a mental health professional’s statutory duty to warn.

O’Hara v. W. Calcasieu Cameron Hosp. Found. (Summary)

EMTALA

O’Hara v. W. Calcasieu Cameron Hosp. Found., No. 2:13-cv-967 (W.D. La. Jan. 20, 2015)

The United States District Court for the Western District of Louisiana granted summary judgment in favor of a hospital on a patient’s Emergency Medical Treatment and Active Labor Act (“EMTALA”) claim, holding that the patient failed to establish that she was diagnosed with an emergency medical condition. The plaintiff patient was experiencing pain, swelling, and difficulty swallowing after a dental procedure. Plaintiff presented at the defendant hospital’s emergency room. The patient was diagnosed with facial cellulitis and given a prescription for the pain. The hospital discharged the patient and instructed her to go to another hospital for additional treatment the following day. The next morning the patient was unable to open her jaw and then brought suit against the hospital claiming that the hospital did not stabilize her as is required by EMTALA.

The court dismissed the patient’s EMTALA claim because she failed to establish that the hospital diagnosed her with an emergency medical condition. The court explained that even though the patient was diagnosed with facial cellulitis, the hospital did not diagnose her condition as an emergency medical condition. The hospital did not have actual knowledge of an unstabilized emergency medical condition before it discharged her; therefore, EMTALA’s stabilization duty did not apply to the hospital.

Miller v. Imaging on Call (Summary)

BREACH OF CONTRACT/GOOD FAITH/NEGLIGENT AND INTENTIONAL INFLICTION OF EMOTIONAL DISTRESS

Miller v. Imaging on Call, No. 3:13-cv-00679 (JAM) (D. Conn. Jan. 12, 2015)

The United States District Court for the District of Connecticut dismissed a lawsuit filed by a plaintiff radiologist against defendant teleradiology company after her privileges were revoked at a hospital at which she provided teleradiology services.

The radiologist entered into a contract as an independent contractor with the teleradiology company to provide services for the hospital. The hospital complained of the radiologist’s performance to the company for a number of years, but not to the radiologist herself. The hospital began a formal investigation regarding the radiologist, but did not tell her that she was under investigation. One week later, the company contacted the radiologist and suggested that she resign her privileges at the hospital, without mentioning that she was under investigation. The radiologist resigned, and the hospital reported her to the National Practitioner Data Bank since she had resigned while under investigation. The radiologist then rescinded her resignation, and the hospital subsequently revoked her privileges. The radiologist filed a lawsuit against the company, alleging, among other things, breach of contract, breach of implied covenant of good faith and fair dealing, negligent misrepresentation, negligent infliction of emotional distress, and intentional infliction of emotional distress, and the company filed a motion to dismiss the lawsuit for failure to state a claim.

On the breach of contract claim, the court ruled in favor of the company and held that the radiologist did not allege enough facts to plausibly show that there was any violation of her contract with the company, as the contract did not require the company to alert the radiologist about complaints from the hospital. The court also found that because the parties maintained an independent contractor relationship, there was no fiduciary or employment relationship that would have triggered a covenant of good faith and fair dealing. Furthermore, the court found no evidence of a bad faith violation by the company.

On the general negligence claim, the court ruled in favor of the company by stating that the radiologist did not identify any duty that the company owed to her apart from the duties undertaken under the terms of the contract.

On the negligent representation claim, the court ruled in favor of the company, stating that the radiologist should have known not to reasonably rely on the company’s assurance that her resignation was merely routine and insignificant. Also, the court dismissed the radiologist’s claims of negligent infliction of emotional distress, finding that the radiologist did not make any factual allegations that the company caused stress enough to put her at risk of illness or bodily harm. Finally, the court found no conclusory factual allegations to suggest that the company intentionally caused the radiologist emotional distress, since there was nothing to suggest that any distress was intentionally imposed on the radiologist.

Jamaleddin v. Oakland Physicians Med. Ctr. (Summary)

DISCRIMINATION/ BREACH OF CONTRACT

Jamaleddin v. Oakland Physicians Med. Ctr., No. 13–cv–12735 (E.D. Mich. Jan. 12, 2015)

The United States District Court for the Eastern District of Michigan granted a hospital’s motion for summary judgment against a resident’s claim of retaliatory harassment, while denying its motion for summary judgment against the resident’s claims of national origin discrimination and breach of contract.

The resident, who was of Arabic descent, had executed a “residency agreement” with the hospital and accepted appointment as a first year resident in family medicine. The resident received several warnings about his professionalism and his communication skills. In his lawsuit, the resident argued that these warnings were rooted in discriminatory motives. He alleged that one of his direct supervisors had told him to “give up [his] Arabic mentality” and had made jokes about whether the resident was using “Arabic time.”

The resident decided to tell another supervisor that he believed he was being discriminated against because of his Arabic descent. That same evening, the resident asked another physician to complete a patient history for him so that he did not have to stay overtime. The hospital discovered this and then fired the resident a week later. According to the resident, the hospital then forced him to sign a resignation form instead of appealing the decision, threatening him that he would “end up nowhere” unless he complied.

The court ruled in favor of the hospital on the retaliation claim, finding that although the resident alleged that he was fired just a week after complaining about discrimination to his supervisor, there was insufficient proof of a causal connection between the two events. However, the court ruled against the hospital on the discrimination claim, noting that even though the hospital had warned him about a lack of professionalism and deficient interpersonal skills, the resident had immediately corrected many of the flaws after he learned about them. In addition, the resident had shown that several of his supervisors gave him positive performance evaluations in the past, undercutting their argument that he was a problem employee. The court also ruled against the hospital on the breach of contract claim, because the residency agreement itself included a clause preventing discrimination on the basis of national origin.