Author: WorkCompAcademy

San Diego Hospital Based Physicians (SDHBP) and its two owners, Dr. Maria Ramirez and Dr. Dalia Strauser, sued El Centro Regional Medical Center alleging the Hospital retaliated against plaintiffs for complaining about patient care practices. The Hospital is a municipal agency owned by the City of El Centro and is governed by a seven-person Board of Trustees. SDHBP is an entity that provides hospitalist personnel and services. SDHBP is owned by Dr. Strauser and Dr. Ramirez, who both specialize in internal medicine and hospital medicine. Dr. Strauser has practiced medicine for more than 20 years and Dr. Ramirez has practiced medicine for more than 15 years. Hospitalists are generally internal medicine doctors who treat hospitalized patients to ensure they receive proper care, including diagnosis and appropriate specialty referrals.

According to allegations in the complaint, the Hospital hired Team Health, Inc. to manage and operate the Hospital’s emergency department. Shortly after, SDHBP became concerned about Team Health’s practices and the nature of the contract between the Hospital and Team Health, which SDHBP believed negatively affected patient care. SDHBP doctors found that Team Health physicians frequently admitted patients into the Hospital (or sought to compel SDHBP physicians to do so) despite the fact that these patients were not properly stabilized, diagnosed, or treated in the emergency room and/or that they should have been transferred to other hospitals with available surgeons and/or necessary medical equipment.

Dr. Ramirez and Dr. Strauser reported to Hospital administrators “at the highest levels” their concerns about patient care arising from Team Health practices and operations. The doctors identified approximately 35 specific cases of inadequate patient care. Later, SDHBP sent an email to Dr. George Hancock, the Hospital’s chief of medicine (who became medical chief of staff on January 1, 2011), detailing 19 separate cases in which Team Health and Hospital practices allegedly negatively affected patient care in a substantial manner. SDHBP also sent the email to several other Hospital officials, including the Board president, the Hospital’s chief of staff, and the Hospital’s quality committee chair.

On March 22, 2011, the Hospital’s Board held its monthly public meeting. During a closed (nonpublic) portion of this meeting, the Board voted to terminate the SDHBP Agreement “without cause.” When Dr. Strauser asked Hospital official Virgen why the Agreement was terminated, he allegedly said ” ‘you turned on the light and all the cockroaches ran away scared.’ ”

Several months later, plaintiffs filed their lawsuit against the Hospital and Team Health. Plaintiffs alleged five causes of action against the Hospital. In the first three, plaintiffs alleged the Hospital violated statutes prohibiting retaliation against physicians for complaining about, or advocating for, patient care. The Hospital moved to strike the complaint under the anti-SLAPP statute. (§ 425.16.) The Hospital argued that plaintiffs’ complaint arose from constitutionally protected activity because it was based on the Board’s contract termination decision, which it said was a “quasi-legislative” act made at an “official proceeding.” The trial court denied the motion, and the Hospital appealed. The Court of Appeal sustained the denial of the anti-SLAPP motion in the unpublished opinion of San Diego Hospital Based Physicians vs El Centro Regional Medical Center.

One of the elements required to reject an anti-SLAPP motion to dismiss is a determination that there is a “probability” that plaintiffs will prevail on its claims. In meeting this burden, the plaintiff cannot rely solely on the allegations in the complaint and must present evidence that would be admissible at trial. The Court of Appeal concluded that plaintiffs met this burden, and may proceed with their case.

CFO.com reports that nine states have seen significant workers’ compensation reform bills signed into law in 2013. Oklahoma’s workers’ compensation reform laws have received the most attention lately because of the inclusion of an opt-out provision, known as the Oklahoma Option. The Oklahoma Option is significantly different from the Texas opt-out option. Employers that opt out in Texas cannot simply endorse their excess liability policy to cover Oklahoma. Rather, employers in Oklahoma that choose the option are required to provide a written benefit plan that serves as a replacement for the workers’ compensation coverage. This benefit plan must provide for full replacement of all indemnity benefits offered in the workers’ compensation system. The key component of the Oklahoma Option for employers is that it gives them full control of the medical treatment through their benefits plan. Unlike the Texas opt-out, the Oklahoma Option does not permit employees to pursue a negligence action through the civil courts.

The recently passed reform bill in Delaware was designed to control medical costs and encourage return-to-work efforts.

The use of physician-dispensed medication has been a significant issue in Florida workers’ compensation. Physicians were charging several times what the same medication would cost from a retail pharmacy, and the costs were not regulated by a fee schedule. New law creates a maximum reimbursement rate for physician-dispensed medication of 112.5% of the average wholesale price, plus an $8 dispensing fee.

Legislation passed in Georgia should have a positive impact on workers’ compensation costs for employers. Effective July 1, 2013, medical benefits for non-catastrophic cases are capped at 400 weeks from the date of accident, whereas previously, injured workers were entitled to lifetime medical benefits for all claims.In Indiana, legislation was passed that establishes a hospital fee schedule at 200% of Medicare rates. This is consistent with other states that base their fee schedules on Medicare rates.

Minnesota joined most other states in amending its statutes to allow for mental-mental injuries (a psychiatric disorder without a physical injury).

Missouri’s reforms were focused on addressing the insolvent second injury fund and returning occupational disease claims to the workers’ compensation system.

Recent legislative changes in New York will reduce employer costs by about $800 million annually. These savings are derived primarily by streamlining the assessment collection process and eliminating the 25-a fund and its associated assessments. New York’s workers’ compensation assessments are the highest in the nation, so employers welcome any relief in this area.

Tennessee and Oklahoma both moved its workers’ compensation dispute resolution process from a court-based system to an administrative system, leaving Alabama as the only state that still uses the trial courts for all such litigation.

In the first effort of its kind, the nonprofit publisher of Consumer Reports magazine released ratings of 2,463 U.S. hospitals in all 50 states on Wednesday, based on the quality of surgical care. The group used two measures: the percentage of Medicare patients who died in the hospital during or after their surgery, and the percentage who stayed in the hospital longer than expected based on standards of care for their condition. Both are indicators of complications and overall quality of care, said Dr John Santa, medical director of Consumer Reports Health.

According to the story in Reuters Health, the ratings will surely ignite debate, especially since many nationally renowned hospitals earned only mediocre ratings. The Cleveland Clinic, some Mayo Clinic hospitals in Minnesota, and Johns Hopkins Hospital in Baltimore, for instance, rated no better than midway between “better” and “worse” on the CU scale, worse than many small hospitals. Because CU had only limited access to data, the ratings also underline the difficulty patients have finding objective information on the quality of care at a given facility.

Nevertheless, “this is a step in the right direction,” said Paul Levy, former president of Beth Israel Deaconess Medical Center in Boston, who was not involved in the project. “To whatever extent you can empower patients to get better care and become partners in pushing the healthcare system to make improvements is to the good.”

CU’s ratings are based on Medicare claims and clinical records data from 2009 to 2011 for 86 kinds of surgery, including back operations, knee and hip replacements, and angioplasty. The rates are adjusted to account for the fact that some hospitals treat older or sicker patients, and exclude data on patients who were transferred from other hospitals. These are often difficult cases that, CU felt, should not be counted against the receiving hospital.

Although the ratings do not explicitly incorporate complications such as infections, heart attacks, strokes, or other problems after surgery, the length-of-stay data captures those problems, said Santa.

Some of the findings are counterintuitive. Many teaching hospitals, widely regarded as pinnacles of excellence and usually found at the top of rankings like those of U.S. News and World Report, fell in the middle of the pack.

“This isn’t the first time we’ve seen this sort of surprise,” said Dr Marty Makary, a surgeon at Johns Hopkins Hospital and author of the 2012 book, “Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care.” “For a complex procedure you’re probably better off at a well-known academic hospital, but for many common operations less-known, smaller hospitals have mastered the procedures and may do even better” with post-surgical care.

CU also found that several urban hospitals did well despite serving many poorer, sicker patients, including Mount Sinai Hospital in New York and University Hospitals Case Medical Center in Cleveland. Rural hospitals did better, on average, than other hospitals, and many hospitals practically unknown beyond their zip code outranked famous ones, including Kenmore Mercy near Buffalo, New York; Arrowhead in Glendale, Arizona; Sacramento Medical Center in California; and Arkansas Heart in Little Rock.

Angelotti Chiropractic, Mooney and Shamsbod Chiropractic, Christina-Arana and Associates, Joyce Altman Interpreters, Scandoc Imaging and Buena Vista Medical Services filed a lawsuit yesterday in the United States District Court, Central District of California seeking to avoid payment of millions of dollars in lien activation fees before the end of 2013. The Defendants are Edmund G. Brown (Governor), Kamala D. Harris (Attorney General), Christine Baker (DIR Director), Ronnie Caplane (WCAB Chair) and Destie Overpeck (DWC Acting Director)

The suit requests declaratory, injunctive and other relief and challenges the constitutionality of certain provisions of SB 863 that retroactively impose a $100 “activation” fee on workers’ compensation liens filed prior to January 1, 2013. Plaintiffs allege that they filed valid liens prior to December 31, 2013 that constitute “vested property rights.” They allege that the mandatory dismissal provisions of the activation fee law interfere with those rights.

The Plaintiffs also complain that other “large holders of workers’ compensation liens are arbitrarily exempted from the fee” such as insurance companies, HMOs and labor union benefit plans. Thus they say that SB 863 “specifically targets independent providers of services to workers’ compensation claimants and was adopted with the purpose of destroying their liens.”

Thus, they allege that these “provisions of SB863 are unconstitutional under the Takings, Due Process and Equal Protection Clauses of the United States Constitution. Accordingly, this action seeks preliminary and permanent injunction preventing Defendants from enforcing these provisions of SB863.”

Christina Arana and Associates Inc. holds approximately 4,500 liens, Joyce Altman Interpreters, Inc. holds approximately 4,745 liens, Sandoc Imaging Inc. holds approximately 2,300 liens and Buena Vista Medical Services Inc. allege they hold approximately 20,888 liens. In total Plaintiffs allege they hold “tens of thousands of liens” which require activation fees in an amount of “more than $2 million” and the Plaintiffs allege they presently lack the ability to pay the lien activation fees.

The complaint will now be served on the defendants, who will likely demur the complaint. This will test the legal validity of the Plaintiff’s’ constitutional theories before a federal judge. After that step, should they survive the demurrer, it is likely that the case will be submitted by way of the summary judgment process inasmuch as there are no substantial disputes as to the facts. This case will move rapidly through the federal system, at least at the trial level.

John Pike, the former police officer who pepper-sprayed students during an Occupy protest at the University of California, Davis is applying for worker’s compensation, claiming he suffered psychiatric injury from the 2011 confrontation.

Pike has a settlement conference set for Aug. 13 in Sacramento, according to the state Department of Industrial Relations’ website. Organizers are already planning a demonstration outside the state building in the hopes of urging the WCAB to reject the former cop’s claim. “It’s so outrageous,” Protest Organizer Bernie Goldsmith said. “While he might be entitled to receive workers compensation, the idea that his own actions of brutality would entitle him to a payout is absolutely unjust. It’s crazy.”

Pike was fired in July 2012, eight months after a task force investigation found that his action was unwarranted. Online videos of him and another officer casually dousing demonstrators with pepper spray went viral, sparking outrage at UC Davis leaders. The images became a rallying symbol for the Occupy Wall Street movement.

Hackers posted Pike’s information online. The former Marine sergeant received scores of threats that led an Alameda County Court judge to rule against releasing the names of other officers at the scene.

This week, a state appeals court ruled news organizations are entitled to know the names of a dozen University of California police officers who were interviewed about the use of pepper spray on demonstrators at UC Davis. The Los Angeles Times and The Sacramento Bee are seeking the officers’ identities, which were redacted from two reports on the incident.

In the aftermath, the University of California agreed to pay $1 million to settle a lawsuit filed by demonstrators and the chief of the UC Davis police department resigned. Ian Lee was one of the protesters pepper-sprayed. He and about 20 others shared in a million-dollar settlement. The college junior hopes Pike’s claim is denied. “It’s wrong what he’s trying to do,” Lee said. “When you reward people like Pike by giving them benefits, you tell people it’s okay to hurt students. That’s the message we absolutely cannot send.”