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Jury Awards $144 Million in HMO Discrimination Lawsuit

Robert Wolf — Tue, 07 Nov 2006 14:25:40 GMT

We all hear the jokes and the stories about HMO plans - they're expensive, unpopular, and many people find them a pain to deal with. Well, a recent jury verdict in Illinois will do nothing but reinforce many beliefs about HMOs.

A health maintenance organization hired by the government to provide coverage for the poor in Illinois will have to pay damages of $144 million for discriminating against pregnant women and other potentially high-risk patients, a federal jury in Chicago decided Monday.

After two days of deliberations, the jury found that Amerigroup Corp. and subsidiary Amerigroup Illinois sought to fatten their profits off Medicaid dollars paid into their plans by signing up healthy clients and intentionally avoiding those who had health issues.

According to an article in the Chicago Tribune, the original award was $48 million, but under the federal False Claims Act it will be tripled to $144 million in what amounts to a major victory for federal and state prosecutors.

Amerigroup, which no longer operates in Illinois, runs managed-care plans that, because of restrictions on doctor and hospital choices to their networks, are a cheaper alternative to fee-for-service Medicaid. Medicaid is jointly funded by the state and federal governments, which have supported the creation of such HMOs to save money.

Prosecutors said they also will seek almost $200 million more in penalties from the Virginia Beach, Va.-based company because it filed more than 18,000 false claims with the state. "The verdict will both reimburse the State of Illinois for the money Amerigroup obtained illegally and punish Amerigroup for their unconscionable conduct," Atty. Gen. Lisa Madigan said in a prepared statement.

Whistleblower and former Amerigroup executive Cleveland Tyson, meanwhile, stands to reap $21 million to $36 million for bringing the suit. Tyson was fired from the company in 2002 before filing a federal suit that accused Amerigroup of filing false Medicaid claims with the state.

His attorneys, Frederick Cohen and David Chizewer of Goldberg Kohn, said the verdict sends a strong message to companies that would defraud government. "Government health-care systems are especially vulnerable to fraud because they are so complex, and whistleblowers provide an invaluable service in protecting our tax dollars from dishonest companies," Cohen said. From 2000 to 2003, Amerigroup collected $243 million in Medicaid money while assuring the Illinois Department of Public Aid that it was offering care to eligible applicants without regard to their health status.

Those assurances were a fraud, charged Assistant U.S. Atty. Samuel B. Cole and Assistant Atty. Gen. David Adams. "The evidence unequivocally established that Amerigroup intentionally turned its back on pregnant women and people suffering from serious medical conditions," Madigan said. Amerigroup trained its marketing representatives to avoid people who faced high medical bills and had a policy of "cherry-picking" healthy clients, according to testimony and documents presented during the month-long trial.

Under the Medicaid compensation system, the company pocketed more money if it paid out less in medical bills. A series of e-mails and statements from Amerigroup executives were key elements of the plaintiffs' case.

In a 2001 e-mail shown to the jury, Amerigroup Illinois' director of medical management told managers, "Please keep up the good work with the marketing reps of not trying to sign up pregnant women." In another e-mail, the executive said the company had continued to build experience in not signing up pregnant women or people from areas where drug abuse was prevalent.

Another Amerigroup executive said in a sworn statement that it was always his policy "to go after the healthies," prosecutors said. Dwight Jones, Amerigroup's corporate representative at the trial, acknowledged on the stand that a large drop in the number of pregnant women the company had as clients was due to an active effort to avoid signing them up in the first place, Cohen said.

Amerigroup's attorneys argued, meanwhile, that the company never discriminated against pregnant women or people with health problems. Lead defense attorney Dan Voelker said the company did attempt to reduce its enrollment of women in their third trimester of pregnancy. But he argued that was to ensure the women weren't forced to switch doctors because they switched health plans.

The defense presented evidence it said showed Amerigroup was always honest with the state about its marketing practices. Amerigroup spokesman Kent Jenkins Jr. said the company will appeal the verdict. "We think that during the course of the trial there were errors that led the jury to consider information that was inaccurate, incomplete and misleading," Jenkins said.

He declined to elaborate, saying it will be a matter for appeal. "Our lawyers feel we have a very strong case in the appeals court," he said. Jenkins said day-to-day operations at the company will continue normally despite the large amount of the verdict. "We have the financial wherewithal to do what we need to do," he said.

Amerigroup has not done business in Illinois since August, but continues to provide Medicaid-based HMO services in nine states.

Amerigroup had $2.3 billion in revenue last year and estimates revenue of $3 billion for this year, Jenkins said. Amerigroup shares closed up nearly 2 percent Monday at $35.41 in trading on the New York Stock Exchange.

Originally posted at InjuryBoard by Robert Wolf

A Few Notes on Medical Mistakes/Medical Malpractice

Jeff Rasansky — Fri, 06 Feb 2009 15:34:57 GMT

Medical mistakes occur far too often. Exact estimates are difficult to locate, however, it isn't surprising when one looks at the medical industry. Their industry is hurting, now more than ever. They are overwhelmed, complex, and stretched to the maximum.

Several studies have been performed regarding medical errors. A phone survey that was conducted by the National Patient Safety Foundation proved that 42% of people believed that they may have experienced a medical error personally, or one may have happened to their friend. This is simply not acceptable!

Common forms of medical malpractice include birth injuries (such as cerebral palsy), items left inside of a person following surgery and unnecessary surgery are all forms of medical malpractice.

Other forms of malpractice include:

Failure to properly diagnose a disease or illness.

Failure to properly monitor patients.

Failure to properly treat the diagnosed disease.

Surgical errors including wrong-site surgery or anesthesia errors.

Failure to fully inform the patient of the risks of certain procedures and surgeries.

Misuse of prescription drugs.

Improper use of medical equipment or implants.

Many people don't realize that doctor's aren't the only medical professionals who patients can sue for medical malpractice. Most health care providers such as chiropractors, therapists, nurses, psychologists and dentists are subject to this sort of legal action.

If you or someone you care about has been involved in a medical malpractice situation, please don't hesitate to contact us. You have a right to legal compensation!

Originally posted at InjuryBoard by Jeff Rasansky

Dallas Malpractice Attorney: Jury Awards $7M In Medical Malpractice Case

Jeff Rasansky — Fri, 19 Dec 2008 15:39:52 GMT

A jury has brought back a verdict in a Westchester County Medical Center case, awarding $7 million dollars to a family in a medical malpractice case. Theresa Capwell was a mother of three who suffered severe brain damage and later passed away after medical professionals failed to diagnose her inflammed pancreas, according to her attorney, Judith Livingston.

Livingston says that after the doctors failed to diagnose the condition, they still had several opportunities to save Capwell. A White Plains jury returned the verdict against the medical center to Supreme Court Justice Nicholas Colabella after a 3 week trial and 24 hours of deliberations. It awarded $3 million to Capwells three daughters and $4 million to her husband.

Livingston claimed that Capwell was admitted to the hospital with symptoms that clearly indicated pancreatitis, but doctors looked for cancer that simply did not exist for two weeks. As a result, Capwell was placed on a breathing machine. The breathing machine caused a buildup of air in her lungs, preventing her lungs from expanding and contracting, therefore preventing oxygen intake.

Several doctors ordered a chest tube to help her breath, but it was never done. As a result Capwell ended up going into cardiac arrest and her brain went without oxygen for 12 minutes. She died a year later after living in a completely incapacitated state.

The medical center released a statement that said they will file a motion to appeal the verdict.

Source: www.nydailynews.com

Originally posted at InjuryBoard by Jeff Rasansky

Former Cy Young Pitcher Jim Palmer Wins Malpractice Suit After Botched Eye Surgery

RLF Staff — Wed, 06 Feb 2008 12:33:46 GMT

Hall of Fame pitcher Jim Palmer was awarded $890,000 after a West Palm Beach jury found an ophthalmologist liable for damaging his vision. After a two-week trial, it took a jury about four hours to decide Palmer should receive the money for suffering, lost wages and mental and physical pain. The jury awarded Palmer $327,000 in lost earnings and $563,000 in pain and suffering.

Palmer sued his ophthalmologist after cataract surgery on his left eye. Palmer's doctor implanted an artificial lens that should not have been used because it was known for creating night vision problems. His attorney said Palmer was talked into a getting a multifocal intraocular lens in his eye that isn't made for people who work at night. That lens was later taken off the market. After the cataract surgery, there were signs of retinal tears that were not investigated. The retinal tears led to a detached retina. Palmer still has night vision problems that have affected his ability to work, as many games are held at night.

Palmer pitched for the Baltimore Orioles, won three Cy Young Awards, admitted into baseball's Hall of Fame in 1990 and is currently an analyst on Orioles television broadcasts.

Originally posted at InjuryBoard by RLF Staff

Former Dallas Cowboy in a Coma: Wife Files Malpractice Lawsuit

RLF Staff — Thu, 24 Jan 2008 16:16:58 GMT

Adriane Springs, the wife of former Cowboys running back Ron Springs, has filed a medical malpractice lawsuit in state district court after her husband, Ron Springs, 51, fell into a coma in October during a surgical procedure to have a cyst removed from his elbow and reportedly remains in an incapacitated state. According to published reports, named in the lawsuit, which is seeking unspecified damages, are Dr. Joyce Abraham, an anesthesiologist; Dr. David Godat, a plastic surgeon; and the Texas Anesthesia Group.

Springs was a Dallas Cowboys running back from 1979-84. He has suffered from the disease since the early 1990s, and complications caused the amputation of his right foot and eventual kidney failure.

The kidney transplant proved successful, however, and Springs and Walls started the Gift For Life Foundation to promote awareness, early detection and prevention of kidney disease and diabetes. The Cowboys named them honorary captains for the team's regular-season opener at Texas Stadium on Sept. 9 for the Sunday night games against the Giants.

But Springs' condition has grown grave since initially slipping into a coma during what was believed to be minor surgery on Oct. 12.

Originally posted at InjuryBoard by RLF Staff

Heparin Overdose in Infants

RLF Staff — Fri, 23 Nov 2007 06:03:18 GMT

Heparin overdose in infants is an increasingly common and fatal medication error. Sadly, this error is preventable if only health care professionals would take the few necessary steps to ensure that this fatal mistake does not occur. Heparin is an anti-coagulant medication often given to premature babies to prevent blood clots. However, if too much is given, it can cause severe internal bleeding and possibly death.

Last weekend, this happened to Denis Quaids' newborn twins, Thomas Boone and Zoe Grace, at Cedars-Sinai Medical Center. Unconfirmed sources say the twins were given 10,000 units of heparin. The standard dose is usually 10 units. The infants are currently in the neo-natal ICU and reportedly in stable condition.

In September 2006, two premature babies died after being given an overdose of heparin at the Methodist Hospital in Indianapolis and reposts claim four more were given a heparin overdose but did not die form the heparin. As in most cases of heparin overdose, human error was to blame - aparently someone put adult doses of heparin in the drawer for infants.

Hospital mistakes such as heparin overdose happen quite commonly, but a study shows that less than 5% of hospital mistakes are reported or persued. Many people believe "accidents happen", but when your or your loved ones' health is at stake, the medical professionals trained to help can not make mistakes. According to a 2004 study, medical mistakes are the 6th leading cause of death un the United States.

For more information on this subject, please refer to the section on Medical Malpractice and Negligent Care.

Originally posted at InjuryBoard by RLF Staff

Preventable Medication Error Responsible for Infant Deaths

Robert Wolf — Tue, 19 Sep 2006 14:29:08 GMT

We've all read the articles that medical errors harm hundreds of thousands, if not over a million people every year. This time, an easily preventable medication error took the life of multiple infants. Lena Nelson had looked forward to buying dolls and other presents for her first granddaughter, who was born prematurely last week. Instead, she was planning Monday for the girl's funeral.

D'myia Sabrina Nelson and another premature baby girl, Emmery Miller, died Saturday after they received an adult dose of a blood thinner at Methodist Hospital.

If this had happened in Texas, recent tort reform would have limited recovery to $250,000 per infant.

According to an article in the Seattle Post-Intelligencer, four other babies also were given overdoses of the drug. Three were hospitalized in critical but stable condition Monday at Methodist Hospital, said spokeswoman Jo Ann Klooz. The fourth was in critical condition at Riley Hospital for Children and continued to suffer from ill effects of the drug, she said.

Hospital officials said that the overdoses were the result of human and procedural error and that their hearts go out to the families, but Nelson said that doesn't ease her pain.

"They couldn't give me enough apologies for what they have done," Nelson said. "They just took her away. It's like murder. She was just taken away from us."

Heparin, which is often used in premature children to prevent blood clots that could clog intravenous drug tubes, arrives at the hospital in premeasured vials. The vials are placed in a computerized drug cabinet by pharmacy technicians.

When nurses need to administer the drug, they retrieve it from a specific drawer, which then locks again.

Sam Odle, chief executive of Methodist and Indiana University Hospitals, said a pharmacy technician with more than 25 years' experience accidentally took the wrong dosage from inventory and stocked it in the drug cabinet in the Newborn Intensive Care Unit. Nurses, who are accustomed to only one dosage of heparin being available, then administered the wrong dose.

The adult and infant doses have similar packaging, officials have said.

Odle said Monday that the three hospitals that make up Clarian Health Partners - Methodist, Riley and Indiana University - would no longer keep certain doses of heparin in inventory. All newborn and pediatric critical care units will require a minimum of two nurses to validate any dose of heparin. And nursing units will receive an alert when a change in packaging or dose is entered in the drug cabinet.

In addition, all employees will be required to sign a document about the importance of correct drug administration by Sept. 23.

Odle stressed that the hospital is "among our nation's safest" and said Methodist would learn from the mistake.

The deaths came just days before the state was to approve a rule that would require hospitals to report errors.

Originally posted at InjuryBoard by Robert Wolf

Preventable Medical Errors - The Third Leading Cause of Death

Robert Wolf — Mon, 23 Jan 2006 09:49:39 GMT

The number of hospital patients who die from preventable errors may be far higher than previously thought, and this trend shows no sign of stopping, according to a new national review of Medicare records by a Denver-based health care ranking group. The findings would make medical mistakes the third-leading cause of death in the country, behind heart disease and cancer.

A 1999 study by the Institute of Medicine, which advises the federal government on health care issues, counted 98,000 deaths in 1999; HealthGrades said there were 195,000 deaths annually from 2000 to 2002, and estimated that Americans paid an extra $19 billion in medical care costs for the victims of mistakes. These reports are nothing short of shocking.

''There is little evidence that patient safety has improved in the last five years," said Dr. Samantha Collier, vice president of medical affairs at HealthGrades, which publishes rankings of hospitals and doctors. ''The equivalent of 390 jumbo jets full of people are dying each year due to likely preventable, in-hospital medical errors, making this one of the leading killers in the US."

Multiple studies have shown that medical errors are widespread, harming up to one in 25 patients who are admitted to the hospital.

''This should give you pause when you go to the hospital," said Dr. Kenneth W. Kizer of the National Quality Forum, a Washington-based group that develops quality measurements for health care. He said HealthGrades' tally would be even larger if researchers factored in errors at nursing homes, private doctors' offices, and other outpatient settings.

According to this published report, HealthGrades officials say their study is particularly gloomy because it suggests there has been no improvement in the death rate following several high-profile mistakes. HealthGrades looked at billing information for 37 million Medicare patients across the country, which list a variety of problems ranging from postoperative infections to reactions to blood transfusions to leaving surgical tools in patients. The group zeroed in on 16 types of mishaps identified by the federal Agency for Healthcare Research and Quality as important, estimating a national death rate based on Medicare patients whose deaths could be attributed to them.

Originally posted at InjuryBoard by Robert Wolf

The Power of Apology

Jeff Rasansky — Mon, 23 Mar 2009 11:57:05 GMT

One of the first lessons a child learns, after the use of “please” and “thank you” is “I’m sorry.” And in the development of a legal claim, “I’m sorry” can often correlate not with the expression of sympathy, but with the expression of wrongdoing.

Thirty-three states currently provide a form of protection for actors who apologize during the course of an injury or civil claim, though the protection varies from state to state. In Texas, for example, apology is limited to the expression of sympathy or compassion in civil cases – any expression of negligence or culpable conduct pertaining to the accident or event is admissible to prove liability.

What does this mean: saying “I’m sorry” is inadmissible; saying “I’m sorry, it’s my fault” is admissible.

Where people get in trouble: saying “I’m sorry, I didn’t see that red light.”

But where the apology rule has made ripples is in medical malpractice claims. At the University of Michigan, an apology policy was adopted to acknowledge preventable errors. Between 2001-2007, existing claims and lawsuits dropped from 262 to 83, and legal costs fell by two-thirds. Patients were compensated without the perceived need of the legal system, though the door remains open for negligence and malpractice claims.

Seems honest explanations, genuine apology, candor, and fair compensation for the harm a patient suffers might be a piece of the medical malpractice puzzle.

Originally posted at InjuryBoard by Jeff Rasansky

Surgeon to Appeal $1.75 Malpractice Verdict

RLF Staff — Mon, 10 Mar 2008 12:19:00 GMT

Dr. Eric Leefmans is expected to appeal a $1.75 million verdict awarded to a patient of the surgeon who sued for medical malpractice during treatment following a 2003 automobile accident.

Attorney Emily Rice of Boston said her client, Dr. Eric Leefmans, plans to appeal a $1.75 million-plus-interest medical malpractice verdict issued by a New Hampshire Court last week. The plaintiff was 42-year-old Randolph Hinz who was operated on by Leefmans and the trauma team at a Concord hospital in 2003 following a car accident.
The jury found Leefmans 100 percent responsible for blindness Hinz alleged is a result of doctor error. The lawsuit claimed stating that the doctors treated the fractures in his leg before stabilizing his condition by giving him blood. Hinz's attorney, Suzanne McDonough of Boston, said Hinz's leg surgery could have waited until after his more serious blood loss was treated. The lawsuit alleged that blood loss resulted in blindness. The other two doctors named in the lawsuit were not found to be at fault.
Dr. Leefmans' supervisors continue to support him throughout the trial and appeals process. Rice and fellow attorney David Gould issued a statement following the verdict, saying:
"Our clients provided excellent care to the plaintiff after his motor vehicle accident, and we are therefore disappointed at the jury's verdict against the Dartmouth-Hitchcock Clinic and Dr. Leefmans." The statement made reference to the testimony of one of the hospital's witnesses, a neuro-ophthalmology expert from Johns Hopkins, who stated that Hinz's injury was not caused by Leefmans's medical care.
Read the Concord Monitor Article on the case.
If you suspect that you or someone you know has been the victim of medical malpractice, contact a medical malpractice attorney today.

Originally posted at InjuryBoard by RLF Staff