OLYMPIA, Wash.—The Washington state chapter of the American College of Emergency Physicians filed a lawsuit against the Washington State Health Care Authority, seeking to stop implementation of a policy that went into effect Oct. 1 under which Medicaid pays for only three nonemergency visits a beneficiary makes to a hospital emergency department each year. According to the lawsuit, filed in Superior Court in Olympia, the policy is illegal because the agency failed to follow its own rulemaking procedure. The group asserts that the agency failed to collaborate with the state hospital and medical associations, as directed by the Legislature, to identify conditions that require emergency treatment. The complaint also contends that the list of diagnostic codes that wouldn't be covered includes codes for conditions that, “according to medical evidence and reasonable medical judgment,” require emergency treatment, and that the policy doesn't follow federal and state laws governing coverage reductions. “We understand that our state Medicaid office is working with 19 other states to develop this policy,” Dr. Stephen Anderson, president of the Washington ACEP chapter, said in a news release. “If this plan goes into effect, other states will certainly follow suit.”
LOS ANGELES—A Los Angeles jury acquitted a transplant surgeon who was accused of taking part in misallocating a donated liver in 2003 and then orchestrating a cover-up of the situation. Dr. Richard Lopez Jr., 55, was found not guilty of all eight crimes Sept. 30, including conspiracy, concealment of material fact and falsification of records, court records say. Lopez at the time was medical director of the liver transplant program at St. Vincent Medical Center, which shut down its liver transplant program in 2005 after the misallocation was uncovered. Lopez's defense attorney, Ken Julian of Manatt, Phelps & Phillips, said Lopez continues to practice medicine at various hospitals in the L.A. area. Lopez was accused of orchestrating a two-year cover-up of the effort to bypass a potential transplant recipient near the top of the liver waiting list who was living in Saudi Arabia at the time, in favor of another man who ranked No. 52 on the wait list. The man who received the liver was also a Saudi citizen, though he was living next to the hospital and was in the intensive-care unit, Julian said. The defense argued that federal prosecutors didn't have jurisdiction in the case, and also that Lopez was being blamed for the sins of many people involved. “There were a lot of hands in this pudding, and Dr. Lopez was essentially the scapegoat for all that went wrong,” Julian said.
LOS ANGELES—Providence Health & Services' Southern California branch has formed a new physician-led alliance with quality and accountability metrics in mind. The new Providence Partners for Health requires doctors to share information on quality and receive feedback from colleagues to show compliance with guidelines for care developed by Providence. “Providence Partners for Health provides a tool for us to partner with physicians to share best practices and clinical data and to foster and sustain a system driven by both quality and value,” Dr. John Armato, chairman of the new alliance, said in a statement. The group will form teams of doctors, clinicians and experts to find ways to improve care and standardize best practices. The move puts Providence in a better position to adapt to changing delivery and payment models, such as accountable care organizations. “The new Providence Partners for Health is not currently an ACO, but could evolve that way,” Kerry Carmody, chief operating officer for Providence Health & Services, Southern California, wrote in an e-mail. “Our current focus is on creating a clinically integrated organization to improve both quality and affordability for all payers including PPOs, HMOs and Medicare. We want to participate in various facets of healthcare-reform initiatives including pay for performance, bundled payments, narrow networks and eventually ACOs.”
PALO ALTO, Calif.—A class-action lawsuit filed following a reported data breach of 20,000 patients' medical records claims that Stanford Hospital & Clinics unlawfully disclosed confidential medical information. The health system discovered in August that medical information for 20,000 emergency room patients released to a billing and collections contractor had been publicly available online for a year. The vendor, Multi-Specialty Collection Services, also was named in the lawsuit filed in Los Angeles County Superior Court. Attempts to reach Multi-Specialty Collection Services at deadline were unsuccessful. “SHC intends to vigorously defend the lawsuit that has been filed as it acted appropriately and did not violate the law as claimed in the lawsuit,” the system said in a statement posted on its website. The lawsuit argues the legal action should include any patients who had visited Stanford Hospital's emergency room between March 1, 2009, and Aug. 31, 2009, whose records appeared on the public website. The complaint was brought by Shana Springer, who sought treatment at the hospital's emergency room in August that year. Stanford Hospital said the billing and collections contractor improperly released the medical records to someone who posted them online. “This mishandling of private patient information was in complete contravention of the law and of the requirements of MSCS's contract with SHC and is shockingly irresponsible.”
