Is University Medical Associates, the doctors' practice group of the Medical University of South Carolina in Charleston, a public or private organization? The question has proved confounding, being answered both ways in recent years.
"If I was pressed, I'd say it was quasi-public," said Marion Woodbury, the organization's chief executive officer. "It has a number of characteristics that drive it to the public side, and a number of characteristics that drive it to the private side."
Carl Mueller, the Greenville lawyer who represented four former employees who sued MUSC and the physicians group saying they were retaliated against for raising questions about billing, doesn't buy Woodbury's explanation. "It's like one day saying you're a woman, then the next day you're a man," Mueller said.
Last month in federal court, lawyers for the doctors' group argued that it was a public entity that could not be sued under the U.S. Constitution's 11th Amendment.
The case was settled before the judge could rule on the question. However, the position is opposite one that University Medical Associates took a year ago when it responded to a Legislative Audit Council report.
University Medical Associates was created in 1991 as a nonprofit corporation after lawmakers gave the presidents and boards of the state's two medical schools oversight over the private practice salaries of faculty. It runs MUSC's ambulatory-care clinics and handles doctors' patient billing. It has its own support staff and a separate budget, board and retirement plan. The structure allows it to avoid certain state rules regarding expenditures, so when it settled the whistleblowers' lawsuit for $500,000, it did not need prior state approval.
Last year's audit questioned spending for meetings, travel, conferences and gifts and asked whether University Medical Associates' expenditures fall under state guidelines if the group represents MUSC. In response, University Medical Associates said it should not be limited to state spending rules because it was not using taxpayer money.
University Medical Associates employs doctors who teach at the College of Medicine, but it cannot buy land without the approval of MUSC trustees, who also approve its bylaws.
Bruce Shaw, the attorney who represented University Medical Associates in the lawsuit, said that under the 11th Amendment, a court could find the practice plan is intertwined with MUSC and deserves the same protection from lawsuits as a public agency. If the question is whether University Medical Associates acts on behalf of the state agency MUSC, the answer could be that the practice plan is private.