A Florida jury awarded an $8.5 million judgment against the MDVIP concierge-medicine network in a case (PDF) that may have hinged on marketing practice as much as it did on medical malpractice.
The jury held MDVIP accountable for a diagnosis missed by a concierge physician even though it was also missed by a specialist that a patient was referred to—an outcome that could have unsettling implications, according to a trade group representing such practices.
The judgment was awarded to the estate of Joan Beber, who had her leg amputated below the knee in 2008. She visited MDVIP-affiliated physician Dr. Charles Metzger, a Boca Raton, Fla.-based internist, for pain that was apparently caused by an undetected blood clot. Beber died of leukemia in 2012. Her husband, Robert Beber, was the named plaintiff in the case.
Beber's attorney, Jack Scarola, argued at trial that the Bebers did not get the “guaranteed exceptional outcomes” they were promised when they paid MDVIP's $1,500 annual fee. (Metzger settled with the Beber family in a separate case.)
“What they got was marketing deception and valueless illusory promises because MDVIP was doing nothing to fulfill its guarantees and to keep its promises,” Scarola said in his closing argument. “They're here to tell you: 'We don't involve ourselves in any way at all, with the decisionmaking process on the part of doctors.' Well, that's right. They don't. But they promised they would.”
MDVIP spokeswoman Nancy Udell said MDVIP intends to appeal the decision "as there were numerous errors in the case."
"While we are sympathetic to the difficulties that the patient and family have faced in this matter, MDVIP believes affiliate Dr. Charles Metzger provided appropriate care.”
The MDVIP network consists of almost 800 doctors who offer a customized wellness and preventive-care program and limit their business to no more than 600 patients. Patients pay a membership fee to sign up with an affiliated physician at an average cost of $1,800. The patient limit is aimed at increasing access for member patients and allowing clinicians to spend more time per visit.
Affiliated physicians must pass a screening program that includes assessment of their credentials, a background check and reference verification, according to the company website. MDVIP, based in Boca Raton, Fla., was owned at one time by Proctor & Gamble Co., but was sold in 2014 to Summit Partners, a private equity firm.
Udell pointed to studies showing higher patient satisfaction and reductions in hospital utilization among MDVIP members.
“MDVIP has hundreds of thousands of patients across the country with annual renewal and satisfaction rates consistently above 90%,” she added.
Dr. Matthew Priddy, president of the American Academy of Private Physicians, a concierge medicine association, said he was glad to hear that MDVIP would appeal. “I think it's crazy,” Priddy said. “It's the wrong verdict.”
Priddy heads Priority Physicians, a five-doctor concierge practice in Indianapolis, which offers a host of services for a flat fee and doesn't accept insurance. While he doubts the verdict will deter physicians from choosing the concierge model, he fears it could have other implications.
"If this stands, it certainly muddies the picture of who's responsible for a medical mistake,” Priddy said. MDVIP, he noted, was not providing medical care. It was referring patients to doctors within its national network of almost 800 physicians.
“If they become responsible if something happens with one of their 800 doctors, that could be a game-changer,” Priddy said. “It may also change the way corporations are set up to manage groups of doctors.” It could also put primary-care physicians at risk any time they referred a patient to a specialist, he said.
Karen Terry, an attorney with Searcy Denney Scarola Barnhart & Shipley, the firm that represented Beber, viewed the impact in that regard more narrowly. The case will affect primary-care physicians' specialty referrals “only if they refer the patient to the wrong specialists or not enough specialists,” she said.
“MDVIP is now held to be vicariously liable for its 784 doctors around the country,” Terry said, which may bring some consumer awareness to the promises being made by concierge practices—particularly MDVIP's promise to coordinate specialty care.
“If you're going to guarantee or promise that to your patients, you should stand by it and do it right,” Terry said.
Jurors ruled that Metzger was responsible for 95% of the negligence in the case, while an orthopedic surgeon was responsible for the other 5%. With this split, Metzger was then ruled responsible for $7 million in pain and suffering damages and $500,000 for medical expenses. The orthopedic surgeon was responsible for $1 million in pain and suffering and more than $36,000 in medical expenses. Robert Beber was awarded $3,000 “as a consequence of MDVIP's fraudulent misrepresentations and/or misleading advertising.”
MDVIP could also be liable for another $1 million to cover the cost of legal fees for the seven-year case, according to Beber's lawyers.
Follow Andis Robeznieks on Twitter: @MHARobeznieks