Recent Court Cases

APRIL 18, 1994 VOLUME 1, NUMBER 21

Some recent court cases of note to those caring for or working with elders:

Fraudulent Medigap Sale

An Alabama insurance salesman persuaded Mattie Foster to purchase a Medicare supplemental insurance policy. Ms. Foster was 70 years old and illiterate. Although she told the agent that she was covered by Medicare, she was actually receiving Medicaid. The agent left brochures explaining the policy, but did not tell Ms. Foster that without Medicare coverage the policy would be worthless.

Three years later, Ms. Foster filed a claim for reimbursement from the insurance company. She was told that the claim was being “investigated,” but no payment was made. A year later Ms. Foster learned from her doctor’s office that the policy was worthless; the doctor’s office also spoke with someone from the insurance company, who promised to “look into the matter” but never did.

Ms. Foster canceled her policy (after having paid a total of $2,468.600 in premiums) and filed suit. The jury awarded her a total of $1 million in punitive damages and $250,000 in actual damages for reimbursement, mental anguish and distress. The trial court reduced the punitive damages to $250,000.

The Alabama Supreme Court reinstated the $1 million punitive award. The actual damages were reduced to $50,000, based on the court’s reasoning that the evidence of distress was “scant.” Foster v. Life Insurance Co. of Georgia, Alabama Supreme Court, January 14, 1994.

Nursing Home Did Not “Dump” Patient

Catherine Fields, a patient at a Florida nursing home, was transferred to the hospital due to respiratory failure. After hospital treatment, the nursing home refused to readmit her because of its “inability to deliver proper patient care.” The hospital filed suit, seeking payment for five days of non-acute care provided while it looked for alternative placement.

The hospital argued that the nursing home’s actions constituted “patient dumping” as defined in federal statutes prohibiting hospitals from transferring patients to other facilities based on the inability to pay. The Federal Court in Florida disagreed, holding that the “patient dumping” prohibition applies only to hospitals, not nursing homes. Even if the federal rules applied to this transfer it was motivated by the need for emergency care and not by the nursing home’s desire to shift the burden of uncompensated medical care to another facility. In re: Senior Care Properties, Inc., Florida Federal District Court, Northern District, November 24, 1993.

Reducing Fractures

A recent study shows that flouride and calcium, taken in combination, may help reduce the risk of bone fractures in elderly women. An interim report of the study relates that 48 women with osteoporosis have taken an experimental slow-release fluoride, along with calcium citrate, for the past 2½ years. During that time, only 10 new fractures have been reported, compared to 26 new fractures in the control group of 51 women receiving a placebo.

Tests also show that there may be some bone rebuilding in the women taking fluoride. The interim results are reported in the current Annals of Internal Medicine.

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