Posts Tagged ‘negligence’

Hospital Gets No Credit For Care Not Paid By Medicare

NOVEMBER 17, 2003 VOLUME 11, NUMBER 20

While in Via Christi’s St. Francis Hospital in Wichita, Kansas, for tests, Lyle Rose fell out of his bed and hit his head. He suffered a subdural hematoma (a blood clot in the brain) and developed other complications. He stayed in the hospital for over a month, but despite the facility’s best efforts he died from his injuries.

Rather than pay for his intensive care stay itself, Via Christi chose to bill Medicare for Mr. Rose’s time in the hospital. Because Medicare pays less than the full cost of patients’ care, Via Christi ended up writing off over $150,000 of the $242,000 it billed for Mr. Rose’s care. Medicare rules precluded Via Christi from seeking payment for any portion of the bill it was required to write off.

After he died, Mr. Rose’s family sued Via Christi for negligence. They alleged that it was the hospital’s fault that he had fallen out of his hospital bed, and a jury ultimately agreed, if only partially. The jury awarded $582,186.01 in damages for Mr. Rose’s death, and ruled that Via Christi was responsible for 36% of that amount, or $209,586.96.

Via Christi then asked the judge to reduce the award because of the unpaid medical care it had provided. Via Christi argued that it had already contributed more than its 36% share of the medical care portion of Mr. Rose’s care; after all, the facility reasoned, the total amount of damages had included the portion of its fee that had been written off.

The trial court agreed and reduced the judgment against Via Christi to just over $115,000. The Kansas Supreme Court, however, reversed the trial judge and reinstated the original judgment against Via Christi.

According to the court, there were two problems with Via Christi’s position. First, Medicare rules prohibit providers from seeking reimbursement for any unpaid portion of a bill otherwise covered by Medicare. Since the Medicare law is federal, it preempted any Kansas state law which arguably might have authorized the offset.

The “collateral source” rule also keeps defendants from introducing information about a plaintiff’s insurance coverage. Medicare, ruled the Kansas court, is after all just an insurance program, and Mr. Rose’s estate should not be penalized for the fact that he was covered by insurance.

Via Christi argued that keeping this information out of the court case gave Mr. Rose’s heirs a windfall. That may be true, reasoned the court, but if there is to be a windfall, it should benefit the victim’s family rather than the hospital. Rose v. Via Christi Health System, October 31, 2003.

Court Dismisses Claim Alleging Neglect Of Mother-In-Law

FEBRUARY 18, 2002 VOLUME 9, NUMBER 34

Frances McMahon spent the last year of her life at Guardian Postacute Services, a Walnut Creek, California, skilled nursing facility. According to her family members, the care at the facility led to her early death; she allegedly suffered from malnutrition and dehydration, lost considerable weight, became bedridden and incontinent. After her death her son and daughter filed a civil complaint against the nursing facility. Ms. McMahon’s son-in-law Ken Moon also filed for damages, alleging that the nursing facility had injured him by its treatment of his mother-in-law.

Mr. Moon claimed that the nursing facility, through its negligence, had inflicted emotional distress on him. The home had injured him, argued Mr. Moon, because he was forced to watch what he thought was substandard and neglectful care being delivered to his mother-in-law, and ultimately was witness to her decline and death.

Normally such a claim for injuries would not be available to someone who is not a blood relative of the actual victim. Mr. Moon argued, however, that his relationship with his mother-in-law was unusually strong. He pointed out that Ms. McMahon had lived with him and his wife for four or five months some years before she went into the nursing home, and that she had spent one month with the couple every year for nearly twenty years.

In order to sustain a claim for negligent infliction of emotional distress under California law, Mr. Moon would have to show that there were “exceptional circumstances” involved in his relationship with his mother-in-law. The trial judge did not believe that Mr. Moon had made a sufficiently good argument, and dismissed him as a plaintiff before trial. Mr. Moon appealed the dismissal.

In his appeal Mr. Moon insisted that he had been injured by the nursing facility’s care of his mother-in-law. He argued that he was a direct victim (since the facility knew he was a concerned family member and disregarded the effect its practices would have on him). He also maintained that he was injured as a “bystander” by virtue of having to watch the mistreatment of the real victim, Ms. McMahon.

The California Court of Appeal considered Mr. Moon’s argument, and agreed that there was no legal claim available to him. They noted that there was a strong relationship between Mr. Moon and Ms. McMahon, but found that he was not a direct victim of the alleged poor-quality care at the facility.

In order to support his claim as a bystander, Mr. Moon would have to show that he was either a relative residing in the same household, a parent, sibling, child or grandchild of Ms. McMahon. In the alternative, if he could have shown that there were no other relatives to make a claim he might be allowed to pursue his legal action, but the ordinary relationship between a mother-in-law and son-in-law, even one with significant ties and a strong emotional bond, would not qualify. Moon v. Guardian Postacute Services, Inc., January 31, 2002.

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