Holland & Hart Healthcare Law Blog

International Patient Dumping by Hospitals Scored in New York Times

On Aug. 3, 2008, the New York Times ran a front page feature story chronicling the apparently widespread practice by U.S. hospitals in dumping illegal (and sometimes legal) immigrants abroad in order to avoid the high cost of treatment and maintenance in the United States.  The feature, “Deported by U.S. Hospitals,” written by Deborah Sontag, largely follows the medical and legal passage of one Luis Alberto Jiménez, a Guatemalan illegal, who was working as a gardener in Stuart, Florida when he was struck by a drunken Floridian, suffering severe traumatic brain injury.

Wisconsin Supreme Court Orders HMO to

In Summers v. Touchpoint Healthplan, Inc., Case Number 2005-AP 2643 (Wisc. May 28, 2008), the Wisconsin Supreme Court ordered Touchpoint to provide coverage for an "experimental" high dose radiation and stem cell recovery procedure for a child suffering from a rare brain tumor. Surgeons removed the tumor and the child’s doctors recommended the high dose radiation treatment with stem cell recovery as the best of the follow-up options to assure full recovery. The problem was that the procedure was "experimental" as defined in the policy and was excluded from coverage under the policy. Included in the plan’s definition of "experimental" was any procedure that was the "subject of any ongoing Phase I or Phase II clinical trial."

Wisconsin Supreme Court Orders HMO to

In Summers v. Touchpoint Healthplan, Inc., Case Number 2005-AP 2643 (Wisc. May 28, 2008), the Wisconsin Supreme Court ordered Touchpoint to provide coverage for an "experimental" high dose radiation and stem cell recovery procedure for a child suffering from a rare brain tumor. Surgeons removed the tumor and the child’s doctors recommended the high dose radiation treatment with stem cell recovery as the best of the follow-up options to assure full recovery. The problem was that the procedure was "experimental" as defined in the policy and was excluded from coverage under the policy. Included in the plan’s definition of "experimental" was any procedure that was the "subject of any ongoing Phase I or Phase II clinical trial."

Indian Health Plans May or May Not Be Exempt From ERISA.

In Dobbs v. Anthem Blue Cross and Blue Shield, No 05-1319 (1-30-07), The Tenth Circuit Court of Appeals remanded the case to the District Court below to determine whether the plaintiffs’ Indian tribal health insurance plan was a “governmental plan” that is excluded from ERISA. The Dobbs brought a suit against Anthem in a Colorado district state court asserting five state law claims against Anthem.  Anthem responded by removing the state court case to a federal district court in Denver, asserting that ERISA preempted the state court claims.  The Dobbs argued that their plan, sponsored by the Southern Ute Indian tribe, was exempt from ERISA because it was a “governmental plan.”  Governmental plans for federal and state employees are exempt from ERISA.  There was no explicit inclusion of Indian tribal plans within the definition of governmental plans in the ERISA statute.

MENTAL DISORDER IS NOT ALWAYS “MENTAL ILLNESS” UNDER INSURANCE POLICY EXCLUSIONS.

Bipolar disorder is a euphemism for what used to be described as “manic depression.”  It is cataloged as a mental disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (IVth Ed.).  Anyone who knows or is related to a manic depressive person would probably describe it as a mental illness.  So do insurance companies.  Many insurance companies exclude or otherwise limit benefits on disability and death insurance policies for conditions of mental illness.  There has been a long running debate among mental health professionals, scientists, philosophers, ethicists and others as to whether the manifestation of behavioral material, or cognitive malfunction in human beings is based on physical or situational causes.

Colorado Supreme Court Holds Insurance Company Liable For Emotional Distress in Bad Faith Case Without Substantial Property or Economic Loss.

Last week the Colorado Supreme Court, in Goodson v. American Standard Insurance Co. of Wisconsin, held that the insurer could be held liable for emotional distress in an insurance bad faith case without having to first prove substantial property or economic loss. The Court specifically overruled State Farm Insurance Company v. Trimble, 768 P. 2d 1243 (Colo. App. 1988) which set forth the substantial property or economic loss prerequisite.

Pacificare Gets It Both Ways In Curious California Ruling On Arbitration Provision.

Pacificare of California had a 1994 health services contract with Saint Agnes Medical Center in Los Angeles, which was supplanted by a new agreement in 2000. The 2000 agreement contained an arbitration provision, the 1994 agreement did not. In March of 2001, Pacificare filed an action in Los Angeles seeking recission of the 2000 agreement and the reinstatement of the 1994 agreement on account of a condition subsequent. Saint Agnes filed its own lawsuit for breach of the 2000 agreement by Pacificare in Fresno County. Saint Agnes successfully obtained a change of venue of the Los Angeles Pacificare suit to Fresno County. Pacificare then sought to have the Saint Agnes suit resolved by arbitration under the arbitration clause in the 2000 agreement which Pacificare had repudiated. The trial court ruled that by repudiating the 2000 agreement Pacificare had waived the benefit of the term of the 2000 agreement, but a California Appeals Court ruled that it had not and that it remained enforceable for the claims covered thereby. See (Saint Agnes Medical Center v. Pacificare of California, Cal., No. S111323, 12/18/03) http://www.courtinfo.ca.gov/opinions/documents/S111323.PDF

Medically Uninsured Have Major Negative Economic Impact in Montana.

An Economist from the University of Montana speaking at the Montana Governor's recent health care summit in September underscored the importance of the health care industry to the Montana economy. The health care industry provides 11% of all private sector jobs in the State of Montana. In Billings and Yellowstone County the industry accounts for 12 percent of jobs and 18% of wages. The industry is currently being whipsawed by declining health care coverage in the population, the lack of skilled health care professionals and the means to pay them and accumulate reinvestment capital for facilities and equipment. Like many other states the rise in the uninsured population is having devastating effects on the health care industry in Montana. 22 % of the population under 65 in the State of Montana is uninsured. 50 of Montana's 56 counties have been designated wholly or partially medically underserved areas.

Company Health Plans Move To Drop Spouses.

The Wall Street Journal reports today that the rise again of double digit increases in the costs of medical health plans has led to movement on the part of employers to impose penalties on coverage of employed spouses of company employees who choose to accept the health insurance benefits of the company rather than their own employer. Companies are also engaging in the "tiering" of employee families with larger families having to pay more for their health insurance coverage.

Colorado Court Holds City Liable For Pretrial Detainee Medical Costs.

The Colorado Court of Appeals ruled in Poudre Valley Healthcare, Inc. dba Poudre Valley Hospital v. City of Loveland, No 02CA0550, that the City of Loveland was responsible to the hospital for the medical care and treatment provided to a pretrial detainee who injured himself escaping from a window of a moving police van.