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Volume 2 Issue 1 |
Spring 2013 |
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| Arbitration in the Long Term Care
Setting: Carter vs. SSC Odin Operating Co. (Carter II) |
Introduction:
In
Fosler v. Midwest Care Center II, Inc., 398 Ill.App.3d 563 (2d Dist.
2009) (modified upon denial of rehearing, March 1, 2010), the Appellate
Court considered the question whether a binding arbitration agreement between a
resident and her nursing home contained in a nursing home admission contract is
invalidated by provisions in the Illinois Nursing Home Care Act (NHCA)
guaranteeing a right to a jury trial. The NHCA states that a party to
a claim brought under the Act "shall be entitled to a trial by jury and
any waiver of the right to a trial by jury, whether oral or in writing, prior to
the commencement of an action, shall be null and void, and without legal force
or effect." 210 ILCS 45/3-607 (2010). The decision in Fosler is
important because the court held for the first time that the NHCA did
not invalidate arbitration agreements between a resident and a nursing home, and
the Federal Arbitration Act(FAA) preempted the anti-waiver provisions
of the NHCA.
The Fosler court determined that a conflict
existed between the FAA and the NHCA, because the FAA
permits and favors arbitration agreements while the NHCA invalidates
them as a matter of public policy. When such a conflict exists, the Supremacy
Clause of the United States Constitution and the doctrine of federal preemption
provide that the state law shall be
preempted by the federal legislation. Fosler, 398 Ill.App.3d at
567-568, citing, Southland Corp. v. Keating, 465 U.S.1, 10-11, 104 S.
Ct. 852, 858 (1984). Moreover, the FAA preempts any state based
statutory, regulatory, or decisional law which places any greater hurdle to the
enforcement of contracts for arbitration than for contracts generally.
The United States Supreme Court, however, has stated
there
are two limitations to the enforceability of
arbitration provisions governed by the Federal Arbitration Act: "they
must be part of a contract 'evidencing a transaction involving commerce' and
such clauses may be revoked upon 'grounds as exist at law or in equity for the
revocation of any contract.'" Southland, 465 U.S. at 10-11.
Consequently, arguments concerning the capacity to sue, authority,
unconscionability, mutuality of consideration, and unavailability of the
arbitration forum are still available to defeat the enforcement of arbitration
agreements under the FAA "savings" clause. Even though the
FAA preempts state laws which invalidate arbitration agreements
generally, state law based contractual defenses not solely aimed at invalidating
arbitration agreements remain available, and a plaintiff thereby can avoid
arbitration.
Before the decision
in the Fosler case was issued, the Fifth District Appellate Court in
Carter v. SSC Odin Operating Co., LLC, 381 Ill.App.3d 717 (2008) held
that the FAA did not preempt the NHCA, and found that the
provisions in the NHCA guaranteeing the right to a jury trial were
sufficient to invalidate arbitration agreements despite the potential conflict
between preemption under the FAA and the Nursing Home Care
Act. The Fosler court considered the decision in Carter
but refused to follow it declaring that Carter incorrectly interpreted
the Supreme Court cases discussing the preemption issue. Fosler, 398
Ill.App.3d 571.[1]
CARTER I:
The nursing home defendant in Carter I
successfully petitioned the Illinois Supreme Court for review of the Appellate
Court decision citing a conflict between the appellate courts in Carter
and Fosler. In Carter I, the Illinois Supreme Court issued a
written opinion agreeing with the Fosler analysis. See, Carter v.
SSC Odin Operating Co., LLC, 237 Ill.2d 30, (2010). The Supreme Court
undertook an analysis of the anti-waiver provisions/public policy set forth in
the Nursing Home Care Act and of the purpose and history of the
Federal Arbitration Act including the federal policy set forth in
several United States Supreme Court decisions that the enforcement of private
arbitration agreements places the FAA in conflict with state laws
requiring litigants to be provided a right to a jury trial in certain types of
actions. The Supreme Court reversed the Appellate Court in Carter
holding that the anti-waiver provisions of the NHCA were the functional
equivalent of anti-arbitration legislation, which is preempted by the
FAA and Supreme Court precedent. Carter, 237 Ill.2d at
38-49. The Supreme Court also concluded that the anti-waiver provisions of the
NHCA were not "grounds which exist at law or in equity for the
revocation of any contract," and amounted to a law disfavoring arbitration which
the FAA specifically prohibits and preempts. However, in Carter
I, the Supreme Court did not address the general contract defenses raised
against the arbitration agreement, and instead remanded the case to the
Appellate Court for consideration of the remaining issues.
CARTER
II:
In Carter v. SSC Odin Operating Co., LLC (Carter
II), 2012 IL 113204 (2012), the Illinois Supreme Court addressed those
remaining issues. On remand in Carter I, the Fifth District Appellate
Court again affirmed the trial court's refusal to compel arbitration. The
Appellate Court looked to general contract defenses applicable to all contracts
and held that the nursing home's promise to arbitrate was illusory, and
therefore, the arbitration agreement was unenforceable for lack of mutuality of
obligation. The Appellate Court also held that even if the arbitration
agreement was enforceable, plaintiff could not be compelled to arbitrate the
wrongful death claim because plaintiff did not sign the arbitration agreement in
her individual capacity but signed the agreement only as the decedent's
(resident's) legal representative.
In Carter II, the Supreme Court stated that the
FAA was enacted "to reverse the
longstanding judicial hostility to arbitration agreements" and "to place
arbitration agreements upon the same footing as other contracts." The Court
reaffirmed that under the FAA savings clause, an arbitration agreement
may be invalidated by a state law contract defense of general applicability,
such as fraud, duress, or unconscionability, without contravening the
FAA, but an arbitration agreement may not be invalidated by a state law
applicable only to arbitration agreements. The Court then reversed the
Appellate Court's decision that the state law contract defense of mutuality of
obligation invalidated the arbitration agreement. The Court held that
principles of contract law do not require an equivalent exchange of obligation
or equivalence in the values exchanged by each of the contracting parties.
Therefore, the Court held that the nursing home's (Odin's) promise was
not illusory because it promised to pay the arbitration fees and to pay limited
attorney's fees of the resident. The Court concluded that the plaintiff's
promise to arbitrate, even if not met with a reciprocal promise to arbitrate by
defendant, was nonetheless supported by consideration, and therefore, the
arbitration agreement was enforceable and the state law contract defense of lack
of mutuality of obligation was not available under the facts of the
case.
In light of the Supreme Court's holding the arbitration
agreement was enforceable as to the Survival Act claims for negligence
and statutory violations pursuant to the Nursing Home Care Act, the
court addressed the question whether the plaintiff was required to arbitrate the
wrongful death claim. Although the Supreme Court held Carter could be
compelled to arbitrate the survival action, she could not be compelled to
arbitrate her wrongful death action because she did not sign the arbitration
agreement. The Court explained that plaintiff (Carter) had signed the
arbitration agreement as the resident's legal representative, and not in her
individual capacity or on her own behalf as a potential wrongful death
plaintiff. The Supreme Court held that plaintiff, as a non-party to the
arbitration agreement, could not be compelled to arbitrate the wrongful death claim. The court found
that the allegation of violation of the Nursing Home Care Act under the
Survival Act is a claim that accrued to the decedent prior to her death
and was brought for the benefit of the decedent's estate, and therefore,
plaintiff was bound to arbitrate that claim. For purposes of the wrongful death
action, however, the court found that plaintiff was not acting in the decedent's
stead, and the wrongful death action did not accrue until death and was not
brought for the benefit of the decedent's estate, but for the next of kin who
were the true parties in interest. Plaintiff, as the decedent's personal
representative in the wrongful death action, was merely a nominal party,
effectively filing suit as a statutory
trustee on behalf of the next of kin. The Supreme Court held that because
plaintiff was not prosecuting the wrongful death claim on behalf of the
decedent, plaintiff was not bound by the decedent's agreement to arbitrate for
purposes of the wrongful death cause of action.
Conclusion:
These decisions by the Illinois Appellate Court and by
the Illinois Supreme Court are important decisions regarding the applicability
and validity of binding arbitration agreements in nursing home cases. While
Carter I focused on the public policy argument and held that the
anti-waiver provisions in the Nursing Home Care Act were preempted by
the FAA and unenforceable because they disfavored arbitration which is
prohibited by the FAA, Carter II focused on principles of
general contract law like consideration, mutuality of obligation, capacity, and
authority. Therefore, if long term care providers carefully draft their
arbitration agreements, this should limit the amount of discretion the courts
have to refuse to enforce arbitration provisions. A long term care provider
interested in enforcing its arbitration agreements should ensure the agreement
is based on a valid enforceable contract.
Removing unconscionable provisions such as onerous
cost sharing provisions, or provisions limiting discovery or caps on damages or
prohibitions on punitive damages will limit the court's discretion to invalidate
the arbitration agreement as a whole.
__________________________________
[1]
Kominiarek Bresler Harvick & Gudmundson, LLC represented the nursing home
defendant in the trial court and for the appeal in Fosler v. Midwest Care
Center II, creating new case law in Illinois that binding arbitration
clauses in nursing home admission contracts are enforceable. (C. Thomas Hendrix and Michael R.
Webber)
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Disclaimer: The material in this newsletter has been prepared by KBHG
for informational purposes only and does not constitute legal
advice.
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Health
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Join Our List
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Volume 1 Issue 3 |
Fall 2012 |
| Announcements |
|
The big news around KBHG this fall is our
move. We have moved office space and while we're still located at 33 North
Dearborn, across from the Daley Center, we are now in Suite 1310.
Please contact us at:
33 North Dearborn
Suite 1310
Chicago, Illinois 60602
T: 312.322.1111
F: 312.782.1432
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| Reporting Requirements: The National
Practitioner Data Bank |
The National Practitioner Data Bank is an electronic
repository of all payments made on behalf of physicians in connection with
medical liability settlements or judgments, as well as adverse peer review
actions against licenses, clinical privileges, and professional society
memberships of physicians and other health care practitioners. The NPDB was
established by Congress as part of The Healthcare Quality Improvement Act of
1986. By federal law, information on all medical liability payments and on
certain adverse actions must be reported to the NPDB. In turn, the NPDB is
required to make this information available to hospitals, state licensure
boards, some professional societies and other health care entities under certain
circumstances. It is primarily an alert or flagging system which is intended to
put parties on notice that the physician may have competence or professional
misconduct problems. The information is considered confidential and is released
only to the eligible entities or to physicians and other health care
practitioners who wish to conduct a self-query.
The NPDB
collects and disseminates information, such as professional liability payments
made on behalf of a physician or other health care practitioners. Adverse
action reports are based on professional conduct that adversely affects
privileges for more than 30 days, such as reducing, restricting, suspending,
revoking or denying privileges. The NPDB also collects and disseminates
information when there is a voluntary surrender of license or restriction of
privileges while under investigation or in lieu of an investigation. Any
voluntary surrender related to retirement, nonpayment of licensure renewal fees
or changes to inactive status, if there is not an investigation in progress, are
not reportable. Any disciplinary actions related to competence or professional
misconduct are reportable, as are professional society review actions taken for
reasons related to competence or professional misconduct that adversely affect
membership in the society. Finally, Medicare and Medicaid exclusion reports
containing sanctions against a practitioner from the Medicare or Medicaid
program due to fraud and abuse are reportable. This list should not be
considered exclusive. Should you have questions regarding whether an occurrence
is reportable, please refer to The National Practitioner Data Bank office Guide Book.
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| Deposition Fees |
Before 1985 in Illinois,
all non-expert treating physicians were like any other witness who received a
subpoena for trial: these witnesses were entitled to only a mileage fee. In
1985, the Illinois Supreme Court created Supreme Court Rule 204(c) which
regulates the depositions of physicians. The Rule stated that a party "may pay a
reasonable fee to a physician for the time he or she will spend testifying in a
deposition." In 1989, the Illinois Supreme Court modified the Rule stating the
party "shall pay a reasonable fee to a physician for the time he or she will
spend testifying at a deposition." See Illinois Supreme Court Rule 204(c).
In changing the Rule, the
Supreme Court articulated its recognition that physicians spend time away from
their practice testifying, and should be compensated for that time lost.
However, the Supreme Court also set forth various fee collecting restrictions,
including that the physician can be compensated only for time spent testifying
at the deposition, the fee should be paid only after the doctor has testified
and it should not exceed an amount which reasonably reimburses the doctor for
the time he or she actually spends testifying at the deposition.
In 2010 the First District
Appellate Court further addressed the issue in Montes v. Mai. 398 Ill.App.3d
424 (1st Dist.2010). After deciding that a chiropractor is a "physician" under
the Supreme Court Rule 204(c), the Court went on to address the concept of a
reasonable fee. In the Montes case, a chiropractor sought $550 per hour for his
deposition testimony with pre-payment and a two hour minimum. Opposing counsel
offered $300 per hour, which the chiropractor refused. The defendant brought a
Motion to reduce the doctor's fees, claiming they were unreasonable. In
evaluating what a reasonable fee was, the court reviewed personal and corporate
records submitted by the doctor. The doctor's deposition fees were calculated
by the court based on his income listed in a W-2 and divided that by 52 weeks at
40 hours a week. This came out to $66.95 per hour. The chiropractor appealed
the decision.
The Appellate Court upheld
the fee calculated by the Trial Court. It also stated that the defendant was
not required to pay a two hour minimum or pre-pay the doctor. He was to be paid
after his deposition for the time he actually spent in deposition. The Court
did go on to suggest that the Trial Court's method of calculation is not the
only means by which a fair and reasonable fee can be calculated and it is
understood that there might be other ways to obtain a reasonable fee. It stated
however that ". . . patently the best approach is for a physician and the
parties seeking a deposition to discuss this matter and reach an agreement".
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Editor in Chief
Partner at KBHG
Disclaimer: The material in this newsletter has been prepared by KBHG
for informational purposes only and does not constitute legal
advice.
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Health
Law Newsletter |
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| Volume 1 Issue 2 |
June 2012 |
|
Announcements |
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We are pleased to announce the
publication of Illinois Civil Practice: Preparing for Trial 2012 edition by the
Illinois Institute for Continuing Legal Education (IICLE).
For more information or to purchase a
copy of the publication, please contact IICLE.
______________________________________________________
Sherry Mundorff has been
appointed by the President of the Illinois State Bar Association to their
Standing Committees on both Women and the Law and Public Relations.
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| Court strictly construes Medical
Studies Act in memo written to surgery center board. |
By: Mary M. Cunningham
In a recent
DuPage County case (Kopolovich v. Shah, 2012 ILL App (2d) 110383), an
anesthesiologist wrote a memorandum to several board members of a day surgery
center stating that a surgery in which he participated differed from what was
consented to by the patient and what was listed on the OR schedule. He alleged
that the surgeon was "deceptive" and "unethical" in performing a full
abdominoplasty ("tummy tuck") instead of a hernia repair, excision and revision
to correct an abdominal wall deformity. An investigation ensued and was not
resolved. The surgeon sued the anesthesiologist and surgery center for
Defamation and False Light Invasion of Privacy.
The
anesthesiologist/defendant argued that the Medical Studies Act applied to the
memorandum because he circulated it to the board only and because it dealt with
matters of Quality Control.
Traditionally
the Medical Studies Act has been relied upon by hospitals to protect Peer Review
documents from disclosure. The purpose of the Act is not to shield hospitals
from liability, but to insure that physicians will engage in effective
examination of their peers in order to advance quality of healthcare. Illinois
courts have consistently held that a Peer Review Committee document is
privileged only if it is "initiated, created, prepared or generated by" a Peer
Review Committee. Thus, a document generated before the Committee is engaged in
reviewing an incident will not be deemed privileged.
The court
rejected the anesthesiologist's argument that the memo was protected. It found
that as there was no Peer Review or Quality Control Committee investigating the
incident before the memo was written, it did not qualify as privileged under the
Act. Also, the anesthesiologist was not a member of any Peer Review or Quality
Control Committee and, therefore, the memo could not have been "initiated,
created prepared or generated by" a Peer Review or Quality Control Committee.
In its very strict interpretation of the statute, the Court found that "even
when the content of the communication is in harmony with the promotion of
internal quality control and improving patient care, the communication is not
privileged under the Act when it is not generated by a Committee of the type
described by the Statute." The memo was not considered privileged and the
plaintiff surgeon was able to proceed with his case for Defamation and False
Light Invasion of
Privacy. |
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Editor
in Chief
Partner at KBHG
Disclaimer: The material in this newsletter has been
prepared by KBHG for informational purposes only and does not constitute legal
advice.
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KBHG |
33 North Dearborn | Suite 700 | Chicago |
IL |
60602 |
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 Health Law Newsletter |
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| Volume 1 Issue 1 |
March 2012 |
 |
Groupon |
Permissible Marketing or Prohibited Fee Splitting?
Most people are familiar with one or more of the myriad of web-based discount sites, such as Woot, LivingSocial, and of course, Groupon. These companies, and many more, are all part of the "deal-of-the-day" industry offering short-term discounts on goods, and increasingly, services. In some states, these services have recently started to include services such as dental cleanings, laser hair removal and varicose vein treatments.
Some service providers, both within and outside the health care industry, have seen these discounted offers as a means to increase visibility and attract new business. In this view, the discounts appear little different from traditional advertising which includes a first time customer discount. However, traditional advertising typically involves a flat rate to make the offer (such as a newspaper ad) and all advertisers pay the same price. As a result, there is no per diem relationship between the cost of the advertisement and the number of individuals accepting the offer.
Under the traditional Groupon model, there is a fee paid to the marketer (such as Groupon) for each voucher sold, typically 50% of the voucher cost to the consumer. It is this per diem association which raises concerns under the Illinois Medical Practice Act.
Section 22.2 of the Medical Practice Act (225 ILCS 60/22.2) is titled "Prohibition against fee splitting" and states: "(a) A licensee under this Act may not directly or indirectly divide, share or split any professional fee or other form of compensation for professional services with anyone in exchange for a referral or otherwise..." Further, section 22.2(f) states that "a licensee under this Act may not divide, share or split a professional service fee with, or otherwise directly or indirectly pay a percentage of the licensee's professional service fees, revenues or profits to anyone for: (i) the marketing or management of the licensee's practice, ... (iv) negotiating fees, charges or terms of service or payment on behalf of the licensee, or (v) including the licensee in a program whereby patients or beneficiaries are provided an incentive to use the services of the licensee."
Based upon section 22.2, a licensee under the Medical Practice Act may be at risk of violating the fee splitting prohibition when utilizing Groupon-type services. In addition, physicians participating in Federal health care programs, such as Medicare or Medicaid, could face criminal liability under the Federal "Anti-Kickback Statute", 42 U.S.C. §1320a-7b(b).
This author is aware that the Illinois Department of Financial and Professional Regulation is conducting a review of the issues raised by Groupon-type services, but no official position has been announced by the Department. Until this issue is more clearly defined, any licensee under the Medical Practice Act should approach these arrangements with caution, and when in doubt, consult a knowledgeable attorney.
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Covenants not to Compete |
| Recent changes in the law and how it may effect your practice
Many of you may be familiar with covenants not to compete, either as an employer who has placed such language in a contract, or as a physician who has been presented with an employment contract containing such language. Basically, a covenant not to compete is a clause that is put in an employment contract which restricts the employee from practicing in a defined geographical area, for a defined period of time, or from accepting patients from the employer's practice after the employee leaves the practice.
Previously, Illinois law was fairly well settled on what would and would not be acceptable in such employment contracts. However, the Illinois Supreme Court recently issued an opinion (Reliable Fire Equipment Company v. Arredondo) regarding the enforceability of covenants not to compete. This could affect any contract you or your practice may currently have in place. Prior to placing such a clause in your practice's employment contracts or signing such a clause yourself, you should determine whether such a clause would be valid.
In determining whether a covenant not to compete clause is valid the courts will look to a three prong test. First, the limitation on the employee must be necessary to protect the legitimate interest of the practice. Second, the limitation would not impose a hardship on the practitioner signing the contract. Third, the scope of the limitation is reasonable.
Significantly, the recent changes address the "legitimate business interest" test. The court will now determine whether a legitimate business interest exists which would support the employer's right to such a clause based on all of the circumstances in each individual case. Instead of using a strict test, the court will consider various factors which include whether the employee has acquired confidential information that he/she may be taking to new employment; the nature of the customer relationship, for example whether the patient relationship is permanent or transitory; and any time and place of practice restrictions.
While the Illinois courts have upheld covenants not to compete in the past, in making this change, the Illinois Supreme Court has made it easier for employers to enforce the covenant not to compete. A court now has more ability to review the entirety of the situation in order to determine whether such a clause is valid and enforceable. The Court has not yet discussed the ramifications on the issue of patients moving practices due to changes in insurance and how this may affect such covenants.
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Editor in Chief
Partner at KBHG
Disclaimer: The material in this newsletter has been prepared by KBHG for informational purposes only and does not constitute legal advice. |
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Kominiarek Bresler Harvick & Gudmundson | 33 North Dearborn | Suite 700 | Chicago | IL | 60602 |
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REPUTATION FOR SUCCESS
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have a reputation for successful litigation
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unparalleled reporting and delivering
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