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Volume 2 Issue 1
Spring 2013
Healthcare Pros
Current Events
Mary M. Cunningham and Lisa M. Green obtain not guilty verdict for surgeon in laparoscopic hernia repair complications case.  Please see our Trial Results page for details.
Arbitration in the Long Term Care Setting:  Carter vs. SSC Odin Operating Co. (Carter II)
CTH
 

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)

 

   

For more information, please visit our website at www.kbhglaw.com
 
Disclaimer: The material in this newsletter has been prepared by KBHG for informational purposes only and does not constitute legal advice.
 

KBHG, LLC | 33 North Dearborn | Suite 1310 | Chicago | IL | 60602

 

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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
Reporting Requirements: The National Practitioner Data Bank
ALG
 
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.  

Deposition Fees
MMC
 

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".  

Editor in Chief  SAM
Partner at KBHG

 

  

For more information, please visit our website at www.kbhglaw.com

 
 
Disclaimer: The material in this newsletter has been prepared by KBHG for informational purposes only and does not constitute legal advice.
 

 
KBHG | 33 North Dearborn | Suite 1310 | Chicago | IL | 60602

 

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Volume 1 Issue 2 June 2012
Announcements
MCK 
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).
 
Michael C. Kominiarek is a contributing author for this handbook.  

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.  
Court strictly construes Medical Studies Act in memo written to surgery center board.
MMCBy: 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. 
Editor in Chief 
Partner at KBHG

 

  

For more information, please visit our website at www.kbhglaw.com

Disclaimer: The material in this newsletter has been prepared by KBHG for informational purposes only and does not constitute legal advice.

 
 
KBHG | 33 North Dearborn | Suite 700 | Chicago | IL | 60602
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In This Issue
Groupon: Permissible Marketing or Prohibited Fee Splitting?
Covenants not to Compete
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Volume 1 Issue 1 March 2012
Groupon
MRWPermissible 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.

Covenants not to Compete
Recent changes in the law and how it may effect your practice
RJG
 

 

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.  

SAM

 

 

Editor in Chief 
Partner at KBHG

 

 

 


For more information, please visit our website at www.kbhglaw.com



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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