U.S. Supreme Court hears arguments in challenge to California's Reproductive FACT Act A California law that requires specified facilities providing pregnancy-related services and counseling to disclose information about the availability of comprehensive reproductive health care services is currently being challenged before the United States Supreme Court. At issue in this case—NIFLA v. Becerra—are efforts by the State of California to ensure that patients receive accurate information about the availability and accessibility of free and low-cost comprehensive reproductive health services. Passed in 2015, the California’s Reproductive Freedom, Accountability, Comprehensive Care and Transparency (FACT) Act requires licensed health-care centers to notify patients of the availability of free or low-cost health care services, including contraception, prenatal care, and abortions, through state programs. The law additionally requires that unlicensed health care centers—for example facilities that provide primarily counseling services—to inform women that there are no licensed medical providers on staff. The issue before the U.S. Supreme Court is whether the disclosures required by the FACT Act violate the Free Speech Clause of the First Amendment. The California Medical Association (CMA) joined the American College of Obstetricians and Gynecologists, American Academy of Pediatrics – California, American Society for Reproductive Medicine and other health care provider organizations to file an amicus brief in support of California’s FACT Act. CMA's brief explained that requiring licensed facilities to inform women of the availability of comprehensive free or low-cost reproductive health care reduces delays in care that can pose significant risks to maternal and fetal health. “Women’s pregnancy-related health care services are highly time-sensitive, and unnecessary delay can pose significant risks to maternal and fetal health,” CMA’s brief said. Additionally, the brief argues that requiring unlicensed medical facilities to inform women that there are no licensed medical providers on staff allows women to make informed decisions about the pregnancy-related services that they receive and prevents such facilities from misleading women into believing that the services being offered are medically necessary or beneficial. CMA’s brief explains that “patients can neither fully consent nor make fully informed decisions about their health care if they are not meaningfully informed about the care they are receiving or the qualifications and expertise of the individual who will be providing the care.” Oral arguments in this case were heard in the U.S. Supreme Court on March 20, 2018, and a decision is expected by the end of June. April 5, 2018 General Amicus Briefs, Legal Advocacy, United States Supreme Court, Women's Health 0 0 Comment Read More »
New health laws 2018: Are you ready? The California Legislature had an active year, passing many new laws affecting health care—with a strong focus on health care coverage, drug prescribing, public health and workers’ compensation issues. The California Medical Association has published a summary of the most significant new health laws of interest to physicians. For more details, see "Significant New California Laws of Interest to Physicians for 2018." January 30, 2018 General Legal Advocacy 0 0 Comment Read More »
Hospital at center of "existential threat" to medical staff self-governance files for bankruptcy The Tulare hospital embroiled in a bitter legal battle over the self-governance rights of its medical staff has filed for Chapter 9 bankruptcy. The filing came just two days before closing arguments were scheduled in the case, Tulare Regional Medical Center Medical Staff v. Tulare Regional Medical Center, et al. Although the hospital is in bankruptcy, the California Medical Association (CMA) will continue to seek a legal remedy in this matter. If the medical staff is unable to resolve the case out of court, the trial court could resume the case and render a judgment after the hospital emerges from bankruptcy. In 2016, lay hospital administrators at Tulare Regional Medical Center (TRMC) terminated the entire medical staff and its duly elected officers. The hospital then adopted new medical staff bylaws in secret and without input from physicians at the hospital. The hospital dictated leadership and standards of medical care, seized control of the disciplinary process without legal or factual justifications, and prohibited the terminated medical staff from voting on medical staff matters or holding leadership positions. CMA has been actively and aggressively supporting the medical staff in this case since the illegal actions of the hospital board in January 2016. CMA believes that, if left to stand, the hospital’s actions will create a dangerous precedent that could have much broader implications for the fundamental rights of medical staffs and physicians’ ability to care for patients in hospitals. “Every once in a while, you get a really important case that’s a flashpoint,” said Long Do, CMA legal counsel and director of litigation in an interview with the American Medical Association (AMA). “This case serves as an existential threat to independent hospital medical staffs.” CMA filed pre- and post-trial amicus briefs and has organized fundraising for the case. Recognizing the far-reaching implications of this case, the AMA Litigation Center and state medical societies have also provided legal and financial support to the physician plaintiffs. “This case epitomizes why protecting medical staff independence and self-governance is a matter of great public importance,” Do wrote in CMA’s post-trial brief. “The record abundantly demonstrates that the hospital has committed serious violations of the medical staff’s rights to independence and self-governance and that such illegal conduct is causing real harm to patients.” It cannot be understated how grave the consequences could be on patient care and safety if the hospital’s illegal actions are left to stand. Medical staff self-governance would become meaningless if a hospital can pick for itself a replacement medical staff and eschew the large body of laws and regulations that require a truly independent medical staff that is self-governing and democratic. This case was recently featured in a New York Times op-ed, which provides a good look at why this local conflict could have a dangerous effect on patient care in U.S. hospitals. If interested in contributing to CMA’s Legal Defense Fund, which is used to litigate cases of critical importance to physicians, please download the contribution form or contact Sarah Wolley directly at swolley@cmanet.org. The Legal Defense Fund of the California Medical Association is a collection of monies voluntarily contributed by the CMA membership for appropriate litigation costs. These funds shall be administered by the Executive Committee of the CMA Board of Trustees. The purpose of this fund shall be to provide monetary support in cases, generally brought by our members, which seek to protect or establish important legal rights of physicians. CMA will consider providing assistance only in those cases which reflect those principles and policies that CMA has established and that impact our members in their practice of medicine. Contributions to the California Medical Association Legal Defense Fund are not tax deductible as charitable contributions for federal income tax purposes. However, the contribution may be tax deductible as a business expense for federal income tax purpose. Contribution to this fund is not a political contribution. October 19, 2017 CMA, General Amicus Briefs, Hospital Medical Staff, Legal Advocacy, Medical Staff, Medical Staff Self-Governance 0 0 Comment Read More »
Webinar: Medical staff self-governance and the Tulare medical staff trial Medical staff self-governance is a vital part of a carefully crafted system designed to ensure the delivery of quality patient care in California hospitals. Join us for a one-hour webinar on Wednesday, September 13, 2017, at 12:15 p.m., for an overview of the rights and responsibilities of the self-governing medical staff under state and federal law, including credentialing, establishing clinical criteria and standards, organizing committees to monitor patient care, reviewing medical records, working with hospital administrators and governing bodies, and peer review, among other things. Presenter: Long Do, CMA legal counsel and director of litigation, will also discuss the recent lawsuit against the Tulare Regional Medical Center for violating the self-governance rights of its medical staff and provide an update on where the case stands. Register today at www.cmanet.org/events. July 24, 2017 CMA, General Hospital Medical Staff, Legal Advocacy, Medical Staff, Medical Staff Self-Governance, Webinars 0 0 Comment Read More »
CMA's Health Law Library updated with 2017 content CMA On-Call, the California Medical Association (CMA) online health law library, has been updated with 2017 content. One of CMA's most valuable member benefits, On-Call contains nearly 5,000 pages of up-to-date legal information on a variety of subjects of everyday importance to practicing physicians. The searchable online library contains all the information available in the California Physician's Legal Handbook (CPLH), an annual publication from CMA's Center for Legal Affairs. New documents for 2017 include: Promoting Quality of Life for Older Patients (#3504) MACRA Overview (#7210) California's Prescription Drug Monitoring Program: The Controlled Substance Utilization Review and Evaluation System (#3212) Other recently updated documents of particularly timely interest include: The California End of Life Option Act (#3459) Non-Contracting Physicians (#7508): With updates on California's new out-of-network billing and payment law (AB 72) Practice Promotion through Third-Party Coupons (#0104): With updates on new state law relating to referrals (AB 2744) CMA members can access On-Call documents free at www.cmanet.org/cma-on-call. Nonmembers can purchase On-Call documents for $2 per page. CPLH, the complete health law library, is also available for purchase in a multi-volume print set or annual online subscription service. To order a copy, visit the CMA resource library or call (800) 882-1262. June 21, 2017 CMA, General Legal Advocacy, CMA On-Call, Health Law Library 0 0 Comment Read More »
Anthem-Cigna mega-merger compromises health care access, quality and affordability Today, the U.S. Department of Justice (DOJ) and a bipartisan group of state attorneys started court proceedings to block the $48 million mega-merger between Anthem and Cigna (U.S. v. Anthem Inc., 16-cv-1493). “The California Medical Association has opposed the Anthem-Cigna mega-merger since day one because it will hurt patients and increase health care costs,” said California Medical Association (CMA) President Ruth E. Haskins, M.D. “Limiting market competition would compel insurers to contract with fewer physicians, resulting in higher premiums and longer wait times for referrals – not to mention forcing many patients to pay more to see out-of-network doctors.” Seventy-one percent of the nation’s metropolitan areas already lack competitive commercial health insurance markets. A merger between Anthem-Cigna would further diminish competition in 121 metro areas throughout the 14 states where Anthem is licensed to provide commercial coverage. “When it comes to scope, coverage and quality of health care, what do you trust – the clinical judgment of trained physicians or the corporate policy of insurance companies?” asked Dr. Haskins. “California’s health insurance markets need more competition to ensure that patients receive quality and affordable care.” In March 2016, a CMA-backed survey of California physicians revealed an overwhelming 85 percent opposed the Anthem-Cigna merger. Out of the 989 physicians surveyed from practices across the state, the majority expressed that the health insurer union could narrow physician networks (82 percent), force physicians to provide fewer services (90 percent) and pressure physicians into refraining from aggressive patient advocacy (75 percent). The DOJ’s lawsuit is supported by 11 states – including California, New York and Connecticut – and the District of Columbia. TWEET THIS NEWS “#AnthemCigna mega-merger compromises health care access, quality and affordability.” @CMAphysicians http://cal.md/2fLEEWN “Re: #HealthCare, who do you trust? Docs' clinical judgment or corp policy of insurance companies?” @CMAphysicians http://cal.md/2fLEEWN 85 percent of @CMAphysicians oppose the #AnthemCigna mega-merger because it’s bad for California patients. http://cal.md/2fLEEWN # # # The California Medical Association represents the state's physicians with more than 43,000 members in all modes of practice and specialties. CMA is dedicated to the health of all patients in California. For more information, please visit cmanet.org, and follow CMA on Facebook, Twitter and YouTube. November 22, 2016 Managed Care Anthem Blue Cross, Cigna, Insurance, Legal Advocacy 0 0 Comment Read More »
State's high court rules health plans cannot negligently delegate payment responsibility The California Supreme Court today ruled that health plans cannot absolve themselves of the responsibility to pay claims for emergency care by noncontracted providers by negligently delegating that responsibility to a risk-bearing organization that it knows—or should have known—to be financially insolvent. "Today's ruling is a huge victory for physicians," said Francisco Silva, Senior Vice President and General Counsel for the California Medical Association (CMA). "California's high court is unequivocally telling health plans they cannot get away with this morally blameworthy behavior. They cannot irresponsibly delegate risk and leave physicians unpaid for services provided in good faith to their enrollees." CMA filed an amicus brief in this case, Centinela Freeman Emergency Medical Assocs. v. Health Net et al., on behalf of a broad coalition of out-of-network health care providers who were left unpaid for emergency medical care when La Vida Independent Practice Association (IPA) went bankrupt in 2010. The IPA, a risk-bearing organization (RBO) that provided health care coverage to hundreds of thousands of patients in Southern California, was contracted by HealthNet and six other health plans to pay insurance claims to providers. Existing law insulates health plans from payment responsibility for medical claims once they enter into a delegation arrangement with an RBO. Notwithstanding such law, the providers in Centinela sought reimbursement from the health plans on the theory that they negligently delegated to La Vida, because they continued to send patients to the IPA when they knew or should have known of its financial distress and impending insolvency. CMA's amicus briefs urged a fair and just interpretation of provisions within the Knox-Keene Act that permit health plans to delegate payment responsibility to risk-bearing organizations. CMA recognizes the viability of the delegation model and accepts that, generally, health plans are absolved of liability after they delegate to an RBO. When health plans delegate negligently, however, CMA believes they must be held accountable for their own misconduct—and the California Supreme Court agrees. "We conclude that a health care service plan may be liable to noncontracting emergency service providers for negligently delegating its financial responsibility to an IPA or other contracting medical provider group that it knew or should have known would not be able to pay for emergency service and care provided to the health plan's enrollees," the court wrote in its ruling. "We further conclude that…a health care service plan may be liable to noncontracting emergency service providers for negligently continuing or renewing a delegation contract with an IPA when it knows or should know that there can be no reasonable expectation that its delegate will be able to reimburse noncontracting emergency service providers for their covered claims." “Imposing a duty on plans to act reasonably in choosing an IPA or other RBO will promote a healthy functioning of the managed health care model endorsed by the Knox-Keene Act. Indeed, a requirement that health care service plans reasonably select financially solvent delegates will more likely result in timely processing and ultimate payment of covered emergency service claims, which will in turn support the continuing availability and provision of such emergency services.” Contact: CMA Center for Legal Affairs, (800) 786-4262 or legalinfo@cmanet.org. November 21, 2016 Managed Care Amicus Briefs, California Supreme Court, Health Net, Legal Advocacy 0 0 Comment Read More »
Supreme Court sends contraceptive coverage under ACA case back to lower court On May 16, 2016, the U.S. Supreme Court issued an unsigned unanimous opinion announcing that it would not rule on the merits of the case regarding the contraceptive coverage requirement under the Affordable Care Act (ACA). The move is seen as an effort to avoid a four-to-four deadlock. The Court instead vacated the judgments of the lower courts and instructed the courts to afford the parties an opportunity to arrive at compromise. The opinion instructs the courts to allow the parties sufficient time to resolve any outstanding issues between them that would accommodate religious exercise while ensuring that women "receive full and equal health coverage, including contraceptive coverage." In February, the California Medical Association (CMA) filed an amicus brief with the Supreme Court in support of the contraceptive-coverage provision for group health plans under the ACA. CMA joined the American College of Obstetricians and Gynecologists, Physicians for Reproductive Health and American Academy of Family Physicians, as well as other state medical associations and health care provider organizations, in filing the brief. The issue in this case, Zubik v. Burwell, is whether the Religious Freedom Restoration Act of 1993 (RFRA) not only entitles religiously-affiliated non-profit corporations to opt out of providing contraceptive coverage themselves, but also prevents the government from arranging for third parties to provide separate coverage to their employees. Under the ACA, employers with more than 50 full-time equivalent employees must provide health coverage for their employees or face fines in the form of a tax. The ACA also requires group health plans to cover certain preventative services at no cost to patients, including a full range of contraceptive coverage. Religious institutions, including churches, temples and mosques, are exempt from the ACA's contraceptive coverage requirement. Nonprofit faith-based charities and religiously affiliated educational institutions and hospitals, however, are not automatically exempted from the requirement; rather, they are afforded an accommodation that requires them to notify the health plan or the U.S. Department of Health and Human Services of their religious objections. Such a notice then triggers independent birth control coverage for employees, students and their dependents who want it. After the U.S. Supreme Court’s 2015 decision in Burwell v. Hobby Lobby Stores, Inc., this accommodation was also extended to closely held for-profit entities that object to providing contraceptive coverage based on their owners’ religious beliefs. The religiously-affiliated non-profit corporations in this case seek a complete exemption from the ACA’s contraception coverage mandate, rather than an accommodation. They contend that by providing notice of their objection they are facilitating the provision of insurance coverage for “morally objectionable” contraceptive services, which violates their rights under RFRA. The RFRA provides that the government “shall not substantially burden a person’s exercise of religion” unless that burden is the least restrictive means to further a compelling governmental interest. CMA's brief stressed the importance of widespread access to contraception as an essential component of health care for women of child-bearing age. The brief also argued that decisions concerning contraceptive use, like all health care decisions, should be made by patients in consultation with their health care professionals based on the best interests of the patient. This is best accomplished when contraceptive coverage is provided within the same overall framework as a woman’s other health care services in consultation with a woman’s chosen provider. The accommodation accomplishes this, while at the same time respecting an employer’s sincerely held religious objections to contraception. For a copy of CMA's brief, click here. June 8, 2016 General Contraception, Legal Advocacy, United States Supreme Court, Affordable Care Act 0 0 Comment Read More »
California Medical Association joins lawsuit against Dignity Health over patients' access to tubal ligations SACRAMENTO — The California Medical Association (CMA) announced today that it has filed a motion to intervene in Chamorro v. Dignity Health, a case involving a Redding, Calif., woman who was denied a tubal ligation agreed upon by her and her physician at Mercy Medical Center Redding, a Dignity Health hospital. “California law clearly forbids unlicensed, untrained administrators from making medical decisions,” said CMA President-Elect Ruth Haskins, M.D. “It is imperative that patients and their physicians determine the best course of medical care to ensure quality treatment and patient safety.” The American Civil Liberties Union initiated the lawsuit on behalf of Rebecca Chamorro and Physicians for Reproductive Health after the hospital cited religious directives in denying Ms. Chamorro a tubal ligation. In joining the lawsuit, CMA asserts that physicians and hospital medical staffs — not hospital administrators or other non-medical laypersons — should be the primary decision-makers in matters pertaining to medical care. In this case, CMA asserts that the medical staff was not consulted in the determination of this particular directive despite it affecting whether and how patients can receive care from physicians who practice at the hospital. “This is not about religious beliefs,” said Francisco J. Silva, CMA general counsel and senior vice president. “This is about ensuring that a patient walking into a hospital can expect to receive sound medical care from trained medical professionals — not from hospital administrators motivated by non-medical policy directives. California law prohibits corporations from practicing medicine in order to protect patients from decisions motivated by non-medical factors that are not related to patient care.” A court hearing on the motion to intervene is scheduled in San Francisco for May 25, 2016. If CMA is allowed to intervene, it will join the plaintiffs as the case proceeds. April 28, 2016 CMA, General Corporate Practice of Medicine, In the Courts, Legal Advocacy, Corporate Bar 0 0 Comment Read More »
CMA files amicus brief in support of hospital medical staff self-governance The California Medical Association (CMA) has filed an amicus brief in support of the medical staff at Tulare Regional Medical Center in its lawsuit against the hospital alleging violations of state laws when the hospital terminated the entire medical staff and its duly elected officers. The hospital has recognized a replacement medical staff formed by a group of seven physicians led by the vice chairman of the hospital board. This group presented itself as a newly formed medical staff after it selected new bylaws and named officers to the medical executive committee. None of the other physicians at the hospital were aware of such actions or voted on the new bylaws and officers. The physicians were told that they would have provisional membership in the replacement medical staff, without any right to hold office or vote on medical staff matters. CMA's amicus brief explains that the replacement medical staff has no legal basis and that the hospital has committed serious violations of the self-governing rights of the original medical staff and its physician members. The brief asserts that the hospital has effectively unseated duly elected medical staff officers in favor of unelected individuals that support the hospital to serve in their stead, unilaterally imposed new medical staff bylaws and blocked the proper use of medical staff funds. Nothing in state law permits a hospital to dissolve an entire medical staff in such manner, CMA notes. CMA emphasizes in its brief that these violations can undermine physician independence and patient care. The laws establishing medical staff independence and self-governance are designed to insulate medical decision-making from interference by hospital administrators or other lay individuals who are motivated by concerns not related to patient welfare. The replacement medical staff, which does not conform to these laws, is already showing signs of undue influence and control by the hospital. Under the bylaws for the replacement medical staff, privileging and other conditions of membership are connected to patient admissions at the hospital. The hospital board also gets control over who serves as medical staff officers, and there are general conditions requiring physicians to uphold the welfare of the hospital. CMA has a long history of fighting for legislation and regulations that establish the right of self-governance for medical staffs. It is also the only statewide advocacy group dedicated to protecting the professional interests of medical staffs to ensure quality care in California’s hospitals. CMA is concerned that the hospital’s actions will create a dangerous precedent if left to stand. Medical staff self-governance would become meaningless if a hospital can pick for itself a replacement medical staff and eschew the large body of laws and regulations that require a truly independent medical staff that is self-governing and democratic. The Tulare County Superior Court declined to grant a temporary restraining order as requested by the medical staff, claiming there was not enough evidence at the early stages of the case to impose such extraordinary relief. The case next proceeds to discovery and fact finding. Read the brief here. March 31, 2016 CMA Hospital Medical Staff, Legal Advocacy, Self-Governance, Amicus Briefs 0 0 Comment Read More »
