Our Client Success Stories
Our attorneys have provided excellent legal advocacy to our clients for over 40 years. We pride ourselves on successfully resolving our client’s challenges and problems. Our lawyers have the distinct legal background and experience to understand the complex environment in which our clients work, including the ever-evolving healthcare field. This expertise allows us to develop individualized legal plans that best meet our client’s long-term objectives.
The case examples below illustrate some of our firm’s most recent success stories. Please note that we do not reveal client names for confidentiality reasons.
Case #1 – Medical Staff Peer Review Corrective Action
We recently represented a physician in a noteworthy peer review case at an academic medical center. The medical staff president initiated a complaint against a surgeon who would later become our client. The complaint was that the surgeon inappropriately collected cash payment from an uninsured patient at the hospital’s point of service instead of having his office invoice and collect payment from the patient. The medical staff felt this was unorthodox, highly inappropriate, and contrary to the medical center’s values. It is important to note that neither the medical staff bylaws nor hospital rules addressed payment collection at the hospital’s point of service. The medical staff president quickly appointed a three-member ad hoc investigation committee, which included one of the surgeon’s competitors, an apparent conflict of interest. The ad hoc investigation committee recommended that the surgeon be disciplined, i.e., lose his medical staff privileges.
Shortly after that, the department chair informed our client that, totally aside from and allegedly unrelated to the corrective action, he was not going to recommend the reappointment of the surgeon to the faculty for the coming academic year. This was an effort to circumvent the medical staff corrective action process with the removal of the surgeon’s faculty appointment, which would have caused the surgeon’s automatic removal from the medical staff since medical staff appointment was contingent on the maintenance of faculty appointment. Unfortunately for the department chair, he did not review the surgeon’s faculty appointment in his rush to remove the surgeon from the faculty and medical staff. Had he done so, the department chair would have seen that the surgeon was not up for academic reappointment for another year! Moreover, the surgeon had an unblemished faculty record.
The surgeon’s dilemma was how to avoid 1) losing his medical staff privileges, 2) removal from the faculty, and 3) National Practitioner Data Bank reporting.
At this stage in the medical staff corrective action process, the surgeon had only a general idea of how to proceed. He understood the steps outlined in the medical staff bylaws. Still, he needed more understanding of what discipline was reportable to the National Practitioner Data Bank, the implications of such a report concerning his licensure and privileges at other hospitals, etc. He also did not fully understand the difference between what was happening regarding discipline and his faculty appointment. Lastly, he did not appreciate his procedural and substantive legal rights.
Finally, we were retained by the surgeon. Parenthetically, it would have been easier to defend our client and avoid discipline had he retained us as soon as the corrective action had been initiated and before the ad hoc investigation committee had rendered a written decision. That said, we got the department chair to withdraw his recommendation of non-reappointment to the faculty for the coming year, given that our client wasn’t even up for re-appointment and had an unblemished faculty record. With some effort, we convinced the hospital’s legal counsel that the disciplinary action, i.e., loss of clinical privileges, was uncalled for. Nothing in the medical staff bylaws or the hospital’s rules prevented my client from collecting his fee at the point of service. We pointed to articles on the subject and convinced opposing counsel that there was nothing unethical or inconsistent with the hospital’s articulated values to do such. Finally, to avoid reporting to the National Practitioner Data Bank, we convinced opposing counsel that the ad hoc committee’s deliberations and conclusion were poisoned by the conflict of interest of a competitor on the panel. Accordingly, the recommendation of the ad hoc committee had to be thrown out.
Ultimately, our client succeeded in the near-impossible: beating back a medical staff corrective action.
Case #2 – Residency Disciplinary Action
A resident engaged us for representation after receiving an adverse action letter from her residency program and not receiving a promotion from her PGY-II to PGY-III. She wanted to continue her residency but needed to know her next steps. Our experience and expertise can help guide residents to a successful resolution in these situations. Here is how we handled this specific matter:
After the engagement, we conducted an initial consultation call with the client. We ask the client questions during these initial consultations to obtain the facts. These questions can cover a wide range of topics depending on the facts of each circumstance but are generally designed to determine what occurred, who the parties involved are, and how the client wants to resolve the matter. After speaking with the client in this matter, we determined that there was substantial evidence indicating that our client would not achieve promotion to a third year of residency. She had received below-average grades in her clinical performance evaluations but had received excellent assessments concerning her bedside manner and outstanding patient surveys. Although she had a good relationship with other residents and patients, the leadership of the residency program wanted her to improve her clinical performance by repeating all her rotations in her second year of residency. The client expressed her desire to appeal or resign and transfer to another residency program.
We also requested and reviewed all the applicable documentation about her matter, including evaluations, assessments, test scores, copies of any disciplinary actions, and relevant policies and procedures. One of the most important documents to review for residency issues is the residency program’s policies and procedures manual, which includes the resident’s rights pertaining to disciplinary actions and due process. If a residency program does not follow its policies and procedures, the client may have a case where their due process rights have been violated. However, our analysis of these documents revealed that her program did not violate her due process rights concerning her non-promotion. The documentation also supported our initial conclusion that it would be difficult to achieve promotion to her third year of residency.
With the above facts in mind, we advised our client that her options would be limited to the following: (i) file an appeal to her adverse action letter; (ii) follow the remedial steps and repeat her PGY-II year as set forth under her adverse action letter; or (iii) resign from the program and apply to other residency programs. We set forth the pros and cons of each option and the likelihood of success based on our review of her documentation and our initial conversations with opposing counsel of the residency program.
Given our recommendations and our client’s belief that she could not succeed in her current residency program, resignation was her best option. Therefore, we engaged with opposing counsel for the residency program and sent a proposal indicating that we would prepare a separation agreement outlining the terms of her resignation. As part of this proposal, we requested the following: (i) a neutral to positive letter of recommendation; (ii) a neutral to positive summative evaluation; (iii) credit for specific rotations in her PGY-II; (iv) an additional five weeks of pay and benefits while she applied to other residency programs; (v) the ability for the physician to contact other members of the hospital entity’s staff to obtain recommendations; and (vi) reimbursement of $1500 for her CME activities, which she had not yet received.
End Result
After exchanging numerous communications with opposing counsel, we obtained all of the above-requested items on behalf of our client during our negotiation with the residency program. Within two weeks, our client had successfully resigned and was already submitting applications to other programs to move forward in her medical career. Given the facts in this case, this was the best potential result, and our client was extremely satisfied with the outcome.
Our law firm specializes in residency disciplinary matters, so please do not hesitate to contact us if your residency program has instituted disciplinary action against you. Additionally, suppose you have any issues during your residency program and fear that you are about to face disciplinary action. In that case, contacting an attorney BEFORE any actions have been instituted is always better. An experienced healthcare attorney, such as those at our firm, can recommend specific steps to take to protect yourself and your livelihood. Please call Barney Cohen for a free consultation at (312) 804-1739.
Case #3 – Physician Contract Negotiation
An experienced physician contacted our firm to assist in negotiating an employment contract that she received from a hospital entity. The physician was highly qualified and had over 14 years of experience in her practice field. However, she believed her compensation in the employment agreement was lower than her market value. The hospital entity stated that the contract was standard for her position and had no room for negotiation. If you are a physician in this position, do not let them tell you that contracts are not negotiable!! Physician contract negotiation is one of the significant areas in which an attorney can help obtain additional compensation and other important contractual provisions. Our firm also has decades of experience negotiating contracts that put physicians in the best position to succeed. Thus, she hired us to move forward with the negotiations.
We initially called the physician to determine her primary desires for the contract negotiation. She had two primary goals for the contract: (1) an increase in base salary and (2) a specific location where she could work with limited weekly hours. With her family in mind, she wanted to limit her travel and days worked. She also wanted a higher base salary to compensate for the limited incentive compensation that she would receive based on the structure of the contract. She was willing to relocate to a more rural location as long as she did not have to provide coverage for multiple hospitals in towns more than two hours away. She also owned her own private practice and medical spa. If she was willing to give up time to dedicate to those entities, she needed the base salary to be more commensurate with her experience and market value.
With the physician’s desires in mind, we conducted a review of her contract and proposed significant changes in our negotiation with opposing counsel, including but not limited to the following:
Outside Work Activities: The contract prohibited her from engaging in similar medical activities that she would provide for the hospital entity. As she owned and operated a private practice and medical spa, we proposed changes to the language allowing her to continue operations in these entities and continue receiving revenue from these external activities.
Covenant Not-to-Compete: The contract limited the physician’s ability to provide competitive services for two years after termination in over seven different counties. We proposed narrowing the scope of this non-compete provision to six months after termination and within 10 miles of the main hospital location. We also proposed changes indicating that the non-compete clause would not apply to her current private practice or medical spa.
Specific Location: The employment agreement provided that she would have to travel to multiple locations, spanning a 200-mile area, to provide medical services. Because she wanted to limit her travel, we proposed that she only provide services at one location and be able to provide 1:5 call coverage at another location that was acceptable to the physician.
Repayment Obligations: The agreement stated that the physician would have to repay any prorated portion of bonuses or relocation expenses received under the agreement if she terminated the contract within the initial four-year term. We proposed to remove any repayment obligations from the agreement in their entirety.
Malpractice Insurance: The initial contract stated that the hospital entity would provide the physician with malpractice insurance with coverage limits of $500,000/$1,000,000. The physician works in a high-risk area of medicine and requires higher coverage limits. Thus, we proposed language increasing the coverage limits to $1,000,000/$3,000,000, which is more appropriate for her medical services.
Additional Compensation: We proposed multiple changes to her compensation under the agreement. We reviewed various data sources, including recent contracts offered to physicians in the same area of practice in similar areas of the country, to determine an adequate market rate for her base salary. Due to our analysis, we requested a 15% increase in her base salary. We also asked for additional increases to her sign-on bonus (from $50,000 to $75,000), the cap on incentive compensation (from $25,000 to $50,000), and relocation expenses (from $$10,000 to $20,000) based on factors that we discussed with the client concerning the specifics of her arrangement. Due to a lengthy initial term of four years, we also requested an additional bonus of $50,000 at the end of her 3rd year of employment and yearly annual raises of a minimum of 3.5% to keep in line with inflation. Several factors led to these requests for additional compensation. Notably, the physician was moving to a rural location where she would be the only physician in her specialty, she would be providing services to more than double the number of patients at the hospital’s other locations, and she had over 14 years of experience in this area of medicine.
Our client received much of what we requested and signed a contract acceptable to both her and the hospital entity. This further proves that if you are a physician told that a contract is “standard” or “non-negotiable,” you must engage an attorney to get a second opinion. An experienced attorney can help you negotiate a contract that serves your needs. If you receive an offer letter or employment agreement, it is in your best interest, including financial interest, to engage an attorney immediately. If you want a contract reviewed or negotiated, please call Barney Cohen for a free consultation at (312) 804-1739.