When Doctors with Malpractice Records Become Insurance Gatekeepers

Shedding Light on a Disturbing Trend in Health Insurance

In a recent eye-opening report by Patrick Rucker of The Capitol Forum and Doris Burke and David Armstrong of ProPublica titled “Doctors With Histories of Big Malpractice Settlements Work for Insurers, Deciding If They’ll Pay for Care,” a disconcerting practice within the healthcare insurance industry has been brought to light. The investigation reveals that medical malpractice consequences for doctors in some cases are nil—and, perhaps, to a dangerous extent. Doctors with histories of significant malpractice settlements or disciplinary actions are often employed by major health insurance companies as medical directors.

This revelation is cause for concern. As medical malpractice attorneys committed to upholding the rights of our clients and neighbors, Colling Gilbert Wright is outraged, and we think you should be too.

The Murphy Family Tragedy

This in-depth report begins with the tragic case of Shawn Murphy, whose wife died due to a botched gallbladder surgery performed by Dr. Pachavit Kasemsap. Despite Kasemsap’s involvement in multiple malpractice cases amounting to $3 million in settlements, including $1 million to the Murphy family, he was welcomed into the health insurance industry as a medical director. This position empowers him to make critical decisions affecting the healthcare of thousands of patients, often without direct patient interaction.

Decision-Making Power in Questionable Hands

These medical directors play a crucial role in determining the fate of treatment requests and claims. However, their backgrounds and qualifications are often shrouded in secrecy, leaving patients and treating physicians in the dark about who is making these life-altering decisions. The report uncovers that at least 12 doctors employed by insurance companies had troubling pasts, including histories of malpractice payments or disciplinary actions.

The implications of this practice are profound. Medical directors like Kasemsap, who have left clinical practice under a cloud, are now in high-paying positions that allow them to overrule the judgments of treating doctors, potentially denying critical and lifesaving treatments. This situation not only raises ethical concerns but also poses significant risks to patient safety and well-being.

In another example, Dr. Jon Erickson was barred from performing orthopedic operations after a series of problematic surgeries but was employed to review such cases for an insurer. This raises questions about the alignment between the qualifications of these directors and the nature of the cases they review.

The article also explores the motivations for doctors to shift to the insurance sector, noting that it offers a lucrative and less demanding alternative to clinical practice. However, this transition places these individuals in roles where their decisions can significantly impact patient care and outcomes for many, many people.

Transparency and Rigorous Standards in Health Insurance

The article stresses the need for transparency and accountability in the health insurance sector. It calls into question the criteria used by insurers to appoint medical directors, the impact of these decisions on patient care, and the lack of medical malpractice consequences for doctors.

From the perspective of medical malpractice attorneys, this investigation reinforces the importance of vigilance in protecting the rights of patients and ensuring that healthcare decisions are made with integrity and competence.

As legal advocates committed to justice and patient welfare, we believe it is crucial to scrutinize the practices of insurance companies and hold them accountable for their choices in medical director appointments. The health and well-being of countless individuals may depend on ensuring these roles are filled by professionals with unblemished records and a clear commitment to patient care.

For families like Shawn Murphy’s, discovering that a doctor responsible for a loved one’s tragic outcome is in a position to affect the care of others adds an extra layer of distress to their grief. This situation raises questions about the individual accountability of doctors like Kasemsap and points to a larger systemic issue within the health insurance industry. It suggests a possible disconnect between the qualifications considered for these influential positions and the imperative to prioritize patient safety and quality care.

Advocating for Change

For attorneys who handle medical malpractice claims, these revelations confirm the necessity of our work. We stand as advocates for those harmed by medical negligence, fighting to ensure that similar tragedies are prevented in the future and for impactful medical malpractice consequences for doctors. We also play a crucial role in challenging insurance practices that may prioritize cost-saving over patient health, advocating for policyholders who face unjust claim denials or treatment refusals.

This report serves as a stark reminder of the complexities at the intersection of healthcare and insurance, highlighting the need for ongoing vigilance, advocacy, and reform. At Colling Gilbert Wright, we are passionate about advocating for the rights and well-being of our clients. We take our responsibility to heart and fight vigorously to ensure that the healthcare system is both just and focused on the genuine well-being of its patients.

How Can a Medical Malpractice Attorney Help?

Medical malpractice can profoundly impact the lives of patients and their families, often leaving them in a state of uncertainty and distress. Understanding the law in Florida, including the medical malpractice consequences for doctors and the potential for lawsuits against insurance companies, is crucial for anyone affected.

Handling claims related to these complex areas of the law can be daunting, but the experienced medical malpractice attorneys at Colling Gilbert Wright can provide invaluable assistance. We can help gather necessary evidence, consult medical experts, negotiate with insurance companies, and represent a client in court if needed. Our knowledge is crucial in navigating the nuances of Florida law and ensuring that rights are upheld and justice is sought.

What Are the Medical Malpractice Consequences for Doctors in Florida?

In Florida, doctors found guilty of medical malpractice are supposed to face significant consequences. These can range from civil liability, where they must compensate the victim for damages (Florida Statutes § 766.102), to disciplinary actions by medical boards, including license suspension or revocation. The Florida Board of Medicine, for instance, strives to impose strict regulations and can take disciplinary action against physicians who violate professional standards (§ 458.331).

Can I Sue If My Health Insurance Company Has Denied My Claim?

When a health insurance claim in Florida is unfairly denied, policyholders have the right to sue for bad faith insurance practices. Under § 624.155, insurers are obligated to handle claims with honesty and fairness. Failure to do so can lead to a bad faith claim, allowing the policyholder to seek compensation beyond the original claim’s value. This includes damages for stress, inconvenience, and attorney’s fees.

Dealing with an insurance claim denial starts with understanding the reason behind the denial. Policyholders should review their policy terms and the denial letter closely. If the denial seems unjust, filing an appeal with the insurance company is advisable. In cases where appeals are unsuccessful, legal action for bad faith may be necessary.

Consult with the Lawyers of Colling Gilbert Wright

Dealing with medical negligence can be challenging. Understanding your rights and the legal avenues available is essential. With our commitment to justice, integrity, and empathy, Colling Gilbert Wright stands ready to guide and support you through these difficult times.

If you’re facing a medical malpractice claim, don’t hesitate to reach out for legal assistance. Contact us online or call (407) 712-7300 today for a FREE case evaluation. We are proud to serve our neighbors in Orlando and throughout Florida.