Tuesday, 4/22/97 Case claims UC hospitals defraud patients
Physician fees may have been charged for surgery by residents
By Hannah Miller Daily Bruin Senior Staff Alleging that UC
Medical Centers regularly defraud and endanger patients undergoing
surgery, a civil case filed late last week may force the hospitals
to restructure their residency programs. The lawsuit, filed by San
Francisco attorney Martin Blake on behalf of the general public,
accuses hospital administrators of using trainee physicians to do
complex surgeries, then charging patients higher fees associated
with the work of senior physicians. "The UCs are a teaching
hospital system, which is good," Blake said. "Residents are allowed
to perform surgeries under the supervision of attending doctors.
But state law does not allow substitution for the doctor named to
do the surgery," Blake continued. As the suit alleges, these
so-called "ghost surgeries" are performed by training physicians
while in their residencies, the mandatory five-year training period
after medical school graduation. While the suit targets all five UC
Medical Centers, UCLA operating-room personnel denied the charges.
"We do not start the surgery unless the attending physician is
there," said Julie Hauser, the administrative nurse of UCLA’s
Surgical Center. "The residents are there to learn the surgery, not
do it." Although residents may handle pre-operative and
post-operative duties, Hauser said, they don’t perform the surgery
themselves. The UCLA Medical Center has approximately 120 residents
in outpatient and inpatient surgery divisions. The UC system argues
that patients are fully aware of who is doing the work. "When
patients come to the UC Medical Centers, they sign a ‘terms and
conditions of service’ form," said Terry Lightfoot, a spokesperson
for the UC President’s Office. "That form states that the UCs are a
teaching hospital and that the attending surgeon may be assisted by
a resident," said Lightfoot. The plaintiffs allege financial fraud,
improper business practices and possible injury by unqualified
surgeons. "We believe that there has been bodily harm," said Blake.
He refused to discuss evidence at this time. The bulk of the
charges question the UCs’ financial honesty. "These hospitals don’t
disclose that the residents have done the surgery," Blake said.
"Then they charge the price of the attending doctor." Last week’s
suit is the second filed against UC Medical Centers in recent
months. A federal investigation had found Med Center administrators
to be overcharging Medicare for service reimbursements. The main
plaintiff, Sharisse Kroter, is not suing in the name of the general
public but rather for personal wrongs committed. If the UC system
is held liable, then any former surgery patient would be eligible
for reimbursement. Baum and Blake, the San Francisco law office
filing the suit, is not specifying an amount for remuneration. "We
can’t estimate that number, it’s too large," Blake said. "It all
depends on who’s paying," he continued. Reimbursement for surgeries
can differ between insurance companies and healthcare management
organizations (HMOs). The reimbursement would go directly to the
patients. Doctors’ fees are only calculated for attending
physicians, not for residents, so putting a number on any financial
discrepancy would be difficult. UCLA Billing would not release
numbers on the projected difference in doctor’s fees. The complaint
was served Monday, requesting an injunction against the alleged
offenses and remuneration for all patients. The UCs have 30 days to
respond. UCLA Medical Center