The United States government recently intervened in a federal court lawsuit pending in the Pennsylvania Western District since 2019 against a major medical school and its cardiothoracic surgery department chairman.
The case is styled United States of America, ex rel., Jonathan D’Cunha, M.D. V. Dr. James D. Luketich, University of Pittsburgh Medical Center, Inc. at University of Pittsburgh Physicians, Civil Action No. 19-495, In the U.S. District Court for the Western District of Pennsylvania. You can read the federal government’s complaint in partial intervention here.
The key issue in this False Claims Act lawsuit involves allegations that the University of Pittsburgh allowed its lead cardiothoracic surgeon to participate in and bill for multiple complex operations at the same time. The evidence includes billing records and came to the surface after a whistleblower blew the lid.
Healthcare whistleblowers sometimes have inside knowledge of dangerous practices that would never be exposed or known to the public without their courage to come forward.
Dangerous surgical practices
According to the lawsuit, for years, the University knowingly allowed its long-time chairman of the Department of Cardiothoracic Surgery to:
• Book and performed three surgeries at the same time
• Miss surgical time even at the outset of those procedures
• Go back and forth between operating rooms and even hospital facilities while his surgical patients remained under general anesthesia
• Leave his anesthetized patients for hours at a time while attending to other matters
• Falsely attest that he was with his patients throughout the entirety of their surgical procedures or during all “key and critical” portions of them, in order to increase surgical volume and revenue
The U.S. government further alleges that many current and former University executives, surgeons, anesthesiologists, nurses, and staff were aware of these serious lapses of patient safety. The glaring question is why there was only one whistleblower! Of course, the patients of the University Hospital and cardiothoracic surgeon were kept in the dark about the dangerous practices.
Rather than being a mere technical violation to billing requirements or hospital policies, the federal complaint alleges that the cardiothoracic surgeon’s routine practices:
• Defied the standard of care
• Abused patients’ trust
• Inflated patients’ anesthesia time
• Increased the risk of complications to patients
• On at least several occasions result in serious patient harm
• Caused some patients to endure additional surgical procedures
• Caused some patients to have extended hospital stays
• Caused numerous patients to develop painful pressure ulcers
• Caused some patients to develop compartment syndrome
• Caused at least two patients to have amputations
The United States government’s complaint in intervention was also critical of the University of Pittsburgh Medical Center for allegedly having deceptive marketing materials that, contrary to what was advertised, regularly sacrificed patient health in order to increase surgical volume and maximize profit.
Problems in Texas
Sadly, this type of situation is not limited to health and surgical care provided at the University of Pittsburgh Medical Center. Indeed, we’ve seen similar concerning issues in Texas surgical and anesthesia cases.
As a Texas medical malpractice lawyer and former hospital administrator, I’ve always viewed hospital billing records as an important source of evidence that should be carefully studied and analyzed. In some situations, key clinical information may be missing from the medical records and billing records provide insights that may fill in the gaps.
For instance, Medicare and private insurance guidelines have requirements applicable to billing practices for anesthesia care. These are particularly relevant in states, such as Texas, where certified registered nurse anesthetists (CRNAs) don’t have unlimited independent practice authority.
When billing under a medical direction model, an anesthesiologist physician can be responsible for medically directing up to four different procedures at once, being handled by four different CRNAs. When billing under a medical supervision model, the anesthesiologist can medically supervise five or more concurrent procedures being handled by CRNAs. The type of billing imposes different obligations on the anesthesiologist’s participation in the case and immediate availability at crucial times of the anesthetic and surgical care.
If you’ve been seriously injured because of poor surgical or anesthetic care in Texas, then contact a top-rated experienced Texas medical malpractice lawyer for a free consultation about your case.