Texas court awards fired doctor nearly $10 million

A Dallas court in April awarded a hefty $9.8 million to an anesthesiologist who said he was fired for speaking out against his employer's allegedly fraudulent patient billing practices.

The verdict could get overturned on appeal. But Neal Fisher, MD, the doctor at the center of the defamation and breach-of-contract case, hopes the jury's decision sends a message that doctors have the right to advocate for patients without fear of retaliation.

"Physician groups should be more careful in the future about just simply discharging somebody who is essentially a whistle-blower for doing the right thing," said Dr. Fisher's attorney, Michael D. Richardson.

Leaders of the medical group practice involved said if the verdict stands, it could impair their ability to police their own through peer review. "We have in place peer review and quality and credentialing processes, and this case revolves around maintaining those standards," said Michael Hicks, MD, president of Pinnacle Anesthesia Consultants. The group denies the allegations of fraudulent billing and unlawful dismissal. No charges have been filed related to the billing fraud.

In his lawsuit, Dr. Fisher alleged that Pinnacle unlawfully dismissed him in 2004 after he voiced concerns that the group practice was billing patients at out-of-network rates, while claiming to be in-network for the major health plans carried by the hospital with which it contracted. A shareholder at Pinnacle, Dr. Fisher alleged that after he spoke up, the company falsely accused him of drug and alcohol abuse, and medical incompetence, to dismiss him without a fair peer review process. He also alleged that the company told other staff and hospital personnel not to use him for cases. He said Pinnacle threatened to fire him unless he underwent a peer review of the charges, agreed to two years of probation and signed an amended contract that included a three-year noncompetition clause if he were let go.

The anesthesiologist refused to accept Pinnacle's terms, and instead, submitted himself to the hospital's impaired physician program. There, Dr. Fisher was drug tested, peer reviewed on his case history "and cleared of everything," Richardson said. But the ordeal harmed Dr. Fisher's reputation and livelihood, he said.

"He wasn't afraid of scrutiny. He didn't want to go through a sham peer review," Richardson said, adding that the purpose of Dr. Fisher's case was to shed some light on Pinnacle's out-of-network billing practices. Before trial, a judge blocked Pinnacle from arguing that Dr. Fisher's failure to agree to the peer review process was a breach of his employment contract.

A unanimous jury vindicated Dr. Fisher, finding that Pinnacle's actions defamed him and violated his employment agreement by firing him without a valid reason. Jurors originally awarded Dr. Fisher $6.3 million. The trial judge within a week added $3.5 in attorney's fees and interest.

Pinnacle CEO Andrea Bohannon said they would appeal the ruling because the court precluded the group from presenting certain facts related to the peer review issue. The practice maintains an independent peer review committee, and "we've never had a physician complain it wasn't a fair process," she said.

Dr. Hicks said Dr. Fisher never brought the billing concerns to the practice's attention, calling it a "smokescreen." He said Pinnacle had reason to terminate Dr. Fisher, but declined to elaborate due to the pending litigation. "This case largely hinges on a practice's ability to manage itself administratively and maintain high quality patient care," Dr. Hicks said.