Texas appeals court upholds $10 million award to fired doctor

The decision hinged, in part, on questions regarding the peer review process.

By Amy Lynn Sorrel — Posted July 14, 2009

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A Texas appeals court recently upheld a $10 million award to an anesthesiologist who said he was fired for speaking out against his employer's allegedly fraudulent billing practices.

Anesthesiologist Neal Fisher, MD, alleged that Pinnacle Anesthesia Consultants PA falsely accused him of medical incompetence and drug abuse after he questioned the group's practice of billing patients at out-of-network rates while claiming to be in-network under their health plans. He said Pinnacle threatened to fire him unless he underwent a peer review of the charges, among other conditions, which Dr. Fisher refused.

Pinnacle denied any wrongdoing and argued in court documents that Dr. Fisher failed to adhere to the practice's policies and procedures, which included standards for medical practice and peer review.

In 2007, a unanimous jury concluded that Pinnacle defamed Dr. Fisher and violated his employment agreement by firing him without a valid reason.

The 5th District Court of Appeals agreed in a June 25 opinion, finding no evidence that Dr. Fisher's contract spelled out criteria requiring a physician to voluntarily submit to peer review upon request. Judges also suggested that Pinnacle leaders failed to follow the company's policies and procedures for initiating the peer review process.

Michael D. Richardson, Dr. Fisher's attorney, said the decision reaffirms doctors' rights to advocate for their patients without fear of retaliation.

"Peer review can be an important tool in making sure good medicine is performed. But it cannot and should not be used for things it's not designed to do," he said.

Pinnacle declined to comment for this story. The group said it is evaluating the opinion and possible appeal options.

Texas Medical Assn. General Counsel Rocky Wilcox said the decision is a reminder that physician groups looking to police their own should adhere to proper peer review policies and procedures and ensure that members' employment contracts specify those standards. The TMA was not involved in the case.

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