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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. 03-17-00352-CV
Regular Panel Decision
Aug 22, 2018

Vista Medical Center Hospital Vista Healthcare, Inc. And Surgery Specialty Hospital, Inc.// State Office of Risk Management v. State Office of Risk Management// Vista Medical Center Hospital Vista Healthcare, Inc. And Surgery Specialty Hospital, Inc.

This case involves cross-appeals stemming from a dispute over the appropriate reimbursement for medical services provided by Vista Medical Center Hospital and its affiliates to injured employees covered by the State Office of Risk Management (SORM) under Texas workers’ compensation statutes. The district court had affirmed 23 administrative orders that required SORM to make additional payments to Vista, a decision which SORM challenged on appeal citing insufficient evidence. Vista, in turn, cross-appealed the district court's denial of prejudgment interest. The appellate court found substantial evidence supported the administrative law judges' conclusion that SORM's original reimbursement model was unfair and unreasonable, and that Vista's proposed methodology was valid. Consequently, the court affirmed the district court's judgment but modified it to include the prejudgment interest that Vista was statutorily entitled to.

Workers' CompensationMedical ReimbursementAdministrative LawAppellate ReviewSubstantial EvidencePrejudgment InterestTexas LawHealthcare ProvidersInsurance DisputesFee Guidelines
References
23
Case No. W2012-02144-COA-R3-CV
Regular Panel Decision
Sep 09, 2013

George R. Vraney, M.D. v. Medical Specialty Clinic, P.A.

This case involves a breach of contract dispute between Dr. George R. Vraney and Medical Specialty Clinic, P.C. Dr. Vraney sued the Clinic for breach of an employment agreement, while the Clinic counter-sued for breach of contract, breach of duty of loyalty, and conversion. The trial court initially granted summary judgment to the Clinic on some claims and determined damages. On appeal, the Court of Appeals of Tennessee found that remaining questions of law and fact precluded the grant of summary judgment on certain issues, although it affirmed the denial of Dr. Vraney's claim for unpaid vacation time and the referral of damages to a Special Master. The case is reversed in part, affirmed in part, and remanded for further proceedings.

Employment LawContract DisputePhysician EmploymentMedical PracticeBreach of Duty of LoyaltySummary Judgment ReversalAppellate ProcedureJudicial RecusalDamages CalculationAccounts Receivable Dispute
References
78
Case No. 03-18-00663-CV
Regular Panel Decision
Dec 05, 2019

Facility Insurance Company v. Vista Hospital of Dallas, Vista Medical Center Hospital and Surgery Specialty Hospitals of America

This case involves an appeal from a suit for judicial review of an administrative decision concerning workers’ compensation medical benefits. Multiple insurance carriers (Appellants) disputed the reimbursement amounts sought by Vista Hospital entities (Appellees) for outpatient medical services provided between 2002 and 2008. Vista initially claimed 70%-100% of billed charges but later revised its calculations to 200% of the Medicare allowable reimbursement, following a 2008 regulatory change and a clarifying court opinion. The State Office of Administrative Hearings (SOAH) and the trial court affirmed Vista's revised calculations as 'fair and reasonable.' The Court of Appeals affirmed the trial court's judgment, finding substantial evidence to support SOAH's decision regarding the reimbursement methodology and the accrual of interest.

Medical Reimbursement DisputesAdministrative Agency ReviewAppellate Court DecisionTexas Labor CodeFee Guideline InterpretationHospital Billing PracticesWorkers' Compensation InsuranceState Office of Administrative Hearings (SOAH)Due Process RightsStatutory Interpretation
References
18
Case No. 03-21-00242-CV
Regular Panel Decision
Dec 28, 2022

Vista Medical Center Hospital, Surgery Specialty Hospital of America, Southeast Houston and Vista Hospital of Dallas v. Texas Mutual Insurance Company

This appeal stems from a dispute over workers' compensation medical benefits reimbursement between multiple hospitals (Vista Parties) and numerous insurance carriers (Carriers) in Texas. The core issue revolves around the application of a "stop-loss exception" under Former Rule 134.401, designed for unusually costly or lengthy hospital stays, which the Vista Parties sought for 542 injured workers. After the State Office of Administrative Hearings (SOAH) largely denied additional reimbursement, the district court affirmed SOAH's order. The Court of Appeals, Third District, affirmed the district court's judgment, rejecting the Vista Parties' arguments that the SOAH order was arbitrary and capricious or lacked substantial evidence. The court found that SOAH properly conducted a case-by-case inquiry into whether services were "unusually costly and unusually extensive" and did not err in its application of the rule or in its findings.

Workers' CompensationMedical ReimbursementStop-Loss ExceptionAdministrative LawAppellate CourtTexas Court of AppealsSubstantial Evidence ReviewArbitrary and CapriciousFee GuidelinesHospital Reimbursement
References
51
Case No. 2-06-016-CV
Regular Panel Decision
Mar 15, 2007

Shioleno Industries, Inc. AND Columbia Medical Center of Arlington Subsidiary, L.P. and Columbia North Texas Subsidiary, GP, LLC D/B/A Medical Center of Arlington v. Columbia Medical Center of Arlington Subsidiary, L.P. and Columbia North Texas Subsidiary, GP, LLC D/B/A Medical Center of Arlington AND Shioleno Industries, Inc.

Shioleno Industries, Inc. appealed a summary judgment granted in favor of Columbia Medical Center of Arlington Subsidiary, L.P. and Columbia North Texas Subsidiary, GP, LLC d/b/a Medical Center of Arlington (the Hospital). The case originated from the Hospital's alleged failure to disclose an employee's positive drug and alcohol test results to Shioleno after an on-the-job injury. Shioleno contended that this omission led to increased workers' compensation premiums and expenses in unemployment benefit disputes. The appellate court affirmed the trial court's judgment, ruling that Shioleno failed to provide a valid authorization for the disclosure of medical information. Consequently, the Hospital had no legal duty to disclose the results and could not be held liable for negligence, breach of contract, or Deceptive Trade Practices Act (DTPA) violations.

Summary JudgmentMedical RecordsDisclosure AuthorizationHealth & Safety CodeNegligenceBreach of ContractDTPADrug TestingAlcohol TestingEmployer Liability
References
13
Case No. 03-17-00357-CV
Regular Panel Decision
Nov 21, 2017

George Allibone, M.D. v. Scott Freshour, in His Official Capacity as the Interim Executive Director of the Texas Medical Board Juanita Garner, Investigator of the Texas Medical Board And the Texas Medical Board

George Allibone, M.D., appealed the denial of his petition for a protective order against an administrative subpoena issued by the Texas Medical Board. The subpoena sought patient medical and billing records for an investigation into complaints against Allibone. He contended the trial court erred by failing to issue findings of fact and conclusions of law and by abusing its discretion in finding the subpoena reasonable and relevant. The appellate court found Allibone waived his complaint regarding missing findings. It also concluded the trial court did not abuse its discretion, citing the Board's need for complete records for investigation and Allibone's failure to prove the unconstitutionality of the statute requiring compliance. The trial court's order was affirmed.

Medical Board InvestigationAdministrative SubpoenaPhysician RecordsConstitutional RightsDue ProcessJudicial Review of Agency ActionAbuse of DiscretionFourth AmendmentTexas LawProfessional Licensing
References
50
Case No. 02-22-00072-CV
Regular Panel Decision
Jul 27, 2023

BioTE Medical, LLC v. John Carrozzella, MD, JCMD Medical Services, Inc., Dan Deneui, and Terri Deneui

This case addresses whether a contractual "residual benefit" clause, requiring a post-termination fee for using a competing treatment method, constitutes a covenant not to compete under Texas law. Appellant BioTE Medical, LLC, licensed a pellet-based bioidentical hormone replacement therapy (BHRT) method. Appellee JCMD Medical Services, Inc., a former customer, terminated its agreement and began using a competitor's BHRT without paying the residual-benefit fee. BioTE Medical sued JCMD for breach of contract. The trial court granted summary judgment to JCMD, finding the clause unenforceable either as a noncompete or a violation of public policy. The appellate court reversed, holding that the residual-benefit clause is not a covenant not to compete as it does not restrict JCMD from competing with BioTE Medical, but rather from using a competitor's product. The court also declined to invalidate the clause on uncodified public policy grounds, deferring to the Legislature's policy determinations.

Contract lawCovenants Not to Compete ActResidual benefit clausePublic policyBioidentical hormone replacement therapy (BHRT)Breach of contractSummary judgmentAppellate reviewTexas lawBusiness and Commerce Code
References
33
Case No. MISSING
Regular Panel Decision
Feb 03, 1992

Medical Designs, Inc. v. Medical Technology, Inc.

This case involves a patent infringement lawsuit filed by Medical Designs, Inc. (MDI) against Medical Technology, Inc. (MTI) and Gary Bledsoe, asserting infringement of two patents: U.S. Patent No. 4,407,276 and U.S. Patent Des. 269,379. The defendants counterclaimed, arguing patent invalidity and unenforceability. The court found that claims 1-7 of the ’276 patent were anticipated under 35 U.S.C. § 102 by prior art, and claims 1-8 were obvious under 35 U.S.C. § 103. Furthermore, the entire ’276 patent was deemed unenforceable due to inequitable conduct by MDI's patent attorney for intentionally omitting material prior art from the Patent and Trademark Office. While the ’379 design patent was found valid and enforceable, MDI failed to prove infringement. Consequently, the court awarded attorneys' fees and damages to MTI and Bledsoe against MDI and Floyd Hutson.

Patent infringementUtility patentDesign patentPatent invalidityPatent unenforceabilityPrior artObviousnessAnticipationInequitable conductAttorney's fees
References
20
Case No. 13-09-00350-CV
Regular Panel Decision
Jan 21, 2010

Gulf Coast Medical Center, LLC, Tony Todd, Crna, Dan Madsen, M.D. and South Texas Medical Clinics, P.A. v. Jacqueline Temple and Marcus Banks, Individually and as Representatives of the Estate of Markasia Banks, a Minor Child

Appellants, Gulf Coast Medical Center, LLC, Tony Todd, CRNA, Dan Madsen, M.D., and South Texas Medical Clinics, P.A., appealed the trial court's denial of their motions to dismiss. The underlying suit was filed by appellees Jacqueline Temple and Marcus Banks, alleging negligence in the care and treatment of their deceased minor child, Markasia Banks. The core issue on appeal was the appellees' failure to timely serve an expert medical report as required by the Texas Civil Practice and Remedies Code. The Court of Appeals determined that the appellees' claims were 'health care liability claims' and that the expert report was indeed untimely, and that an abatement due to a failure to provide medical authorization did not extend the deadline. The court also affirmed the constitutionality of the expert report requirement. Consequently, the appellate court reversed the trial court's judgment, granted the appellants' motions to dismiss, and remanded the case for the award of attorney's fees and costs to the appellants.

Health Care Liability ClaimExpert Medical ReportMotion to DismissTimeliness of ReportAbatementMedical MalpracticeNegligenceDue ProcessTexas ConstitutionAppellate Review
References
32
Case No. 03-05-00032-CV
Regular Panel Decision
May 04, 2007

Board of Medical Examiners for the State of Texas and Donald W. Patrick, M.D., J.D., as Executive Director of the Board of Medical Examiners for the State of Texas v. Vivian Adaobi O. Nzedu, M.D.

The Texas State Board of Medical Examiners denied Dr. Vivian Nzedu's medical license application, citing her failure to pass the USMLE within the statutorily permitted attempts. The Board included an examination attempt made prior to the effective date of the 'three-attempts statute' (September 1, 1993). The trial court initially sided with Dr. Nzedu, ruling that pre-1993 attempts should not be counted. However, the appellate court reversed this decision, concluding that counting pre-statute examination attempts is not an unconstitutional retroactive application of the Medical Practice Act, as it merely draws upon antecedent facts and does not impair a vested right. The court deferred to the Board's reasonable interpretation of the statute. The case was remanded for a determination of attorneys' fees.

Medical LicensingUSMLEStatutory InterpretationRetroactivityVested RightsAdministrative LawTexas Medical Practice ActPhysician LicensureExamination RequirementsAppellate Review
References
24
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