Recently, AALM Past-President Robert Bitonte, M.D., J.D. was successful in authoring and having the Los Angeles County Bar Association (LACBA) pass two important resolutions that are now being considered by the California State Bar Association, which address critical physician concerns in the area of medical malpractice litigation and medically necessary care. These resolutions are explained below with links to the actual documents:
Resolution for Section 801.01 of California Business and Professions Code– The caps on medical negligence and wrongful death claims have been raised substantially since 1975, yet the minimum reporting requirement to the California State Medical Board remains the same ($30,000). The minimum reporting requirement needs to be raised so that physicians do not have to be scrutinized by the Medical Board and face possible discipline in virtually all medical negligence causes of action claims. Increasing the reporting requirements in medical negligence actions will allow more room for plaintiffs and defendants to settle cases without adding to the burden of physicians facing mandatory scrutiny by the California Medical Board. This is essentially advocating to raise the minimum reporting threshold requirement in cases of medical negligence and wrongful death claims. Recent California law AB 35 lays the caps on non-economic damages for medical negligence and wrongful death causes of actions; however, the law did not simultaneously raise the reporting requirements to the Medical Board. Raising the reporting threshold under the law will allow for easier settlements with physician consent, without increasing the burden on physicians when they are reporting to the California Medical Board.
Resolution for Section 3428 of California Civil Code – Medically necessary care is mandated in California, but is not defined in the Health and Safety Code, the Insurance Code, or the Civil Code. We propose a definition of medical necessity that is consistent with the California case law established by the California Supreme Court Case Sarchette v. Blue Shield. This will prevent payors from drafting their own definitions of medical necessity or creating rules of medical necessity. The proposal is that “medically necessary care” be defined as “legally prescribed medical care that is reasonable and comports with the medical community standard” as articulated in the California Supreme Court case Sarchette v. Blue Shield. The intention is to ensure that patients receive medically necessary care that is covered by payors, who often create their own definition of medical necessity or subject medical necessity determination by rules.
