[ WAR ON HMO ]
Indian Cardiologist Takes on Big Insurance Giant
Dr. Nanavati vs. Horizon Blue Cross Blue Shield

"I will not give up. I'll take my case to the Supreme Court. "I'll fight as long as I have to fight. I just want to give them a message. It's like David vs. Goliath," vowed Dr. Nanavati, a noted Cape May Court House-based cardiologist, after a NJ State appeals court ruled that he will receive no benefits even though he won a lawsuit against Horizon Blue Cross Blue Shield in 2007.

The battle against New Jersey's largest health insurer began in 1996 when Dr. Nanavati was dropped from the HMO's roster that allows doctors advertising and referrals in exchange for discount to plan subscribers after a disciplinary complaint was filed by the Attorney General against him. The allegations were investigated by the Board of Medical Examiners and Dr. Nanavati was charged with writing an exorbitant number of prescriptions to two patients and for failing to properly record or document them.

Dr. Nanavati with a patient.

Dr. Nanavati came to the United States in 1970 to continue his medical education. He became board certified in cardiology in 1977. After serving in a hospital in DuBois, Pennsylvania, he received medical privileges at Burdette Tomlin Memorial Hospital in Cape May Court House, New Jersey.

In a special interview with NRI Today, Dr. Nanavati, who owns the Cape Heart Clinic in the area, said the ordeal dates back to an incident in 1992 for which he was investigated by the state Medical Examiners Board. "A patient I was treating committed suicide and his wife sued me for not treating him for depression," the doctor explained. "He'd been in an auto accident and was in a lot of pain, but did not fit any symptoms for depression, so I did not treat him for it."

He said his malpractice insurance provider forced him to settle the lawsuit, which he said is standard following a death under any circumstances, but the Board of Examiners saw that the case was frivolous and dismissed the serious charges against him. The Board only reprimanded him for not keeping proper records.

"Horizon relied on the state board as its quality assurance program," he said, meaning the insurance company had no way of actually judging a physician's quality of care on its own. "When the State Board initiated the investigation against me, Horizon dropped me as a participating physician without even knowing anything about the incident."

"The quality in medicine is very difficult and expensive. So, most of the HMOs depend upon hospital privileges. In my incidence, I was dismissed by medical director but their credential committee gave me the privilege! Many non-profit organizations have estimated death in the hospital and outside in excess of 100,000. Many doctors are aware of which doctors are incompetent, and do not refer their family or friends to them….Some of these doctors do not deserve to be near the patients." Nevertheless, Horizon reinstated him in 1997 but dropped him thereafter in 2000 arguing that Dr. Nanavati had breached the terms of the agreement by being reprimanded earlier and that it never had a settlement or agreement with the doctor.

As a result, he lost a lot of patients and thereby the civil action against Horizon. He said that in the past seven years he could accept patients who were wealthy enough to pay out of their own pocket. "I've had to turn so many patients away."

Dr. Nanavati further said, "In the Court we presented very low mortality on our side as compared to other HMO doctors. But the Court did not pay any attention and removed it from evidence. In my previous case, Supreme Court of New Jersey had stated that 'probable harm is good enough to dismiss the doctor.' But, what about the HMO or the Hospital?"

"I'm not giving up. There are many doctors like me who are tired of fighting these insurance monopolies. They (the HMOs) think they can do anything they want because of how big they are."

According to April Kauffman, the wife of an Atlantic County endocrinologist who is a long-time opponent of HMOs and an activist for an improved healthcare system, "I'm proud of Dr. Nanavati for standing up against the tyranny of Blue Cross. Maybe more physicians will be encouraged and join in the fight against the insurance companies."

Two years ago, a trial court ruled in Dr. Nanavati's favor and determined that Horizon had breached a contract and a settlement suit with the cardiologist that led to him being put him back on the list of physicians after almost seven years, but at the same time it denied compensation due to the cardiologist.

This denial was upheld on April 2009 by a three-judge appellate court which concluded that Dr. Nanavati had not made a convincing case for how much money he lost during the time he was off Horizon's list.

This decision does not surprise Dr. Nanavati who further said, "The US Congress has given HMOs immunity from damages in cases where death has resulted even when it was found they denied lifesaving treatments. I wasn't expecting any money. I'm just glad to be able to help more local heart patients who are covered by Horizon."

Dr. Nanavati is aware that many people have been denied proper treatment and in some cases even died as a result of Horizon's dropping him as a participating physician and pointed to the state-of-theart technology he uses in the diagnosis and treatment of his patients as a contributing factor to the superb mortality rates he's seen over the years.

His advanced diagnostic machines – several hundred thousand dollars worth of them – tell him much more information about his patients than standard blood pressure equipment found in doctors' offices elsewhere.

"This one measures blood pressure using 15 parameters," he said proudly pointing to his Cardiodynamic monitor, one of the advanced devices he uses. "Standard machines do not give enough information to properly treat the patients." He also uses an ANSAR monitor, which measures the inner autonomic nervous system. He said ANSAR aids in the early diagnosis of heart disease as well as numerous other medical conditions such as diabetes and syncope, or fainting spells.

This is not the first time Dr. Nanavati's has taken on more stronger and formidable foes. In the 80's, he sued the Burdette Tomlin Memorial Hospital to retain privileges after the medical staff executive committee revoked Nanavati's staff privileges for alleged "disruptive behavior" and "failure to cooperate with hospital personnel."

Referring to that case, Dr. Nanavati said, "When I joined Burdette Tomlin, Dr. Sorensen was the chief cardiologist even though he was only board certified in internal medicine and not in cardiology. He had exclusive control over allocating electrocardiograms (EKG's), which are a substantial source of revenue."

"When I demanded a share in these readings, they turned a deaf ear to me. This surprised me because there was no reason why someone so less qualified should control the EKG readings. I requested the Executive Committee of the medical staff following which I was given EKG readings for a couple of days per week."

But it was not the matter of EKG readings alone. Dr. Nanavati was disheartened when an incorrect reading by Dr. Sorensen led to the death of at least one patient in 1981- Elsie Steinmeyer, died from an ailment that had been diagnosed incorrectly. "Dr. Sorenson and another doctor misdiagnosed that Mrs. Steinmeyer had myocardial infarction and because of this misdiagnosis and treatment the patient died".

"Even the autopsy confirmed that the cause of her death was indeed pulmonary embolism which I had determined and not the conservative estimate made by Dr. Sorenson and the third doctor. "The conservative interpretation probably cost the patient her life. A correct interpretation of the EKG would have saved her life because a pulmonary embolism is fully treatable if it is diagnosed and quickly handled. This is just one instance. There were many other deaths. The mortality rate in Burdette Tomlin was a shame at that time."

Soon after, Dr. Sorensen and the Executive Committee led a group boycott of patient referrals. Dr. Nanavati said it was "a conspiracy," hinting at racism prevalent in medical circles in the United States against physicians of different ethnic background. "After I spoke up against the malpractice at the hospital, several doctors agreed on the Hospital floor and at a restaurant meeting of the Staff, to take actions against 'the Indian.'"

"I also came to know that Dr. Sorensen had instructed emergency room physicians to keep referrals 'in the family' and boycott me."

In final analysis, hospital lost lot of credibility as about $2 million was paid to the chairman and lawyer, Allen Gould and his law firm partner, Carl Valore. Justice was served later when Carl Valore lost his license and went to jail for cheating a client. And the Hospital never tried to recover their lost money.

This litigation raged in state as well as federal courts, trial and appellate, and presented an extraordinary number of difficult legal issues in the fields of procedure, judgments, defamation, and antitrust. "The jury, following a lengthy trial, awarded me a substantial antitrust verdict against Burdette Tomlin and forced the hospital to reinstate me to the staff," added Dr. Nanavati, who is not afraid to go to extraordinary lengths to fight injustice and expose malpractices by hospitals and HMOs in a bid to save patients.

[BY A. SHARMA]