Monday, November 26, 2012

When Zealousness Becomes Malicious

When does zealousness become malicious?

It seems that's what is being asked of the  U.S. District Court in Sacramento in a case brought by five California chiropractors against The Travelers after the insurance company accused them of illegally practicing medicine and seeking criminal prosecution. 

Judge Lawrence K. Karlton ruled that the chiropractors can proceed with a civil action alleging Travelers Property and Casualty Co. engaged in malicious prosecution by persuading prosecutors to file criminal charges against them.

At the heart of the action is the practice of manipulation under anesthesia (MUA), whereby chiropractors make adjustments on a patient who is sedated by anesthesia administered by a medical doctor.

The story starts in August 2005, when San Joaquin County Deputy District Attorney James C. Wydert, according to the story reported in WorkCompCentral this morning, filed a criminal complaint against Michael Yates and Joseph Ambrose at the request of Travelers based on the recommendations of its investigator in the matter, William Reynolds. 

The DA alleged improper practice of medicine for performing MUAs, insurance fraud, conspiracy and grand theft. 

Wydert also filed a separate criminal complaint against Richard Sausedo and Pedram Vaezi alleging illegal practice of medicine and insurance fraud.

Then in March 2006, Wydert filed a criminal complaint accusing Wilmer Origel of insurance fraud and practicing medicine without a license.

The complaints against Yates, Ambrose, Sausedo and Vaezi were all dismissed “in the interest of justice,” according to documents filed with the federal court. In 2008, a jury in Stockton returned a 10-2 verdict to acquit Origel.

According to Daniel Horowitz, who was Origel’s attorney during the criminal proceeding, documents were discovered that suggested Reynolds “was running the show” and the district attorney’s office was doing what he said to do.

Reportedly, Reynolds on Aug. 25, 2005, said in an email to Steven K. Piper, another Travelers investigator, that a successful prosecution could be a "huge benefit to the company."

In the same email, he also said that a California Insurance Department investigator indicated the department wanted to prosecute all chiropractors for billing for MUAs.

“It would dramatically affect the insurance commissioner’s budget and political standing to have a major arrest investigation of this magnitude,” Reynolds wrote, according to the WorkCompCentral story. “The financial impact would be huge!”

The California Board of Chiropractic Examiners had issued a statement in 1990 that MUAs were within the chiropractic scope of practice and issued formal rules to that effect in March 2010.

Judge Karlton said the emails show Reynolds “was both interested in the monetary benefits to his company of declaring MUAs illegal and saw his influence as a motivating force in the criminal prosecutions.”

Karlton also wrote that Lon Malcom, a criminal investigator for the Department of Insurance, said during a March 29, 2011, deposition that an affidavit he submitted to the San Joaquin District Attorney’s Office to establish probable cause for a search warrant was “totally based” on information provided by Reynolds.

The case is going through procedural issues now with the latest activity being a dismissal of certain causes of action against Travelers, but also upholding other substantive allegations of the plaintiffs.

Regardless of the outcome of this case, which may or may not survive procedural challenges, it is a disgusting display of the callous disregard of the insurance industry, and of the government, for the rights of professionals (or anyone for that matter) where they are clearly operating within the law.

It's not the alleged crime that motivated these people to cause grief for others. It is the Almighty Dollar.

There's a reason that insurance is categorized as a part of the Financial Industry - because it's all about money, and this case demonstrates that to an unfortunately perverse degree.

I don't care if you're a medical professional, a legal professional, an insurance professional, an injured worker, an employer or the government. Money corrupts.

Reynolds, Piper and all of the others may all be fine people - but their zealousness was supercharged by the perception of power fueled by monetary gain. They went over the line by a wide margin.

I do not know the fate of Reynolds, Piper or anyone else involved in the manipulation of the system, but in my mind they are the ones that deserve punishment for these dishonest, unethical acts. The Travelers should likewise be made to account for the injustice brought upon these chiropractors.

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