Zamora-Quezada v. Healthtexas Medical Group, Civ.A. SA-97-CA-726-FB.
| Decision Date | 30 November 1998 |
| Docket Number | No. Civ.A. SA-97-CA-726-FB.,Civ.A. SA-97-CA-726-FB. |
| Parties | Dr. Jorge ZAMORA-QUEZADA, M.D., Dr. Martin Guerrero, M.D., and Their Named and Unnamed Patients and Survivors of Patients, Plaintiffs, v. HEALTHTEXAS MEDICAL GROUP OF SAN ANTONIO, Primary Carenet of Texas, L.L.C., Humana Health Plans of Texas, Humana Gold Plus, Pacificare of Texas and Secure Horizons, Defendants. |
| Court | U.S. District Court — Western District of Texas |
David M. Adkisson, Law Offices of David M. Adkisson, San Antonio, TX, Deborah C. Hiser, Advocacy, Inc., Austin, TX, Randall C. Jackson, Jr., The Jackson Law Firm, San Antonio, TX, Robert J. Provan, Provan & Associates, Austin, TX, Donald P. Wilcox, Texas Medical Association, Austin, TX, for Jorge Zamora-Quezada, M.D., Martin Guerrero, M.D.
Peter James Stanton, Law Offices of Peter J. Stanton, San Antonio, TX, Deborah C. Hiser, Advocacy, Inc., Austin, TX, Robert J. Provan, Provan & Associates, Austin, TX, Donald P. Wilcox, Texas Medical Ass'n, Austin, TX, for Arthur Barrientes, Rita Barrientes, Joe Albert Garcia, Teresa Riojas Garcia, Ardelia J. Herrera, Eugene Herrera, Dianna Barron Lopez, Kimberlee Marshall, Raymond B. Mendiola, Juanita Vera Mendiola, Olga R. Murray.
Deborah C. Hiser, Advocacy, Inc., Austin, TX, Robert J. Provan, Provan & Associates, Austin, TX, Donald P. Wilcox, Texas Medical Ass'n, Austin, TX, for Norma Martinez, Maria Campos.
John Joseph Franco, Jr., Jenkens & Gilchrist Groce, San Antonio, TX, Rebecca Jo Reser, Lawrence D. Smith, Jenkens & Gilchrist, San Antonio, TX, for HealthTexas Medical Group of San Antonio, Primary Care net of Texas, L.L.C.
Bruce Edwin Anderson, Brin & Brin, San Antonio, TX, for Humana Health Plans of Texas, Inc.
Bruce Edwin Anderson, Brin & Brin, San Antonio, TX, John Joseph Franco, Jr., Jenkens & Gilchrist Groce, San Antonio, TX, for Humana Gold Plus.
Andrew Scott Hanen, Hanen, Alexander, Johnson & Spalding, L.L.P., Houston, TX, for Pacificare of Texas, Secure Horizons.
ORDER GRANTING IN PART AND DENYING IN PART CONSOLIDATED MOTION TO DISMISS OR, IN THE ALTERNATIVE, FOR SUMMARY JUDGMENT
The cycles of health and disease and life and death have been extant on this small planet at least since the Cambrian Era six hundred million years ago. The context of this case is the recent blink of the past seventy-five years of health care in the United States.
In a more simple time, Dr. James Clarence Mudd of Springfield, Kentucky, assisted by his granddaughters opening farm gates, ministered to the sick and wounded.1 Dr. Joaquin Gonzalez of San Antonio, Texas, made house calls to patients, using his wife's vintage handbag to carry tools of his profession until he could afford a proper physician's valise.2 Exercising their medical arts, and often compensated with poultry and produce, the bedside manner was no doubt excellent but infant mortality was high, polio crippled, life spans were short and medical technology incipient. Some would say the good old days were not all that good.
In the mid to late twentieth century, an amendment to the social contract evolved resulting in the chickens and vegetables being replaced with pictures of George Washington and Abraham Lincoln sent by public and private third-party payors.3 Physician incomes rose exponentially.4 The infusion of capital enabled medical science to augment medical art to delay death—even though nature still bats last.
The professional heirs of Drs. Mudd and Gonzalez are now often corporate employees caught between ancient Hippocratic devotion to patients and social policy questions of allocation of resources, and between historic vows of service when health care was the domain of religious and charitable institutions and modern business organizations owing allegiance to stockholders.
The reasonable balance sought by people of goodwill to the challenge of fairly and efficiently sharing the blessings of better health and longevity for the most part must be struck in the market place and in the political laboratories of the elected legislative and executive branches. The Americans with Disabilities Act and the Rehabilitation Act are two of those experiments in the democratic process.5 The physician and patient plaintiffs invoke those statutes in the judicial branch seeking redress for alleged grievances against Humana Gold Plus and other defendants. Plaintiffs basically contend a modern version of the Golden Rule is being wrongfully applied by defendants: They who have the gold rule. Defendants deny any unjust conduct.
Two physicians and thirteen patients allege the defendant health care entities created a contractual arrangement which results in discrimination against the disabled, subjecting defendants to injunctive relief under the Americans with Disabilities Act ("ADA"), compensatory and punitive damages under section 504 of the Rehabilitation Act ("Rehabilitation Act") and liability under various state law causes of action. Plaintiffs maintain the financial arrangement between and among the payors and the medical providers creates cost-cutting incentives to delay or deny professional treatment and services in an effort to force higher-cost disabled patients to go elsewhere. The two physician plaintiffs also contend their employment was terminated as a result of advocating for their patients and giving care which infringed on this contractual arrangement.
Humana Gold Plus, Humana Health Plans of Texas (collectively referred to as "Humana" or "Humana defendants"), PacifiCare of Texas ("PacifiCare") and Secure Horizons are health maintenance organizations, or HMOs, which provide medical benefits to their enrollees. HealthTexas Medical Group of San Antonio, Inc. ("HealthTexas") is a group of physicians who contract with HMOs to provide medical care to the enrollees of the HMOs. Primary CareNet of Texas, L.L.C. ("Primary CareNet") is an administrative company which negotiates the contracts between HealthTexas and the HMOs, charging HealthTexas a fee for providing administrative services, such as issuing physician payroll checks. Some plaintiffs are enrolled with Humana; others are enrolled with PacifiCare or Secure Horizons. All plaintiffs who are patients were receiving treatment at HealthTexas. Drs. Zamora and Guerrero were physician employees of HealthTexas.
The Humana defendants move to dismiss or alternatively for summary judgment on their enrollees' ADA and Rehabilitation Act causes of action. The Humana defendants contend: (1) the Court has no jurisdiction because plaintiffs failed to exhaust their administrative remedies under the Medicare Act; (2) plaintiffs lack standing to sue under the ADA and Rehabilitation Act; (3) plaintiffs have not pleaded and cannot maintain viable causes of action under the ADA and Rehabilitation Act; (4) summary judgment should be granted in the Humana defendants' favor as to the individual enrollees. HealthTexas and Primary CareNet move for summary judgment as to enrollee Olga Murray's claims.6
Motions to dismiss function to test the formal sufficiency of a complaint against the pleading requirements of the federal rules. In analyzing a defendant's request for dismissal, the court must accept the allegations in plaintiff's complaint as true and construe them in a light most favorable to the plaintiff. Conley v. Gibson, 355 U.S. 41, 45-46, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957). To qualify for dismissal, it must appear to a certainty from the pleadings a plaintiff can prove no set of facts in support of claims for relief. Id. When matters outside the pleadings are considered, the motion to dismiss is converted to a motion for summary judgment.7 Summary judgment is appropriate if no genuine issue of material fact exists and the moving party is entitled to judgment as a matter of law. FED.R.CIV.P. 56. A fact is "material" if its resolution in favor of one party might affect the outcome of the suit under governing law. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). An issue is "genuine" if the evidence is sufficient for a reasonable jury to return a verdict for the nonmoving party. Id. The moving party bears the burden of informing the court of the basis for its belief there is an absence of genuine issue for trial and for identifying those portions of the record which demonstrate such absence. Matsushita Elec. Ind. Co. v. Zenith Radio Corp., 475 U.S. 574, 586-87, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986); Leonard v. Dixie Well Serv. & Supply, Inc., 828 F.2d 291, 294 (5th Cir. 1987). When the moving party has met its burden, the nonmovant "must do more than simply show that there is some metaphysical doubt as to the material facts," it must come forward with "specific facts showing that there is a genuine issue for trial." Matsushita Elec. Ind. Co., 475 U.S. at 586-87, 106 S.Ct. 1348 (quoting FED.R.CIV.P. 56(e)).
Plaintiffs allege the drive to place cost containment above patient welfare led defendants to discriminate against disabled patients and physicians in relationship with them in violation of the ADA and the Rehabilitation Act. Plaintiffs Arthur Barrientes, Rita V. Barrientes, Raymond B. Mendiola, Juanita Vira Mendiola and Eugene Herrera received treatment at HealthTexas through their enrollment in Humana health plans and were assigned to Dr. Zamora as their treating physician. These enrollees allege the Humana defendants delayed or denied them full and equal enjoyment of medical treatment and services in violation of the ADA, 42 U.S.C. § 12182(a)8, and limited or denied medical treatment and services in violation of section 504 the Rehabilitation Act, 29 U.S.C. § 7949. Humana moves to dismiss or for summary judgment on these discrimination causes of action.
Plaintiff Olga Murray received treatment at...
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