Whistle-blower: Steward Health Care restricted referrals, compromised care to keep patients in network

A physician filed a whistle-blower lawsuit against Boston-based Steward Health Care, alleging the health system put significant personal pressure on him and other physicians to refer patients only to Steward hospitals and specialists, according to The Boston Globe.

Here are seven things to know about the lawsuit, which is pending in Suffolk Superior Court.

1. In his lawsuit, Stephen Zappala, MD, a urologist, claims Steward representatives would cancel appointments his office made for patients at Burlington, Mass.-based Lahey Hospital & Medical Center, Boston-based Dana-Farber Cancer Institute and other competing hospitals.

2. The 35-page lawsuit further alleges Steward representatives lied to patients. Dr. Zappala claims health system representatives would call his patients and incorrectly tell them they were required to have their operations at a Steward facility, even when Dr. Zappala had recommended another hospital, according to the report.

3. During a court hearing in March, Callan Stein, an attorney for Steward and two of the three physicians named as defendants in the lawsuit, said policies discouraging referrals are "extremely common" and legal, according to The Boston Globe. However, Dr. Zappala and another physician deposed in the case said Steward's methods were extreme.

4. When Dr. Zappala refused to comply with Steward's policies, the health system allegedly disciplined him for minor offenses. However, Mr. Stein said Dr. Zappala was disciplined for legitimate infractions, including being out of town when a hospitalized patient needed him. Steward eventually terminated Dr. Zappala's privileges to operate at Steward Holy Family Hospital in Methuen, Mass.

5. Dr. Zappala said he referred patients to hospitals outside of Steward's network for innovative procedures. For example, Dr. Zappala said he referred patients to Dana-Farber for an operation in which surgeons removed only part of a patient's cancerous kidney. He believed this operation was less risky than the operation Steward surgeons routinely performed in which they removed the entire kidney. Steward allegedly refused to approve these referrals.

"We clearly compromised their care to keep them in the network," Dr. Zappala told The Boston Globe.

6. Claudia Gabrielle, MD, another former Steward physician who was recently deposed in the case, said Steward would publicly shame physicians who refused to comply with its strict referral policy. Hospital executives allegedly projected physicians' names onto a screen during meetings. Listed alongside each physician's name was the number of patients who had gone out-of-network for care.

7. Steward and the physicians named as defendants in the case deny the allegations. They recently asked Judge Elizabeth Fahey to dismiss the lawsuit. The judge denied the request in April.

Access the full Boston Globe article here.

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