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University of Miami v. Juanita Ruiz
SC05-2164
>> LADIES AND GENTLEMEN, THE
FLORIDA SUPREME COURT.
PLEASE BE SEATED.
>> GOOD MORNING.
OUR NEXT CASE IS UNIVERSITY
OF MIAMI VERSUS RUIZ.
MR. STARK, READY TO PROCEED?
>> THANK YOU.
MAY IT PLEASE THE COURT.
STEVEN STARK ON BEHALF OF
PETITIONER, THE UNIVERSITY
OF MIAMI DOING BUSINESS OF
THE UNIVERSITY OF MY AM A MY
SCHOOL OF MEDICINE.
A QUESTION TO BE CERTIFIED
OF DIRECT AN EXPRESS
CONFLICT BETWEEN OUR
DECISION AS THE 3rd DISTRICT
COURT OF APPEALS AND THE
RUIZ CASE AND THE 5th CASE
IN ALEX DAERN.
MY PORTION OF THE APPEAL
DEALS WITH THE ISSUE OF THE
FINDINGS BY THE HEARING
OFFICER AS WELL AS THE
DISTRICT COURT OF APPEAL
THAT THE PHYSICIANS THAT
PROVIDE THE DELIVERY
SERVICES AND THE DELIVERED
THE BABY MRS. RUIZ'S BABY IN
THIS CASE FAILED TO PROVIDE
NOTICE SUCH THAT THEY WERE
NOT ENTITLED TO THE
EXCLUSIVE REMEDY OF THE
STATUTE.
>> WELL, THEN, LET'S NUT IN
SORT OF PERSPECTIVE.
WE HAVE A STATUTE.
>> YES, SIR.
>> THAT REQUIRES CERTAIN
NOTIFICATIONS TO BE GIVE TON
PATIENTS THAT WOULD THEN
PROVIDE IN THE EVENT THERE
IS A MISHAP IN THE BIRTH
THAT WOULD ALLOW THE
INDIVIDUALS TO RECOVER
WITHOUT REGARD TO WHETHER
ANYBODY DID ANYTHING WRONG,
BUT IF YOU DON'T GIVE THE
NOTICE, AND IT HAS SOME
CRITERIA INTO THE STATUTE,
THEN THE FAMILY OF THAT
CHILD WOULD HAVE A LEGAL
ACTION OR A BECAUSE OF
ACTION.
S THAT YOU THE CONTEXT WE'RE
IN?
>> THAT IS THE CONTEXT WE
ARE IN.
>> AND NOW, CAN YOU HAVE A
DIFFERENT CIRCUMSTANCE?
IT SEEMS TO ME THAT THIS
CASE BECAUSE OF THE NATURE
OF THE STRUCTURE MAYBE A
LITTLE DIFFERENT THAN MOST
BECAUSE WE HAVE A UNIVERSITY
CLINIC KIND OF A SETTING AND
DOCTORS ARE NOT NECESSARILY
ASSIGNED TO PATIENT AS THEY
WOULD BE IN A PRIVATE
OFFICE.
DOES THAT ALTER WHAT WE ARE
LOOKING AT OR THE
APPLICATION OF THE STATUTE
AT ALL HERE?
>> WE CERTAINLY ARGUED IT
DUNDZ ARE THE CIRCUMSTANCES
AS PRESENTED HERE.
THIS IS ACTUALLY NOT A
UNIVERSITY CLINIC, BUT A
PUBLIC HOSPITAL WITH THE
PUBLIC HEALTH TRUST.
>> THE UNIVERSITY OF MIAMI
PROVIDES --
>> THE UNIVERSITY MIAMI
CONTRACTS WITH THE TRUST'S
PERMITTED PHYSICIANS TO
CONRACT WITH THE HOSPITAL TO
PROVIDE THE SERVICES THIS
CHT THOSE DOCTORS ACTUALLY
HAVE AN INDEPENDENT CONRACT
WITH THE PUBLIC HEALTH
TRUSTS OF DADE COUNTY THAT
WAS ESTABLISHED PURSUE ANT
TO CHAPTER 154 TO PROVIDE
SUPERVISION OF THE RESIDENTS
PROVIDING CARE AT THESE
FACILITIES.
>> YOU OF BUT YOUR ARGUMENT
IS SORT OF, IT IS ALMOST TO
BE, IT IS NOT THAT IT IS
SIMPLE AND APPEAL BECAUSE IT
IS SIMPLE IS THE STATUTE
SAYS OR AND/OR MEANS OR.
>> WELL, YES, MY ARGUMENT --
>> IS IT MORE SOPHISTICATED?
>> WELL, THAT IS THE FIRST
PART OF IT.
THEN, THERE IS ONE OTHER, I
THINK, VERY SIMPLE PART OF
IT.
THE STATUTE DOES SAY IT IS
EITHER OR.
THIS COURT, THE 3rd DISTRICT
COURT OF APPEAL RECOGNIZED
IT IS TWO INDEPENDENT
EXCEPTIONS TO THE NOTICE
REPORT.
>> HOW ABOUT A LIBRARY
BECAUSE YOU DIDN'T GET TO
THE PART WHERE YOU ARE
RELYING ON AN EXCEPTION OR
AN EXCUSE.
AND SO LET'S HAVE CONTEXT.
>> THE EXCEPTION HERE IS THE
EMERGENCY EXCEPTION.
AND THE REASON WHY WE ARE WE
SUGGESTED THE EMERGENCY.
IN FACT, THERE IS NO
QUESTION THAT THE EMERGENCY
EXCEPTION DOES APPLY.
BUT OF BY DEFINITION.
THE EMERGENCY EXCEPTION IS
INVOKED WITHIN THE PATIENT
COMES IN IN LAB ARE AND
DELIVERY ESSENTIALLY.
>> SO YOU HAD A CLINIC THAT
INITIALLY AS THE MOTHER CAME
IN DID RECEIVE SOMETHING,
BUT THEN, WHEN SHE CAME IN
FOR THE DELIVERY, SHE DID
NOT RECEIVE SOMETHING ELSE
WHEN HER FIRST CONTACT WITH
THE DOCTOR?
>> THAT IS CORRECT.
>> THAT IS THE CORE REG.
>> THAT IS THE LAST
POSITION, THAT IF THE
CONCLUSION IS THAT THE
PHYSICIANS HAD TO GIVE
NOTICE AT THE TIME WHEN SHE
ARRIVED FOR THE DELIVERY
THAT THAT NOTICE THERE IS AN
EXCEPTION BECAUSE OF THE
EMERGENCY SERVICES.
>> I GUESS MY QUESTION THEN
IS BECAUSE WE WOULD BE
INTERPRETING THE STATUTE
GENERALLY IF IF ANOTHER
SITUATION SOMEBODY MANY
FORMAL SITUATION, SOMEBODY
SEEING A PHYSICIAN FOR
MONTHS BEFORE HAS
ESTABLISHED PATIENT
PHYSICIAN RELATIONSHIPS NO
NOTICE IS GIVEN THEN THAT
WOMAN GOES INTO EMERGENCY
CIRCUMSTANCE, CAN THE DOCTOR,
IN THAT SITUATION, RELY ON
THE EMERGENCY EXCEPTION EVEN
THOUGH THEY HAD REASONABLE
OPPORTUNITY?
>> NO.
>> WELL, THEN, BUT THE
STATUTE SAYS OR.
>> THE STATUTE DOES SAY OR,
BUT THE STATUTE ALSO TALKS
ABOUT THIS COURT IN THE CASE
WAS THE FIRST THAT ACTUALLY
ADOPTED THE NOTICES NOT
REQUIRED IF IT IS NO
STANDARD.
WHAT THE LEGISLATURE DID WAS
NOT ONLY TAKE THAT LAN GAIN
AND PUT NIGHT THE STATUTE,
BUT ALSO, ADDRESSED THE
QUESTION THAT I THINK AROSE
IN THE CASE, WHICH IS
ACTUALLY VERY SIMILAR TO OUR
CASE.
AND THAT QUESTION IN THAT
CASE WAS, WELL, WHAT IF IT
IS AN EMERGENCY
CIRCUMSTANCE?
WHAT IF THE WOMAN COMES IN
LABOR AND DELIVERY AN UPPER
IM PAL ALSO, A UNDER FLORIDA
LAW, UPPER GOOD MEDICAL
JUDGMENT CAN NOT TRANSFER
THAT PATIENT ANYWHERE.
THEY ARE GOING TO DELIVER,
YOU HAVE TO PROVIDE THE
SERVICES, NOTICE IMPRACTICAL
AS A MATTER OF LAW AT THAT
POINT.
AND THAT ANSWERS THAT
PARTICULAR QUESTION.
>> I JUST WANT TO -- I AM
NOT SURE YOU HAVE ANSWERED
THE QUESTION, HOW ARE YOU
THEN ASKING US TO CONTRUE
THE STATUTE?
ARE YOU SAYING IT IS CASE
SPECIFIC?
THAT YOU LOOK AT WHETHER
THERE IS TRULY A REASONABLE
OPPORTUNITY BEFOREHAND OR DO
YOU, DO YOU READ THE TWO
REQUIREMENTS TOGETHER?
EXPLAIN THAT TO ME.
>> WELL, I DO NOT BELIEVE
THAT YOU NEED TO MAKE THE OR
A CONJUNCTIVE.
THAT IS EVENTUALLY WHAT THE
3rd DISTRICT AND THE HEARING
OFFICER DID IN THE CASE.
BECAUSE THE CONCLUSION WAS,
YES, THERE IS AN EMERGENCY
CIRCUMSTANCE, BUT IF, IN
FACT, IT WAS PRACTICALABLE
FOR YOU TO GIVE NOTICE
PREVIOUSLY, THEN WE FIND
THAT THE FACT THAT IT IS AN
EMERGENCY CIRCUMSTANCE
DOESN'T APPLY?
>> I DON'T UNDERSTAND, THEN,
HOW DOES THAT, IF THAT IS
THE CONCLUSION THEN WHY IS,
FOR THE DOCTOR THAT HAS HAD
THE LONGSTANDING
RELATIONSHIP WITHIN THE
EMERGENCY OCCURRED AT THE
END, DOESN'T IT TALK, THE
STATUTE DOESN'T TALK ABOUT
THE TIMING.
I THINK IF YOU LOOK AT THE
ARGUMENT WE MADE IN OUR
BRIEF.
>> LOOK AT THE STATUTE,
OKAY?
WHAT THE STATUTE
SPECIFICALLY SAYS, EACH
PARTICIPATING PHYSICIAN
SHALL PROVIDE NOTICE TO THE
PATIENT.
LET'S LOOK AT THE WORDS.
I DON'T HAVE A PATIENT IF I
AM A PHYSICIAN, IF, THIS IS
WHAT THE 3rd DISTRICT SAID
IN OUR CASE, THERE WAS THE
ABSENT OF A PRIOR
PROFESSIONAL RELATIONSHIP
PREEN THE UNIVERSITY
PHYSICIANS AND MISS RUIZ,
DESPITE THAT, THE COURT
CONCLUDED THAT THERE WAS
REASONABLE OPPORTUNITY TO
FURNISH NOTICE.
ABSOLUTELY NOT.
THE DEFINITION OF THE
STATUTE REQUIRES THAT THERE
BE A PATIENT-PHYSICIAN
RELATIONSHIP.
A PROVIDER-PHYSICIAN
RELATIONSHIP.
UNDER YOUR CIRCUMSTANCE, AT
THAT POINT AND TIME, WHEN
THAT RELATIONSHIP IS
ESTABLISHED, AND THAT DOCTOR
WHO DOESN'T HAVE TO ACCEPT
THE PATIENT NECESSARILY
ACCEPT THAT PATIENT, THAT
PATIENT NOW SAYS THIS IS MY
POSITION AN BELIEVE ME, FOR
MEDICAID, MED CAID, OTHER
CAUSE, THAT PATIENT DOES
HAVE TO SAY, THIS US MY
PHYSICIAN, NO I IT FOR
CERTAIN BILLING
REQUIREMENTS.
>> YOUR SCENARIO.
THE DOCTORS THAT FACILITY
WOULD NEVER HAVE TO GIVE
NOTICE?
>> THAT IS NOT TRUE.
THERE MAY BE A CIRCUMSTANCE
WHERE THEY WOULD HAVE TO.
>> ALL RIGHT.
LET'S TAKE THE CIRCUMSTANCE
HERE.
AND, WELL, LET'S TALK ABOUT
THE HOSPITAL IN GENERAL.
THE DOCTORS THERE HAVE
PRIVATE PATIENTS OTHER THAN
THOSE THAT COME INTO THE
HOSPITAL FOR DELIVERY?
YES.
>> THEY HAVE TO HAVE THEIR
OWN PRACTICE OUTSIDE.
>> AS PART OF A HOSPITAL, DO
THEY HAVE PATIENTS?
>> NO, THEY HAVE RENTED
SPACE AT THAT TIME FOR SOME
PRIVATE OFFICE, BUT NO
LONGER HAVE, BUT THEY, THEY
DID NOT HAVE -- THOSE
DOCTORS WHO DO THE
DELIVERIES AT THIS HOSPITAL
AND DELIVER PEOPLE WHO ARE
NOT THEIR PRIVATE PATIENTS
OUTSIDE OF THE HOSPITAL
WOULD FALL INTO THIS
EMERGENCY SITUATION AND
NEVER HAVE TO GIVE NOTICE
BECAUSE YOU JUST SAID AS I
UNDERSTOOD THE ARGUMENT.
WHEN YOU DOM THE HOSPITAL IN
LAB OAR, IT IS AN EMERGENCY
SITUATION.
>> THAT IS TRUE.
BY DEFINITION.
>> SO ANY DOCTOR, THAT FA FA
LITTLE TY WHO IS SEEING
PATIENTS THAT ARE NOT PAIR
PATIENT IN THEIR PRIVATE
PRACTICE WOULD NEVER HAVE TO
GIVE NIC NOTICE UNDER YOUR
SCENARIO?
>> UNLESS, OF COURSE,,
UNLESS, OF COURSE, THEY HAD
ACTUALLY SEEN, TREATED,
EVALUATED THAT PATIENT IN A
WAY -- I JUST MADE THE
PERIMETERS.
>> OKAY.
IF THE PERIMETERS NEVER SEE
THEM, YOUR ANSWER WOULD
CORRECT.
THEY WOULD NOT HAVE TO GIVE
NOTICE, ALTHOUGH, THERE ARE
CASES, THERE IS THE SUN LIFE
CASE IN WHICH THE COURT
CONCLUDE WHEN THEY DID GIVE
A NOTICE, THE HOSPITAL THAT
SAYS IT IS US AN OUR DOCTORS
AN NURSES, MIDWIFES, THEY
SAID THAT NOTICE WAS
SUFFICIENT.
OUR NOTICE HERE DIDN'T SAY
THAT.
WE HAD ARGUED IT SHOULD
APPLY, THE COURT SAID NO, IT
REALLY DOESN'T UNDER THE
CIRCUMSTANCES.
>> WASN'T THERE A SIMPLE WAY
TO HAVE DEALT WITH THIS.
THE HOSPITAL COULD HAVE, I
BELIEVE LATER PUT THAB BROW
CURE THIS NIC, A BROCHURE
LISTS OF THE DOCTORS AT THE
HOSPITAL WHO IN FACT
PARTICIPATE IN THAT PLAN?
>> THEY DON'T LIST THEM.
WHAT IT ACTUALLY SAYS AND I
THINK IT SAID UNSUN LIFE
ALSO THAT THIS INCLUDES
NOTICE AS TO US AN ALL OF
THE PARTICIPATING STAFF WHO
ARE ALSO PARTICIPANTS IN
NIKA.
THEY DO DO THAT.
NOW, THAT IS A HOSPITAL
NOTICE THAT SEEMED TO BE
SUFFICIENT FOR THE
PHYSICIAN.
IT IS STILL A QUESTION OF
HOW DO YOU IMPOSE, I SAY I
AM INTO REBUTTAL TIME.
BUT IF CAN I ANSWER THE
QUESTION.
HOW DO YOU IMPOSE UPON A
PHYSICIAN?
A DUTY THAT PHYSICIAN, IT IS
AN INDEPENDENT DUTY, ALL OF
THE CASES SAY IT, TO NOTIFY
A PATIENT OF THEIR PARTITION
IS PASSION IN NIKA WHEN THEY
HAVE NOT YET ESTABLISHED ANY
RELATIONSHIP WITH THAT
PATIENT SUCH THAT PERSON
SUCH AS THEY WOULD EVEN BE
DEEMED A PATIENT OF THEM
SUCH THAT THEIR LEGAL DUTIES
AS A PHYSICIAN.
YOU HAVE RECURRING PRACTICE;
HOWEVER, SHOULDN'T THERE BE
SOME OBLIGATION ON THE PART
OF THE PHYSICIAN INTHEY WANT
TO TAKE ADVANTAGE OF THIS
PARTICULAR LAW?
YOU ASSUME THAT VIRTUALLY
EVERY POSITION WOULD WANT TO
TAKE ADVANTAGE TO THIS
PARTICULAR LAW IF THERE IS
RECURRING SITUATION,
SHOULDN'T THERE BE SOME
OBLIGATION ON THE PART OF
THE PHYSICIAN TO DEAL WITH
THAT?
THAT IS THAT IT IS NOT FAS
THERE WAS AS SINGLE
EMERGENCY, THAT MAY NEVER
OCCUR AGAIN, IT IS WE ARE
REALLY TALKING ABOUT IS THAT
THERE ARE A LOT 6:00 OF
"EMERGENCY SITUATIONS" YET
WE CAN SEE THAT PERHAPS NO
EFFORT IS MADE EVEN THOUGH
WE KNOW THIS IS GOING TO
HAPPEN AGAIN TO DO THE BEST
THAT WE COULD WITH REFERENCE
TO NOTICE.
ISN'T THERE SOME OBLIGATION?
>> IFULLY A PERSPECTIVE
BASIS, THAT MAY WELL BE
TRUE, CERTAINLY IT IS WHAT
IS BEING DONE NOW; HOWEVER
NOT EVERY SINGLE QUOTE ON
QUOTE UNIVERSITY FACULTY
MEMBER -- NOT EVERY
ATTENDING PHYSICIAN AT ANY
OF THE HOSPITAL FACILITIES
ARE UNIVERSITY FACULTY
MEMBERS, WHAT YOU ARE
EVENTUALLY SAYING THAT
EVERYBODY EMPLOYED BY THE
HOSPITAL OR THE UNIVERSITY
OR BOTH OR, UP, OR SOME PENT
PARTY OR PENT COMPANY HAS TO
GIVE NOTICE THROUGH THE
HOSPITAL, NOW, IF, IN FACT,
THE HOSPITAL'S OPPORTUNITY
TO GIVE NOTICE IS INPUTTEDED
TO THE DOCTOR, THEN, IN THE
CASE, THEN, WE SHOULD HAVE
ALSO BEEN GIVEN THE BENEFIT
OF THE RECEIPT OF THE NOTICE
WHICH THEY STIPULATED TO, IN
FACT, THIS PATIENT
PACIFICALLY SAID, I BELIEVE
THAT WHOEVER WAS ON CALL
THAT DAY WOULD DELIVER MY
BABY.
SHE DIDN'T -- SHE KNEW
EXACTLY WHAT THE NOTICE
REQUIRED.
UNLESS -- IF IT IS FOR DUE
PROCESS PURPOSE, ACTUAL
NOTICE OF THE INFORMATION IS
SUFFICIENT TO COMPLY WITH
THOSE PURPOSES AND IN THIS
CASE, IT SHOULD BE ENOUGH.
THERE MAY BE OTHER CASES AND
OTHER CIRCUMSTANCES, I DON'T
BELIEVE THE RECORD IN THE
CASE DEVELOPS SUFFICIENTLY
TO HAVE IMPOSED THE DUTY
UPON THESE INDEPENDENT
INDIVIDUAL PHYSICIANS
PARTICULARLY GIVEN THE
RAMIFICATIONS OF THE
CONCLUSION THAT THEY HAD THE
DUTY TO NOTIFY WHICH IS AT
THAT POINT, THEY HAD A
PHYSICIAN-PATIENT
RELATIONSHIP EVEN THOUGH
THEY NEVER MET THE PATIENT.
YOU ARE INTO YOUR REBUTTAL.
>> THANK YOU.
>> MAY IT PLEASE THE COURT,
I AMGEN RAL COUNSEL.
I AM HERE PRY AMLY TO TAKE
THE BASIC POSITION, DON'T
THROUGH THE ALEXANDER CASE
AUN ARE THE BUS BECAUSE WE
THINK THE ALEXANDER CASE IS
GOOD LAW.
THE ANSWER TO JUSTICE'S
QUESTION.
YOU ARE NOT GOING TO GET
EXCUSED FROM NOTICE IF YOU
HAD ANY KIND OF PROFESSIONAL
RELATIONSHIP AT ALL, PERIOD.
>> BUT UNDER THESE KIND, IT
SEEMS THIS IS THE WAY THEY
ARE STRUCTURED.
>> YEAH.
I NEVER HAVE A RELATIONSHIP
WITH ANY OF THEM THERE AND
SO WE STILL WANT TO TAKE
BENEFIT OF IT, SO I MEAN --
>> I AM NOT GOING IN THAT
PARTICULAR DIRECTION BECAUSE
THAT IS COUNSEL HERE.
WHAT I AM COMING FROM THAT
IS WE GOT THE TWO SEPARATE
AND DISTINCT EXCEPTIONS.
THERE ARE ISSUES OF
PRACTICALABILITY THAT HAVE
NOTHING TO DO WITH
EMERGENCIES.
I MEAN, A WOMAN COMES CAN IN
FROM AN AUTOMOBILE ACCIDENT
IN COMA.
AND IT IS NOT AN EMERGENCY
CIRCUMSTANCE, BUT YET GIVES
BIRTH AT THE LATER POINT AND
TIME.
MAYBE THAT IS AN EMERGENCY
BECAUSE THEY ARE IN COMA.
THIS THEY GO IN FOR, THEY GO
IN IN DISNEY WORLD AND FROM
TALLAHASSEE, THEY GO IN
BECAUSE THEY, THEY HAVE
PAINS AND SO FORTH, BUT NOT
REALLY IN A DELIVERY ISSUE,
SOMEONE CALLS IN AN OB CALLS
IN AND GIVES ADVICE OVER THE
TELEPHONE.
WHEN THAT HAPPENS, THAT IS
PROVIDING SERVICE, IT IS
IMPRACTICAL TO GIVE NOTICE,
BUT THE MOTHER-TO-BE IS NOT
IN AN EMERGENCY SITUATION.
>> YOU ARE ARGUING, GENERAL
COUNSEL FOR IQA, IT IS
INTERESTED IN MAKE SHOO SURE
THE INTENT OF THE STATE USE
IS FULFILLED, THAT IS THAT
IT WOULD BE PATIENTS HAVE
MEANINGFUL NOTICE AND AN
OPPORTUNITY TO CHOOSE IN
WHAT THEY ARE GOING TO DO,
WHETHER THEY ARE GOING TO GO
TO A PARTICULAR PLACE THAT
IS OR IS NOT COMPLIED WITH.
THERE IS ANYTHING, I
UNDERSTAND, WE ARE HERE ON
CONFLICT, BUT THERE IS A
STATEMENT IN THE OPINION,
THE 3rd DCA OPINION THAT
TALKS ABOUT THE NIKA
BROCHURE WAS STAPLED IN THE
FRONT OF THE BROCHURE, IT
DOES NOT CONTAIN ANY
REFERENCE, THE HOSPITAL
REPRESENTATIVE DID NOT
DISCUSS THE BROCHURE WITH
ARE YOU I, EITHER THE
BROCHURE OR THE
ACKNOWLEDGMENT INDICATED ANY
OF THE PHYSICIANS WERE
PARTICIPANTS.
DOES THAT HAVE ANY LEGAL OR
FACTUAL SIGNIFICANCE?
>> NO.
THE ONLY REQUIREMENT UNDER
THIS LAW HAS BEEN UPHELD BY
THIS COURT HAND HAS BEEN
UPHELD BY EVERY DISTRICT
COURT.
>> BUT I MEAN, DON'T WE WANT
TO MAKE SURE THAT THINGS ARE
MEANINGFUL JUST LIKE HERE,
OBVIOUSLY, IF SHE IS GOING
TO UNIVERSITY OF MIAMI AND
THE CLING, SHE HAS MADE THAT
DECISION, WE GET THE DOCTORS
THAT ARE THERE.
I AM NOT SURE WHAT A
SEPARATE NOTICE REQUIREMENT
WOULD EVEN DO BECAUSE THEY
HAVE ACCEPTED WHERE YOU ARE
GOING.
I AM CONCERNED WITH THEIR
BEING ALMOST LIKE LESS THAN
A LIP SERVICE TO REQUIREMENT
THAT ACTUALLY INFORMS THE
PATIENT OF WHAT THE
SIGNIFICANCE OF THIS IS.
SO THAT IS -- NO, NO, AIM
SAYING THE DESCRIPTION THAT
YOU JUST READ ABOUT HOYT WAS
PRESENTED AND SO FORTH, THE
PURPOSE IS HAVE TO DELIVER
IT.
THERE IS A PRED SOOD DURE
THAT YOU RECEIVED IT
CREATING REBUTTAL PRESUMTION
THAT OCCURRED, BUT THE
NOTICE ISSUED QUITE FRANKLY,
NIKA DOESN'T CARE WHERE THE
PATIENT RECEIVED NOTICE OR
NOT.
IF THE CLAIM MEETS CRITERIA,
THEY PAY THE CLAIM, THE
PURPOSE IS FOR THE PATIENT
AND THE INTERESTING ISSUE
IS, THE CLAIMANT WHO RAISE
THE NOTICE ISSUE TO AVOID TO
DMORT A TORT ACTION, SO WE
ARE HERE TO TRY TO EXPLAIN
THAT WE THINK THAT THE 5th
DISTRICT COURT OF APPEAL'S
DECISION IN ALEXANDER IS
REALLY GOOD LAW.
WE DO NOT BELIEVE FRANKLY
THAT WE'RE IN CONFLICT.
THE GALAN CASE DID IN FACT
REVIEW THERE ISSUE AND THE
NEXT YEAR THE LEGISLATURE
MADE ISSUE.
>> IT BRINGS UP ALEXANDER,
AS I RECALL, THE PATIENT
APPEARED AT THE HOSPITAL AT
THREE DIFFERENT TIMES AND
BOTH ALL OF WHICH COULD HAVE
BEEN EMERGENCY SITUATIONS.
>> WELL, YES.
FROM WAS NEVER ANY
PREREGISTRATION.
>> THAT IS RIGHT.
>> HERE, THERE WAS PREREG
RACIAL.
THREE WEEKS BEFORE SHE
ACTUALLY APPEARED AT THE
HOSPITAL, SO ISN'T THERE A
DIFFERENCE WHEN THERE IS THE
THREE-WEEK PERIOD WHERE SOME
KIND OF NOTICE POS MIA HAVE
BEEN GIVEN?
>> IN ALEX AN SDMER
>> NO.
I AM TALKING ABOUT THE CASE
BEFORE IT.
AS OPPOSED TO THE THREE
EMERGENCY SITUATIONS IN
ALEXANDER.
>> YEAH.
I THINK YOU HAVE TO
RECOGNIZE IN ALEXANDER, ALSO
HOSPITALS HAVE TO SEE
EVERYBODY WHO WALKS IN THE
DOOR BY STATE AND FEDERAL
LAW AND SO THE FACT THAT
THEY CAME IN, YOU KNOW, IS
NOT NECESSARILY A REASON TO
GIVE ANYBODY A NOTICE, HE
ESPECIALLY WHEN THEY LEFT,
SO I THINK THAT IS WHAT
GALAN BASICALLY SAID AND I
KNOW I AM INTO IT HERE JUST
ABOUT.
BUZZ GALNAN BASICALLY SAID
--
>> YOU ARE BEYOND YOUR TIME.
DID HE RECEIVE HIS FIVE
MINUTES?
>> MR. STARK?
>> YOU ARE NOT ADVOCATING
ANY PARTICULAR SIDE IN THIS.
YOU ARE TRYING TO BE SURE
THERE IS REASONABLE IN TERM
TATION INVOLVED HERE.
>> DO NOT THROW THE
ALEXANDER CASE UNDER.
>> THAT IS CORRECT.
>> MR. CONNOLLY?
>> THANK YOU.
THANK YOU CHIEF JUSTICE
LEWIS.
MAY IT PLEASE THE COURT, MY
NAME IS LINCOLN CONNOLLY
WITH CHARLES BAUMBERGER, OUR
OFFICE IN MIAMI.
WE REPRESENT RUIZ AND THEIR
CHILD MICHAEL ANTHONY RUIZ
IN THE PROCEEDING.
>> IN THE CASE, WHAT WAS THE
REASONABLE OPPORTUNITY FOR
THESE PHYSICIANS TO GIVE HER
NOTICE?
>> WELL, FIRST OF ALL, IN
THE CIRCUMSTANCE, RIGHT
OUTSIDE OF THE BUILDING, I
BELIEVE THIS IS 8 DN THE
EXHIBITS, DR. NORRIS, WHO IS
ONE OF THE PARTICIPATING
PROVIDERS HERE IS LISTED AS
PHYSICIAN PRACTICING IN
THERE THE UNIVERSITY MIAMI
OBGYN GROUP.
HE WAS THE MEDICAL DIRECTOR
WHEN SHE CAME IN TO
PREREGISTER, HE IS THE
MEDICAL DIRECTOR COULD HAVE
WHO PREREGISTERED TODAY,
WHAT NEW PATIENTS ARE COMING
IN, GIVEN NOTICE FOR HIMSELF
OR ANY PHYSICIANS AND, IN
FACT, SHE GAVE BIRTH ON HER
ANTICIPATED DUE DATE, CALL
IN LABOR.
>> AS BEFORE?
>> BACK TO THE CLINIC SHE
PREREGISTERED IN.
>> RIGHT.
>> THIS IS PUT INTO
PERSPECTIVE.
THIS IS NOT GOING DOWNTOWN
TO JACKSON HOSPITAL, WHERE
YOU HAVE GOT, YOU GOT
EVERYBODY COMING IN FROM
GUNSHOTS TO EVERYTHING.
THIS IS A BIRTHING CLINIC?
THIS IS OB/GYN CLINIC?
>> YES, YOUR HONOR.
>> A VERY SPECIFIC PURPOSE?
>> YES, YOURONOR.
>> DOES THAT MAKE A
DIFFERENCE FROM OTHER CASES
WHERE YOU HAVE A SILK STOCK
GROUP OF DOCTOR, THEY HAVE
ALL KINDS OF PRENATAL CASE,
THEY MEET THE DOCTORS DAY IN
AND DAY OUT EVERY WEEK OR
EVERY MONTH.
AND THIS SITUATION WHERE
FOLKS COME IN AND REGISTER
AND THEN THEY ARE GOING TO
GIVE BIRTH.
THERE IS A DIF TLANS
SCENARIO THAT SHOULD MAKE A
DIFFERENCE IN THE
INTERPRETATION OF THIS LAW?
>>S WITH WELL, AS WE LOOK
AT, THIS IT PROVIDES FOR
EACH PAR SIS PATING
PHYSICIAN TO GIVE NOTICE.
WHAT I THINK IS HAPPEN
HAPPENING IN THE REAL WORLD,
THEY ARE DELEGATING THAT TO
ADMINISTRATIVE STAFF.
THE DOCTORS ARE NOT SITTING
DOWN AND GIVING THIS NOTICE,
IN FACT, DR. NORRIS THED HE
UNDERSTOOD, IT WOULD BE
TAKEN CARE OF BEFORE HE EVER
SAW THE PATIENT.
IN SITUATIONS WHERE A
PATIENT DOES NOT HAVE A
PRENATAL RELATIONSHIP WITH A
PHYSICIAN, USUALLY BECAUSE
OF FINANCIAL CIRCUMSTANCES
AND THEY HAVE TO GO TO THESE
COUNTY CLINIC, I BELIEVE IT
MAKES SENSE AND IT WOULD
COMPORT WITH THE LEGISLATIVE
INTENT FOR THE CLINIC TO SAY
ALL OF THESE DOCTORS ARE
PARTICIPATING PROVIDERS OR
MR. STARK WOULD SAY THE
CLINIC OR THE UNIVERSITY
MIAMI DOESN'T HAVE ANY
OBLIGATION UNDER NIKA, IN
THAT CASE, IF YOU OF WE ARE
GOING TO CONSTREW EACH
PHYSICIAN AND THE
ADMINISTRATIVE STAFF CAN'T
DO IT EITHER, THE DOCTORS
HAVE TO DO IT, THAT IS NOT
REAL WORLD.
>> BUT I GUESS WHAT I AM
TRYING TO UNDERSTAND IN THE
REAL WORLD, AGAIN, YOU TAKE
SOMEONE WHO HAS GOT
INSURANCE, WHO HAS NO
CHOICES, THEY PICK THEIR
DOCTOR, THIS THAT IS WHAT
THEY ARE REALLY LOOKING AT,
NOT THE HOSPITAL, THEY, THE
DOCTOR TELLS THEM WHAT
HOSPITAL AND THEY ARE GOING
TO THEN LATER ON PREREGISTER
MAYBE AT THE HOSPITAL.
AND THERE, YOU HAVE A
SEPARATE NOTICE PROVISION,
BUT HERE, AGAIN, THE
PREREGISTRATION, WHEN SHE
WENT TO JACKON CENTER, THE
PLACE WHERE SHE WAS
DELIVERING WAS IT THE SAME
PLACE WHERE SHE WENT FOR
PRENATAL VISIT?
>> NO, JUSTICE PARIENTE.
>> HE KAY.
BUT THE PHYSICIANS THAT WERE
GOING TO END UP PERFORMING
THE DELIVERY WORK AT LEAST
THAT SIGN THAT YOU GAVE,
THAT IS WHERE THEY WERE AC
AT YARKSON NORTH ATTORNEY
CENTER?
>> CORE RECEIPT.
SO THEN WHEN SHE GOES AND
SHE -- ARE YOU CHALLENGING
THE NOTICE THAT THE HOSPITAL
GAVE?
>> WE WERE, YOUR HONOR.
WE ELECTED NOT TO.
>> SO WHEN SHE IS MAKING THE
CHOICE TO GO.
ALL RIGHT.
I AM GOING HERE.
PRESUMABLY, WE KNOW WHAT
HAPPENS WHEN YOU GO TO
HOSPITALS, YOU GET ALL OF
THESE FORMS, NO ONE KNOW,
BUT THAT IS THE PART.
SHE THEN IS ELECTING TO GO
TO FACILITY WHERE, WHERE
THERE IS NIKA COMPLIANCE.
THE IDEA THEN THAT THE
DOCTORS AND THE PRACTICAL --
I MEAN WHAT CHOICE WOULD SHE
HAVE OTHER THAN, DOESN'T
HAVE A SEPARATE DOCTOR TO GO
TO, THOSE ARE THE ONLY
DOCTORS THAT WOULD BE
WORKING OUT OF THAT
PARTICULAR CLINIC, WHERE YOU
CAN'T GO AND SAY I WILL GET
ANOTHER DOCTOR TO COME HERE.
>> WELL, THE RECORD ITSELF
IS NOT DEVELOPED AS TO WHAT
OTHER OPTIONS.
>> BASICALLY, WHAT I AM
GETTING AT, WHERE WOULD THE
CHOICE BE FOR HER WHEN SHE
DECIDED TO GO TO THIS PLACE,
THEY HAVE ON STAFF PHYSICIANS,
WHAT IS, WHAT IS THE MEANING
OF ANY ADDITIONAL NOTICE AS
FAR AS REASONABLE
OPPORTUNITY ASPECT OF THE
SITUATION?
>> WELL, THE -- MRS. RUIZ
TESTIFIED, AS I RECALL, SHE
SELECTED JACKSON NORTH BASED
ON RECOMMENDATION OF OTHER
EXPECTANT MOTHERS WHO
DELIVERED THERE.
IT WAS AN EASY PLACE TO GO
TO.
THERE IS NO DEVELOPMENT IN
THE RECORD BY EITHER SIDE
ABOUT WHAT OTHER PLACES SHE
COULD HAVE GONE TO IN DADE
COUNTY.
>> DO YOU AGREE SHE DIDN'T
HAVE A PHYSICIAN-PATIENT
RELATIONSHIP WITH THE
DOCTORS THAT SHE IS NOW
SUING BEFORE THE EMERGENCY
AROSE?
>> THEY HAD NOT TREATED HER
M; HOWEVER, THE UNIVERSITY
OF MIAMI WAS AWARE SHE HAD
COME IN FOR
REPREREGISTRATION BEFORE THE
WENT TO LABOR.
I WILL DIRECT THE COURT TO,
I BELIEVE IT IS EXHIBIT 7,
WHICH ARE THE EXHIBITS TO
THE DEPOSITION, THE
UNIVERSITY OF MIAMI DIRECTOR
OF 3rd PARTY BILLING
COMPLIANCE, I THINK.
IF YOU LOOK AT EXHIBIT 2,
EXHIBIT 3, EXHIBIT 4 TO HER
DEPOSITION EXHIBITS WERE ARE
7 IN THE PROCEEDING, THEY
SHOW THAT THE UNIVERSITY OF
MIAMI LOGGED HER IN IN THE
BILLING SYSTEM ON AUGUST
12th AND AUGUST 10th OF
1998.
THE DAY BEFORE SHE CAME IN.
THE UNIVERSITY OF MIAMI WAS
AWARE OF THIS IN
PRACTICAL TERMS, HOW COULD
THESE FISZ HAVE GIVEN HER
NOTICE OF THEIR PARTICIPATION
IN THE NIKA.
>> THEY ARE DOING IT WILL
NOW.
>> JUSTICE IT IS PRACTICE CAL
FOR UNIVERSITY OF MIAMI TO DO
IT FOR THE PHYSICIAN FILLING
THAT IF NOT GOING IMPOSE THAT
OBLIGATION ON THE EMPLOYERS
STATUTE REALLY ISN'T CRAFTED
FOR THE THE REAL WORLD EITHER
BUT FOR THE DOCTORS TO SAY,
OKAY, PLEASE SUBMIT THIS LIST
WITH MY NAME ON IT AS
PARTICIPATING PROVIDER WHEN
THE PATIENT PREREGISTERS.
>> ARE YOU IN AGREEMENT, THAT
EVERY DELIVERY, IS AN
EMERGENCY?
>> ULTIMATELY, THE BREADTH OF
EVERY LIVE INFANT BECOMES
EMERGENCY MEDICAL CONDITION
UNDER STATITY SO THEREFORE
EXCEPTING THE UNIVERSITY
MIAMI'S ARGUMENT WOULD BE
SWALLOW THE RULE NOW THEY
COME IN AND SAY WELL, WE
DON'T REALLY MEAN THAT IT WAY
SO LET'S PUT OTHER -- OTHER
WORDS IN THE STATUTE CAT
BRIGHT LINE RULE.
>> 16 HOURS LABOR OR SO HERE
SFIE BELIEVE SHE CAME IN, ON
THE AFTERNOON 13th LABOR, AT
ABOUT, I WANT TO SAY 4:00
P.M., SHE DELIVERED I THINK
AT 6:00 IN THE MORNING WITH
CESAREAN SECTION.
.
>> I JUST WANT TO MAKE SURE
SO YOU WOULD IF THE BROCHURE
HAD INDICATED, THAT THE
PHYSICIANS ON THE STAFF WERE
ALSO PARTICIPATING IN THE
NIKA PLAN WE WOULDN'T BE
HERE?
>> UNDER THEE$$!! SUN LIFE
DECISION OUT OF 4th DISTRICT
THAT WOULD BE SUFFICIENT.
I KONT!!$$!!!!!!CONTINUE KNOW -- I HAVE
CONCERNS.
WE HAVE CONCERNS ABOUT THE
NIKA BROCHURE ITSELF WE
ELECTED NOT PROCEED WITH
APPEAL OF THATTING AS TO THE
PUBLIC HEALTH TRUST, BUT I
WOULD NOT CONCEDE IS THAT THE
NIKA PRO CHUR AS DELIVERED IN
THIS CASE IS SUFFICIENT UNDER
STATUTE THAT IS NOT REALLY
ISSUE HERE NOO THIRD DISTRICT
CERTIFIED CONFLICT, IS THERE
CONFLICT BETWEEN ON THIS
ISSUE BETWEEN DISTRICTS OR
ARE ALL THESE CASES FACT
SPECIFIC THIS CASE WHERE
THERE WAS -- CERTIFIED.
>> THEY ARE DIFFERENT WHEN IT
COMES TO THE FACTS OF EACH
CASE BUT FOR THE BROAD
PRINCIPLES, THEY ARE IN
CONFLICT, YOU KNOW, WE COULD
SEE -- CONCEDED THIRD DRRTH
THEY COULD DISTINGUISH
ALEXANDER ON FACTS IF THEY
CHOOSE I TO BELIEVE PUT IN A
FOOTNOTE THAT WAS POSSIBLE.
>> WHAT IS THE PRINCE$$!!IPLE IN
ALEXANDER IN CONFLICT WITH
THIS.
>> ANY TIME THE PATIENT
EVENTUALLY IS ANYTHING
EMERGENCY MEDICAL CONDITION
THAT IS ACTIVE LABOR ANY
PRIOR OPPORTUNITIES THAT
EXISTED TO GIVE NOTICE NO
LONGER MATTER.
AND NOTICE IS EXCUSED.
>> IN ALEXANDER WERE THERE
REALLY ANY OPPORTUNITIES,
UNLIKE THIS CASE, WHERE,
WHERE MAYBE THERE ARES WAS A
PRIOR OPPORTUNITY, BECAUSE
SHE PREREGISTERED AT THE
HOSPITAL, IN ALEXANDER, EVERY
TIME SHE APPEARED AT THE
HOSPITAL, IT SEEMS THERE WAS
AN EMERGENCY CONDITION, AND
SO, ISN'T THAT DOESN'T THAT
MAKE A DIFFERENCE AS TO
WHETHER OR NOT THEY REALLY
HAVE THE SAME PRINCIPLE OF
LAW IN THEM?
>> WELL, IN ALEXANDER, I
DON'T BELIEVE THE EMERGENCY
CONDITIONS THAT SHE WAS AT
THE HOSPITAL ON THREE PRIOR
OCCASIONS FOR WERE EMERGENCY
MEDICAL CONDITIONS UNDER
395.002.
I THINK.
>> WHICH MAKES IT EVEN MORE
DIFFERENT IT SEEMS TO ME,
BECAUSE THEN SHE IS PRESENTED
FOR THE FIRST TIME AT THE
HOSPITAL ON AN OICHLTS BGYN!!$$!!!!!!
BGYNSITUATION IN EMERGENCY SO
UNDER THOSE CIRCUMSTANCES,
WOULDN'T YOU HAVE TO AGREE,
THAT THE EXCEPTION FOR THE
EMERGENCY WOULD IN FACT APPLY
WHEREAS IN THIS CASE, SHE
PRESENTED AT THE HOSPITAL AT
LEAST, ONE OTHER POINT, IN A
NONEMERGENCY SITUATION WHERE
OSTENSIBLY, SOME KIND OF
NOTICE WOULD HAVE BEEN GIVEN.
>> SPEAK LAST OCCASION
PRESEBLTED TO ORLANDO
REGIONAL MEDICAL CENTER
ALEXANDER.
>> RIGHT YOU SAID THAT WAS
THE ONLY OBICHLT!!$$!!!!!!!!-GYN SITUATION
WHERE SHE PRESENTED AT
HOSPITAL.
>> ONLY EMERGENCY MEDICAL
CONDITION WITH ACTIVE LABOR,
AS I UNDERSTAND THE ALEXANDER
PIN THE FACTS OF IT.
BUT,S IF IT IS A DIFFICULT
STATUTE BECAUSE IT IS CRAFTED
KIND INFORM A BROAD WAY THAT
DOESN'T MEET EVERY REAL WORLD
SITUATION I THINK THAT IS WHY
THIS COURT GALEN AND FLORIDA
VERSUS BRANF SAID HAVE TO BE
FACT!!$$!!!!!!
FACTUAL -- OR WHEN INFORMS
PRACTICABLE I THINK TO THE
EXTENT THAT THIS MIGHT
EXPLAIN ALEXANDER.
OR OUR TAKE ON IT THAT A
WOMAN WHO IS PREGNANT,
PRESENTS TO THE HOSPITAL FOR
MEDICAL CARRY EVEN THROUGH
THE EMERGENCY ROOM NOT FOR
DELIVERY OF THE INFANT BUT
FOR SOME MEDICAL CARRY, THAT
IT IS REASONABLE TO CHARGE
THE HOSPITAL WITH NOTICE THAT
THIS PATIENT MAY BE PRESENTS
THERE FOR DELIVERY WHEN
FILLING OUT THE OTHER FORMS
SAY BY THE WAY, SINCE YOU ARE
PREGNANT WOMAN WHO IS HERE
FOR MEDICAL TREATMENT SHOULD
YOU COME HERE DELIVERE YOUR
CHILD, WE HAVE YOU KNOW WE
ARE PARTICIPANT IN THE
NIKPROGRAM.
>> WHEN IS FIRST TIME A
PHYSICIAN PATIENTLY
RELATIONSHIP AROSE BETWEEN
MRS. RUIZ AND THE UNIVERSITY
PHYSICIAN?
>> SPECIFICALLY HANDSON
TREATMENT, IT WAS WHEN SHE
CAME IN, ON AUGUST 13, IN
LABOR.
HOWEVER, SHE PRESENTED TO
THIS FACILITY THAT IF YOU
LOOK AT THE PHOTOGRAPHS OF
EXHIBIT 8, HAVE UNIVERSITY
MIAMI'S NAME ALL OVER IT CHLT!!$$!!!!!!!!.
TO PREREGISTER, AND I BELIEVE
WAS POINTED OUT EARLIER THIS
IS A RECUR THING WHERE THEY
KNOW THESE PATIENTS ARE GOING
TO COME IN PREREGISTER NOT
COME BACK --
>> I GUESS THE -- THERE IS AN
ISSUE OF FACT THAT HAS TO
OCCUR I MEAN A FINDING AS TO
WHEN THE PHYSICIAN-PATIENT
RELATIONSHIP ARISES?
BECAUSE, AGAIN, THE MR. STARK
HAS CONCEDED THAT IF THERE
WAS AN ONGOING
PHYSICIAN-PATIENT
RELATIONSHIP, THEY CAN'T RELY
ON THE EMERGENCY EXCEPTION
THEY'VE GOT TO GIVE THE
NOTICE AT THE TIME THE $$
PHYSICIAN-PATIENT
RELATIONSHIP ARISES.
DO YOU READ THE STATUTES
BEING CONTINGENT ON LOOKING
AT WHEN THE ACTUALLY
PHYSICIAN-PATIENT
RELATIONSHIP COMES INTO
BEING?
>> I DO NOT JUSTICE PREBTE,
IT -- PARIENTE IT DOES NOT
SAY O O UPON FORMATION
PHYSICIAN PATIENT
RELATIONSHIP NOTICE SHALL BE
GIVEN IT SAYS EACH
PARTICIPATING PHYSICIAN SHALL
GIVE NOTICE TO OBSTECKTRICAL
PATIENTS, WE HAVE,$$!!!! -- WHEN IT
COMES TO THE DELIVERY OF
INFANTS A SYSTEM WHERE
OBTRISH SEAN OBS TRIR SEAN IN
PRIVATE SMITH A SAY OKAY I
WILL BE YOUR DOCTOR THAT IS
NOT TRUE IN ALL CIRCUMSTANCES
THAT OBSTETRICIAN MAY GO ON
VACATION BE OUT SICK MAY NOT
BE WORKING NIGHT SHIFT HAS A
PARTNER SOMEONE ELSE COVER
FOR HIM, AND SO, NO DOCTOR
EVERY KNOWS FOR SURE THAT
THEY WILL BE THE DOCTOR THAT
WILL DELIVER THE INFANT AND
UNDER UNIVERSITY MIAMI
ARGUMENT BECAUSE DR. NORRIS
AND DR. BARKER DIDN'T KNOW
THAT THEY WOULD BE WOSHG!!$$!!!!RKING
WHEN WAUPITA RUIZ CAME IN, TO
DELIVER HER CHILD THEY HAD NO
OBLIGATION TO PROVIDE --
>> BUT HE CONCEDES THAT IN A
SITUATION WHERE YOU THAT
PATIENT GOES TO A SEPARATE
PRACTICE OVER SAEFRL-MONTH
PERIOD, THAT THEY CAN'T RELY
THEY CAN'T SAY WELL, THE
EMERGENCY AROSE WHEN THE
PERSON YOU NOE!!$$!!!!KNOW SAY PREMATURE
BIRTH COME INS SEVEN MONTHS
IF THEY HAVE BEEN, SEEING
THEM, THROUGHOUT, THEY'VE GOT
TO GIVE THAT NOTICE, DO YOU
SEE THAT AS BEING A --
STATUTE -- ACTUALLY, EXPLAINS
OR -- WOULD THEY WOULD A
DOCTOR IN THAT SITUATION
STILL BE ABLE TO SAY I
COULDN'T GIVE THE NOTICE
BECAUSE OF THE EMERGENCYING
EXCEPTION?
>> NOT SO MUCH THAT BUT THAT
THOSE DOCTORS I CAN ASK WE
DIDN'T KNOW WHICH ONE OF US
WAS GOING TO BE DELIVERING
THIS INFANT CASE WE DIDN'T
KNOW WHEN SHE WAS GOING TO GO
INTO LABOR AND WHAT OUR WORK
SCHEDULE IS IF WE LOOK HERE
THE SPROENLTD DUE DATE DR.
NORRIS DR. BARKER WERE
WORKING THAT TODAY IF THEY
CHECKED THE DATE SHE WAS DUE
WHOS WOULD WORKING WOULD HAVE
KNOWN DR. NORRIS DR. BARKER
WOULD HAVE BEEN WORKING.
>> I'M STILL TRYING TO
UNDERSTAND HOW THEN,
UNDERSTAND THE PLAIN LANGUAGE
THAT THE PURPOSE OF THE
STATUTE BEING TO ALLOW A
PATIENT WHO HE HAS -- TO TAKE
INFORMED CHOICE BETWEEN USING
OBSTETRICIAN PARSE PAILTHS IN
THE PLAN AND USING ONE WHO
DOES NOT, DO YOU READ THAT
OVERALL THAT IS THE PURPOSE
OF THE STATUTE.
>> 316 YES YOUR HONOR.
>> OKAY.
AND YOU THINK THAT IT DOESN'T
ANTICIPATE THAT IT MAKES A
DIFFERENCE AS TO WHEN THE
PHYSICIAN-PATIENT
RELATIONSHIP ARISES?
.
>> IT IS WHEN THE PHYSICIAN
REGARDLESS WHEN HE FIRST DOES
HANZ ONLY TREATMENT, HAS THE
OPPORTUNITY TO KNOW THAT HE
WILL BE PHYSICIAN IN TO
FURNISH NOTICE WHAT A THIRD
DISTRICT I THINK PICKED UP ON
IN THIS CASE, IS THAT AND AS
CHIEF JUSTICE LEWIS WAS
ASKING IN SITUATIONS IN THE
POORER COMMUNITIES, DO YOU
NOT HAVE PATIENTS THAT HAVE
THESE ONGOING PRENATAL
DR.-PATIENT RELATIONSHIPS YOU
ARE GOING TO SET UP IS DYM
CRIMINAL TORY SYSTEM
POTENTIALLY SUBJECT TO EQUAL
PROTECTION ISSUE WHERE POORER
EXPECTANT MOTHERS ALL LOSE
RIGHT TO PROCEED WITH A
COMMON LAW --
>> GUESS MY EARLY$$!!IER QUESTION
IN THAT SITUATION, THE PERSON
IS CHOOSE THE CLINIC NOT
CHOOSING THE DOCTOR, SO THEY
HAVE MADE THEIR INFORMED
CHOICE, THEY'VE GOTTEN THEIR
NOTICE FROM THE CLINIC, THAT
THEY PARTICIPATE, ISN'T THAT
THEIR INFORMED CHOICE, THE
DOCTORS ARE SECONDARY I GUESS
THAT IS WHAT IN ANOTHER
SITUATION YOU REALLY ARE
CHOOSING THE DOCTOR AND THEN
THE HOSPITAL IS SECONDARY.
ISN'T THAT THE REALITY OF HOW
THESE THINGS WORK?
>> WELL HERE, FACTUALLY IN
THIS CASE, IF WE LOOK AT THE
NIKA BROCHURE IT SAYS THAT
ANY HOSPITAL WITH A
PARTICIPATING PHYSICIAN ON
STAFF AND HERE THERE WAS
NOTHING FURNISHED EITHER BY
MISS WADL-E.Y. CLERK GAVE
PAMPHLET STAPLED AMONGST TWO
OTHERS TESTIFIED SHE DOESN'T
KNOW ANYTHING ABOUT NIKAICHLT
CAN'T EXPLAIN TO PATIENTS NOR
BROCHURE NOR STAMP
ACKNOWLEDGING RECEIPT OF
THE --
>> WHETHER INFORMED NOTICE
QUESTION I ASKED EARLIER
ASSUMING SHE MADE AING ME ON
-- MEANINGFUL CHOICE NOT
CHALLENGING IT THE FACILITY
-- THEN ISN'T THAT -- THAT IS
WHERE THE RELATIONSHIP WAS,
NOT WUTH!!$$!!!!ITH THE DOCTOR.
>> BUT IT IS NOT JUST ENOUGH
THAT THE FACILITY --
>> IN OTHER WORDS SHE
COULDN'T SAY I'M GOING
FACILITY BUT I'M NOT GOING I
DON'T WANT TO PICK THESE
DOCTORS, COULD SHE?
>> NO, IF SHE WAS GOING TO BE
AT THAT FACILITY WOULD HAVE
TO BE THOSE DOCTORS.
>> ALL ARE ALL THE DOCTORS IN
THAT FACILITY A PART OF THE
NICAALSO THERE ARE DOCTORS
THERE WHO WON'T.
>> NO NOAA NO THE RECORD IS
ALL ATENDING PHYSICIANS THERE
UNIVERSITY MIAMI PROFESSORS
AND THEY ARE ALL PARTICIPANTS
OF NIKA WITH NIKA -- SPISHG
-- CIRCLES BACK TO HEART OF
THIS, THIS IS NOT A FACILITY
THAT TREATIES -- GUNSHOT
WOUNDS ALL THOSE THINGS;
CORRECT?
IT AP DECK TO MANY MIS,
SURGERIES IT IS OBICHLT!!$$!!!!!!!!-GYN KIND
OF CLINIC YOU CALL IT A
HOSPITAL,BUT I MEAN IT IS --
FOR THAT PURPOSE.
>> MATERNITY ZMROOERNT
EXACTLY WITH THE IT IS FOR
BETS GABBING TO THE QUESTION
WHY THEN, SHOULD THAT INITIAL
NOTICE NOT BE SUFFICIENT THAT
IS WHERE YOU ARE GOING.
THIS IS NOT REALLY THAT
SITUATION, OF THE SILK
STOCKING OIBGYN WE LET YOU GO
WHERE YOU WANT, THEY ARE
REALLY ONE AND THE SAME ARE
THEY NOT, WE CAN TALK ABOUT
LEGAL DISTINCT ENTITIES, BUT
IN OPERATION, ARE THEY NOT
JUST ONE OPERATION.
>> THAT MAY BE THE CASE YOUR
HONOR, IF THIS IS LIKE THE
SUN LIFE CASE WHERE THE
NOTICE SAID, THAT THIS
HOSPITAL HAS PARTICIPATING
PHYSICIANS ON STAFF, THIS
BROCHURE THAT NIKA WAS GIVING
OUT AT THE TIME I DON'T KNOW
IF IT CHANGED OR NOT, JUST
SAYS THAT IF YOU ARE HOSPITAL
HAS PARTICIPATING PHYSICIANS
ON STAFF, SO EVEN IF THIS
NOTICE WASN'T BURIED, AMONGST
WHAT TO OTHER THINGS EVEN IF
MICHELLE WADLY SAID TO
JUANITA RUIZ STOP FOR A
MINUTE LOOK AT THIS READ THIS
GOING TO LIMIT YOUR LEGAL
RIGHTS --
>> CHANGES THESE LEGAL ISSUE
THEN.
>> BUT IT DOES NOT SAY THAT
THAT -- FRATERNITY CENTER WE
HAVE PARTICIPATEDING FIZZING
ON NIKA ON.
>> YOU HAVE CHAENGZ LEGAL
ISSUE FROM WHETHER THIS IS
NOT ICATION FORM IS
SUFFICIENT COMPLIANCE, RATHER
THAN WHAT A YOU ARE
PRESENTING IS THAT THE
PRESENT TO A HOSPITAL ALL
EMERGENCY, WHAT A PRIOR
RELATIONSHIP IS SEEMS TO JUST
CHANGE THE TO THE!!$$!!!!!!TAL FOCUS WITH
THE ONE HAS TO DECIDE IF IT
IS THE LANGUAGE OF THAT
BROCHURE THAT DOESN'T
COVER --
>> LANGUAGE NAF BROCHURE
DOESN'T KFBER FOR PHYSICIANS.
>> RIGHT THAT IS NOT OUR
LEGAL ISSUE TODAY IS IT --
>> THEY ARE SAYING THAT THAT
THE FACT THAT THE HOSPITAL
FURNISHED NOTICE SHOULD COVER
PHYSICIANS AS WELL EITHER
BECAUSE THEY ALSO HAVE
CONTRACTS PUBLIC HEALTH TRUST
TRUST SZS 50IS SZ TRUST SZS
50IS SZ
.
>> THEY CAN GET IT EVEN IF NO
NO TIFSZ WAS GIVEN THE ISSUE
HERE IS.
>> BUT THAT IS BUT AGAIN I
MEAN WE ARE NOT DISCUSSING
WHETHER IMMUNITY APPLIES OR
NOT IT IS A QUESTION OF YOU
TO DO CERTAIN THINGS TO
OBTAIN I AM MUNLITY THAT'S
WITH THE WE ARE TALKING
ABOUT.
>> I UNDERSTAND THAT
ALEXANDER CASE TO ANSWER THE
QUESTION THE PATIENT'S
PRIVATE PHYSICIAN WAS NOT A
PARTICIPANT -- PARTICIPATING
PHYSICIAN, THE PATIENT CAME
INTO THE HOSPITAL THREE
TIMES, WITH EMERGENCIES BUT
THE ER MEDICAL STAFF THAT
ACTUALLY DELIVERED THE BABY
THAT COURT CONCLUDED IT WAS
EMERGENCY SITUATION, THEY
WERE ENTITLED TO THE $$
EXCLUSIVITY THE APE SKRAIS
MUCH LIKE US BOARD OF REGENTS
UNIVERSITY MEDICAL CENTER
STATUTORY TEACHING HOSPITAL,
ATTENDING PHYSICIANS
SUPERVISED JUST LIKE IN THIS
CASE, AND THAT CASE THEY
CONCLUDED THAT -- THAT THEY
DIDN'T GIVE NOTICE THEREFORE
THERE IS NO EXEXCLUSIVITY
WITH THE THE COURT CASE WE
AFFIRM AS TO THE HOVZ THAT
HAD PREREGISTRATION ABILITY,
BUT WE REVERSE AS TO THE
ATTENDING PHYSICIANS AND THEY
SPECIFICALLY SAY LIMITED
RECORD HERE DOES NOT INDICATE
FOR EXAMPLE WHETHER PRIOR TO
DELIVERY, THESE ATENDING
PHYSICIANS HAD ANY PRENATAL
OR OTHER PRIOR PROFESSIONAL
RELATIONSHIP WITH THESE
PATIENTS, SUCH AS NIKA NOTICE
COULD REASONABLY HAVE BEEN
GIVEN THAT'S OUR POSITION.
>> IS THAT A FACTUAL
SITUATION -- MATERNITY CLINIC
>> A BIRTHING CENTER, SAME
THING.
>> STATUTORY TEACHING
HOSPITAL BISHLTHDING CENTER
RES DEN --
>> RESIDENTS.
>> -- HVPDZ MAY BE A LITTLE
DIFFERENT I MEAN SHANS AND
JACKSON -- DIFFERENT THAN
LITTLE BIRTHING CLINIC, DOES
THAT INVOLVE A BIRTHING
CLINIC THAT WE ARE TALKING
ABOUT?
MANNED OR STAFFED BY JUST A
GROUP OF PHYSICIANS FOR THAT
ONE PURPOSE.
>> AFE WAS IN FACT UNIVERSITY
MEDICAL CENTERS --
OBSTECKTRICAL DELIVERY UNIT
WHAT A IT IS WE DON'T KNOW IF
A BIG HOSPITAL OR NOT, BUT
THE PROBLEM HERE IF I RENT
SPACE NEXT DOOR TO BAPKOIST
BAPTIST HOSPITAL MIAMI SAY SO
AND SOP OBSTECK RICKAL GROUP
THEY WOULD SAY OBVIOUSLY,
THEY SHOULD HAVE GIVEN NOTICE
TO EVERYBODY WHO CAME INTO
THE EMERGENCY ROOK MIGHT
DELIVERER THERE IN FACT WHAT
THEY ARE SUGGESTING THAT WE
ACTUALLY NEED TO GIVE NOTICE
TO EVERYBODY WHO IS A
RESIDENT AT DADE COUNTY MAY
DELIVER AT THESE HOSPITALS
MAKES ABSOLUTELY NO SENSE,
TO REQUIRE WHEN IN FACT THEY
HAVE NOT SEEN THE PATIENT,
HERE THE PATIENT DID IN THE
REAL WORLD, HAVE A REAL
CHOICE.
SHE CHOSE CLINIC SHE KNEW THE
PHYSICIANS WOULD BE SUPPLIED
BY THE HOSPITAL, NOTICE WAS
GIVEN, THERE IS NO
CONSTITUTION!!$$!!!!!!!!!!!!!!!!!!!!!!
CONSTITUTIONAL INFIRMITY HERE
IS THAT WHY THEY PUT IT IN,
AND THE EMERGENCY EXCEPTION
WHICH WASN'T PRESENT IN AFE
CASE NOW IS HERE WE BELIEVE
THE APPELLATE COURT WAS WRONG
AND THAT THEY SHOULD HAVE
CONCLUDED THAT EXCLUSIVITY
APPLIED TO EVERYBODY NOT JUST
THE HOLLYWOOD.
>> THANK YOU VERY MUCH.
.
>> WE'LL TAKE THE CASE UNDER
ADVISEMEN