Treating Physicians vs. Expert Witnesses

Rule 26(b)(4)(A) of the amended rule of the Mississippi Rules of Civil Procedure titled: Trial preparation: experts appears to distinguish between experts retained or specially employed to provide expert testimony (hired guns) in part (ii) and an expert who has not been retained or specially employed to provide expert testimony (such as a treating physician) and provide much less information.  The case of Chaupette v. State, 136 So. 3d 1041 (SCT 2014) states that a physician can testify without being accepted as an expert regarding:  1)  “the facts and circumstances surrounding the care and treatment of the patient”; 2) what his records about the patient reveal”; and 3) “what conditions the patient was suffering from if the opinion was acquired during the care and treatment of the patient.”  However, a physician cannot testify about the significance of a patient’s condition or industry standards without first being accepted as an expert.  (citing Foster v. Noel, 715 So 2d 174 and Langston v. Kidder, 670 So. 2d 1. So if the treating physician is just going to testify about the patient’s condition, treatment and his records, he doesn’t have to be listed as an expert.  If the treating physician testifies about the effect of the injury or condition, such as future restrictions or future medical expenses, he does need to be listed as an expert.  To be safe, the physician should be listed as an expert per Rule 26.

HIPPA Case of Interest

On Jan. 29, 2020, OCR released a notice regarding a recent federal court ruling in the case of Ciox Health, LLC v. Azar, et al., where a federal judge in the District Court for the District of Columbia vacated the “third-party directive” within the individual right of access “insofar as it expands the HITECH Act’s third-party directive beyond requests for a copy of an electronic health record with respect to protected health information (“PHI”) of an individual … in an electronic format.”¹ Additionally, the court held that the fee limitation set forth at 45 CFR § 164.524(c)(4) should only to an individual’s request for access to their own records, and does not apply to an individual’s request to transmit records to a third party.

The Ciox Health case centered on the restrictions the Department of Health and Human Services (“HHS”) and the Office for Civil Rights (“OCR”) put in place in the 2013 Omnibus Rule² and through informal guidance published in 2016 regarding fees that can be charged to patient in searching for, retrieving, and delivering their records and PHI as it pertains to third-party directives. Third-party directives are a mechanism promulgated by the HITECH Act that granted individuals the right to obtain a copy of their PHI maintained electronically, and “if the individual so chooses, to direct the covered entity to transmit such copy directly to an entity or person designed by the individual.”³ Additionally, the HIPAA Privacy Rule permits a reasonable cost-based fee to provide the individual (or the individual’s personal representative) with a copy of the individual’s PHI, or to direct a copy to a designated third party. The fee may include only the cost of certain labor, supplies, and postage (this fee is also referred to as the “Patient Rate”).⁴

The 2013 Omnibus Rule broadened the third-party directives to PHI maintained in any format, not just electronic records. Moreover, the 2013 Omnibus Rule amended the Patient Rate and required actual labor costs associated with the retrieval of electronic information to be excluded.⁵

In 2016, HHS issued a guidance document titled Individuals’ Right under HIPAA to Access their Health Information 45 C.F.R. § 164.524 (the “2016 Guidance”).⁶ The 2016 Guidance made two notable requirements that gave rise to the current litigation. Most significantly, HHS declared that the Patient Rate applies “when an individual directs a covered entity to send the PHI to a third party.”⁷

“This limitation,” HHS said, referring to the Patient Rate, “applies regardless of whether the individual has requested that the copy of PHI be sent to herself, or has directed that the covered entity send the copy directly to a third party designated by the individual (and it doesn’t matter who the third party is).”⁸

Additionally, in the 2016 Guidance, HHS provided a methodology to calculate the Patient Rate in requests for an electronic copy of PHI maintained electronically. The methodology would require the entity to determine a fee by calculating the actual allowable costs to fulfill each request or by using a schedule of costs based on the average allowable labor costs to fulfill standard requests. HHS also provided an option for entities to charge a flat rate for requests for electronic copies of PHI not to exceed $6.50 as an alternative to going through the process of calculating these costs.

In this case, HHS was sued by Ciox Health, a medical record retrieval company, over the changes to the Patient Rate set forth in both the 2013 Omnibus Rule and the 2016 Guidance. Ciox Health argued that the $6.50 flat fee is an arbitrary figure that bears no relation to the actual cost of honoring patient requests for copies of their health information, and such a low fee has negatively impacted its business. Ciox Health claims the 2013 Omnibus Rule and the 2016 Guidance, “unlawfully, unreasonably, arbitrarily and capriciously,” restrict the fees that can be charged by providers and their business associates for providing copies of the health information stored on patients.

The district court, in declaring the changes to the Patient Rate set forth in the 2013 Omnibus Rule unlawful, held that HHS cannot rely on its general rulemaking authority to supplement the limited-scope, third-party directive enacted by Congress in the HITECH Act. The court held that the 2013 Omnibus Rule’s expansion of the third-party directive is therefore arbitrary and capricious. Moreover, the district court held that the 2016 Guidance that worked a change into the Patient Rate was akin to a legislative rule that HHS had no authority to adopt without notice and comment. As a result, the court vacated the 2013 Omnibus Rule’s expansion of the HITECH Act’s third-party directive beyond requests for a copy of electronic records with respect to PHI of an individual in an electronic format. The court also declared unlawful and vacated the 2016 Guidance as it extended the Patient Rate to third-party directives without going through notice and comment.

Health care providers and medical records access companies are no longer required to limit the fees charged to their average costs, or charge a $6.50 flat fee, when a patient requests their medical records be transmitted to a third party. The fee limitations will still apply to individuals when they request their own records, however, as decided in the Ciox Health decision, on January 23, 2020.

OCR released a notice on Jan. 29, 2020 that the right of individuals to access their own records and any fee limitations that apply when exercising this right still apply. However, OCR appears to have at least accepted this ruling for now, as it pertains to third-party directives. OCR stated that it will continue to enforce the right of access provisions in 45 CFR § 164.524 that are not restricted by the court order. The court order can be viewed here.

Sheriff Fees Increase

Effective January 1, 2020, the Sheriff’s fee for service of process in civil cases rose from $35.00 to $45.00 in Mississippi.  The increase applies to both initial service of civil actions and to post-judgment service of executions, garnishments, etc.  This change may be found in Miss. Code Section 25-7-19.  

Bell Family Law CLE dates

July 10     Jackson

July 24     Oxford

July 31     Mississippi Gulf Coast

The dates for the Bell Family Law CLE are above.  It is well worth the time and effort to go.  I always find some random bit of caselaw that I can use on a current or future case.  

Child Support on a High Income Parent

Last week, the Mississippi Court of Appeals decided Descher vs. Descher located here.  One of the issues is that the chancellor ordered more in child support than the child's actual expenses.  The Court of Appeals found this was proper.

This was the reasoning.

This Court has previously rejected “the argument that equates reasonable support with subsistence” and adopted the view that “the ‘reasonable needs’ of the child ought to be viewed at least as broadly as the reasonable needs of a wife seeking alimony.”  Ali v. Ali, 232 So. 3d 770, 777 (¶21) (Miss. Ct. App. 2017).  The monthly expenses provided for in a party’s Rule 8.05 financial statement do not set a cap on an award of child support.  Even if a child’s basic needs are met, “[i]t is not an abuse of discretion for the chancellor to consider the standard of living to which the child is accustomed in deciding what amount of support is reasonable.”  Ali, 232 So. 3d at 777 (¶21) (citing Moulds v. Bradley, 791 So. 2d 220, 228-29 (¶24) (Miss. 2001) (Diaz, J., concurring)).  Even though April claimed less than $4,000 in monthly expenses for the children, her Rule 8.05 declaration did not cap out the maximum amount of child support the chancellor could grant.  Jeff’s monthly income and his earning potential far surpass April’s.  As Justice Diaz said in his concurring opinion in Moulds, “[t]he trial court should not limit the amount in child support to the child’s ‘shown needs,’ because a child is not expected to live at a minimal level of comfort while the non-custodial parent is living a life of luxury.”  Moulds, 791 So. 2d at 229 (¶26) (Diaz, J., concurring) (citing People ex rel. Graham v. Adams, 608 N.E.2d 614, 616 (Ill. App. Ct. 1993)).

Discovery of Insurnance Coverage in Mississippi

“Often in litigation, counsel may be reluctant to produce a copy of an insurance policy. As a result, counsel may not promptly provide an insurance policy to the other side. The reluctance and delay in the production may be understandable, but it is not permitted. Indeed, Mississippi Rule of Civil Procedure 26(b)(2) specifically provides for the "discovery of the existence and contents of any insurance agreement under which any person carrying on an insurance business may be liable to satisfy part or all of a judgment which may be entered in the action or to indemnify or reimburse for payments made to satisfy the judgment."  Entergy Miss., Inc. v. TCA Cable Partners, 22 So. 3d 284, 288 n.2 (Miss. Ct. App. 2009).  “The failure to provide or the unreasonable delay in providing an insurance policy should be considered a sanctionable event, and courts should not allow parties or counsel to avoid this requirement through delay or complete omission.”  Id.

Universal Life Church Marriage

In Blackwell v Magee, the Mississippi Supreme Court held that the Universal Life Church was authorized to solemnize marriage.  This is essentially an online ordained minister.  Currently, the exact opposite is true in Tennessee and the marriage are not valid.  This is currently being litigated in Tennessee.