A Psychiatrist's Expert Report on the First
HMO Malpractice Lawsuit - continued

Page 3

Provider Handbook. I assume that option was also in place in July, 1998. Mr. Plocica’s clinical status met the criteria described in the Handbook for the ICM option, but it was never  offered. The withholding of extra-contractual benefits to which Mr. Plocica was entitled limited the treatment options available, and influenced Dr. Eudaly in his clinical decision-making process.

Dr. Neller allegedly requested a peer-to-peer review with Dr. Eudaly for the morning of July 8, 1998. He allegedly left a single phone message with Dr. Eudaly’s office on the morning of July 8 for Dr. Eudaly to call back on that day between 9AM-12 PM. Dr. Neller did not make any additional efforts to reach Dr. Eudaly or attempt to obtain updated clinical information about Mr. Plocica when he failed to hear from Dr. Eudaly by  noon that day. When he was informed by Merit /Magellan’s care manager McDaniel in the early afternoon of July 8 that Mr. Plocica had been discharged, he did not make any effort to determine if an admission to the partial hospital program (PHP) level of care was medically necessary or appropriate. No clinical information was obtained by Merit/Magellan between the afternoon of July 6 through July 8, 1998 that would support any determination about the appropriate level of care. There was no high-risk assessment performed on Mr. Plocica at discharge by Merit/Magellan in violation of its own High Risk/Aftercare Guidelines.

There was ample documentation in the medical record, both from the physician progress notes and from the nursing notes, that Mr. Plocica was profoundly depressed, mentally confused, seclusive in his hospital room, and that he continued to express suicidal ideation, fear of discharge, and uncertainty about his future right up until the time of discharge from the hospital. He remained on suicide precautions and fifteen minutes checks. His clinical status justified additional inpatient treatment, or treatment in a facility with 24-hr nursing supervision  based upon any credible medical necessity and level of care guidelines. Merit/Magellan’s care manager Joan McDaniel never even attempted to document information about Mr. Plocica’s clinical status from the afternoon of July 6 through July 8, 1998 either from All Saints’ UR nurse Kathy Fields or directly from Mr. Plocica’s medical record.  Ms. McDaniel never communicated updated clinical information about Mr. Plocica  to Dr. Neller between July 6- July 8, 1998.

The following is an exchange from Dr. Neller’s deposition testimony of May 27, 1999:

Q: All right. And then assuming that he was not going to have 24-hour supervision, was it appropriate to discharge him on July 8^th?”  

A: [Neller]: “I would have to say yes.”  

Q: “All right. Now what had changed between July 6^th and July 8^th in terms of Joe Plocica’s clinical status?”  

A [Neller]: “I don’t know.”  

Q: What had changed in terms of his symptoms?”  

A [Neller]: “I don’t have that information.”  

(continue)

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