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

Page 4

An important question in this case is why Dr. Eudaly failed to call Dr. Neller for the peer-to-peer review allegedly scheduled on July 8, 1998. Dr. Eudaly testifies he never received a telephone message from Dr. Neller or a written memo from Kathy Fields regarding the July 8, 1998 review. Even if he had been aware of the scheduled review, Dr. Eudaly’s deposition testimony indicated his belief, based upon past dealings with Merit/Magellan and with Dr. Neller in particular that it would be an exercise in futility to participate in the review. In response to the question asked at her July 17, 2000 deposition, “Now-and the impression you formed from your conversation with Dr. Eudaly is that he didn’t think it would do any good to call Dr. Neller; is that a fair summary,” All Saints UR nurse Kathy Shields testified, “yes.”

Dr. Eudaly testified that in a previous review with Dr. Neller regarding a different patient, “he [Neller] told me he’s going to stick by the books” (referring to Merit/Magellan’s own medical necessity and level of care guidelines). He testified that he believed Dr. Neller had no intention of approving any additional inpatient days “because when the man says [it’s] the last day, that’s the last day.”  Dr. Neller documented on the July 6, 1998 Review Form under the heading “SUMMARY: RECOMMENDATION FOR THE REVIEW” the following: “D/C [Discharge] or peer [Peer-to-Peer Review] 8 July, ’98.” However, in his own deposition testimony, when asked, “On July 8, 1998, was he [Mr. Plocica] ready to be discharged from the psychiatric floor of All Saints Hospital,” Dr. Neller responded, “I would have to say yes.” In my opinion, this indicates that Dr. Neller, since he had had no updated clinical information about Mr. Plocica from the afternoon of July 6 through his discharge on July 8, 1998, never had any intention of authorizing additional inpatient days for Mr. Plocica’s treatment.  Dr. Eudaly summed up his experiences in dealing with managed behavioral health organization utilization review by testifying that “[he’d] been doing this for years and getting nowhere.”

All Saints UR nurse Shields testified in her deposition that Dr. Neller had a reputation with other physician providers for being tough and “very rigid” in his review decisions. She herself felt constant pressure from Merit/Magellan to get patients discharged quickly from the hospital. When asked in her deposition, “And you understood that what Merit/Magellan was doing with respect to both All Saints and Dr. Eudaly was passing the pressure on, didn’t you, “ her response was, “In my opinion, yes.” And to the question, “Now, and you saw that pressure from Merit/Magellan act on doctors other 

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