One might presume (or at least hope) that negligent doctors with a track record of paying large sums to settle multiple Florida medical malpractice lawsuits would have a tough time continuing to work in the health care industry. That person would be wrong.
Not only is it rare for a doctor to lose their state-issued license to practice medicine in Florida, a new report by ProPublica revealed that several physicians repeatedly found negligent in providing patient care now earn healthy sums working for health insurers — approving or denying coverage for patient insureds.
The first example involved a surgeon who practiced for years in Brevard County, Florida — during which time he settled five Florida medical malpractice lawsuits for a collective $3 million. Among the patient allegations against him:
- He negligently cut the aorta of a patient who underwent surgery for her gallbladder. She died just before her 40th birthday, leaving behind a husband and two teen daughters.
- He negligently stapled and stitched a patient’s rectum to her vagina.
The surgeon denied these and three other claims against him, but ended up paying sizable settlements to each of those claimants for medical malpractice.
Those harmed might take comfort in the fact that he hasn’t worked as a practicing surgeon for a dozen years. However, he was hired to work as a medical director for a health insurance company, where he is a critical gatekeeper deciding which patient procedures will be covered by the insurer and which won’t. Not only that, he oversees more than a dozen other medical directors.
Although medical directors like him never see patients in person, they can overrule the doctors who do when they recommend medicines, tests, treatments, or procedures.
ProPublica reported that on average, a single medical director reviews 10,000+ patient claims for coverage a year. In a few cases, doctors astonishingly ruled on more than 10,000 claims in a single month. That breaks down to a single person ruling on more than 333 cases a day – and that assumes the doctor actually worked 30 days straight, which is unlikely.