Roger

I. INTRODUCTION

A workers’ compensation system medical provider network terminated the contract of an orthopedic surgeon for two separate, albeit interrelated, reasons: First, he was unreachable by independent reviewing physicians hired by the network to evaluate four nonstandard treatments he was regularly prescribing for his workers’ compensation patients. Second, he was prescribing those nonstandard treatments on a wholesale basis, and not taking the time to justify their application to particular patients. As we show below, the medical provider network was well within its rights in terminating his contract. The case becomes more complicated, though, when one realizes that the medical provider network did not comply with the letter of the contract as regards the process of termination. The contract clearly provided for a graduated, three-step disciplinary process based on first, second, and third offenses: first a warning letter, second a set of counseling “sessions,” and only then, third, actual termination. And that didn’t happen. The network terminated the physician after one lengthy telephone discussion with one independent reviewing physician about one patient. Despite…