By Ronald M. Davis, MD

This column was originally published in AMA eVoice on Feb. 14, 2008. Dr. Davis is president of the American Medical Association.

California's medical students received some good news last month when the state's Supreme Court declined to review an appeal filed by the University of California in a closely watched legal battle involving student tuition hikes.

The court's decision in Kashmiri v. UC Regents came Jan. 23, about two months after a lower court ruled this past November that the university had broken implied contracts with its students after raising professional degree program fees. In light of the decision, the university must issue an estimated $40 million in refunds and interest to those affected, most of which will go to those enrolled in the school's professional graduate degree programs before 2003. The case began that year when students from the university's professional schools filed a lawsuit for breach of contract based on the university repeatedly raising its tuition and fees despite having promised not to do so.

The outcome might not have been possible without the efforts of the Litigation Center of the AMA and State Medical Societies, which joined the California Medical Association in filing an amicus curiae, or "friend-of-the-court," brief last May in support of the students. The brief pointed out that increases in tuition worsen medical students' already steep debt burden and can exacerbate physician shortages in medically underserved areas and some medical specialties, which can disproportionately affect minority populations.

This verdict is the latest in a long line of victories for the Litigation Center, a powerful advocate for physicians and medical students, and a shining example of collaboration within medicine. It's like having the nation's physicians right there with you in the courtroom.

Established as a coalition in 1995 by the AMA and the state medical societies, the Litigation Center provides physicians with expertise, usually in the form of an amicus curiae brief, and financial assistance. All 50 state medical societies and the Medical Society of the District of Columbia are members of the Litigation Center.

Since its inception, the Litigation Center has lent the capabilities of its experienced health care attorneys to more than 150 cases, many of which have addressed important specialty-specific issues and have involved the relevant specialty societies. This docket of cases ranges across the entire medical-legal landscape, including medical staff privileges, scope-of-practice matters, public health topics, and meritless medical liability lawsuits—a particular area in which the Litigation Center has made an impact in recent months.

Late last year, Lawrence E. Stewart, MD, a Mississippi otolaryngologist, recouped about $4,500 after a circuit court sanctioned an attorney and his firm for wrongfully suing Dr. Stewart and refusing to drop the claim even after discovering the mistake. In a similar case, Cleveland orthopedic surgeon Michael A. Banks, MD, recently won back the $4,500 in attorney's fees (PDF, 145KB) he spent defending a lawsuit filed against him despite the patient's statement to her legal counsel that Dr. Banks was not the doctor who had mistreated her. In both cases, the Litigation Center and the physicians' respective state medical societies contributed toward their legal fees.

The Litigation Center selects cases depending on their importance to the medical profession and how likely they are to be precedent-setting, and involvement often comes at the request of a state medical society. At any time, the Litigation Center has about 25 active cases. Forums range from administrative proceedings to cases before the U.S. Supreme Court.

Several cases in which the Litigation Center has been involved have set important legal precedents. For example, in Lawnwood Medical Center v. Lawnwood Medical Center Medical Staff, the Litigation Center helped the medical staff of Lawnwood Regional Medical Center in Fort Pierce, Fla., regain privileging control. The suit focused on the constitutionality of a state law, enacted at the hospital's urging, that gave the hospital the authority to alter the medical staff's bylaws. A Florida circuit court found the law unconstitutional, a significant victory because the hospital's legislative tactics could have been replicated by other hospitals unhappy with their medical staff bylaws. The state Supreme Court is now considering the matter.

In another case, Moran v. Rush Prudential HMO, Inc., the Litigation Center filed two amicus briefs in support of a patient whose health plan had refused to pay for microneurolysis surgery, even though an independent reviewer had found the surgery to be medically necessary. The case, ultimately decided by the U.S. Supreme Court, hinged on whether the federal Employee Retirement Income Security Act (ERISA) preempted a provision of Illinois law that required independent review. The Supreme Court held in favor of the patient.

The Litigation Center also has made a difference on the public health front, signing onto amicus briefs in many lawsuits against tobacco companies. Several have supported state or local smoke-free air laws. The Litigation Center was involved in the U.S. government's landmark lawsuit against the major tobacco companies (PDF, 5.6MB), which found that those firms violated civil racketeering laws and defrauded the American people by lying for decades about the health risks of smoking and their marketing to children.

Last year, the Litigation Center filed an amicus brief in a food labeling case in New York in which a district court declared invalid a New York City Board of Health regulation requiring certain restaurants to provide nutritional information about their food. The board of health has issued a revised regulation to address the court's concerns, and the new regulation has again been challenged in court. The Litigation Center has joined the Medical Society of the State of New York and several public health organizations in signing onto an amicus brief defending the revised regulation.

Many others—maybe even you—are affected every day by legal issues; be assured that the Litigation Center is there to advance the AMA's agenda and to support the medical community. If you or a colleague need help with a legal issue, call the Litigation Center at (312) 464-4110 or send an e-mail explaining your circumstances. Or ask your state medical society to refer the case to the Litigation Center. Together, we can protect the rights of physicians and medical students, and help shape the future of medicine in the nation's courtrooms.

Please send comments, questions, and replies to amaprez@ama-assn.org.

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