Archive for the ‘Dr. Michael Katz’ Category

Can You Secretly Record the Medical-Legal Exam?

SecretSurveillanceVideoOver the summer I did a series of pieces on Dr. Michael Katz, who got busted by a judge for lying under oath about the length of the medical-legal exam that he did on the defendant’s behalf. He was claiming it was 10-20 minutes or so, yet a secretly recorded video had him at just one minute and 56 seconds. The judge wasn’t pleased.

A mistrial was declared and the good doctor was referred to the District Attorney for possible perjury prosecution, to the Administrative Judge for possible civil contempt and to the Department of Health – Bureau of Professional Medical Conduct to evaluate his fitness to practice medicine.

I covered a lot of angles in that series, even doing original research on the length of exams by other “frequent flyer” experts that insurance companies rely upon, and finding an average length of under five minutes for those I looked at.

But one piece was missing from my series: Is it permissible for plaintiffs’ representatives that accompany them to these exams to surreptitiously videotape the doctor doing the exam, and if this is done, does that video need to be exchanged? The reason it was missing is that there really isn’t much in the way of law in this area.

To be sure, Justice Duane Hart‘s initial reaction in the Katz case was that this was improper conduct by the plaintiff, and initially sanctioned him. That sanction was withdrawn, but in the process he had also declared a mistrial on a case that had been going for a month. The problem that Justice Hart had to wrestle with is that there is no statute governing this and little case law.

This week on that subject, in the New York Law Journal, comes an article by Ben Rubinowitz and Evan Torgan (Turning the Table: Cross-Examining IME Doctor Using Video of Exam, $ub). They are, by all measures, well respected attorneys here in New York, and these guys frequently lecture on various aspects of personal injury practice.

In the absence of either statute or case law to analyze whether it’s acceptable to video, they turn to ethics opinions. But:

[T] he ethical opinions regarding secret video-recording specifically fail to provide clear guideposts for attorneys. For example, the American Bar Association, in opinion 01-422, found that, in general, undisclosed taping by an attorney or his agent was not in and of itself prohibited. In accordance with that opinion, The New York City Bar modified its previously held position that undisclosed videotaping was unethical, holding that such conduct was permissible, but only where the lawyer “has a reasonable basis for believing that disclosure of the taping would significantly impair pursuit of a generally accepted societal good.”

What constitutes “a reasonable basis for believing that disclosure of the taping would significantly impair pursuit of a generally accepted societal good”? Good question, glad you asked. And no, I don’t have the answer because such answer does not (yet) exist. Do I think it is a generally accepted societal good to catch a doctor doing a 2-minute exam that he claims was a 15-minute exam? Yep, I sure do. The scoundrels should be purged from our midst if we would like our system of justice to have more integrity.

It’s unclear to me why recording such exams should be a problem. Defendants, after all, are free to do secret surveillance of plaintiffs. Why shouldn’t a plaintiff be able to do likewise to the defense medical examiner, especially when we have excellent reasons to believe there is widespread corruption going on? The doctor isn’t even a party to the action.

Back to Rubinowitz and Torgan:

As it relates to personal injury actions, defense attorneys have become well versed in the use of videos to discredit a plaintiff’s claim of injury. While the law regarding the surreptitious taping of a plaintiff in a personal injury action has developed over many decades the issue of the propriety of the taping in the first instance and its disclosure seems to have been answered: There is no prohibition against such taping and there are now definitive time periods in which disclosure of the video must be revealed.

When it comes to the videotaping of the IME, however, the law is not so clear. In New York not only is there no statute directly on point but there is a paucity of case law supporting or prohibiting such conduct. The question that will likely be addressed in the near future is whether the plaintiffs attorney or his agent should be permitted to videotape the independent medical examination, and if so, when disclosure should be made. Many see no difference between the defendant’s right to surreptitiously videotape the plaintiff and the plaintiff’s right to surreptitiously videotape the IME. Both the plaintiff and the defendant are seeking to use the video for a similar purpose: to discredit the credibility of an individual through the use of extrinsic proof.

The sooner this gets resolved by the appellate divisions, the better, perhaps with a bit of help from the various ethics committees. But from were I sit, there is simply no sound reason to object to the practice. Every other formal part of litigation where evidence may be presented to a jury is recorded somehow, without exception. That a doctor would be able to claim something happened at a medical-legal exam — which is very much a formal procedure — when the plaintiff says no such thing happened, is very easily remedied.

Why would anyone be upset about making the process more honest? Why should there even be ambiguity over how long the exam took or whether certain tests were done?  As I noted over the summer when discussing next steps for this problem, technology is now completely unobtrusive. And with Google Glass coming along, the filming couldn’t be easier.

Quickie Medical Exams: What Next?

FraudSo? Now what?

I started this series with the story of one doctor, Michael Katz, getting busted on the witness stand for lying about a defense medical exam that lasted less than two minutes. I followed up regarding the judge’s referrals for punishment, and then did an analysis of other exams Dr.Katz had done, timed by others, that averaged less than five minutes.

And having used him as an example, I then went on to present evidence that these premature evaluations are not an isolated problem. The average exam times for three other “frequent flyer” insurance doctors, from the data I found, all averaged under five minutes.

I think it’s fair to ask the question, how much insurance fraud is going on by the insurance companies? The more denials insurance companies can conjure, the more money they make. But remember, peoples’ economic lives may well be at stake for the Workers Compensation, No-Fault and personal injury cases that these exams are done for.

What next? I SAID, “WHAT NEXT!”

Yeah, I’m yelling, and why the hell shouldn’t I? There are thousands of exams being done each year, just by the four doctors that I briefly investigated. The scope of financial losses to the citizenry (and gains for the insurance companies) may be well up in the tens of millions or hundreds of millions a year when you extrapolate out across all the exams. Just in New York.

I’m just one guy banging away on a keyboard. I don’t have the resources for a proper investigation to tally the damage. I don’t have subpoena power. But others do. It isn’t enough for me to yell about problems, I should suggest solutions:

Like the District Attorneys, such as Queens District Attorney Richard A. Brown who already has the Michael Katz perjury file heading toward his office for potential prosecution. But why stop at perjury when the real issue may be insurance fraud?

And this holds true for Attorney General Eric Schneiderman as well. This matter isn’t, after all, limited to any one particular county.

And then there is U.S. Attorney’s Office, both Preet Bharara in the Southern District and Loretta A. Lynch in the Eastern District. Wire and mail fraud are often the basis for federal jurisdiction, and let’s face it, if there are problems in New York with these quickie exams there are problems elsewhere.

Do I have faith that these prosecutors will undertake a wide-ranging insurance fraud investigation simply because there is evidence of it, there are vast sums of money at stake, and that many thousands of already-injured consumers may be victimized a second time?  I’m allowed to wish, aren’t I?

On a strictly court-wide level, one of the issues that came up in the trial with Michael Katz was the surreptitious video that captured him doing the one minute, 56-second exam. The judge thought it might not be proper to do so, and if done, that the video should have been exchanged. Plaintiff’s counsel thought otherwise. This is not the type of thing in which you will find a lot of direct-on-point appellate law.

But we shouldn’t even need appellate courts, since the answer I think should be clear, despite Justice Hart’s declaration of a mistrial in the Michael Katz matter.

First off, defendants are already free to video plaintiffs at their depositions or to hire investigators to video plaintiffs secretly. Everything we do in litigation is recorded somehow, because everything has the potential to be contentious.

Why would taking video of a doctor doing a medical-legal exam not be permitted? Is there any colorable reason to object, other than the fact that an insurance doctor won’t be able to say he did a 30 minute exam when it actually lasted four minutes? And that he won’t be able to claim certain tests were done if they weren’t done? Are we afraid of taking away the opportunity to commit a a fraud on the courts?

And why wouldn’t the video be protected as attorney work-product, the same as the notes that might be taken by a lawyer attending the exam with a client? Do plaintiffs get copies during the discovery process of the raw notes that the doctors take? Do we get the letters from the insurance companies and their lawyers to their doctors? No, we don’t, not in New York. Unless a doctor inadvertently leaves the letter in his file and gets caught with it later.

According to Chief Justice Jonathon Lippman, these exams are part of the adversarial process. Can you think of any other aspect of the process where one side or the other doesn’t have the right to record it? As CJ Lippman wrote in Bazakos v. Lewis in dissent:

It is beyond cavil that a statutory medical examination is an adversarial process. The examinee’s attendance is compelled by rule of law (see 22 NYCRR 202.17), and his or her engagement and interaction with the examining physician is nonconsensual. Indeed, because of the inherently adversarial nature of these types of examinations, this Court long ago recognized the examinee’s right to be examined in the presence of his or her attorney

Perhaps, in days gone by, bringing in a videographer, and setting up a camera with tripod would have seemed an intrusion that got in the way, and people figured having a representative there was enough. But as we can plainly see, these quickie exams appear to be rampant and the consequences can be devastating.

Technology advancements cannot be understated. Anyone can use an iPhone and be completely discreet. And with Google Glass now coming fast, video recording would be completely unobtrusive as the camera would be worn like eye glasses. There’s no logical reason to say no to recording.

One thing for CJ Lippman to consider, if someone was kind enough to forward this little posting to him, is amending 22 NYCRR 202.17 to make clear that a party is permitted to audio or video record the exam. Is there any benefit to leaving it ambiguous?

And while we wait for the modification, the lower courts can make it clear in Preliminary Conference form orders that this right exists. Again, there is no benefit to ambiguity.

What do we gain by having videos? Plenty. Sure, it’s still possible for frequent flyer doctors to fudge their findings, it’s just more difficult when a range of motion, for instance, is captured on camera. And it sure looks bad for a doctor if a report details no limitations on a range of motion but the video shows the range of motion was even tested.

There are these benefits:

  1. Exams will generally be more thorough, and if not, the jury will know it clearly without having to depend on the word of a paralegal against the doctor’s word that the exam was a quickie;
  2. Longer exams will likely lead to them being more consistent with the findings of actual, treating physicians;
  3. If defense medical exams are closer to reality, then the differences between the parties will be narrowed, and narrowed differences lead to fewer motions and quicker resolutions of cases;
  4. Quicker resolutions of cases leads to fewer burdens on the judiciary, which can then focus its limited resources on cases with bona fide differences instead of contrived differences.

In essence, the only ones who lose out here are those that seek to commit insurance fraud.

I have spent many hours on this series. Now it is up to you, dear reader, to do something about it.

If you’re a prosecutor, then have the courage to investigate as the scale may be stunning in its expanse.

If you’re a journalist, take the time to further uncover the depths of the fraud.

If you’re a lawyer, take the time to educate as many as you can, via op-ed pieces, websites, newsletters or any other medium you can use, and make it clear in preliminary conference orders that your client has the right to this.

If you’re a judge, you can remove the ambiguity over whether these medical-legal exams can be recorded, and remove the ambiguity over what occurs during those exams.

If you’re a legislator, remember this when insurance companies scream they are the victims of insurance fraud, and you can wonder if they are actually the cause.

I’m done banging this keyboard. I’ve given you more than ample evidence to raise questions and investigate further.

The issue is yours. What will you do with it?

I rest. For now. And reserve the right to reopen my case.

Updated: I didn’t expect to reopen my case so soon, but:

Part 6: To Tell the Truth: Which Doctor’s Signature is the Real One?

Part 7: Doctor Testifies That Six Different Signatures Are All His (8/5/13)

Premature Evaluations – The Evidence on Quickie Medical-Legal Exams

cowboy-backlit-2-727485-788981When I started this series, dear reader, I had no idea it would be so easy to find multiple doctors doing 1,000- 2,000 medical legal exams each year, and that I would be able to demonstrate that their average exam times were likely under five minutes each. But if you read today, you will see that this is the result from my investigation. Welcome to Part 4.

I didn’t write this multi-part series just to pick on orthopedist Dr. Michael J. Katz because he was busted for lying on the witness stand about his secretly recorded one minuted 56 second evaluation. That type of story is a one-day affair.

Nor am I doing it because Justice Duane Hart shipped the transcripts off to the DA, the Chief Adminsitrative Judge and the Office of Professional Medical Conduct. Again, that would be another one-off kind of story.

Nor am I doing it because my analysis found that his usual exam is likely under five minutes, which is also contrary to what he testified.

No, it really isn’t about that. Dr. Katz, you see, is a symptom of a larger problem. So is Dr. Israel, who was placed on probation for his conduct doing defense medical exams.

If it was just about them, you might think these two were mere aberrations. But I’m here to present evidence that these premature evaluations are part of what I think is a systemic disease. It isn’t something new, though I have new material. It was evident four years ago when the New York Times did a story.

The Times covered the problem of bogus medical-legal exams back in 2009 as it pertained to Workers Compensation claims. The article was scary in how awful and slip-shod they were. And a secret videotape came into play there also.

The substance of the article was that their review of case files and medical records and interviews with participants indicated that the exam reports were routinely tilted to benefit insurers by minimizing or dismissing injuries.

The doctor nabbed on video by the Times was Hershel Samuels, caught dictating injuries as the exam was in progress, but the report came back without injuries. This quote was priceless:

“If you did a truly pure report,” he said later in an interview, “you’d be out on your ears and the insurers wouldn’t pay for it. You have to give them what they want, or you’re in Florida. That’s the game, baby.”

Dr. Samuels, who was 79 at the time, surrendered his license four months later.

To injured people the Workers’ Comp payments could mean putting food on the table and paying the rent; to others it is a “game” on getting $100-200 for each medical exam in the hope of a big volume practice, while turning a blind eye to the physicians’ oath to “Do no harm.”

If you want to understand the scale of all this, and why I’ve been banging away on my keyboard about these exams starting with Dr. Katz, consider this: In the Workers’ Compensation arena alone there are more than 100,000 exams each year.

One of the doctors in that New York Times piece was Dr. Edward Toriello, an orthopedist. The Times has this to say about him:

Like many who perform the exams, he views the compensation system as bloated with charlatans. Dr. Toriello, who does about 30 such exams a week, estimates that 80 to 85 percent of the time he finds no disability or need for medical treatment in workers whose doctors have found otherwise. He says the disparity is explained by the “comp mentality.”

Comp mentality by the injured? Or a desire to minimize injuries so that the insurance companies will give him more business? Should someone investigate who the charlatans are?

I decided to do some follow up and see how long his exams actually were, the same way I did for Dr. Katz last week.

You’ll remember, I hope, that the data I used previously to discover how long Dr. Katz spent on his medical “exams” – yeah, I think scare quotes is appropriate now for that word — was gathered from two companies that send representatives to the evaluations with the clients, IME Watchdog and IME Advocates. They both track how long the exams take (among other things), and I found from their data that Dr. Katz’s exams were just four to five minutes long on average.

Dr.  Toriello has testified he does 30-40 exams each week (1,500-2,000 per year). The two companies furnished me with data from 57 reports they had on Dr. Toriello.  And the average time for one of Dr. Toriello’s exams, the basis of which might have profound impact on an injured person’s life for many years to come, or even for the rest of their lives is ….  No, it isn’t 45 minutes. Or 20 minutes. Or 10 minutes.

It’s four minutes and 49 seconds. The distribution looks like this:

1-minute exams – 2
2-minute exams — 11
3-minute exams — 9
4-minute exams — 4
5-minute exams — 12
6-minute exams — 7
7-minute exams – 5
8-minute exams –- 1
9-minute exams — 3
11- minute exam – 2
14-minute exam – 1

Dr. Lisa Nason is another frequent orthopedic examiner. And Dr. Nason once testified that, at the medical evaluation office she goes to in Brooklyn for just this purpose, they try to see claimants every 15 minutes. Her average time doing an exam in the 37 reports that I have? 4:22 minutes. Her distribution looked like this:

1-minute exams — 1
2-minute exams — 5
3-minute exams — 10
4-minute exams — 5
5-minute exams — 8
6-minute exams — 2
7-minute exams — 2
8-minute exams — 3
11-minute exam –- 1

But wait! I’ve been discussing time doing the exam, but the testimony that I found from her about seeing someone every 15 minutes includes taking a history. Wouldn’t it be fair to Dr. Nason to do an apples-to-apples comparison and include her intake time asking how the claimant felt? Maybe then it will come to 15 minutes?

Lucky for you, dear reader, the reports I have almost always indicate the time taking a history. But the total time, alas, even when you factor in history, still doesn’t make it to 15 minutes. Which is not so lucky for Dr. Nason. Her average intake took 4:08, and the distribution looks like this:

1 minute intake — 4
2 minute intake — 7
3 minute intake — 6
4 minute intake — 6
5 minute intake– 6
6 minute intake – 1
8 minute intake – 3
10-minute intake -1
11-minute intake – 2
[One of the 7-minute exams includes the intake, so the exam average should be a bit lower and the intake average a bit higher.]

So, in total, she is averaging 8:30 minutes total time per claimant, inclusive of talking, not the 15 minutes she discussed with a jury.

And then there is Dr. Jean-Robert Desrouleaux, a neurologist. I heard he was testifying in the Bronx yesterday before Judge Julia Rodriguez, so, with a draft of this piece already written, I decided to go watch. Some of his exams, he testified, are done in the same place and on the same day as Dr. Nason, sort of like a factory tag-team match for the insurance company.

He testified that these exams are only 1-2% of his practice. But then he testified he does 20-30 per week (1,000 – 1,500/yr.), taking a total of four to six hours each week. I’ll help you with the math: if he is doing medical-legal exams five hours per week and this is 2% of his practice he is working 250-hour weeks, which is mighty impressive considering the week has just 168 hours in it.

He also claimed to be paid about $125-$150 for each one. Imagine, in the short time available, trying to read medical records, x-rays, deposition transcripts, legal filings and whatever else the insurance company might send, do an intake, conduct an exam and write a report for that price. Something has to give for this business model and if you guessed accuracy and quality then you would be guessing the same as me.

Dr. Desrouleaux was asked if any of his exams were under three minutes. He said he would be surprised if that was true. He was asked if any were under five minutes. He again said he would be surprised if that was true.

But I have 32 reports from Dr. Desrouleaux and he averages four minutes 15 seconds per exam, and seems to have a pretty heavy emphasis on the two to three minute variety. He even has some one-minute exams.

Can you imagine, if you were a claimaint, that your economic future could be decided by a one to three minute exam? His distribution looks like this:

1 minute exam — 3
2 minute exam — 8
3 minute exam — 8
4 minute exam — 5
5 minute exam — 1
6 minute exam — 1
7 minute exam — 2
8 minute exam — 1
10 minute exam –1
15 minute exam –2

Don’t click away, I got more stuff in this evidentiary round-up!

When the New York Times did its investigation, it found that Dr. Samuels was being hired by “IME” brokers — there’s those scare quotes again — who would actually transcribe his reports. The brokers could, in essence, do whatever they wanted with those reports changing findings if they wanted to, and the doctor that had done a gazillion exams would likely never know the report had been changed.

When the doctors take the witness stand they often call these companies “expert panels,” as if it is some badge of honor to take part.

I wrote about one of those companies back in 2008 (How to Fool a Jury (Is It Insurance Fraud?)), called Integrated Risk Services. It seems that one of their doctors forgot to remove the letter they sent to him about how to write a report — the letter that had these delightful instructions about how to write a skewed report:

  • Point out whatever findings or claims are not related [to the lawsuit]. Otherwise be silent on causal relationship.
  • If prognosis appears good, then state that – otherwise be silent
  • If you can state that plaintiff can participate in all normal activities, do so. If not, be silent

Nothing like a completely objective exam. huh?

JonathonLippmanThere are some in the judiciary that understand the problem with these exams, though I fear they are in the minority. Two of them, however, happen to be Chief Judge Jonathon Lippman and Appellate Division Justice Justice Douglas McKeon, who I wrote about back in 2009: Is the “Independent” Medical Exam Dead? after Rowe v. Wahnow was decided in the First Department.

In Rowe, plaintiff’s auto case was tossed out based on the “IME” reports of the defendant’s doctors.  But in dissent comes Justice  McKeon, ripping into the concept that such “IME” reports are actually independent. And he does so by citing Chief Judge Lippman:

…the “independent” prong of the term, has long been winked at by the bench and bar. Few consider the physical examination conducted for purposes of litigation as independent; indeed, one court has described it as part of the “adversarial process” (Bazakos v Lewis, rev’d on other grounds) with Chief Judge Lippman forthrightly observing that “[t]hese exams, far from being independent in any ordinary sense of the word, are paid for and frequently controlled in their scope and conduct by legal adversaries of the examinee (id. at 6 [Lippman, Ch. J., dissenting).

Have things changed since 2009? Will the story of what happened to Dr. Katz make its way to the appellate judges? Will the evidence of quickie medical exams finally coming screaming home to the trial courts? Will more of these exams be taped, surreptitiously or not?

Stay tuned for Part 5….

Update –Part 5: Quickie Medical Exams: What Next? (7/23/13)

Part 6: To Tell the Truth: Which Doctor’s Signature is the Real One? (7/30/13)

Part 7: Doctor Testifies That Six Different Signatures Are All His (8/5/13)

Programming Note on Quickie Medical-Legal Exam Series

Pinocchio-007Thus far I’ve done three pieces this week on quickie defense medical exams, starting with Dr. Michael J. Katz getting busted for lying, the sanctions he may face and an investigative analysis of some of his other exams.

I intend to continue next week with more, including another investigative piece on how much time  some other doctors popular with insurance companies spend with the claimants. Was Michael Katz (and Dr. Robert Israel before him) an aberration?

The story, by the way, has been ignored by the main stream press. Despite that, there have been over 15,000 page views of those blog posts. For a small, niche blog like mine, that’s a lot.

While some have come in from Above the Law (calling the story a “blockbuster”) and a couple of other blogs such as the Village Voice (which scored an interview with Dr. Katz), the vast majority have come in directly because they are circulating in the local legal community via email. Reddit, Facebook and Twitter have accounted for more as part of the word-of-mouth spread.

While the press might not yet understand what  is happening, the local legal community knows that these doctors have seen thousands of claimants, and all those cases will be affected, with tens of millions of dollars or more on the line.

Also, a new website seems to have been spawned dedicated to the quickie medical exam: Bad IME

Stay tuned for Part 4.

(And a hat tip to Professional Liability Matters for the Pincchio graphic.)

So, Just How Short Were Dr. Katz’s Medical-Legal Exams? (updated)

Defense Medical ExamsIn part one of this series on defense medical exams I wrote about Dr. Michael J. Katz getting busted for lying on the witness stand about the one minute and 56 second orthopedic exam he did in Bermejo v Amsterdam.

In part two I followed up with Judge Duane Hart’s subsequent referral this week of Dr. Katz for civil contempt, criminal perjury and professional misconduct proceedings.

Now in part three let’s turn to investigating other exams that Dr. Katz has done, to see if his conduct in Bermejo was an aberration or systemic. I’ll try to quantify his medical exams.

But how do you quantify quality? Well, you can start by looking at its most basic element: How much time did the doctor spend actually testing/measuring/probing the person? Because if the time is too short, it’s simply impossible to do many tests.

That is a basic premise that even Dr. Katz was forced to acknowledge, crude as it is. After testifying that his first exam of Manuel Bermejo took 45 minutes (as per his notes) and his second exam of Mr. Bermejo likely took 10-20 minutes (based on his custom and practice), and plaintiff’s counsel knowing for certain that didn’t happen because he secretly videotaped the event, Dr. Katz was asked if his exam “could have taken two to three minutes.” Dr. Katz testified, “I don’t think that’s really potentially possible.”

No matter how good a doctor may be, it still takes time to run a person through the various tests needed for an orthopedic evaluation. Nobody disputes the premise.

Now all you folks reading this will agree that anecdotal evidence is a lousy way to prove a point. What if, for example, Dr. Katz’s one minute 56 second exam was an aberration, for whatever reason? How would that reflect on all the other exams he has done? Does that one incident reflect a pattern of behavior? Does it reflect on a potential perjury prosecution?

Since anecdotes are of only limited use, I looked for a database to analyze Dr. Katz’s exams. And I found one, which I’ll discuss momentarily, with dozens of his exams and with the time of each one recorded.

Before discussing my analysis of those reports, however, I need to discuss the nomenclature that gets used. Ever since I was sworn in 26 years ago, the term “Independent Medical Exams” has been used by lawyers and judges to describe the system by which insurance companies hire doctors to examine people that make claims in lawsuits, or for no-fault benefits or workers’ compensation benefits.

That nomenclature, Independent Medical Exams, has long been the subject of derision among plaintiff’s attorneys due to the vested interests the insurance companies have in limiting payments, and the “frequent flyer” doctors wanting some of that nice, steady insurance company business.

Many of us that share my side of the v. will stop others trying to discuss the “IME,” insisting that they be called for what they are: Defense Medical Exams, or DMEs. The term medical-legal exam can also be used as a neutral phrase, but the one thing you can’t call them is independent. Some in the judiciary, including Chief Judge Jonathon Lippman, agree.

I’ll support my point that Dr. Katz’s quickie DME exam of Mr. Bermejo was  not a one-off kind of event, I hope, by pointing to the only databank I know of on the subject, collected from IME Watchdog. This young company sends a “Watchdog” with plaintiffs on these exams, taking notes on what happens. It isn’t generally advisable that the trial lawyers themselves attend, for if they want to challenge the doctor regarding what happened, they might become a witness, and the trial lawyer can’t be a witness.

As a young lawyer I went on many of these myself, since I wasn’t going to be trying the case. But others that also accompany the clients are paralegals, nurses and folks with a general familiarity with how the exams are done, and the fortitude to say “no” to the doctors if they ask inappropriate questions.

An inappropriate question would be “how did the accident happen?”. That’s inappropriate because the doctors are there to report on the injuries, not to conduct an off-the-record deposition on liability that they will then memorialize in a report in their own words. The defense lawyers and doctors already have the depositions that discuss the event itself, so letting your client be cross-examined by the defense doctor, without a stenographer present, could be foolish.

So if a doctor claims he did x at the exam, and didn’t actually do x, there will be someone there to testify about it (other than the plaintiff who is simply trying to follow the doctor’s instructions and can’t be taking notes at the same time).

Since there was a sharp conflict over what happened at the first exam of Mr. Bermejo — the doctor claimed it was 45 minutes and the plaintiff’s paralegal, also in attendance, testified it was about 10 minutes, but only three or four of those minutes was part of the actual exam — plaintiff’s counsel decided to surreptitiously record the second physical exam. As noted in the initial post in this series, he’d been burned once and didn’t want it to happen again.

Now for the data I promised you, looking at other medical-legal exams:  As of July 9, 2013, IME Watchdog has attended 1,378 defense medical exams.

I’ve obtained their reports on many of the “frequent flyer” doctors, of whom Dr. Katz was one of the most frequent. The time he spent actually examining people is reflected on their reports. Dr. Katz’s custom and practice for the 36 exam reports that I viewed seem to be a very long way from the 10-20 minutes that he told Justice Hart for the second exam, and light years from the 45-minutes he claimed for his initial exam.

On the 36 IME Watchdog reports I viewed, I found Dr. Katz spent an average of 4:10 on each one:

2-minutes —  1 time
3-minutes —  5 times
4-minutes —  8 times
5-minutes –- 11 times
6-minutes  –-  2 times
7-minutes  –  3 times
8-minutes  –  1 time
9-minutes –- 2 times
10-minutes -– 1 time
12-minutes — 1 time
20-minutes – 1 time

Since Dr. Katz testified at trial that he didn’t remember the second exam that got him into trouble — though Justice Hart was incredulous as to the claim of 45-minutes on the first exam (“What universe does he live in? If I ever see a doctor do a 45-minute IME it will be the first time.”) –  Justice Hart asked him about his custom and practice. That, Dr. Katz testified, would be 10-20 minutes.

So if you remove the two outliers (a 2-minute and a 20-minute exam) in trying to find a “customary” evaluation then you get 3:45. I don’t think too many folks would dispute that either of these two numbers, 3:45 and 4:10, is a very long way from 10-20 minutes.

There are more exams reports, but these 36 were taken at random and I think after seeing that many it likely represents a pretty good sampling.

Update: After publishing this, I heard from IME Advocates, which also sends someone to accompany litigants to these medical-legal exams. They have records on 20 more DMEs from Dr. Katz. Those stats look like this, for the time actually spent on the exam itself, with an average time of 4:45, inclusive of one aberrational one:

3 minute exams – 5
4 minute exams – 7
5 minute exams – 4
6 minute exams – 2
7 minute exams – 1
13 minute exam – 1

It’s also worth noting another little nugget of testimony that Dr. Katz gave, at a trial before Brooklyn Supreme Justice Francois Rivera that I wrote about quickly at the the bottom of my first post on the subject. This was the case where, after making an inquiry, Justice Rivera said that he was “satisfied that this witness is less than forthcoming” and was concerned with Dr. Katz “materially misleading the court.”

In the case before Justice Rivera, Dr. Katz was also challenged on the length of his exam, with the plaintiff’s testimony that it took two to five minutes. Dr. Katz was asked if he had ever done them in five minutes. He said he wasn’t certain, but that “it would be out of the ordinary.”  In fact, a five minute medical-legal evaluation that may be used to turn injured people out of court and deprive them of insurance recoveries that they are entitled to, was exceptionally ordinary for Dr. Katz.

My personal opinion is that when you think about insurance fraud, this is a mighty big thing to consider. He once testified, after all to doing 750-1,000 medical-legal exams a year.

Do I have more to come? Will there be a part 4 to this series? What do you think?

Updates:

Part 4: Premature Evaluations — the Evidence on Quickie Medical-Legal Exams (7/16/13)

Part 5: Quickie Medical Exams: What Next? (7/23/13)

Part 6: To Tell the Truth: Which Doctor’s Signature is the Real One? (7/30/13)

Part 7: Doctor Testifies That Six Different Signatures Are All His (8/5/13)

Dr. Michael Katz’s License and Liberty Placed in Jeopardy Due to Lying Over Medical-Legal Exam

Medical-LegalReporting by: Samson Freundlich and Eric Turkewitz
[Post based on handwritten notes from inside the courtroom -- subject to correction when we obtain the transcript.-- Transcript now in; edits added in red]

The time had come for a local orthopedist to face the music yesterday afternoon after a New York judge found he had lied under oath in April. But he was nowhere to be seen in the courtroom.

Queens Supreme Court Justice Duane Hart showed no mercy in leveraging the few powers that he had at his disposal to see appropriate punishment administered to Dr. Michael J. Katz for lying about a medical-legal exam that he conducted. The exam in that multi-million dollar case took just one minute and 56 seconds, according to a surreptitiously made surveillance video, and Justice Hart concluded it would not have been possible for the doctor to make the findings that he did in that brief time.

As we discussed in our initiating post, Justice Hart believed he was without legal authority to directly sanction Dr. Katz for the wasted time and money of the two to three week trial, because Dr. Katz was not a party to the lawsuit. But that didn’t mean the court didn’t have other arrows in its quiver.

The court has ordered the trial transcripts be forwarded to the following for further inquiry, investigation and appropriate action:

  1. Referral to the Queens Administrative Judge so that Dr. Katz can be held in civil contempt of court for perjury;
  2. Referral to the Queens District Attorney for prosecution for perjury; and
  3. Referral to the Department of Health – Bureau of Professional Medical Conduct to evaluate his fitness to practice medicine. (This statement was made off the official record.)

Dr. Katz, it seems, blundered badly when he declined to leave the medical-legal consult business in which he was seeing upwards of 1,000 people a year. From this he once testified that he may have had revenues of a million dollars or more per year.  Had he bowed out of that business and returned his efforts to practicing medicine, instead of trying to assist insurance companies generate greater profits, Justice Hart might have been more lenient on him.

A new trial has been ordered for September 9, 2013. When plaintiff’s counsel requested the doctor’s tax records for the new trial yesterday, to challenge the doctor’s assertions on revenues from his medical-legal business (he testified that 40% of his practice was medical-legal), the judge shrugged off the application as collateral to the fraud that he saw.  Dr. Katz, apparently unremorseful for his conduct or naively unaware of the gravity of his predicament, was still doing these medical-legal exams even after he was caught perjuring himself on April 11th. The judge’s ire, as noted yesterday, was apparent through his on-the-record comments:

It is like a wound that is festering. Every time he does another IME. When is it going to stop? He is making 7 figures a year doing IME’s. Then he comes to my part and lies.

Justice Hart unsealed the court record July 1st, made the above referrals today, and Dr. Katz now sits in more legal hot water than he ever could have imagined just one week ago. There is still the prospect of Attorney General Eric Schneiderman investigating the cozy relationship between insurance companies and the doctors that so eagerly do their bidding. And litigation could easily follow in matters where judges and juries had previously relied upon Dr.Katz’s reports and testimony to get cases dismissed or to limit damages.

Defense counsel yesterday pleaded for permission to hire a new doctor for the September trial to examine the injured plaintiff. Justice Hart was steadfast and unwavering, however, as he shot that idea down, ruling that the defense was stuck with Dr. Katz for the new trial.

There is little doubt that insurance companies throughout New York are now scrambling to make similar motions for new doctors to examine a variety of litigants, both for Dr. Katz and Dr. Robert Israel, who was slapped with his own sanctions just last month.

With straight faces, the defense attempted to argue that Dr. Katz was now an adverse witness to their case due to an unsympathetic bench.  Justice Hart was unmoved in the argument, and ordered that Dr. Katz must appear if subpoenaed by any party to the trial. He went on to say that if Dr. Katz attempts to invoke his Fifth Amendment rights to refuse to answer questions, that he would consider holding him in contempt.

Defense attempts to preclude Drs. Katz and Israel from testifying in future trials seem doomed to fail. They are, after all, eyewitnesses to injuries.  If a convicted felon came upon a car accident shortly after it happened and saw injuries, would he be precluded from testifying simply because one side or the other didn’t like his testimony? If he saw the injuries a month or year later, would he magically be precluded? Are prisoners precluded from testifying? Making matters worse for those that hired these doctors over the years is that they are responsible for creating them as witnesses.

Justice Hart said that if Dr. Katz is subpoenaed and refuses to come to court, he will make sure that he is brought in and put on the stand. If he refuses to answer questions presented — and their appears to be no realistic way he could testify without further perjuring himself or admitting that his prior testimony was false — Justice Hart said he would consider a further contempt hearing and that there would be strong negative inferences in front of the jury.

The physician, said Justice Katz, “has no further right to claim the 5th Amendment” as he has already testifiedJuly 8 Transcript

Yeah, there is more to come in this story, and more regarding the broader implications for our very busted medical-legal exam system that allows insurance company doctors to question litigants without a stenographer or recording and write down whatever they want in their reports and present that to judges and juries.

Stay tuned….

Updates:

Part 3: So, Just How Short Were Dr. Katz’s Medical-Legal Exams? (Dozens of his other exams are investigated) 7/10/13)

Part 4: Premature Evaluations — the Evidence on Quickie Medical-Legal Exams (A look at other doctors and their exams) — 7/16/13

Part 5: Quickie Medical Exams: What Next? (7/23/13)

Part 6: To Tell the Truth: Which Doctor’s Signature is the Real One? (7/30/13)

Part 7: Doctor Testifies That Six Different Signatures Are All His (8/5/13)

Judge Rips Doc for “Huge Lie”; Perjury Prosecution Possible; Victims May Number in Thousands

Queens-SupremeCourt

Supreme Court, Queens County

Reporting by Samson Freundlich and Eric Turkewitz

Last week a state trial judge unsealed a record showing falsified testimony by a New York orthopedist who conducts up to 1,000 medical-legal exams each year.  Queens Supreme Court Justice Duane Hart unsealed the April 12, 2013 testimony of Dr. Michael J. Katz as he pondered a referral to the District Attorney for perjury over “a huge lie” concerning so-called “Independent Medical Exams.”

Dr. Katz, an orthopedist frequently hired by insurance companies to defend personal injury cases — who has testified that he may make over a million dollars a year just from his medical-legal practice — had testified in the recent case that he likely spent 10-20 minutes on his examination of the plaintiff. A surreptitiously made video, however, revealed that he spent a mere one minute and 56 seconds on the exam and could not have made all the findings he testified about within that short time.

The underlying labor law case concerns a severe ankle fracture that resulted in a fusion of the joint as well as a shoulder injury that required surgery, suffered when Manuel Bermejo fell from a Bakers Scaffold. The court indicated that there was potential for a verdict of “several million dollars” based on the injuries.

The transcripts in Bermejo v Amsterdam that we obtained over the July 4th break detail Justice Hart’s concerns not merely with the fact that Dr. Katz was dishonest regarding the estimated length of the actual exam, but that the substance of what he testified to could not be true. Justice Hart said, “He testified as to findings that he obviously could not have had in a minute and 56 seconds.”

These medical exams are often critical to the defense of  personal injury cases, and are also used by insurance companies to “evaluate” whether they should continue to pay No-Fault or Workers Compensation benefits. The reason the exams are often problematic is that the insurance carriers have a vested interest in limiting payments and only retaining doctors that give them favorable reports, and there is no stenographer to record what transpires. Quickie exams that serve only to deny benefits to the injured are a constant problem.

But this case had actual evidence in the form of a secretly made video recording. It shows Dr. Katz examining Mr. Bermejo as plaintiff’s trial counsel, who recorded it,  and a paralegal-translator looked on. This was the second exam that Dr. Katz had done of Mr. Bermjo, as he had undergone shoulder surgery after the first examination.

Plaintiff’s counsel was moved to record this second exam, according to court transcripts, because he believed that Dr. Katz had been dishonest in his report of what transpired at the first one. The initial exam, Dr. Katz claimed, lated 45 minutes and he also claimed that plaintiff’s counsel impeded it. (The paralegal that was present took the stand and sharply disputed both points.) When the time came for the second exam, plaintiff’s counsel secretly recorded it to protect himself from any possible complaints or accusations from the doctor.

This secret recording was not exchanged during the litigation, as plaintiff’s counsel said there was no requirement to do so since Dr. Katz was a non-party, and the only potential use of the video was if Dr. Katz perjured himself. When Dr. Katz offered testimony at trial that was completely inconsistent with the actual events, the evidence was submitted to the court. As a result of this video substantively contradicting the trial testimony, and concerned about a breach of the discovery rules and orders by the failure to disclose, Justice Hart declared a mistrial after 2-3 weeks of trial.

In a remarkable hearing before Justice Hart after the false testimony had been given, Dr. Katz’s criminal defense attorney stated that the perjury was the fault of the court because the court had demanded the doctor tell the truth in answering the question about how long such exams usually take. Justice Hart characterized this as “the dumbest thing I ever heard” either inside the courtroom or out.

At a hearing July 1st to apportion responsibility for the cause of the mistrial, Justice Hart initially sanctioned the defense firms $10,000.00 each, noting that “It is the carriers and Dr. Katz that I would love to sanction, but I can’t do that” as sanctions are restricted by the court rules to parties and their attorneys. Unhappy with that restriction, Justice Hart said, “You can probably hear my teeth grinding.”

The court had also initially sanctioned plaintiff’s trial counsel $250 for not exchanging the video, which sanction was also withdrawn and plaintiff’s counsel absolved of fault for causing the mistrial. The judge derided Dr. Katz on his assertion that his first exam lasted 45 minutes, and said “it would have been reasonable” to want such a recording. Justice Hart, who has served  since 1981 as attorney, law secretary or judge, said regarding the alleged 45-minute claim by Dr. Katz, “What universe does he live in? If I ever see a doctor do a 45-minute IME it will be the first time.”

All the attorney sanctions were vacated later in the hearing.

Justice Hart, in finding that it was the doctor’s false testimony that caused the mistrial, stated that while he had seen abuse of the system before, “This is clearly the most blatant example of a doctor getting up there and just not telling the truth.” He also suggested that plaintiff’s counsel who had spent $40,000 on trying the case so far, should sue Dr. Katz for the expenses and legal fees caused by the mistrial.

Feeling handcuffed by the relatively few options available to him for a non-party witness that lies and causes a mistrial, and recognizing that there are others doing the same, Justice Hart asked the attorneys:

How do I stop carriers from putting people  like Dr. Katz on the stand and causing the state to spend thousands and thousands of dollars trying a case and putting a lying witness on the stand? How do people like me, people in this building, people that wear black robes send a message to them that they cannot condone perjury?

Despite all the admonitions thus far from Justice Hart the matter remains open as Dr. Michael Katz is still conducting medical-legal examinations and has refused to retire from these activities.  Justice Hart had offered him the option of bowing out of the business and he declined. Thereafter the court ordered a full transcript, intending to send the matter to the Administrative Judge for a civil contempt hearing and send the matter to the District Attorney with a recommendation that they explore a perjury prosecution.

Regarding the fact that Dr. Katz was still doing these medical-legal exams on July 1st when this hearing took place, and recognizing that he had been caught lying back on April 12th, Justice Hart said:

It is like a wound that is festering. Every time he does another IME. When is it going to stop? He is making 7 figures a year doing IME’s. Then he comes to my part and lies.

Judge Hart did not mince words when he said that, aside from the effect of any potential criminal issues, that Dr. Katz’s career was essentially finished when it comes to his substantial medical-legal practice: “Dr. Katz’ future doing IME’s because he lied in this one will probably be finished.”

“It is that the tape shows that he didn’t do the tests that he spent a considerable period of time talking about that he did. That is the perjury. Yes, didn’t do the tests. It is not just me saying it. It is not just the plaintiff saying it. The defendants are saying it too. Does your client really think if the insurance industry or some of the insurance companies that hired him before when they find out that he lied, do you really think they are going near him?”

The impending denouement of Dr. Michael Katz is all the more stunning since it comes fresh on the heels of his fellow New York orthopedist Dr. Robert Israel being sanctioned for his conduct in medical-legal exams. Dr. Israel had been doing up to 1,500 per year, but has now been barred from doing them for three years.

Together, Drs. Katz and Israel have no doubt sent New York’s insurance carriers frantically scrambling, as the two of them were responsible for thousands of insurance exams each year, the results of which are now all thrown into question. The scope and scale of insurance fraud being perpetrated — by the insurance companies themselves — could have resulted in hundreds of millions of dollars in payments being withheld. It remains unclear just how many New Yorkers have been fraudulently denied benefits based on quickie exams that were set up to deny benefits and minimize jury verdicts.

The scope of such an investigation of the insurance industry, it seems, could only be done by Attorney General Eric Schneiderman.

Last week’s hearing regarding Dr. Katz was adjourned until this afternoon (July 8th) at  2:00 pm. It is unclear whether Dr. Katz will voluntarily agree to halt his lucrative medical-examination business — though this now seems like a moot point now since the record regarding his false testimony has now been unsealed.

It’s worth adding that this is not the first time Dr. Katz was caught by a court with less than candid conduct that caused a mistrial. A year earlier while testifying in Brooklyn, Dr. Katz went outside the confines of his report to suddenly testify about a relationship between tinnitus and aspirin. Justice Francois Rivera, after making an inquiry, said that he was “satisfied that this witness is less than forthcoming” about his decision to suddenly stray from his report to a new subject, and was concerned with Dr. Katz “materially misleading the court.”

The legal fallout may result in any or all of the following:

  • Civil contempt of court;
  • Criminal perjury prosecution by the District Attorney;
  • Civil suits for causing this mistrial by any/all of the attorneys involved;
  • Civil suits based on fraud by past litigants saying they were also victimized by Dr. Katz;
  • Action against his license from the Department of Health-Bureau of Professional Medical Conduct;
  • Racketeering suits for conspiring with insurance companies to commit insurance fraud; and
  • Investigation by the Attorney General into the issue of insurance fraud perpetuated by the insurance industry.

These predictions regarding a wide-ranging insurance fraud scandal are backed up by Justice Hart, who repeatedly referenced the insurance carriers as being part of the problem:

I can blame the attorneys and the carrier who hired him to do an IME on this case because they should have known what this guy was doing. They should have known. And again the man is making literally millions of dollars doing IME’s. Now, he gets caught lying. There is no other way to put it. He lied. There is no other way to make it nice. He said the IME took between 10 to 20 minutes. It took a minute and 56 seconds.

The transcript of the proceedings is here: July 1 Transcript

From what we’re watching unfold, this may be the tip of the iceberg.  Stay tuned…

Part 2: Dr. Michael Katz’s License and Liberty Placed in Jeopardy Due to Lying Over Medical-Legal Exam  — 7/9/13

Part 3: So, Just How Short Were Dr. Katz’s Medical-Legal Exams? (Dozens of his other exams are investigated) —  7/10/13

Part 4: Premature Evaluations — the Evidence on Quickie Medical-Legal Exams – 7/16/13

Part 5: Quickie Medical Exams: What Next? (7/23/13)

Part 6: To Tell the Truth: Which Doctor’s Signature is the Real One? (7/30/13)

Part 7: Doctor Testifies That Six Different Signatures Are All His (8/5/13)