In Brief: Physician Wins Judgment Against Anthem Blue Cross; CDPH Fines Nursing Home

Physician Wins $3.8 Million Judgment Against Anthem Blue Cross

A Los Angeles family practice physician has won a $3.8 million jury verdict against Anthem Blue Cross of California for his claims the insurer intentionally barred him from their provider network.

Jeffrey Nordella, M.D., the director of Porter Ranch Quality Care, a San Fernando Valley family practice, had claimed the insurer has systematically excluded him from their provider network after he had complained the insurer prioritized profits over patient care. The Los Angeles County Superior Court Jury concluded that Anthem had acted with both fraud and malice.

Nordella had a long history of challenging denied claims from Anthem when he was in their provider network more than a decade ago. He was told when reapplying to join the network for its preferred provider network that he wasn't board certified in family medicine and that it had enough primary care physicians in the area.

"This verdict sends a message to doctors that they have a voice. They can stand up and fight back against insurers. This is a huge win, not only for my client, but for all physicians," said Theresa Barta, Nordella's attorney.

Anthem could be held liable for an even larger amount, as the jury reconvenes later this week to discuss potential punitive damages for its actions. The insurer said it is considering an appeal.

CDPH Fines Nursing Home $100,000

The California Department of Public Health has fined a San Diego-area nursing home $100,000 after a patient with a history of dementia choked to death on his breakfast.

According to a report on the CDPH's website, the Villa Rancho Bernardo Care Center had neglected to properly cut the pancakes and sausages on Oct. 31 of last year for the 61-year-old dementia patient, who was listed as a “compulsive food seeker” and tended to bolt his meals. In this instance, he stuffed two uncut sausage patties and two pancakes into his mouth.

A licensed vocational nurse did not check the state of the food prior to it being given to the patient, the report said.

The CDPH levied an AA citation against Villa Rancho, the most severe it can issue.

UCSF May Have Found Less Toxic Brain Cancer Treatment

Researchers at UC San Francisco say they may have discovered a therapy to combat brain cancer that is significantly less toxic than the traditional means for fighting the disease.

A study of 44 patients who received a regimen of chemotherapy and immune therapy for a rare form of brain cancer called CNS lymphoma fared as well or even better than those who received the traditional therapy – a combination of chemical and radiation doses. In many cases, the radiation kills brain cells and can often contribute to a patient's death.

With the new treatment, the regimen is crafted around the presence of the BL6 gene in the tumors.

According to the phase two clinical trial, a majority of those in the clinical study remain alive five years after their original diagnosis.

The study's findings were published in the most recent edition of the Journal of Clinical Oncology.