Becker's Spine Review

7 SPINE Orthopedic patient's death highlights potential dangers of prior authorization By Alan Condon A negligence and medical malpractice lawsuit against an in- surer has been picked up by the family of a patient who died during the litigation process. e case relates to Kathleen Valentini, 47, a North Carolina woman who was denied coverage for an MRI that the lawsuit argues could have avoided amputation and potentially death following the discov- ery of sarcoma in her right hip, Medscape reported July 1. Seven details: 1. Ms. Valentini was referred to orthopedic surgeon Steven Bauer, MD, aer experiencing pain in her hip. Dr. Bauer ordered an MRI aer an X-ray failed to reveal the cause of her pain. 2. Group Health Inc. allegedly denied coverage of the MRI, claim- ing it would be "medically necessary" only if Ms. Valentini failed to improve aer six weeks of physical therapy, according to court docu- ments filed June 15 in the U.S. District Court for the Southern District of New York. 3. Dr. Bauer appealed the denial, arguing the MRI was medically nec- essary and that Ms. Valentini had just finished a full course of physical therapy, which Group Health paid for. 4. e payer reversed its decision almost 40 days later and on March 14, 2019, an MRI revealed a sarcoma in the patient's hip. "Had you come to us a month sooner, we could have used chemotherapy. Now we can't; we have to amputate before we treat with chemo," physicians at Memorial Sloan Kettering Cancer Center in New York City told Ms. Valentini, according to court documents. 5. Ms. Valentini's leg, hip and pelvis were amputated. Further testing found cancer nodules in her right lung, and she died two years later. e lawsuit argues Group Health's denial and prolonged prior autho- rization delayed Ms. Valentini's treatment, which led to her amputa- tions and long-term prognosis. 6. In 2021, a judge sided with Group Health on the negligence and medical malpractice charges, stating the insurer had no duty of care nor a physician-patient relationship with Ms. Valentini, according to court documents. 7. However, Ms. Valentini's family appealed to the U.S. Appeals Court for the Second Circuit, which is expected to hear the case later this year. n Spine surgeon gets jail time for abusing patient during hospital visit By Alan Condon W oojin Cho, MD, a former attending orthopedic surgeon and chief of research at Montefiore Hospital in New York City, was sentenced on July 19 to nine months in prison for sexually abusing a patient who had gone to him for an appointment, according to the Bronx County District Attorney's Office. The patient, a 22-year-old woman, went to an appoint- ment at the Montefiore Spine Center, where Dr. Cho, 48, "grabbed the victim's chest area and kissed her in the neck and cheek," according to investigators. "He also touched her private area under her clothes and put the victim's hand on his private area," investigators said. Af- ter the appointment, Dr. Cho saved his cellphone number in the patient's phone and asked her to be his "sugar baby." During a controlled call conducted by investigators, Dr. Cho admitted to touching her, which he said was part of the exam and told her she would receive "a lot" if she kept the incident a secret, according to investigators. Dr. Cho was arrested on Sept. 15, 2020, and a jury convicted him of forcible touching, third-degree sexual abuse and second-degree harassment on May 25, 2022. n Orthopedic surgeon must face suit in patient's death By Carly Behm A n orthopedic physician will have to face a lawsuit over allegations he failed to diagnose cancer in a patient's leg, according to the Texas Court of Appeals. Raymond Fulp, DO, was sued by the mother of Regino Gonzalez Jr., a patient Dr. Fulp saw for a left femur fracture in 2010, according to July 21 court documents. Mr. Gonzalez's mother, Juana Laguna, alleged that Dr. Fulp failed to diagnose her son's fracture as a pathological fracture caused by osteosarcoma during surgery. She also alleged that a surgery that inserted an intramedullary rod spread the cancer through Mr. Gonzalez's leg. She filed her original lawsuit in 2013, court documents said. Mr. Gonzalez was added as an additional plaintiff when he "reached the age of majority." Mr. Gonzalez had his leg amputated in 2011, and the cancer eventually metastasized to his lungs. He died in 2017, and his sister Joanna Gonzalez Acevedo, also was added as a plaintiff. Wrongful death and survival claims were added in 2019. Although the court initially dismissed claims against Dr. Fulp, the judgments were reversed. n

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