A Coeur d’Alene doctor was awarded $879,000 by a Kootenai County jury that determined he was wrongfully terminated for refusing to allow his patients to be referred to a clinic staffed by medical school graduates completing their physician training.
Thomas Neal sued Ironwood Family Practice in June 2017, alleging he’d been forced out of the practice he’d worked at for more than 23 years and where he was a partner. Ironwood had agreed with Kootenai Health in 2015 to partner with its residency program, now known as Kootenai Clinic Family Medicine Residency, for care of patients that would be supervised by its team of physicians. Ironwood’s doctors were paid a stipend under the terms of the agreement, according to court records.
Neal objected to the relationship, saying that it would require him to admit patients through the residency program, rather than at a hospital through a board-certified doctor trained in hospital care. He also said the requirement to supervise residents would take away time spent caring for his own patients.
“I am not willing to spend 4 or 5 full weeks out of office per year (in addition to any vacation time off) taking care of patients that are mostly not my patients,” Neal wrote in a May 25, 2015, letter to his fellow board members at Ironwood. “I would be more productive spending that time in the office and providing better care for my patients.”
Mary Schultz, one of the attorneys representing Neal at a 10-day trial that ended Sept. 30 in Kootenai County District Court, said Neal was concerned about the care of his patients and the financial agreement between the clinic and Kootenai Health.
“This is a physician who was terminated from 24 years of practice that he built because he prioritized his patients’ safety when they were being admitted into the hospital,” Schultz said.
Ironwood ended Neal’s employment in November 2015, according to court records. Neal said he offered a compromise that would have allowed his patients to be admitted to the hospital under the care of a board-certified physician while he continued to work at the practice before he was terminated.
Ironwood fought the lawsuit, arguing that Neal had not been fired but “terminated his relationship” with the provider, according to court filings, and disputed that patients had to be admitted to the clinic and not through the hospital.
Peter Erbland, the attorney representing Ironwood, said they respect the jury’s verdict but “respectfully disagree with that decision.”
“We are in the process of evaluating the strong possibility of appeal of that decision,” Erbland said.
Dr. David Chambers, a family practice specialist with Ironwood and board member, said the clinic stood by its partnership with Kootenai Health and that patient services would not change as a result of the jury verdict. Physicians have a duty to help train and teach, he said.
“We took this on because we felt it was important,” Chambers said.
The jury found that Neal had been fired and had a professional right to object to his patients being admitted to the clinic, rather than at the hospital, and that he was fired in violation of that professional right. The vote was 9 to 3. The jury awarded Neal a little more than $704,000 in lost wages, and $175,000 in additional damages.
Schultz said the jury verdict signaled a defense of physicians objecting to what are known as “clinically integrated networks,” agreements between physician practices and admitting hospitals that allow for coordinated care, but that Neal believed potentially jeopardized the care of his patients.
“His termination letter itself said, your decision to admit your patients through hospitalists is unacceptable to us. Here’s your notice,” Schultz said.
Chambers said such agreements are common and vetted by legal experts.
Neal has joined the staff at Northwest Specialty Hospital, based in Post Falls, where he practices family medicine, Schultz said. He is under no clinically integrated network agreement there.
Kootenai County District Court Judge Lansing Haynes is scheduled to hear arguments about interest and attorney fees at a hearing later this month.