Title: Stevenson v. Commonwealth

State: virginia

Issuer: Virginia Supreme Court

Document:

Present:  All the Justices 
 
WILLIAM C. STEVENSON 
 
v.  Record No. 990032    OPINION BY JUSTICE ELIZABETH B. LACY 
 
 
 
November 5, 1999 
COMMONWEALTH OF VIRGINIA 
 
FROM THE COURT OF APPEALS OF VIRGINIA 
 
William C. Stevenson, an Associate Professor of Surgery 
and Director of Liver Transplantation at the University of 
Virginia Medical School, was indicted by an Albemarle County 
grand jury on one count of forgery and one count of uttering a 
forged writing in violation of Code § 18.2-172.  He pled not 
guilty and, following a two-day trial, a jury convicted Dr. 
Stevenson of forgery and recommended a fine of $1.00.  The 
jury acquitted Dr. Stevenson on the charge of uttering a 
forged document.  The Circuit Court of Albemarle County 
entered judgment on the jury verdict.  The Court of Appeals, 
following a rehearing en banc, affirmed the judgment of the 
trial court by an evenly divided vote without opinion.  
Stevenson v. Commonwealth, 28 Va. App. 562, 507 S.E.2d 625 
(1998). 
 
The issue presented to us in this appeal is whether the 
facts of this case establish beyond a reasonable doubt that 
Dr. Stevenson committed forgery as charged in the indictment, 
that is, whether "[o]n or about February 6, 1996, in the 
County of Albemarle, WILLIAM C. STEVENSON did unlawfully, 
feloniously and knowingly forge a cardiac stress test writing, 
to the prejudice of Trigon Blue Cross/Blue Shield."  The crime 
of forgery requires not only that a writing be forged, but 
that the forged writing prejudiced or could prejudice the 
right of another.  Terry v. Commonwealth, 87 Va. 672, 673, 13 
S.E. 104, 104 (1891). 
In this case, Dr. Stevenson admits that he produced a 
forged writing by altering a date on his patient's cardiac 
stress test report.  However, Dr. Stevenson argues that when 
he altered the stress test report, there was no possibility 
that the altered document did or could prejudice Trigon's 
rights.  Therefore, Dr. Stevenson asserts he was not guilty of 
the crime of forgery.  We agree. 
 
The evidence taken in the light most favorable to the 
Commonwealth, the prevailing party at trial, showed the 
following.  In 1995, Leonard Kraditor, a patient of Dr. 
Stevenson, began experiencing liver failure.  Dr. Stevenson 
sought to have Kraditor placed on the nationwide list of 
patients needing organs, but was told by the University of 
Virginia Medical Center (Medical Center) personnel that it 
would not place Kraditor on the transplant list until 
Kraditor's medical insurance carrier, Trigon Blue Cross/Blue 
Shield (Trigon), pre-authorized payment for the transplant 
operation. 
 
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Dr. Stevenson was anxious to have Kraditor placed on the 
transplant list before the Christmas holiday.  Although he 
submitted a letter explaining the medical necessity for the 
liver transplant as part of the procedure for obtaining pre-
authorization from Trigon, and attempted to contact the 
director of medical policy at Trigon, he was unable to secure 
the pre-authorization before the Christmas holiday.  
Nevertheless, the administrator of the Medical Center agreed 
to place Kraditor on the transplant list without receiving 
pre-authorization for the transplant procedure from Trigon.  
 
A liver became available and Dr. Stevenson successfully 
performed the transplant operation on January 21, 1996.  The 
next day, January 22, 1996, unaware that the surgery had been 
performed, Trigon rejected the pre-authorization request 
because Trigon considered Kraditor a high risk for the surgery 
and needed the "results of his cardiac, renal and pulmonary 
evaluations" before pre-authorization could be issued.  
 
By January 28, Kraditor's body was rejecting the new 
liver.  When Dr. Stevenson sought to have Kraditor placed on 
the transplant list again, he was told that the Medical Center 
would not place Kraditor on the list again until the "pre-
authorization" for the now-completed transplant surgery was 
received from Trigon.  The only cardiac evaluation available 
to Dr. Stevenson was a cardiac stress test performed on 
 
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Kraditor in April 1994.  On January 30 or 31, Dr. Stevenson 
changed the date shown on the report for the administration of 
Kraditor's stress test from April 1994 to October 1995.  After 
attaching a cover note to the altered stress test report, Dr. 
Stevenson left the papers on his desk.  Shortly thereafter, 
Kraditor decided not to undergo further transplant surgery and 
informed Dr. Stevenson of his decision.  Kraditor died of 
liver failure on February 2, 1996. 
 
On February 6, 1996, the altered stress test report was 
sent to Trigon.  Relying on the altered stress test report as 
an indication that Kraditor's cardiovascular system could 
survive the transplant surgery and recovery, on February 12, 
1996 Trigon issued the pre-authorization for Kraditor's now-
completed liver transplant.  Trigon was unaware that the 
surgery had been successfully completed at the time it issued 
this pre-authorization. 
 
While this evidence establishes that Trigon relied on the 
altered stress test report in issuing its pre-authorization 
for Kraditor's January 21 liver transplant operation, it does 
not establish that this reliance and subsequent issuance of 
the pre-authorization prejudiced or could have prejudiced 
Trigon's rights.  According to Trigon officials who testified 
at trial, pre-authorization is a mechanism which allows the 
medical provider to obtain a preliminary indication of whether 
 
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Trigon will pay the costs associated with the medical 
treatment to be performed, prior to incurring the expense of 
performing the treatment.  Pre-authorization, according to Dr. 
Richardson Grinnan, Trigon's Senior Vice-president and Chief 
Medical Officer, is a "service to physicians and subscribers 
to prevent after-the-fact medical necessity denials."  
Although some insurance plans require pre-authorization as a 
condition for payment of a claim, Kraditor's health insurance 
policy with Trigon did not.  Therefore, any prejudice to 
Trigon in terms of liability for the transplant procedure did 
not include the existence or non-existence of pre-
authorization by Trigon for the procedure. 
More importantly, assuming that issuance of the pre-
authorization could limit Trigon's ability to contest the 
medical necessity of a procedure after the fact, Trigon did 
not and could not have suffered such prejudice under the facts 
of this case.  Dr. Grinnan testified that when procedures are 
not pre-approved, determinations as to payment are made on 
information available after the procedure.  In this case, 
according to Dr. Grinnan, when Kraditor survived the liver 
transplant without cardiac complications, the altered stress 
test "would not have had an adverse determination on whether 
or not [Trigon] would have paid that bill."  Dr. Grinnan and 
Dr. Lawrence Colley, head of Trigon's medical policy 
 
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department, both testified that Trigon would have approved 
payment for the procedure once it learned that Kraditor had 
survived the operation even if there had been no stress test 
report. 
Our conclusion that potential prejudice to Trigon was not 
established in this case is not based simply on the fact that 
Trigon was liable for the cost of the procedure whether or not 
the pre-authorization was issued.  The controlling fact in 
this case is that, at the time the forged writing was made, no 
prejudice did or could attach to Trigon as a result of the 
altered stress test report, because at that time the surgery 
had been successfully completed and Trigon acknowledged that 
its liability existed at that time.  Accordingly, any 
limitation on Trigon's right to contest the medical necessity 
of the procedure imposed by the subsequent issuance of the 
pre-authorization was immaterial.  Because Trigon's liability 
could not have been affected by the forged writing, no real or 
potential prejudice to Trigon could result from the forged 
writing.  Therefore, in the absence of such prejudice to 
Trigon, the crime of forgery was not established.  
Accordingly, we will reverse the conviction and dismiss the 
indictment. 
Reversed and dismissed.
 
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