Opinion ID: 2263396
Heading Depth: 2
Heading Rank: 3

Heading: Unlawful Trade Practice.

Text: Appellants also claim that Dr. Stark and the Medical Group violated the District of Columbia Consumer Protection Procedures Act (CPPA). [7] In doing so, they essentially restate their claim of fraudulent misrepresentation as a claim under the statute. Specifically, in the language of their brief on appeal, they cite three alleged misrepresentations of a material fact by Dr. Stark and the Medical Group which, they say, had a tendency to mislead, namely that: (I) they had taken the requisite steps to obtain insurance authorization for Mrs. Caulfield's colonoscopy and that MetLife had denied authorization when in fact they had not; (ii) Appellee Stark had performed a `CPT Code 99213' office visit when in fact he had not; and (iii) Mrs. Caulfield's diagnosis was diarrhea when there was no medical justification for this diagnosis. Although this court has held that the CPPA applies to non-lawyers who purport to practice law, Banks v. District of Columbia Dep't of Consumer & Regulatory Affairs, 634 A.2d 433, 437 (D.C.1993), we have not previously considered whether the CPPA applies to the medical profession. In Banks, we upheld an order of the District of Columbia Department of Consumer and Regulatory Affairs (DCRA) that concluded Banks had engaged in deceptive trade practices, D.C.Code § 28-3904(a), (b), and (d), based on his unauthorized practice of law. [8] Id. at 440. Having ruled as we did in Banks with respect to legal services, we can discern no reason why the performance of medical services should not be a trade practice as well under the CPPA. Id. at 437. Several years after Banks, in Osbourne v. Capital City Mortgage Corp., 727 A.2d 322, 326 (D.C.1999), we held that the clear and convincing evidence standard applies to claims of intentional misrepresentation under the CPPA, but we did not address whether the CPPA also embraces claims of unintentional misrepresentation. Thus, the Caulfields, who claim unintentional misrepresentation in a patient-physician context under the CPPA, raise an issue of first impression for this court. This issue has, however, been considered in a federal district court decision, Dorn v. McTigue, 121 F.Supp.2d 17, 19 (D.D.C.2000) ( Dorn I ), where Judge Urbina concluded that an unintentional-misrepresentation claim would fall outside the scope of the CPPA as it applies to the medical field. That decision is not binding on this court, however. See M.A.P. v. Ryan, 285 A.2d 310, 312 (D.C.1971). Thus, unintentional misrepresentation under the CPPA is still an open question. Assuming for purposes of this case (without deciding) that unintentional misrepresentation claims are available under the CPPA, there is a major roadblock to recovery discussed in a later opinion in the Dorn litigation (limited after Dorn I to intentional misrepresentation). See Dorn v. McTigue, 157 F.Supp.2d 37 (D.D.C. 2001) ( Dorn II ). In Dorn II, Judge Urbina suggested (without deciding) that the CPPA did not extend to tort claims for malpractice, that is, to claims challenging a physician's competence. Id. at 46. As of the time he wrote he was correct. Recently, we held that, before an amendment to the law in October 2000, a plaintiff could not pursue damages under the CPPA for personal injury of a tortious nature. Childs v. Purll, 882 A.2d 227, 237 (D.C. 2005) (tenant precluded from bringing suit for personal injury under CPPA against landlord accused of misrepresentation about presence of lead-based paint in apartment). [9] Accordingly, if any of the Caulfields' claims is best characterized as a claim for personal injury, that claim is barred. Ms. Caulfield apparently believed that she did not need a colonoscopy because of the first and third alleged misrepresentations: (1) the Medical Group had sought authorization for the colonoscopy from Ms. Caulfield's insurance carrier, which had failed to authorize it, coupled with (2) Dr. Stark's written diagnosis of diarrhea, without any further diagnosis, on a billing form. Her reliance on these two actions, however, constitutes attacks on the actual performance of [a physician's] medical service, which would be more appropriately addressed in the context of a[] medical malpractice claim. Nelson v. Ho, 222 Mich.App. 74, 564 N.W.2d 482, 487 (1997) (holding that physician's failure to inform patient of inherent risks involved prior to performing nasal surgery and representation that he would use nondissolvable sutures in her nose was not conduct in violation of Michigan Consumer Protection Act). The Caulfields' first and third claimed misrepresentations, therefore, are barred by this court's decision in Childs, because they accrued in 1995, five years before the CPPA was amended to allow the recovery of damages for personal injury claims sounding in tort. See supra note 9. The second alleged misrepresentation, however, cannot be disposed of under Childs, because, unlike the other two, it cannot be characterized as a physician's performance of a medical service. Rather, it is more properly described as a misrepresentation used to generate a fee. A misrepresentation for that purpose would appear to fit naturally within one or more of the four CPPA provisions on which the Caulfields rely. See supra note 7. As elaborated earlier, Dr. Stark tendered a bill in the amount of $70 to Ms. Caulfield for a medical consultation which no one disputes took place. The Caulfields contend, however, that the scope of Dr. Stark's services did not conform to the definition of CPT Code 99213 that was used on the billing form, and that it was inappropriate for him to write a diagnosis of diarrhea, without more, on that form. In short, they claim that Dr. Stark obtained a fee based on false representations. If there is to be any recovery at all against a physician or a medical practice under the CPPA as applied in 1995, see supra note 9, there has to be a way of distinguishing a valid statutory claim from a personal injury action outside the scope of the statute. Accordingly, in Dorn II, Judge Urbina articulated a basis for recovery against a medical practice under the CPPA that is distinguishable from a malpractice claim. A patient, he said, may recover damages from a physician under the statute ifbut only ifthere is a nexus between the [CPPA claim] and the entrepreneurial aspect of the medical practice. 157 F.Supp.2d at 47. More specifically, Judge Urbina concluded that the CPPA would afford recovery for a physician's (intentional) misrepresentation only if the plaintiff can prove (by clear and convincing evidence) that the claim at issue was generated by an entrepreneurial motive. [10] Dorn II, 157 F.Supp.2d at 46. A plaintiff, in other words, had to link the misrepresentation to a motive for financial gainfor example, by using a misleading sales pitch to get the medical business. In Dorn II, however, Judge Urbina concluded as a matter of law that the record did not establish that the doctor's statement at issue was made for entrepreneurial motives. Moreover, it fell well short of what is needed to allow a jury to infer intentional misrepresentation by clear and convincing evidence. Id. at 49. The Caulfields are pursuing a negligent misrepresentation claim for which they insist the bar is lower than required for the intentional misrepresentation claim in Dorn II. They rely on Banks and the plain language of the CPPA to argue that there is no entrepreneurial nexus requirement. We agree with Judge Urbina that there should be a clear basis for distinguishing a misrepresentation claim that falls within the statute from a personal injury claim that falls outside it. [11] For reasons that follow, however, we need not adopt a formulation, such as Dorn II's entrepreneurial nexus requirementor any otherat this time, because there was no material misrepresentation here. As elaborated earlier in Part II.B.2., Dr. Stark performed services for which he billed Ms. Caulfield. Although the Caulfields maintain that he used an improper billing code, they did not specify in court what the appropriate billing code would have been or contend that the fee would have been less if another, more appropriate code had been used. Furthermore, on this record, we cannot see how a reasonable juror could have found that the doctor's reference to diarrhea in the small space on the billing formrepresenting one though not all of her symptoms amounted to a failure to state a material fact that had a tendency to mislead. The state of Washington's Court of Appeals has stated a distinction under that state's Consumer Protection Act (CPA) that is relevant here: [T]he mere reporting and treatment of subjective symptoms described by a patient does not constitute fraud or a violation of the CPA. We note a vast difference between fraud and good faith medical response to patients' subjective complaints. State Farm Fire & Cas. Co. v. Huynh, 92 Wash.App. 454, 962 P.2d 854, 858 (1998) (sustaining verdict that chiropractor who submitted false bills and reports to insurance company after treating patients for injuries in staged auto accident was liable under state's CPA). We believe that, after learning all the facts and inspecting Dr. Stark's bill, a reasonable juror could only find a good faith medical response to the Caulfields' subjective complaints, not a misrepresentation or omission having a tendency to mislead. Id. Again, in this case, we do not need to consider how to draw a line between misrepresentations cognizable under the CPPA and personal injury actions because there was no misrepresentation here. We conclude as a matter of law that Dr. Stark's notations on his billing form cannot be characterized as misrepresentations or omissions of material facts which had a tendency to mislead (or came within any of the other CPPA formulations on which the Caulfields rely, see supra note 7).