Opinion ID: 1842233
Heading Depth: 1
Heading Rank: 4

Heading: Qualified Health Care Provider

Text: Louisiana Revised Statutes 40:1299.42 sets forth the requirements for a health care provider to qualify for the protections and benefits of the Act as follows: A. To be qualified under the provisions of this Part [Part XXIII. Medical Malpractice Act], a health care provider shall: (1) Cause to be filed with the board proof of financial responsibility as provided by Subsection E of this Section. (2) Pay the surcharge assessed by this Part on all health care providers according to R.S. 40:1299.44. (3) For self-insureds, qualification shall be effective upon acceptance of proof of financial responsibility by and payment of the surcharge to the board. Qualification shall be effective for all others at the time the malpractice insurer accepts payment of the surcharge. Subsection E provides, in pertinent part: E. (1) Financial responsibility of a health care provider under this Section may be established only by filing with the board proof that the health care provider is insured by a policy of malpractice liability insurance in the amount of at least one hundred thousand dollars per claim with qualification under this Section taking effect and following the same form as the policy of malpractice liability insurance of the health care provider[.] Thus there are two prongs to the test of whether a health care provider is qualified under the Act, namely, (1) proof of financial responsibility filed with the Board, La.Rev.Stat. Ann. 40:1299.42 A(1) and 40:1299.42 E, and (2) payment of the surcharge, La.Rev.Stat. Ann. 40:1299.42 A(2), which is necessary to provide monies for the fund, La.Rev.Stat. Ann. 40:1299.44 A(2)(a). [8] But the qualification inquiry does not end here. The two prongs inquiry satisfies only the financial aspects of qualifying under the Act. There are licensing requirements that must be satisfied in order for a physician to qualify under the Act. Of significant relevance are the definitions of health care provider and physician as used in the Act. The Act defines those terms, in pertinent part, as follows: Health care provider means a person, partnership, limited liability partnership, limited liability company, corporation, facility, or institution licensed or certified by this state to provide health care or professional services as a physician, hospital, ... or any professional corporation a health care provider is authorized to form under the provisions of Title 12 of the Louisiana Revised Statutes of 1950, or any partnership, limited liability partnership, limited liability company, management company, or corporation whose business is conducted principally by health care providers, or an officer, employee, partner, member, shareholder, or agent thereof acting in the course and scope of his employment. La.Rev.Stat. Ann. 40:1299.41 A(1), (Emphasis added). Physician means a person with an unlimited license to practice medicine in this state. La.Rev.Stat. Ann. 50:1299.41 A(2), (Emphasis added). In its opinion reviewing the trial court's denial of the exception of prematurity, the court of appeal reviewed only the two financial prongs necessary for a health care provider to qualify under the Act. The appellate court first reviewed the proof of financial responsibility filed by CompHealth. The court noted that the claims-made policy was effective from February 1, 2001 to February 1, 2002, but that CompHealth purchased tail coverage on February 27, 2002 to provide coverage for claims arising during that policy period but not reported until after the expiration of the claims-made policy. The court of appeal concluded, correctly, that CompHealth and Dr. Plautz satisfied the first prong by purchasing tail coverage which covered the claim filed on December 18, 2002. The court then reviewed the surcharge prong and determined that CompHealth and Dr. Plautz had also met this requirement. The court relied upon Bennett, supra and Bennett's interpretation of La.Rev.Stat. Ann. 40:1299.42 E(1) to support its decision. Supra, at p. 363. Because qualification is effective, for those not self-insured, at the time the malpractice insurer accepts payment of the surcharge, and CompHealth had purchased tail coverage for the period in which the alleged malpractice occurred, the appellate court reasoned that CompHealth and Dr. Plautz were QHCPs, notwithstanding that the PCF had subsequently disqualified Dr. Plautz and refunded the surcharge. O'Brien, at p. 7-8, 877 So.2d at 155. The court of appeal fell into legal error by applying only the financial aspects required under the Act and failing to inquire as to whether the physician was eligible for qualification. Well accepted principles of statutory interpretation dictate that when a law is clear and unambiguous and its application does not lead to absurd consequences, the law shall be applied as written and no further interpretation may be made in search of the intent of the legislature. La. Civ.Code Ann. art. 9; Russo v. Vasquez, 94-2407, p. 6 (La.1/17/95), 648 So.2d 879, 883. Accordingly, the starting point for the interpretation of any statutory provision is the language of the provision itself. Ginn v. Woman's Hosp. Found., Inc., 02-1913, p. 9 (La.4/9/03), 842 So.2d 338, 344. Louisiana Revised Statutes 40:1299.44 provides for the creation, funding and administration of the PCF. Louisiana Revised Statutes 40:1299.44 D provides for the creation of the Board. This Board has full authority for the management, administration, operation and defense of the PCF in accordance with the provisions of the Act. La.Rev.Stat. Ann. 40:1299.44 D(2)(a); Dunn v. Bryant, 96-1765, p. 10 (La.App. 1 Cir. 9/19/97), 701 So.2d 696, 702, writ denied, 97-3046 (La.2/13/98), 709 So.2d 752. The Act authorizes the Board to adopt and promulgate such rules, regulations and standards as it may deem necessary or advisable to implement the authority, and discharge the responsibilities, conferred and imposed on it by the Act. La.Rev.Stat. Ann. 40:1299.44 D(3); Id. Therefore, the PCF possesses the requisite authority to determine eligibility in its administration of the PCF. The Board determined that physicians not licensed by the state of Louisiana were not eligible to participate in the PCF, and refunded the surcharges CompHealth had paid for such physicians. The Act defines physician to mean[ ] a person with an unlimited license to practice medicine in this state. [9] La.Rev.Stat. Ann. 40:1299.41 A(2). The Act provides, in pertinent part, `Health care provider' means a person ... licensed ... by this state to provide health care or professional services as a physician... La. Rev. Stat Ann. 40:1299.41 A(1). The plain language of the Act mandates that a physician must have a license from Louisiana in order to be eligible for the PCF. If CompHealth disagreed with the Board's determination that CompHealth's locum tenens physicians without Louisiana licenses were ineligible to participate, it had the right to appeal that determination to the Board, which is mandated to place such appeals on the agenda of its next meeting. La. Admin. Code tit. XXXVII, § 513D (2002). The pivotal undisputed fact in this case is that Dr. Plautz was not licensed by the State of Louisiana to practice medicine. The dispositive issue before us is whether a physician not licensed by the State of Louisiana is eligible for qualification under the Act. The statutory language is clear that only those individuals and entities that meet the definition of health care provider in La.Rev.Stat. Ann. 40:1299.41 A are eligible for qualification. It is uncontested that Dr. Plautz was not licensed by Louisiana to provide health care or professional services as a physician, thus, he was never at any time eligible for coverage under the Act. The appellate court's extension of coverage to Dr. Plautz was erroneous. Nor do we agree with CompHealth's argument that it is a QHCP and therefore, Dr. Plautz, as an agent of CompHealth, is also a QHCP. La.Rev.Stat. Ann. 40:1299.41 A(1) provides, in pertinent part: Health care provider means a person, partnership, limited liability partnership, limited liability company, corporation, facility or institution licensed or certified by this state to provide health care or professional services ... or any professional corporation a health care provider is authorized to form under the provisions of Title 12 of the Louisiana Revised Statutes of 1950, or any partnership, limited liability partnership, limited liability company, management company, or corporation whose business is conducted principally by health care providers, or an officer, employee, partner, member, shareholder, or agent thereof acting in the course and scope of his employment. (Emphasis added). CompHealth contends that as a QHCP, Dr. Plautz, as its agent, was also a QHCP. La.Rev.Stat. Ann. 40:1299.45 A(2) provides, in pertinent part: When, and during the period that each shareholder, partner, member, agent, officer or employee of a corporation, partnership, limited liability partnership, or limited liability company, who is eligible for qualification as a health care provider under this Part, and who is providing health care on behalf of such corporation, ... is qualified as a health care provider under the provisions of R.S. 40:1299.42 A, such corporation, ... shall, without the payment of an additional surcharge, be deemed concurrently qualified and enrolled as a health care provider under this Part. (Emphasis added). Contrary to CompHealth's argument, the corporation's qualification is concurrent with the qualification of the agent or employee who is providing health care on behalf of such corporation. [10] The Board argues that under La.Rev.Stat. Ann. 40:1299.45 A(2), Comp Health could have attempted to prove in the trial court that each of the shareholders or employees of Comp Health, who are eligible for qualification as a health care provider under the Act, was indeed PCF qualified. Had this been proven, then CompHealth could correctly have been found to be a QHCP without the payment of an additional surcharge. No evidence was submitted to show that each shareholder or employee of CompHealth, who was eligible for qualification, was PCF qualified under the Act. The Board takes the position that Comp Health was not qualified for the claims made by the plaintiffs. We agree. Simply stated, a plain reading of the statute suggests that the corporation's qualification is dependent upon each shareholder, agent, officer or employee that is providing health care being qualified under La.Rev.Stat. Ann. 40:1299.42 A. If the doctor is not a QHCP, then neither is the corporation. Defendants cite Miller v. Columbia/HCA Healthcare Corp., [11] and Caruso v. Columbia/HCA Healthcare Corp., [12] to support their argument that CompHealth is entitled to qualification. However, those cases are inapplicable because in both matters, the hospital and/or doctor was a QHCP. In Caruso, the plaintiffs filed suit against University Healthcare System d/b/a Tulane Univ. Hospital and Clinic and its corporate owner, Columbia/HCA. Both defendants filed exceptions of prematurity, which the trial court granted. In affirming, the court of appeal agreed with Columbia that La.Rev.Stat. Ann. 40:1299.42 E(2) and La.Rev.Stat. Ann. 40:1299.45 A(2) mean that the corporate owner of a qualified health care provider is also treated as a qualified health care provider. [13] Caruso, at p. 2, 724 So.2d at 275. In Miller, the plaintiffs filed their claim with the PCF against Columbia/Lakeview Regional Medical Ctr. (the hospital) and Dr. Portacci. They then filed a petition against Columbia, the corporate owner of a qualified health care provider, alleging liability on Columbia's part individually, for its own actions, and vicariously for the actions of the hospital and hospital staff. In reversing the trial court's denial of the exception of prematurity, the court of appeal, relying upon Caruso, also found that a corporate owner of a qualified health care provider is treated as a QHCP without the necessity of qualifying independently and paying an additional surcharge. Miller, at p. 5, 754 So.2d at 1000. These two statutory provisions, La.Rev.Stat. Ann. 40:1299.42 E(2) and La.Rev.Stat. Ann. 40:1299.45 A(2) indicate a legislative intent not to require multiple qualifications and surcharges where common ownership is present. Caruso, at p. 2, 724 So.2d at 275, (emphasis supplied). Because Dr. Plautz is not a QHCP, then neither is CompHealth, at least for the purposes of any malpractice action against Dr. Plautz.