Dr. Gregory Stewart of Watauga Orthopedics conducted shoulder surgery on Johnson City resident Theresa Doty, the plaintiff, on July 7, 2017, following an April 2017 motor vehicle accident involving a city-owned tractor, according to a memorandum of law and fact filed in Circuit Court in April.
According to court documents, Johnson City resident Ronald Weaver was operating a city-owned tractor when he lost control and slid into the passenger side of a vehicle carrying Doty. Erick Herrin, the attorney representing the city in this case, said the road was slick after a light rain and that the tractor’s tires did not sufficiently grab the pavement as Weaver was braking. Court records say Doty was 78 years old at the time of the accident. Weaver and the city are both listed as defendants in the lawsuit.
Doty is suing the city for up to $300,000, and in court documents filed in April, Johnson City challenged the “reasonableness” of using Doty’s incurred hospital charges, which totaled $204,196, to seek damages. The city claims Johnson City Medical Center, which is part of the Ballad Health system, overcharged Doty for her medical expenses, which court documents say were ultimately satisfied by Medicare payments totaling $13,443.71. JCMC charged Doty $9,728 for the visit to the emergency room and $194,468 for the surgery on her shoulder.
"Ballad Health accepts Medicare payment and associated copays and deductibles as payment in full," Ballad Health said in response to a request for comment.
Marc Chapman, owner of Chapman Consulting, a firm that conducts reviews of medical bills, argued in an analysis submitted with the city’s filings in April that, based on his calculations, the center should have charged $39,952 rather than $204,196 for Doty’s total medical expenses.
Herrin said high incurred medical expenses are a national issue and are not isolated to Johnson City Medical Center.
According to the June 24 filing, Herrin asked Stewart “numerous times” about discounted rates accepted by medical providers from insurers, including whether there is a significant difference between “a typical billing and what might be a reasonable charge based on reality.”
Stewart answered that there is “a large difference between the typical bill” sent for medical services and “what is reflected in reality with the money that changes hands.”
Doty’s attorney, Sandy Gothard, said in the motion that the bills incurred by Doty are “typical, undiscounted” rates for the area.
Stewart later said that he doesn’t know how those are charges are set and how they are paid.
Gothard claims in the motion that the defendants in this case “continue to attempt to” submit evidence in violation of the state’s collateral source rule, which, according to the Upper Cumberland Business Journal, prevents defendants in personal injury lawsuits from introducing evidence that shows the plaintiff received payments or benefits from a third party, like a health insurance provider, for damages.
“If you cause an injury to another party, then you owe the total charge for your damages,” Gothard said on Tuesday. “The (Tennessee) Supreme Court has made it perfectly clear that that’s the law, and Mr. Herrin keeps trying to circumvent that through Dr. Stewart and that motion in limine he filed previously.”
When these cases go to court and are reviewed by a judge or jury, they’re only supposed to consider the total charge of the treatment, Gothard said.
“It doesn’t matter if your uncle came in and paid the bill for you or your health insurance, who gets a discount on it,” he said. “You’re entitled to receive the total charges that you caused.”
On Tuesday, Herrin called Gothard a “gentleman and a scholar” and said he makes a “good argument.”
“His argument is that I’m trying to bypass the collateral source rule,” Herrin said. “My argument is I’m not trying to take advantage of the collateral source rule, I’m trying to rebut a presumption that exists that allows non-discounted medical bills to be admitted into evidence in a trial.”
Herrin said he and Gothard have agreed to respond to each other’s pending motions in limine and will be setting a hearing date.
Plaintiff's Motion in Limine by David Floyd on Scribd