The Legal Intelligencer

Philadelphia, Monday, June 6, 2003

REGIONAL NEWS

 

By Jennifer Batchelor
Of the Legal Staff

 

Rather than holding a discount dental referral plan responsible for independently investigating the dentists on its provider list, the Philadelphia Court of Common Pleas has ruled in a dental malpractice action that it was sufficient for the plan to confirm that its dentists were licensed to practice in Pennsylvania.

In so holding, Judge Mary D. Colins declined to impose upon the referral plan the same duties of care assigned to HMO's, hospitals and other professional health care providers.

"[The plan's] practice of relying on the credentialing process of the Pennsylvania Board of Dentistry to affirm the current state licensure of the practitioners it listed as participants in its discount plan was reasonable for the level of service it offered." Colins wrote in Stephens v. Pacropis.

The judge issued her opinion in the case after plaintiffs Jenny and Victor Stephens appealed the court's grant of summary judgment in favor of the defendant AmeriPlan USA Dental Care.

According to the opinion, Jenny Stephens signed on to AmeriPlan in March 2000 and thereby obtained a list of dentists' approved by the plan. To be on the company's list, a dentist had to have a current license to practice and be willing accept discounted payments from AmeriPlan's subscribers, Colins said.

In May 2000, Jenny Stephens went to defendant Gary Pacropis, D.D.S., for a tooth extraction, the opinion states. In a subsequent malpractice suit against the dentist, the plaintiffs alleged that Pacropis' treatment fell below the standard of care.

The Stephenses also sued AmeriPlan for alleged negligence and fraudulent misrepresentation, Colins said. According to the opinion, the plaintiffs claimed that the plan had advertised its careful screening of the dentists on its provider list and, therefore, should have used reasonable care in providing Jenny Stephens with competent and qualified dentists.

To determine whether a discount dental referral plan may be found liable for corporate negligence, the court examined the duties of care owed to patients by HMO's, hospitals and other professional health care providers.

Depending on the provider, such duties might include the use of reasonable care in maintaining safe and adequate facilities, selection and retention of only competent physicians, oversight of patient care supplied by all medical practitioners, and formulation, adoption and enforcement of adequate rules and policies to protect patients, the opinion indicates.

Defendant AmeriPlan is clearly not a health maintenance organization or professional health care provider of any sort," Colins concluded. AmeriPlan is simply a discount dental plan. An individual subscriber does pay a fee to the plan, but then pays a discounted fee for specific dental services directly to the individual dentist he or she chooses from the plan's rolls. AmeriPlan does not employ dentists or reimburse them for services provided to patients in the plan."

Additionally, the judge said, the dental plan does not act as an insurer that coordinates the delivery of medical care, not is it responsible for referring patients to specialists or other physicians.

Unlike AmeriPlan, an HMO might make referrals and indeed combines the delivery and financing of health care, providing basic health services to its subscribers for a fixed fee, the opinion states.

In a footnote at the end of her opinion, Colins said that unlike an HMO, a dental referral plan does not play a central role in its subscribers' total health care. In contrast to the plan, she said, HMOs daily involve themselves in decisions affecting their subscribers' medical care.

Colins thus concluded that summary judgment in favor of the plan was proper in Stephens.

Alan Schwartz and Stephen Pokiniewski Jr. of Anapol Schwartz, Weiss Cohan Feldman & Smalley were listed as the attorneys for the plaintiffs. Joel Albert of the Law Offices of Joel B. Albert was listed as counsel for AmeriPlan.

(Copies of the 5-page opinion in Stephens v. Pacropis, PICS NO. 03-0862, are available from The Legal Intelligencer. Please call the Pennsylvania Instant Case Service at 800-276-PICS to order or for information. Some cases are not available until 1 p.m.)

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