Bill Text: TX SCR30 | 2017-2018 | 85th Legislature | Introduced
Bill Title: Granting Barbara Stegall permission to sue the Texas Municipal League, TML MultiState Intergovernmental Employee Benefits Pool, Inc., and UMR, Inc.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2017-03-16 - Referred to State Affairs [SCR30 Detail]
Download: Texas-2017-SCR30-Introduced.html
By: Hall | S.C.R. No. 30 |
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WHEREAS, Barbara Stegall, individually and as representative | ||
of the estate of Joe Stegall, alleges that: | ||
(1) in the spring of 2014, Joe Stegall began | ||
experiencing fevers and a feeling of being unwell; | ||
(2) Mr. Stegall was employed as the chief financial | ||
officer for the City of Royse City, Texas, and as a city employee, | ||
was eligible for, and participated in, the city's medical and | ||
prescription drug insurance provided by the Texas Municipal League | ||
and TML MultiState Intergovernmental Employee Benefits Pool, Inc.; | ||
(3) the Texas Municipal League and TML MultiState | ||
Intergovernmental Employee Benefits Pool, Inc., provided medical | ||
and prescription drug coverage to Joe and Barbara Stegall, and UMR, | ||
Inc., was the third-party administrator; | ||
(4) in May 2014, Mr. Stegall felt ill, and was taken to | ||
the hospital by Mrs. Stegall and was admitted, examined, and | ||
informed that he had cholangiocarcinoma, more commonly known as | ||
bile duct cancer; | ||
(5) Mr. Stegall returned home to form a treatment plan | ||
with his oncologist, Dr. Ahmer Younas at Texas Oncology in Rowlett, | ||
Texas, and made an appointment with a second oncologist, | ||
Dr. Douglas Orr at Texas Oncology in Dallas, Texas; | ||
(6) in subsequent appointments, Dr. Younas and | ||
Dr. Orr advised Mr. Stegall that he had cholangiocarcinoma, bile | ||
duct cancer, and hepatocellular carcinoma, liver cancer; | ||
(7) Dr. Younas advised Mr. Stegall to start | ||
chemotherapy for the bile duct cancer first and add another form of | ||
chemotherapy for the liver cancer at a later date, and Mr. Stegall | ||
promptly began a chemotherapy regimen of gemcitabine and cisplatin | ||
to treat the bile duct cancer; | ||
(8) as a result of the positive response Mr. Stegall | ||
exhibited to chemotherapy, on October 23, 2014, Dr. Younas | ||
recommended that Mr. Stegall add to his chemotherapy regimen | ||
another drug that would target the liver cancer; | ||
(9) Dr. Younas prescribed sorafenib, known in the | ||
United States by the brand name Nexavar, in tablet form to treat the | ||
liver cancer, and sought authorization for the drug from the Texas | ||
Municipal League and TML MultiState Intergovernmental Employee | ||
Benefits Pool, Inc.; | ||
(10) Nexavar is FDA-approved for the treatment of | ||
hepatocellular carcinoma, from which Mr. Stegall suffered, and | ||
Nexavar increases the survival rates and life expectancy of | ||
patients with advanced liver cancer; | ||
(11) the Texas Municipal League and TML MultiState | ||
Intergovernmental Employee Benefits Pool, Inc., refused to | ||
authorize the drug for Mr. Stegall, and on October 30, 2014, a | ||
written denial signed by Carol Padgett, RN, BSN, CCM, Medical | ||
Intelligence Care Management, on TML MultiState Intergovernmental | ||
Employee Benefits Pool, Inc., letterhead was sent to Mr. Stegall, | ||
at the address of Texas Oncology, citing as the basis for the denial | ||
that, "The requested service was determined to be unproven."; | ||
(12) Dr. Younas persisted in efforts to obtain | ||
chemotherapy for Mr. Stegall and engaged in a telephone conference | ||
with Dr. Philip Schulman, an employee or agent of the Texas | ||
Municipal League, TML MultiState Intergovernmental Employee | ||
Benefits Pool, Inc., or UMR, Inc.; | ||
(13) Dr. Younas learned that Dr. Schulman, and by | ||
extension, the Texas Municipal League, TML MultiState | ||
Intergovernmental Employee Benefits Pool, Inc., and UMR, Inc., did | ||
not believe that Mr. Stegall had liver cancer; | ||
(14) due to the urgency of Mr. Stegall's need, | ||
Dr. Younas and his staff immediately began efforts to procure | ||
Nexavar for Mr. Stegall without insurance and at no cost to | ||
Mr. Stegall through a Resources for Expert Assistance and Care | ||
Helpline program; | ||
(15) the Texas Municipal League and TML MultiState | ||
Intergovernmental Employee Benefits Pool, Inc., acted | ||
intentionally to discourage Mr. Stegall from obtaining Nexavar; | ||
(16) on November 5, 2014, PMC Multistate Case Manager | ||
Carol West, an employee or agent of the Texas Municipal League, TML | ||
MultiState Intergovernmental Employee Benefits Pool, Inc., or UMR, | ||
Inc., advised Dr. Younas's staff that the Texas Municipal League | ||
and TML MultiState Intergovernmental Employee Benefits Pool, Inc., | ||
would terminate all of Mr. Stegall's future coverage if he took | ||
Nexavar and experienced complications from it; | ||
(17) the communication caused Mr. and Mrs. Stegall to | ||
believe that the Texas Municipal League and TML MultiState | ||
Intergovernmental Employee Benefits Pool, Inc., were looking for | ||
reason to cease payment for Mr. Stegall's treatment, and that any | ||
attempt to circumvent coverage decisions by the Texas Municipal | ||
League and TML MultiState Intergovernmental Employee Benefits | ||
Pool, Inc., would be met with immediate termination of all | ||
benefits; | ||
(18) the attempt of the Texas Municipal League and TML | ||
MultiState Intergovernmental Employee Benefits Pool, Inc., to | ||
cease coverage for Mr. Stegall's treatment, and allow his death, | ||
had a devastating impact on Mr. Stegall's demeanor and spirit, and | ||
caused both Mr. and Mrs. Stegall severe mental distress; | ||
(19) on November 11, 2014, Dr. Younas's staff was | ||
contacted regarding difficulties verifying the status of | ||
Mr. Stegall's insurance coverage, and Dr. Younas's office | ||
responded by resubmitting the authorization request for Nexavar to | ||
confirm the absence of coverage; | ||
(20) on November 21, 2014, the Texas Municipal League | ||
and TML MultiState Intergovernmental Employee Benefits Pool, Inc., | ||
suddenly and without explanation, reversed course and authorized | ||
the Nexavar; | ||
(21) the coverage decision was conveyed in a telephone | ||
call initiated by Dr. Younas's office, and the Texas Municipal | ||
League and TML MultiState Intergovernmental Employee Benefits | ||
Pool, Inc., did not take any affirmative steps to notify | ||
Mr. Stegall of its change in decision; | ||
(22) for Mr. Stegall and his family, the reversal came | ||
too late, and over the course of four excruciating weeks, during | ||
which time Mr. Stegall, Dr. Younas, and Dr. Younas's staff worked | ||
tirelessly to obtain the Nexavar, Mr. Stegall's condition | ||
worsened; | ||
(23) Mr. Stegall was admitted to the hospital on | ||
Friday, December 12, 2014, where he died four days later; | ||
(24) the Texas Municipal League and TML MultiState | ||
Intergovernmental Employee Benefits Pool, Inc., and its agents, | ||
including UMR, Inc., denied Mr. Stegall access to Nexavar both | ||
directly by denying coverage and indirectly by threatening to end | ||
all coverage if he obtained Nexavar without the approval of Texas | ||
Municipal League and TML MultiState Intergovernmental Employee | ||
Benefits Pool, Inc., or UMR, Inc., thus denying Mr. Stegall | ||
coverage to which he had a contractual right, as well as the medical | ||
benefits of timely access to the Nexavar; | ||
(25) the wrongful and intentional acts of the Texas | ||
Municipal League, TML MultiState Intergovernmental Employee | ||
Benefits Pool, Inc., and UMR, Inc., ultimately caused Mr. Stegall's | ||
premature death on December 16, 2014, at the age of 60; | ||
(26) the actions of the Texas Municipal League, TML | ||
MultiState Intergovernmental Employee Benefits Pool, Inc., and | ||
UMR, Inc., demonstrate gross negligence and a wilful intent to | ||
deprive Mr. Stegall of the benefits of his coverage and of his life | ||
for the sake of financial economy; and | ||
(27) the Texas Municipal League, TML MultiState | ||
Intergovernmental Employee Benefits Pool, Inc., and UMR, Inc., must | ||
be held liable; now, therefore, be it | ||
RESOLVED by the Legislature of the State of Texas, That | ||
Barbara Stegall is granted permission to sue the Texas Municipal | ||
League, TML MultiState Intergovernmental Employee Benefits Pool, | ||
Inc., and UMR, Inc., for wrongful death, negligence, breach of | ||
contract, breach of the duty of good faith and fair dealing, and | ||
violations of the Texas Insurance Code and Texas Deceptive Trade | ||
Practices-Consumer Protection Act, subject to Chapter 107, Civil | ||
Practice and Remedies Code; and, be it further | ||
RESOLVED, That if Barbara Stegall is successful in proving | ||
her allegation against the Texas Municipal League, TML MultiState | ||
Intergovernmental Employee Benefits Pool, Inc., and UMR, Inc., | ||
Mrs. Stegall is entitled to an award of actual, compensatory, and | ||
statutory damages and reasonable attorney's fees and costs | ||
authorized by law; and, be it further | ||
RESOLVED, That the suit authorized by this resolution shall | ||
be brought in Dallas County; and, be it further | ||
RESOLVED, That the attorney general, the Texas Commissioner | ||
of Insurance, the executive director of the Texas Municipal League, | ||
and the chairman of the board of TML MultiState Intergovernmental | ||
Employee Benefits Pool, Inc., be served process as provided by | ||
Section 107.002(a)(3), Civil Practice and Remedies Code. |