Third District Court of Appeal Finds In Favor Of Stroke Patient

The case of ACOSTA v HEALTHSPRING OF FLORIDA, INC., offers an analysis of what is and what is not a”health care provider” for purposes of the Florida Medical Malpractice Act.

Angel Acosta suffered a stroke in May 2009, and was initially evaluated at North Shore Medical Center. HealthSpring provided Medicare health insurance benefits to Mr. Acosta.
The Acosta’s sued HealthSpring and alleged that:

HealthSpring’s administrative personnel–not medical staff–failed to provide contractual authorization for Mr. Acosta to be transported promptly to the University of Miami hospital for an urgent carotid endarterectomy to prevent a second major stroke.

The Acosta’s alleged that HealthSpring’s administrative delay in authorizing Mr. Acosta’s transfer resulted in his second stroke four days after the first. The Acostas alleged that one or more administrative employees at HealthSpring belatedly authorized transfer to Mercy Hospital instead of the University of Miami Hospital because HealthSpring enjoyed a lower “preferred provider” rate at Mercy Hospital for the services in question.

Thus, the issue was whether the Acostas’ claims against HealthSpring was subject to Florida’s medical malpractice statute, or whether it was ordinary Negligence. This is a distinction with a big difference. First and foremost, the statute of limitations for Medical Malpractice actions is 2 years, whereas the negligence statute is 4 years. In addition, medical malpractice clams must be pre-suited.

The Circuit Court entered a summary final judgment in favor of HealthSpring of Florida, Inc. The Acosta’s appealed to The 3rd DCA.

The Third District reversed the lower courts ruling, and held:

The fact that a health maintenance organization (HMO) is included in definition of “health care provider” under medical malpractice statute does not talismanically transform every decision or non-decision made by a clerk or administrative staffer into a medical judgment so as to make an action based on such a decision subject to statute’s presuit notice requirements and the two-year limitations period applicable to medical malpractice actions. West’s F.S.A. §§ 766.106(1)(a), 766.202(4).

The question of whether a fact pattern falls within the definition of a Medical Malpractice Claim or ordinary negligence claim, is one to which there is often not a clear answer. If there is any doubt, the best practice is to proceed as if the claim were a Medical Malpractice claim, and plead both Negligence and Medical Malpractice.