Coastal Neurological Institute, a Mobile, Alabama neurology and neurosurgery practice, has been named in three notable legal matters: a $1.4 million federal False Claims Act settlement in 2017 over fraudulent Botox-related billing, a $4.5 million wrongful death jury verdict in 2014 tied to a fatal allergic reaction during an MRI, and a 2003 Alabama Supreme Court decision in a medical malpractice case arising from a patient’s death during back surgery.
$1.4 Million False Claims Act Settlement
In December 2015, the U.S. Attorney’s Office for the Southern District of Alabama filed a federal complaint against Dr. James M. Crumb, Coastal Neurological Institute PC, and Mobility Metabolism and Wellness PC. The government alleged that Dr. Crumb, a physical medicine and rehabilitation specialist, worked in concert with CNI to defraud Medicare, Medicaid, and TRICARE.1Courthouse News Service. Feds Claim Ala. Docs Made $1M in False Claims
According to the complaint, the defendants submitted thousands of false claims dating back to at least 2007 and collected more than $1 million in improper reimbursements. Prosecutors said Dr. Crumb assigned false diagnoses of two rare neurological disorders, Spasmodic Torticollis and Genetic Torsion Dystonia, to more than a thousand patients in the Mobile area over a relatively short period. The patients themselves were said to be unaware of the diagnoses. The fabricated conditions were then used to justify Botox procedures the government described as medically unnecessary and unsupported by the medical charts.1Courthouse News Service. Feds Claim Ala. Docs Made $1M in False Claims
The complaint also alleged billing for repeat procedures that were never performed, over-ordering of Botox medication, and billing for medically unnecessary ultrasound guidance used during routine blood draws, Botox injections, and trigger point injections.2Fierce Healthcare. Four Doctors in the News This Week for All the Wrong Reasons
On June 22, 2017, the Department of Justice announced that Dr. Crumb and Coastal Neurological Institute paid $1.4 million to resolve the allegations. Dr. Crumb and Mobility Metabolism and Wellness also entered a three-year Corporate Integrity Agreement with the HHS Office of Inspector General, running from May 2017 through September 2020, that required ongoing claims review and compliance monitoring. That agreement has since been closed.3HHS Office of Inspector General. Mobility Metabolism and Wellness PC and James M. Crumb MD
$4.5 Million Wrongful Death Verdict in the Cecil Roy Thomas Case
In September 2014, a Mobile County jury returned a $4.5 million punitive damages verdict against Coastal Neurological Institute in a wrongful death lawsuit brought by the estate of Cecil Roy Thomas. Thomas, 56, died on June 18, 2008, after suffering a severe allergic reaction to an MRI contrast agent during a routine outpatient procedure at the clinic.4AL.com. Jury Awards Mobile Mans Estate $4.5 Million
The estate’s lead attorney, Ty Brown of the Birmingham firm Marsh, Rickard and Bryan, argued that clinic staff failed to immediately administer epinephrine, the first-line treatment for serious allergic reactions. Brown told reporters that Thomas went more than 16 minutes without receiving epinephrine and that the drug was not given until paramedics arrived. The lawsuit also alleged that the office lacked basic emergency equipment and medications needed to manage the kind of severe reaction known to occur with contrast agents.4AL.com. Jury Awards Mobile Mans Estate $4.5 Million5Marsh, Rickard & Bryan. Medical Malpractice Case $4.5 Million Verdict in Mobile County Alabama
Attorneys for Coastal Neurological Institute contested the cause of death, arguing that Thomas died from a cardiac event rather than anaphylaxis.6JAB Law LLC. Mobile Personal Injury Attorney Jury Verdict The one-week trial was held before Circuit Judge Robert H. Smith. After the verdict, defense attorney Danner Frazier of Frazer, Greene, Upchurch and Baker said his team was “analyzing what our next step will be.”4AL.com. Jury Awards Mobile Mans Estate $4.5 Million The available record does not indicate whether the verdict was later appealed, reduced, or resolved through a post-trial settlement.
Ronderos v. Rowell at the Alabama Supreme Court
An earlier matter involving the practice reached the Alabama Supreme Court in 2003. The case, styled Dr. Juan Ronderos and Coastal Neurological Institute, P.A. v. Myrtle Rowell, as Administratrix of the Estate of Richard Larry Rowell, arose from the death of a patient during back surgery.7FindLaw. Ronderos v. Rowell, 868 So.2d 422
Richard Larry Rowell underwent a thoracoscopic diskectomy performed by Dr. Juan Ronderos on February 10, 1998, followed by a second procedure two days later. About five hours into the second surgery, Dr. Ronderos converted from the minimally invasive approach to an open thoracotomy. Roughly two hours later, Rowell went into cardiac arrest and died. His estate sued, alleging failure to obtain informed consent, negligent performance of both surgeries, inadequate monitoring of blood loss, improper conversion to the open procedure, and failure to resuscitate in a timely manner.7FindLaw. Ronderos v. Rowell, 868 So.2d 422
The issue that reached the Supreme Court was whether the estate’s expert witness was qualified to testify. Dr. Ronderos and CNI argued that the plaintiff’s expert, orthopedic surgeon Dr. John Regan, could not testify against a neurosurgeon. Under Alabama law, the qualifications required of an expert depend on whether the defendant physician is classified as a specialist, and the defendants contended that Dr. Ronderos’s board certification in neurosurgery should control.8vLex. Ronderos v. Rowell, 868 So.2d 422
On June 6, 2003, the Alabama Supreme Court affirmed the trial court’s denial of summary judgment. The court held that a physician’s specialist status must be evaluated based on credentials at the time of the alleged malpractice, not at the time the lawsuit is filed. Because Dr. Ronderos was not board-certified when he performed the 1998 surgeries, receiving certification roughly three months later, the court applied the standard for non-specialists. Under that standard, Dr. Regan was found qualified, since the thoracoscopic diskectomy procedure was common to both neurosurgeons and orthopedic surgeons and he had the relevant training and experience.7FindLaw. Ronderos v. Rowell, 868 So.2d 422 The ruling allowed the malpractice case to proceed to trial. The ultimate outcome of the underlying lawsuit is not reflected in the available record.