Texas 2017 - 85th Regular

Texas House Bill HCR91 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	85R22668 TK-D
2	2	By: Laubenberg, Leach H.C.R. No. 91
3	3	Substitute the following for H.C.R. No. 91:
4	4	By: Laubenberg C.S.H.C.R. No. 91
5	5
6	6
7	7	HOUSE CONCURRENT RESOLUTION
8	8	WHEREAS, Barbara Stegall, individually and as representative
9	9	of the estate of Joe Stegall, alleges that:
10	10	(1) in the spring of 2014, Joe Stegall began
11	11	experiencing fevers and a feeling of being unwell;
12	12	(2) Mr. Stegall was employed as the chief financial
13	13	officer for the City of Royse City, Texas, and as a city employee,
14	14	was eligible for, and participated in, the city's medical and
15	15	prescription drug insurance provided by the Texas Municipal League
16	16	and TML MultiState Intergovernmental Employee Benefits Pool, Inc.;
17	17	(3) the Texas Municipal League and TML MultiState
18	18	Intergovernmental Employee Benefits Pool, Inc., provided medical
19	19	and prescription drug coverage to Joe and Barbara Stegall, and UMR,
20	20	Inc., was the third-party administrator;
21	21	(4) in May 2014, Mr. Stegall felt ill, and was taken to
22	22	the hospital by Mrs. Stegall and was admitted, examined, and
23	23	informed that he had cholangiocarcinoma, more commonly known as
24	24	bile duct cancer;
25	25	(5) Mr. Stegall returned home to form a treatment plan
26	26	with his oncologist, Dr. Ahmer Younas at Texas Oncology in Rowlett,
27	27	Texas, and made an appointment with a second oncologist,
28	28	Dr. Douglas Orr at Texas Oncology in Dallas, Texas;
29	29	(6) in subsequent appointments, Dr. Younas and
30	30	Dr. Orr advised Mr. Stegall that he had cholangiocarcinoma, bile
31	31	duct cancer, and hepatocellular carcinoma, liver cancer;
32	32	(7) Dr. Younas advised Mr. Stegall to start
33	33	chemotherapy for the bile duct cancer first and add another form of
34	34	chemotherapy for the liver cancer at a later date, and Mr. Stegall
35	35	promptly began a chemotherapy regimen of gemcitabine and cisplatin
36	36	to treat the bile duct cancer;
37	37	(8) as a result of the positive response Mr. Stegall
38	38	exhibited to chemotherapy, on October 23, 2014, Dr. Younas
39	39	recommended that Mr. Stegall add to his chemotherapy regimen
40	40	another drug that would target the liver cancer;
41	41	(9) Dr. Younas prescribed sorafenib, known in the
42	42	United States by the brand name Nexavar, in tablet form to treat the
43	43	liver cancer, and sought authorization for the drug from the Texas
44	44	Municipal League and TML MultiState Intergovernmental Employee
45	45	Benefits Pool, Inc.;
46	46	(10) Nexavar is FDA-approved for the treatment of
47	47	hepatocellular carcinoma, from which Mr. Stegall suffered, and
48	48	Nexavar increases the survival rates and life expectancy of
49	49	patients with advanced liver cancer;
50	50	(11) the Texas Municipal League and TML MultiState
51	51	Intergovernmental Employee Benefits Pool, Inc., refused to
52	52	authorize the drug for Mr. Stegall, and on October 30, 2014, a
53	53	written denial signed by Carol Padgett, RN, BSN, CCM, Medical
54	54	Intelligence Care Management, on TML MultiState Intergovernmental
55	55	Employee Benefits Pool, Inc., letterhead was sent to Mr. Stegall,
56	56	at the address of Texas Oncology, citing as the basis for the denial
57	57	that, "The requested service was determined to be unproven.";
58	58	(12) Dr. Younas persisted in efforts to obtain
59	59	chemotherapy for Mr. Stegall and engaged in a telephone conference
60	60	with Dr. Philip Schulman, an employee or agent of the Texas
61	61	Municipal League, TML MultiState Intergovernmental Employee
62	62	Benefits Pool, Inc., or UMR, Inc.;
63	63	(13) Dr. Younas learned that Dr. Schulman, and by
64	64	extension, the Texas Municipal League, TML MultiState
65	65	Intergovernmental Employee Benefits Pool, Inc., and UMR, Inc., did
66	66	not believe that Mr. Stegall had liver cancer;
67	67	(14) due to the urgency of Mr. Stegall's need,
68	68	Dr. Younas and his staff immediately began efforts to procure
69	69	Nexavar for Mr. Stegall without insurance and at no cost to
70	70	Mr. Stegall through a Resources for Expert Assistance and Care
71	71	Helpline program;
72	72	(15) the Texas Municipal League and TML MultiState
73	73	Intergovernmental Employee Benefits Pool, Inc., acted
74	74	intentionally to discourage Mr. Stegall from obtaining Nexavar;
75	75	(16) on November 5, 2014, PMC Multistate Case Manager
76	76	Carol West, an employee or agent of the Texas Municipal League, TML
77	77	MultiState Intergovernmental Employee Benefits Pool, Inc., or UMR,
78	78	Inc., advised Dr. Younas's staff that the Texas Municipal League
79	79	and TML MultiState Intergovernmental Employee Benefits Pool, Inc.,
80	80	would terminate all of Mr. Stegall's future coverage if he took
81	81	Nexavar and experienced complications from it;
82	82	(17) the communication caused Mr. and Mrs. Stegall to
83	83	believe that the Texas Municipal League and TML MultiState
84	84	Intergovernmental Employee Benefits Pool, Inc., were looking for
85	85	reason to cease payment for Mr. Stegall's treatment, and that any
86	86	attempt to circumvent coverage decisions by the Texas Municipal
87	87	League and TML MultiState Intergovernmental Employee Benefits
88	88	Pool, Inc., would be met with immediate termination of all
89	89	benefits;
90	90	(18) the attempt of the Texas Municipal League and TML
91	91	MultiState Intergovernmental Employee Benefits Pool, Inc., to
92	92	cease coverage for Mr. Stegall's treatment, and allow his death,
93	93	had a devastating impact on Mr. Stegall's demeanor and spirit, and
94	94	caused both Mr. and Mrs. Stegall severe mental distress;
95	95	(19) on November 11, 2014, Dr. Younas's staff was
96	96	contacted regarding difficulties verifying the status of
97	97	Mr. Stegall's insurance coverage, and Dr. Younas's office
98	98	responded by resubmitting the authorization request for Nexavar to
99	99	confirm the absence of coverage;
100	100	(20) on November 21, 2014, the Texas Municipal League
101	101	and TML MultiState Intergovernmental Employee Benefits Pool, Inc.,
102	102	suddenly and without explanation, reversed course and authorized
103	103	the Nexavar;
104	104	(21) the coverage decision was conveyed in a telephone
105	105	call initiated by Dr. Younas's office, and the Texas Municipal
106	106	League and TML MultiState Intergovernmental Employee Benefits
107	107	Pool, Inc., did not take any affirmative steps to notify
108	108	Mr. Stegall of its change in decision;
109	109	(22) for Mr. Stegall and his family, the reversal came
110	110	too late, and over the course of four excruciating weeks, during
111	111	which time Mr. Stegall, Dr. Younas, and Dr. Younas's staff worked
112	112	tirelessly to obtain the Nexavar, Mr. Stegall's condition
113	113	worsened;
114	114	(23) Mr. Stegall was admitted to the hospital on
115	115	Friday, December 12, 2014, where he died four days later;
116	116	(24) the Texas Municipal League and TML MultiState
117	117	Intergovernmental Employee Benefits Pool, Inc., and its agents,
118	118	including UMR, Inc., denied Mr. Stegall access to Nexavar both
119	119	directly by denying coverage and indirectly by threatening to end
120	120	all coverage if he obtained Nexavar without the approval of Texas
121	121	Municipal League and TML MultiState Intergovernmental Employee
122	122	Benefits Pool, Inc., or UMR, Inc., thus denying Mr. Stegall
123	123	coverage to which he had a contractual right, as well as the medical
124	124	benefits of timely access to the Nexavar;
125	125	(25) the wrongful and intentional acts of the Texas
126	126	Municipal League, TML MultiState Intergovernmental Employee
127	127	Benefits Pool, Inc., and UMR, Inc., ultimately caused Mr. Stegall's
128	128	premature death on December 16, 2014, at the age of 60;
129	129	(26) the actions of the Texas Municipal League, TML
130	130	MultiState Intergovernmental Employee Benefits Pool, Inc., and
131	131	UMR, Inc., demonstrate gross negligence and a wilful intent to
132	132	deprive Mr. Stegall of the benefits of his coverage and of his life
133	133	for the sake of financial economy; and
134	134	(27) the Texas Municipal League, TML MultiState
135	135	Intergovernmental Employee Benefits Pool, Inc., and UMR, Inc., must
136	136	be held liable; now, therefore, be it
137	137	RESOLVED by the Legislature of the State of Texas, That
138	138	Barbara Stegall is granted permission to sue the Texas Municipal
139	139	League, TML MultiState Intergovernmental Employee Benefits Pool,
140	140	Inc., and UMR, Inc., for wrongful death, negligence, breach of
141	141	contract, breach of the duty of good faith and fair dealing, and
142	142	violations of the Texas Insurance Code and Texas Deceptive Trade
143	143	Practices-Consumer Protection Act, subject to Chapter 107, Civil
144	144	Practice and Remedies Code; and, be it further
145	145	RESOLVED, That if Barbara Stegall is successful in proving
146	146	her allegation against the Texas Municipal League, TML MultiState
147	147	Intergovernmental Employee Benefits Pool, Inc., and UMR, Inc.,
148	148	Mrs. Stegall is entitled to an award of actual, compensatory, and
149	149	statutory damages and reasonable attorney's fees and costs
150	150	authorized by law; and, be it further
151	151	RESOLVED, That the suit authorized by this resolution shall
152	152	be brought in Dallas County; and, be it further
153	153	RESOLVED, That the attorney general, the Texas Commissioner
154	154	of Insurance, the executive director of the Texas Municipal League,
155	155	and the chairman of the board of TML MultiState Intergovernmental
156	156	Employee Benefits Pool, Inc., be served process as provided by
157	157	Section 107.002(a)(3), Civil Practice and Remedies Code.