85R22668 TK-D
By: Laubenberg, Leach H.C.R. No. 91
Substitute the following for H.C.R. No. 91:
By: Laubenberg C.S.H.C.R. No. 91
HOUSE CONCURRENT RESOLUTION
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.