Texas 2017 - 85th Regular

Texas Senate Bill SCR30 Compare Versions

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