Death outside rehab center shows need for changes in health care

By chance, not design, I interviewed Marilyn Richard and her attorneys exactly four years after her son died in the parking lot of a Las Vegas rehab hospital. She was somber Tuesday as she described her only child as "kind and compassionate" and "a gentle giant who was everybody's big brother."

Brice Richard was 283 pounds and 6-foot-5, an imposing man, married less than a year. He was 28 when he died.

Brice, a gentlemen's club doorman, injured the lower half of his body in a motorcycle accident Aug. 5, 2003. He was operated on at University Medical Center and after nine days was transferred to the Harmon Medical and Rehabilitation Hospital.

Although experts testified he was obviously at risk of developing blood clots, during the nearly three weeks he was at the rehab hospital, he wasn't treated with blood thinners.

On Sept. 4, 2003, the rehab hospital discharged him. His bride, Brittany, was taking him home about noon when a blood clot in his leg broke loose. He died in the hospital's parking lot.

Dr. Lamont Ellis, the doctor who supposedly had been treating Brice, testified during trial that he never once saw Brice, didn't even know who he was. Documents kept at Harmon were signed by "Dr. Samuels." Except Julie Samuels was no doctor; she was a nurse.

The trial ended Aug. 29 with a $2.4 million verdict for Brice's mother and his wife. The jury found that Inpatient Physicians Network, which provides staff for the rehab hospital, and Ellis were negligent in Brice's medical care. The rehab hospital settled for $50,000 before the trial.

Samuels was sued, too, but she died after the lawsuit was filed.

A jury determined that Inpatient Physicians Network was 20 percent culpable, Ellis was 25 percent culpable, and 55 percent of the responsibility was that of "all other persons."

Ellis, who no longer works for Inpatient Physicians Network, declined to comment. Inpatient Physicians Network will appeal, said President Sherif Abdou, who contends some of the responsibility for Brice's death rests with UMC as well as Samuels. "I'm not sure anybody would have made a difference in the outcome," he said.

David Francis and David Churchill, the attorneys for Brice's mom and wife, contend that what happened in this case happens frequently: physicians leaving patient care to nurse practitioners to boost profits.

Two things made this more than just an unfortunate death.

There was an attempted cover-up. Brice's records were altered to say he had been receiving blood thinners. A pharmacist who brought his own records to court exposed the cover-up. His records didn't match the ones the rehab hospital presented. Ellis blamed the cover-up on the late Samuels.

Without those records, "it would have been just another sad situation, just another death that happened," Francis said. "If they did everything right, why go back and change the records?"

Jurors said they were also shocked when Ellis admitted he never once saw his patient during the entire time Brice was at the rehab facility. Ellis testified that he'd never treated Brice, never reviewed his records, and that his signature on the rehab hospital's records was a stamp.

Under the law, whether Ellis saw Brice or not, he was responsible for all medications prescribed by a nurse practitioner.

Churchill said it's "incredibly prevalent" in rehab centers that nurse practitioners handle patient care. He said another problem is that under managed care, some insurance companies (in this case, Health Plan of Nevada) pay a set amount to the rehab facilities. It's called reimbursement on a "capitated" basis; the amount the insurance company pays is "capped."

Churchill and Francis contend rehab centers have a financial incentive to give as little attention to those "capitated" patients as possible, or discharge them as early as possible, and focus instead on the patients whose insurance pays per doctor's visit.

Abdou defended the use of nurse practitioners, saying they have a place practicing medicine and are well-trained.

But if there is a pattern, and some doctors in rehab centers truly are actually not treating "capitated" patients but leaving their care to nurses, then what happened to Brice Richard isn't just his family's story.

It could next be your family's story.

Jane Ann Morrison's column appears Monday, Thursday and Saturday. E-mail her at Jane@reviewjournal.com or call 383-0275.