Highlands Physicians, Inc. v. Wellmont Health System

CourtCourt of Appeals of Tennessee
DecidedDecember 28, 2017
DocketE2017-01549-COA-R3-CV
StatusPublished

This text of Highlands Physicians, Inc. v. Wellmont Health System (Highlands Physicians, Inc. v. Wellmont Health System) is published on Counsel Stack Legal Research, covering Court of Appeals of Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Highlands Physicians, Inc. v. Wellmont Health System, (Tenn. Ct. App. 2017).

Opinion

12/28/2017 IN THE COURT OF APPEALS OF TENNESSEE AT KNOXVILLE November 15, 2017 Session

HIGHLANDS PHYSICIANS, INC. v. WELLMONT HEALTH SYSTEM

Direct Appeal from the Law Court for Sullivan County No. C41368C E. G. Moody, Chancellor

No. E2017-01549-COA-R3-CV

This is an interlocutory appeal as of right from certification of a class. Plaintiff, a physician-owned independent practice association, and Defendant, an organization that owns several hospitals and medical clinics, formed a physician-hospital organization to further their mutual interests, such as joint negotiations with entities such as insurance companies. Plaintiff filed this class action lawsuit alleging, among other things, that Defendant breached the contractual non-solicitation and non-competition agreement between the parties, which caused harm to Plaintiff and its members. Plaintiff moved to certify a class consisting of itself and its members, and Defendant objected. The trial court certified the class with respect to all claims pursuant to each of the three categories of class actions specified in Rule 23.02 of the Tennessee Rules of Civil Procedure. We reverse the trial court’s certification of the class pursuant to Rule 23.02 subsection (1) of the Tennessee Rules of Civil Procedure. We affirm the judgment of the trial court and certification of the class pursuant to subsections (2) and (3) of Rule 23.02 and remand for further proceedings.

Tenn. R. App. P. 3 Appeal as of Right; Judgment of the Law Court Reversed in part, Affirmed in part, and Remanded

BRANDON O. GIBSON, J., delivered the opinion of the court, in which D. MICHAEL SWINEY, C.J., and JOHN W. MCCLARTY, J., joined.

J. Ford Little and William Kyle Carpenter, Knoxville, Tennessee, for the appellant, Wellmont Health System.

Elizabeth Hutton, Johnson City, Tennessee, and Gary Michael Elden, Pro Hac Vice, and Matthew C. Wolfe, Pro Hac Vice, Chicago, Illinois, for the appellee, Highlands Physicians, Inc. OPINION

I. FACTS & PROCEDURAL HISTORY

This is an interlocutory appeal as of right filed pursuant to Tennessee Code Annotated section 27-1-125 by the Defendant/Appellant Wellmont Health System (“Wellmont”). Our review on appeal is therefore limited to the trial court’s certification of a class of plaintiffs pursuant to Rule 23 of the Tennessee Rules of Civil Procedure and does not extend to the merits of the underlying case.

Plaintiff/Appellee Highlands Physicians, Inc. (“HPI”) is a doctor-owned independent practice association consisting of healthcare providers whose practices are primarily located in Northeast Tennessee and Southwest Virginia. HPI’s membership consists of about 1,500 physicians and other health care practitioners. The organization was formed to represent the interests of its physicians and their practices in negotiations and collaborative ventures with health care payors and hospitals. Wellmont is a Tennessee corporation that operates multiple hospitals and outpatient clinics in generally the same geographic area as HPI. Wellmont is also the successor by merger to Bristol Memorial Hospital, Inc. (“Bristol Hospital”).

In 1993, HPI and Bristol Hospital, Wellmont’s predecessor, formed what is now known as Highlands Wellmont Health Network (the “Network”). The Network is a Physician-Hospital Organization (“PHO”), which is a common type of organization formed between doctors and hospitals to promote objectives such as negotiating contracts with health insurance companies (also known as “payors”). Both HPI and Wellmont are fifty percent owners of the Network, and they are parties to a Stockholders Agreement (“SA”) that governs the rights and obligations of the parties in the Network. In the original SA, Section 3 set forth each party’s agreement to a “Covenant Not to Establish Entity Similar to the [Network].” In general, this section provided that the parties, their officers, their shareholders, and their members were prohibited from competing with the Network or soliciting the Network’s payors. In 1995, Wellmont and HPI purportedly entered into an amendment of the SA (the “Amendment”), but the record is unclear as to whether either party has ever located a fully executed copy thereof. Whether the Amendment is valid and enforceable is not for determination on this appeal, but while the purported Amendment reiterated the parties’ non-competition and non-solicitation agreement, it removed those duties from the officers, directors, shareholders, and members of HPI and Wellmont.

HPI and Wellmont operated well within the confines of the Network for several years. However, around 2011or 2012, the senior leadership at Wellmont began to 2 change, and the relationship between HPI and Wellmont deteriorated over the next few years. According to HPI, the new leadership at Wellmont took an adversarial position to HPI and HPI’s members who were not employed by Wellmont. HPI sets forth a multitude of allegations in its verified complaint to support the proposition that, under new leadership, Wellmont began to deliberately undermine HPI, dismantle the Network, and reduce resources previously devoted to maintaining clinical integration1 within the Network. HPI alleges that this had a detrimental effect on the Network’s ability to maintain a high level of clinical integration. Additionally, HPI alleges that Wellmont unlawfully diverted two major insurance contracts from the Network to Wellmont individually. The first contract was entered into separately by Wellmont with Humana Medicare Advantage in June 2012 (the “Humana Contract.”). HPI apparently considered litigation against Wellmont at that time but ultimately decided against it. The second contract was entered into separately by Wellmont and Cigna in 2014. HPI alleges that Wellmont aggressively solicited Cigna to make a separate deal with Wellmont, including telling Cigna that the Network and/or HPI were not sufficiently clinically integrated. HPI claims that these actions by Wellmont constitute a clear breach of the Stockholders Agreement and cost HPI and its members tens of millions of dollars in damages.

Based on the aforementioned conduct, HPI filed a verified complaint against Wellmont on February 2, 2016,2 for claims of breach of contract, declaratory and injunctive relief, breach of fiduciary duty, defamation, tortious interference with a business, and deceit of a third party. With respect to declaratory and injunctive relief, HPI requests that the trial court make the following declarations and enjoin Wellmont from taking any action inconsistent with such declarations:

1. The SA does not permit Wellmont to contract with an existing Network payor separately from the Network or solicit payors of the Network (except, if the Amendment is effective, as provided in its Section 3.2.2(i)).

2. In Section 3.2.2(i) of the Amendment, the phrase “managed care networks competing with” does not include a network that already 1 According to the Network’s 2011 Annual Report to its Members, the Network defined “clinical integration” as “individual providers cooperating in an interdependent fashion so they can pool infrastructure and resources to develop, implement and monitor evidence-based protocols and various systematic processes, which enable them to furnish higher quality care in a more efficient manner.” The Network’s status as clinically integrated has legal consequences on its ability to negotiate contracts with payors on behalf of its shareholders. 2 HPI and Wellmont previously entered into a “Standstill Agreement” that tolled the statute of limitations on these claims for a period of time to allow the parties to attempt to resolve the matter without resorting to litigation. This case was filed pursuant to the Standstill Agreement, and HPI’s complaint was therefore deemed to have been filed on June 22, 2015.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Califano v. Yamasaki
442 U.S. 682 (Supreme Court, 1979)
Gulf Oil Co. v. Bernard
452 U.S. 89 (Supreme Court, 1981)
General Telephone Co. of Southwest v. Falcon
457 U.S. 147 (Supreme Court, 1982)
Woodrow Sterling v. Velsicol Chemical Corporation
855 F.2d 1188 (Sixth Circuit, 1988)
In Re American Medical Systems, Inc. Pfizer, Inc.
75 F.3d 1069 (Sixth Circuit, 1996)
Amanda Elliott v. R. Michael Cobb
320 S.W.3d 246 (Tennessee Supreme Court, 2010)
Lee Medical, Inc. v. Paula Beecher
312 S.W.3d 515 (Tennessee Supreme Court, 2010)
Walker v. Sunrise Pontiac-GMC Truck, Inc.
249 S.W.3d 301 (Tennessee Supreme Court, 2008)
Eldridge v. Eldridge
42 S.W.3d 82 (Tennessee Supreme Court, 2001)
State v. Scott
33 S.W.3d 746 (Tennessee Supreme Court, 2000)
State v. Gilliland
22 S.W.3d 266 (Tennessee Supreme Court, 2000)
Boyd v. Comdata Network, Inc.
88 S.W.3d 203 (Court of Appeals of Tennessee, 2002)
White v. Vanderbilt University
21 S.W.3d 215 (Court of Appeals of Tennessee, 1999)
State v. Lewis
235 S.W.3d 136 (Tennessee Supreme Court, 2007)
Konvalinka v. Chattanooga-Hamilton County Hospital Authority
249 S.W.3d 346 (Tennessee Supreme Court, 2008)
Walker v. City of Houston
341 F. Supp. 1124 (S.D. Texas, 1972)
Flautt & Mann v. Council of City of Memphis
285 S.W.3d 856 (Court of Appeals of Tennessee, 2008)
Johnson v. Nissan North America, Inc.
146 S.W.3d 600 (Court of Appeals of Tennessee, 2004)
Overstreet v. Shoney's, Inc.
4 S.W.3d 694 (Court of Appeals of Tennessee, 1999)
Freeman v. Blue Ridge Paper Products, Inc.
229 S.W.3d 694 (Court of Appeals of Tennessee, 2007)

Cite This Page — Counsel Stack

Bluebook (online)
Highlands Physicians, Inc. v. Wellmont Health System, Counsel Stack Legal Research, https://law.counselstack.com/opinion/highlands-physicians-inc-v-wellmont-health-system-tennctapp-2017.