Highlands Physicians, Inc. v. Wellmont Health System

CourtCourt of Appeals of Tennessee
DecidedSeptember 25, 2020
DocketE2019-00554-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. 2020).

Opinion

09/25/2020 IN THE COURT OF APPEALS OF TENNESSEE AT KNOXVILLE June 11, 2020 Session

HIGHLANDS PHYSICIANS, INC. v. WELLMONT HEALTH SYSTEM

Appeal from the Law Court for Sullivan County (Kingsport) No. C41368 E. G. Moody, Chancellor ___________________________________

No. E2019-00554-COA-R3-CV ___________________________________

In this class action lawsuit involving an association of physicians alleging breach of an agreement by the defendant hospital corporation, a three-week jury trial resulted in a verdict of more than $57 million in damages. The trial court denied the defendant’s post- trial motions and subsequently awarded over $5 million in attorney’s fees and expenses. The defendant has appealed. Determining that the trial court erred in failing to submit the attorney’s fee issue to the jury, we vacate the award of attorney’s fees and expenses and remand the issue to the trial court for determination by a jury. We affirm the trial court’s judgment in all other respects.

Tenn. R. App. P. 3 Appeal as of Right; Judgment of the Circuit Court Affirmed in Part, Vacated in Part; Case Remanded

THOMAS R. FRIERSON, II, J., delivered the opinion of the court, in which D. MICHAEL SWINEY, C.J., and JOHN W. MCCLARTY, J., joined.

W. Brantley Phillips, Jr.; Russell E. Stair; and Matthew J. Sinback, Nashville, Tennessee, and W. Kyle Carpenter, J. Ford Little, and William F. Clayton, Knoxville, Tennessee, for the appellant, Wellmont Health System.

James G. O’Kane and Emily L. Herman-Thompson, Knoxville, Tennessee, and Gary M. Elden, Matthew C. Wolfe, and Peter O’Neill, Chicago, Illinois, for the appellee, Highlands Physicians, Inc.

OPINION

I. Factual and Procedural Background

This is the second appeal in this class action lawsuit. This Court’s opinion in Highlands Physicians, Inc. v. Wellmont Health Sys., No. E2017-01549-COA-R3-CV, 2017 WL 6623992, at *1-3 (Tenn. Ct. App. Dec. 28, 2017) (“Highlands I”), details the factual and procedural history of this matter up to the time of the first appeal as follows:

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 2011 or 2012, the senior leadership at Wellmont began to 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

-2- new leadership, Wellmont began to deliberately undermine HPI, dismantle the Network, and reduce resources previously devoted to maintaining clinical integration[FN] 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, 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 includes the HPI-Wellmont Network.

3. By its conduct, Wellmont breached SA 3.

4. By its conduct, Wellmont has breached its fiduciary duties of care and loyalty to HPI.

5. By its conduct, Wellmont has committed an intentional tort damaging HPI and its members, as set out [in the complaint].

-3- 6. Each shareholder must put the interest of the Network ahead of its own interest.

7. Absent consent of both shareholders, neither shareholder may: (i) divert for its own benefit a corporate opportunity of the Network; (ii) compete with the Network; or (iii) solicit any payor of the Network to contract with a shareholder separately from the Network.

8. Each shareholder must comply with SA 4 procedures to call to the other’s attention any potential legal or practical impediment to continuation of the Network or the SA and thereafter to arbitrate any issues on those subjects.

9. Each shareholder must take all actions and invest all resources reasonably necessary to ensure that the activities of the Network, HPI and Wellmont remain lawful, ethical, and clinically integrated.

10.

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Highlands Physicians, Inc. v. Wellmont Health System, Counsel Stack Legal Research, https://law.counselstack.com/opinion/highlands-physicians-inc-v-wellmont-health-system-tennctapp-2020.