Petition

    v.

MAGELLAN BEHAVIORAL HEALTH, HIGHMARK BLUE CROSS AND BLUE SHIELD and GREENSPRING HEALTH SERVICES,

     v.

MAGELLAN BEHAVIORAL HEALTH,
HIGHMARK BLUE CROSS AND BLUE
SHIELD and GREENSPRING HEALTH
SERVICES,

          Defendant.

     AND NOW, comes the Petitioner, Daniel S. Shrager, M.D., by and through his attorneys, Ray F. Middleman and Malone, Larchuk & Middleman and petitions this Court for a Preliminary Injunction pursuant to Pa. R.C.P. 1531, and in support thereof, avers as follows:

1. Plaintiff has filed a Complaint against the Defendants, Magellan Behavioral Health ("Magellan"), Highmark Blue Cross and Blue Shield ("Highmark") and Greenspring Health Services ("Greenspring"), claiming interference with business relations, slander/libel, breach of contract, civil conspiracy and requesting declaratory judgment. A true and correct copy of the aforesaid Complaint is attached as Exhibit "A" and incorporated herein by reference.
2. Dr. Shrager is a medical doctor licensed to practice medicine in the Commonwealth of Pennsylvania and is also a board-certified psychiatrist. He is 57 years of age. The Affidavit of Dr. Shrager is attached as Exhibit "B" (* Not available on the Web version.)
3. Dr. Shrager has maintained a practice in the Shadyside district of Pittsburgh, Pennsylvania, where he has provided psychiatric care to a broad range of patients for twenty-five (25) years.
4. Highmark is a medical insurance company and Magellan and Greenspring are Highmark's third party administrators.
5. Since 1991, Highmark and Greenspring have considered Dr. Shrager to be an acceptable provider of psychiatric care and have approved payment for the services Dr. Shrager has provided to insured patients.
6. During those nine years, Dr. Shrager complied with all requests for quality assurance reviews made by Highmark and Greenspring, and has never been asked to produce patient psychiatric records.
7. Recently, Magellan has become affiliated with Greenspring and demanded that, as a condition of his continued network participation, Dr. Shrager produce patient files for review by Magellan. See Exhibit "C" copy of letter from Magellan dated April 24, 2000.
8. In making its request, Magellan did not seek consent from Dr. Shrager's patients or inform Dr. Shrager of the qualifications of the persons who would be reviewing the confidential patient records. Further, Magellan provided no guidelines or written procedures for obtaining patient consent or authorization for such record review.
9. Psychiatric patient case records are privileged pursuant to 42 Pa.C.S.A. §5944.
10. A psychiatrist has no authority to release patient records to any party absent a proper patient authorization. 42 Pa.C.S.A. §5944.
11. Dr. Shrager, initially, reluctantly agreed to Magellan's request by letter dated May 8, 2000, and asked only that Magellan obtain a full release from the involved patients, use blinded files, and provide information regarding the qualifications of the persons reviewing the confidential records. See Exhibit "D" copy of Dr. Shrager's letter of May 8, 2000.
12. On May 18, 2000, having received no written response from Magellan and having received an unexpected phone message on May 15, 2000, advising him that he was to be made inactive as a provider, Dr. Shrager again wrote and requested information regarding the status of the record review process. See Exhibit "E" copy of Dr. Shrager's letter of May 18, 2000.
13. Thereafter, on May 24, 2000, Dr. Shrager received, via Federal Express, a letter dated May 10, 2000, requiring that the record review be completed prior to May 19, 2000, or Dr. Shrager's "status as an approved provider could be impacted." See Exhibit "F" copy of letter of May 24, 2000 from Magellan.
14. Subsequently, by letter of June 12, 2000 (mistakenly dated May 12, 2000), Magellan advised Dr. Shrager that he had been placed on inactive status. Dr. Shrager was notified about a review of his "decredentialing" was permitted if a written request was made within thirty (30) days. See Exhibit "G" copy of letter dated May 12, 2000 from Magellan.
15. Thereafter, by letter dated July 12, 2000, Dr. Shrager requested reconsideration of Magellan's decision to render his status inactive and a hearing. See Exhibit "H" copy of letter from Dr. Shrager's counsel to Sam Donaldson.
16. Magellan has never responded to Dr. Shrager's request for reconsideration and hearing.
17. Since Magellan's decision to render Dr. Shrager inactive, Dr. Shrager has been unable to accept new patients covered by Highmark.
18. Dr. Shrager had, however, continued to receive reimbursement from Highmark for treatment of existing patients
19. On or about September 13, 2000, Dr. Shrager became aware that Magellan was contacting his current patients by telephone and letter, informing them that Dr. Shrager was no longer a Highmark participant, and that he had voluntarily left the Highmark program – an assertion which is untrue.
20. Dr. Shrager learned of Magellan's contact with his patients only when he received a telephone call from a distraught patient who had received a communication from Magellan regarding Dr. Shrager's status.
21. Upon information and belief, the recipients of the information did believe that Dr. Shrager was not accepted by the Defendants as a provider of psychiatric services because of unethical or unprofessional conduct.
22. The Defendants have falsely informed Dr. Shrager's patients that Dr. Shrager voluntarily left the Highmark system.
23. Dr. Shrager's patients have been led to believe, by the Defendants, that Dr. Shrager had abandoned them.
24. Dr. Shrager has received frantic telephone calls from his patients, wondering why he no longer wished to treat them.
25. Unless the Defendants' improper conduct is immediately enjoined, Dr. Shrager will be irreparably injured in that:
    1. his professional reputation as an ethical and competent psychiatrist will be
       destroyed;
    2. his psychiatric practice, which he has spent twenty-five years building,
       will be ruined;
    3. his referral network, which has also taken twenty-five years to build, will
       be depleted;
    4. he will permanently lose the services of Delores Perrotta, R.N.C., M.S., a
       psychiatric nurse/psychotherapist, who was trained by him and has worked
       for him for 18 years, as well as lose the patients that she treats for Dr. Shrager;
    5. he will be unable to prevent his patients' conditions from deteriorating; and
    6. he will continue to experience a great deal of emotional pain because of
       the crises that Magellan's decision has been causing the lives of his patients.
26. The Defendants have wrongfully and without justification deemed Dr. Shrager an unacceptable provider of psychiatric services and have refused to pay for the services provided by Dr. Shrager to insured patients who have selected him or wish to select him as their psychiatrist.
27. The activities sought to be restrained are actionable as they represent a tortious interference with Dr. Shrager's business, a breach of contract, libel, and/or slander.
28. The Plaintiff's right to relief is clear in that the Defendants incorrectly justify their actions solely on the grounds that Dr. Shrager has refused to comply with a request by Magellan to review patient psychiatric records. Dr. Shrager has never refused a record review.
29. Magellan's request of Dr. Shrager is illegal absent proper patient authorization. 42 Pa.C.S.A. §5944.
30. A greater injury will result by refusing to grant the injunction than by granting it in that the request for injunctive relief is a request to return the parties to the status quo ante.

     WHEREFORE, Daniel S. Shrager, M.D. requests that this Honorable Court enter an Order pursuant to Pa. R.C.P. 1531, providing for the following:

1. A Preliminary Injunction during the pendancy of this action according to the prayer of the Complaint and requested injunctive relief;
2. A Preliminary Injunction enjoining the Defendants from denying Dr. Shrager the status of approved or credentialed psychiatric care provider in the Highmark system for both new and existing patients;
3. A Preliminary Injunction requiring Defendants to identify any and all parties whom Defendants have informed that Dr. Shrager is no longer an approved or credentialed psychiatric services provider and to contact each of these persons in writing and inform them of the injunction and inform them that the dispute between Dr. Shrager and the Defendants is limited to the issue of the confidentiality of the records, and to further inform them that the Defendants are not questioning, nor have they ever questioned, Dr. Shrager's professional ethics or competence.
   

Respectfully submitted,
MALONE, LARCHUK & MIDDLEMAN, P.C.


By:____________________________________
     Ray F. Middleman, Esquire
     Attorney for Plaintiff,
     Daniel S. Shrager, M.D.