WA: Legal Roundup Division II
Dr. Jolley sued Regence Blueshield for violating the Consumer Protections Act and for terminating his practitioner agreement, arguing that Regence failed to provide him with a fair review. The trial court granted summary judgment on both issues in favor of Regence. Dr. Jolley appeals.
Dr. Jolley and Regence entered into a practitioner agreement whereby the agreement was later amended to satisfy the WACs in regards to the process of dispute resolution. The agreement discussed termination in three sections including an at will termination clause, a termination upon suspension of the doctor’s ability to practice medicine, and a section stating that a provider may be terminated if they fail to meet the Company’s Credentialing criteria.
In 2003 the Washington State Department of Health Medical Quality Assurance Commission (MQAC) issued charges against Dr. Jolley for having sexual relations with his patients’ mothers. His license was suspended but he was granted a stay for the suspension and was placed on probation for 10 years. Regence notified him that his contract automatically terminated when his license was suspended and explained his right to appeal. During the appeal process his contract was later reinstated by an arbitrator, however, Regence again terminated his contract under the at will clause. Jolley appealed. Regence later stated that they had terminated him for conditions on his license. An arbitrator found for Regence and stated specifically that Regence met their fair review standard and provided Jolley with an opportunity to state his case.
The Court of Appeals addressed the issue of fair review, which requires notice and an opportunity to be heard. Jolley argued that he did not receive proper notification because he was told his termination was under the at will clause but later found out that it was due to conditions on his license. The Court disagreed with Jolley holding that Regence had reasons for its at will termination, which did not convert it to a for cause termination. Second, Jolley argued that he did not have the opportunity to be heard, however, the court disagreed finding that Jolley went through both Regence’s internal appeals process and an arbitration provided to him, which gave amble opportunity to be heard.
The Court of Appeals held that he lacked standing to bring a CPA claim, but even if his claim were considered it would fail because there is not evidence to support an unfair or deceptive act or practice.