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ment Opportunity Commission (EEOC) of Judge Hughes’ decision in favor of a Houston debt collection agency against the woman, Donnicia Venters. EEOC charged that Houston Funding II Ltd. fired Ms. Venters after she sought ap- proval to pump breast milk at the office. Judge Hughes ruled that even if that were true, Ms. Venters could not claim discrimination under Title VII because lactation is not pregnancy, childbirth, or a related medical condition. TMA and TPS argue in their brief that federal law protects lactation because it is one of several medical conditions re- lated to pregnancy that requires care af- ter childbirth. “Since the yielding of milk by mammary glands is a medical condi- tion caused by pregnancy and childbirth, lactation is a ‘related medical condition’ as contemplated by Title VII,” the brief said. “Title VII protects employees from be-
ing fired ‘because of sex’ or ‘on the basis’ of sex,” it added. “Congress amended Title VII, in response to a Supreme Court case, to clarify that those terms ‘include, but are not limited to, because of or on the basis of pregnancy, childbirth, or related medical conditions.’ It is clear that Congress intends to protect women, such as Venters, from being fired based on medical conditions relating to their pregnancy and/or childbirth.” The brief also says breastfeeding ben- efits both the mother and child and that public policy demands protection for lac- tating mothers at work. Thus, TMA and TPS said, a jury should decide whether Houston Funding discriminated against Ms. Venters, or, as the company claims, it fired her for abandoning her job.
“This important ruling allows thou-
sands of physicians to use class arbitra- tion against a health insurer that has un- derpaid them for more than a decade,” said then-American Medical Association President Jeremy A. Lazarus, MD. “With- out this broad-scale arbitration, physi- cians would have no practical means of challenging a health insurer’s unfair pay- ment practices.” The decision in Sutter v. Oxford Health
Plans concludes a dispute dating back to September 2003, when New Jersey pediatrician John Sutter, MD, alleged that Oxford Health Plans had systemati- cally bundled, downcoded, and delayed payments for his services and those of 20,000 other physicians in its network. Oxford Health Plans had challenged le- gal decisions supporting class arbitration of the dispute and appealed the case to the U.S. Supreme Court.
The Litigation Center of the AMA and the Medical Society of New Jersey (MSNJ) filed a friend-of-the-court brief urging the high court not to limit physi- cians’ ability to fight insurer disputes as a group. The AMA-led brief noted that health insurers like Oxford know that arbitrating disputes with individual phy- sicians works to their advantage by al- lowing contract violations and underpay- ments to persist and leaving physicians with no effective means to challenge unfair business practices.
The high court’s ruling in favor of physicians boosts the medical profes- sion’s efforts to address unfair corporate policies of large health insurers that are bad for patients and physicians. n
Crystal Zuzek is an associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email at
crystal.zuzek@texmed.org.
Supreme Court backs physicians in insurer arbitration
The U.S. Supreme Court ruled that indi- vidual physicians can come together as a group to fight the unfair business prac- tices of large health insurers.
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August 2013 TEXAS MEDICINE 39
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