Gasline Newsletter November 2008

Volume 10, No. 6

CSA Winter Hawaiian Seminar

Beat the winter blahs! Attend the CSA’s Winter Hawaiian Seminar, January 19-23, 2009, at the beautiful Hyatt Maui Resort & Spa. Learn the latest on pain medicine, malignant hyperthermia, preeclampsia/eclampsia, tracheal stenosis and pulmonary stenting, anesthesia for emergency surgery in infants, hypotoxemia during one-lung ventilation, and more.

Prospect Case on Balance Billing

The California Supreme Court heard oral arguments on November 5 in Prospect v. Northridge, a case which at the appellate level had upheld the legality of balance billing for non-contracted emergency services. A Court of Appeals had ruled balance billing was consistent with the common law doctrine of quantum meriut, whereby a person providing a valuable service or benefit is entitled to reasonable compensation. In their questions and comments, the justices gave no clue as to the probable outcome. A decision is expected early next year.

The appellant payer (Prospect Medical Group) and its ally, DMHC, had the advantage of framing the discussion by speaking first and then last in rebuttal. Arguing for the emergency physicians (Northridge Emergency Medical Group), San Francisco attorney Jerome Falk Jr., was better organized and seemed more persuasive. But it was a challenge for him to focus the Court on the real issues of the case after the rather confusing and “throw everything against the wall” approach of the payer advocates. Prospect and DMHC counsels lamented the “evils” of balance billing that allegedly threaten the basic premise of pre-paid health care and the entire health care system. Essentially they argued public policy, which is the domain of the legislature, from the payer point of view rather than the legal issues properly before the Court.

The questions asked by several of the justices indicated unfamiliarity with some basic healthcare considerations. Several were reading (probably the briefs) during the presentations and the questions seemed to become better informed and more to the point as the proceedings continued. At the outset, several of the justices seemed to reflect distaste for balance billing but that diminished as the issues came more into focus.

CMA, CSA et al. v. DMHC

Meanwhile, the challenge to the DMHC regulation defining balance billing as an “unfair billing pattern” occurred on November 21 in the Sacramento Superior Court. Judge Michael Kenny was inclined to uphold the authority of DMHC to define the term as its regulation did effective Oct. 15, 2008, especially after DMHC insisted only a mere definition was involved and that any enforcement authority was a different issue to be decided at a different time. Judge Kenny took the matter under submission. The hearing was on motions related to the case and marked only the first step in what could be a lengthy process.

ASA Committee Nominations Open for 2009-2010

Every year the ASA President-Elect invites nominations to serve on ASA committees during his term. This is an opportunity to become involved in committees that address topics and activities of interest to the members. If you wish to serve, or continue to serve on an ASA committee, please note:

You must submit a self-nomination via the ASA Web Site ( by January 15, 2009.
You also may ask Dr. Mason to submit a colleague nomination on your behalf.
Any request for a colleague nomination from Dr. Mason must be sent to her at no later than December 19 with a copy of your self-nomination.
The nomination form is in the ASA Web Site members only section. If you don’t have your login information, please contact Sandra Cincotti at
Before submitting a self-nomination, you may wish to review the current ASA committee listing on ASA’s Web Site (see “About ASA” and click on “ASA Committee Listing").

Assembly Speaker Karen Bass Addresses the CSA LPAD

The November 22 special meeting of the Legislative and Practice Affairs Division (LPAD) featured a luncheon talk by Assembly Speaker Karen Bass (D-Los Angeles). A licensed Physician’s Assistant, Speaker Bass emphasized health care concerns in discussing current state budget problems. While expressing hope that the Legislature’s special session might take some positive action, her lack of optimism proved well founded when a package of budget cuts and tax increases was defeated on November 26. Bass’ willingness to address the CSA group reflects the solid relationship our organization enjoys with the legislative leadership.

CSA Online Survey about CME Program Locations

The CSA Online Survey about CME program venues is located at the bottom of the CSA Home Page on the right side ( Please visit the home page and vote. There is only one question so it will only take a minute of your time. Thanks.

Michael W. Champeau, M.D.

The California Society of Anesthesiologists (1948 - 2008) celebrates 60 years of dedication to patient safety, compassionate care, and physician advocacy

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