[pt 1 available here] The Fortune news story about the medical mafia of Vegas centers around the plight of personal injury plaintiff Cynthia Johnson who got caught up in the medical mafia drama when she utilized the services of Bob Vannah, Howard Awand and Mark Kabins for legal and medical aid.
The part of the story that particularly caught our attention is the details about how Bob Vannah reacted to the attention of how he handled Ms. Johnson's case and his [alleged] involvement with the medical mafia:
Cynthia Johnson entered the courtroom on July 21, 2005, for a routine
procedural hearing. Though her case was the only one on the docket, she was
surprised to see the courtroom packed with men in dark suits. Vannah seemed
rattled, she says, and he complained to the judge that government lawyer Ruth
Cohen had "leaked it all over the community that I'm being investigated by her
and her cronies for criminal conduct." At the hearing's conclusion, a newspaper
columnist rushed up to Johnson, asking, "Are you seeking to get compensation for
injuries you don't really have?"
Johnson had no idea what was happening. After the hearing, Vannah screamed,
"Things are not what they're supposed to be," as he rushed across the parking
lot with an associate, she recalls. The bewildering scene made Johnson so uneasy
that she told [Mark] Kabins she would not undergo [the surgery he
recommended].
Even better was how Mr. Vannah treated his personal injury client (who had signed a medical lien with his office) when she came to see him:
He requested that [Johnson] sign a document releasing him from her case. He
claimed -- incorrectly -- that she'd failed to disclose previous visits to a
chiropractor. If she signed, he continued, she'd owe him no attorney fees and
would be responsible only for her medical costs, which had climbed into the many
thousands.
As she resisted, he grew more agitated, screaming that if she didn't sign,
she'd owe him vast sums. He stood, banging the table and yelling that she was
under federal investigation and that "the government had killed people for
lesser things than you're doing right now," she recalls.
Vannah, of course, is completely innocent of all wrong doing. Well, at least he says so:
Vannah denies any impropriety and says he isn't surprised that Johnson's
accident received extra attention from the government, given that a government
employee caused it. Vannah has not lost sleep over the protracted investigation,
he says -- even though he has been subpoenaed by government investigators, has
been able to dodge an ethics complaint by a client over his payments to Awand,
and has been secretly taped boasting "there are five or six judges that will do
anything I want." Still, he notes, prosecutors have not charged him with
anything.
So, to wrap up: Mr. Vannah's not being charged. The prosecution of Noel Gage was thrown out due to the government's refusal to offer immunity to [alleged crooked doctor] Mark Kabins--the immunity issue is now on appeal before the 9th Circuit. Mark Kabins is being prosecuted for his involvement in the medical mafia and performing [allegedly] unnecessary surgeries. And Vegas hasn't had its medical or legal community cleaned up at all.
[Updated Editor's Note: a tip of the cap to the Nevada State Bar for finally getting at least minorly involved in the allegations of corrupt legal representation. They have filed a Complaint against Gage for sharing legal fees with Awand. No word on a complaint against Vannah. They might have wanted to suspend them all from the practice of law for awhile, but they wouldn't want to step on too many toes, would they.]
Oh, and there's one final lesson to learn for you Plaintiff's attorneys out there. If you're suspected of criminal conduct in your practice, don't yell at a client until she's in tears:
Johnson left Vannah's office in tears that day, without signing the
document. She had several chilling realizations. Her lawyer appeared to be under
investigation, though she had no idea for what. He was panicking. And he'd just
threatened her. She needed help from someone she could trust.
The next day, Johnson called every local attorney she could think of -- and
almost no one called back. Her case had become radioactive. Sleepless,
depressed, and not knowing what else to do, she finally found a lawyer who
steered her to Ruth Cohen, the government lawyer on the other side, who
immediately called her back. Within days, Johnson was sitting down with the
FBI.
What the article fails to mention is that Ruth Cohen left the government to work for an insurance company. (sigh)
ReplyDeleteWhat this blog fails to mention is that the state bar actually HAS announced that it is going after Gage.
Once again, another lop-sided post.
Now updated to reflect a "fair and balanced" view.
ReplyDeleteThank you.
ReplyDeleteKeep up the good work LE! Stay on their asses. Maybe the law will never catch up with these guys, but let's at least get all the info out there for everyone to see. Reasonable people can come to their own conclusions...
ReplyDeleteGood summary of this article LE. I would still recommend the full read for everyone. Especially all of you that think in Las Vegas justice is blind. Las Vegas gave birth to the Medical Mafia, not the other way around. They are not unique, they are simply a product of our environment. Sorry if that bursts any bubbles.
ReplyDeleteI'm with you, LE, my favorite quote from the story, "After the hearing, Vannah screamed,
ReplyDelete'Things are not what they're supposed to be,' as he rushed across the parking
lot with an associate..."
So how are things supposed to be Mr. Vannah? You get rich & everyone does what you want? Poor guy...
Read the full article. Only a very small percentage of the involved doctors are named. Just about every spine surgeon in Las Vegas was somehow involved in the medical mafia (many through active practice, others through a coerced conspiracy of silence). That includes neuro and orthopedic spine surgeons. Defense attorneys could not get Las Vegas-based docs to testify against the Medical Mafia. Awand would call defense experts and get them to change testimony or refuse to appear at trial.
ReplyDeleteThe article also omits the many "discogram" doctors, life-care plan witnesses, and several UNLV economics professors who moonlighted as loss-of-earnins/loss-of-household-services/future-loss experts.
Valley Hospital, a major player in the scheme, is omitted as are the radiology centers (in which the dirty doctors had finiacial stakes), and the many outpatient surgical centers.
Finally, the article only names a small percentage of the involved lawyers. During the golden years of the scheme - 1996-2006 - Awand had many of our collegues lining up to get people in to Kabins and Thalgott to have discograms and back surgeries. If the cases didn't settle, they went to Awand's A-team trial lawyers. Awand would script the examinations by the trial attorneys and the testimony of the docs.
This scheme was far larger and more diffuse than anyone from the United States Attorney's office can even imagine.
And much of it remains ongoing.
@ 3:05 PM
ReplyDeleteEXACTLY!!!!
It has been a sad affair for years, huh. So much so that many young attorneys on both sides of the V. have an incredibly skewed vision of litigation, evidence, etc. Very accruate post.
Ruth Cohen works for an insurance company?
ReplyDeleteInsurance defense attorneys should not complain. They made lots of money off the arrangement too (albeit while their clients got their asses kicked by Vannah and Eglet). By the way, how is it the Mike Hall and Nelson Cohen are the only defense attorneys who would go on record for the article?
ReplyDelete@ 3:05 pm
ReplyDelete"This scheme was far larger and more diffuse than anyone from the United States Attorney's office can even imagine."
Really? Your post just sounds paranoid. This whole thing sounds like another cockeyed conspiracy theory like the Apollo moon landing.
Which is greater @3:05's paranoia or @5:02's naivete'?
ReplyDeleteDoes anyone really believe that the only people involved are those named in the article?
@5:08:
ReplyDeleteI'm going with 5:02. Most of the posts on here sound like a bunch of defense attorney conspiracy theorists. I especially appreciate people who claim to know more than the U.S.A.'s office, who has been reviewing mountains of documents/testimony for the better part of 5 years-but I'm sure you know better.
Why doesn't anybody ever mention that Awand used to work with defense attorneys as much as plaintiff's attorneys?
And yes, Ruth Cohen went to work for an insurance company when she left the government (I want to say SF, but I don't remember for certain).
One last thing...regardless of truth/falsity of the whole "medical mafia" thing, "poor guy" are two words I would never use to describe Bob Vannah.
Ruth Cohen went to work for Atkin Winner & Sherrod. SF might be a client of that firm , but they do not appear to be an in-house counsel shop like Sherman or Clayson Marias. Are you folks wholly incapable of looking people up on the State Bar's website?
ReplyDeleteAnd - Kissinger was right. Even paranoiacs have enemies. There is a great deal more to this story than just sour grapes by defense counsel...
Legitimately injured people deserve recoveries, but gaming the system on either side ultimately hurts all of us. As someone who practiced elsewhere before being admited in Nevada some years ago(and still practices regionally), if 20% of what is alleged is true (and I believe the percentage is more like 75%) all the conspirators deserve the spend the rest of their lives in government housing.
ReplyDeleteOur court system has a horrible reputation, and unfortunately, it is well deserved, despite the fact that almost all Las Vegas lawyers and judges are, on a personal level, really nice people.
Give the deserving plaintiffs the money they deserve. Defense the rest.
" There is a great deal more to this story than just sour grapes by defense counsel..."
ReplyDeleteThe point is, why does everybody who criticizes the "medical mafia" profess to know more about it than the USA's office? These critics do away with the presumption of innocence, and throw these guys in the fire because they have worked with them on cases and got whooped (bias?).
The fact is, the government has investigated this case for over five years. First, they have only had "enough" evidence to even indict three people (who happen to not even be the big fish they are after) out of dozens of "targets." Second, even with those they did indict, they failed to convict (granted, Awand and Kabins have not been tried to a jury yet).
To make matters worse, the Gage case was tried to an out of state judge, so the "the judges are in their pocket" argument is out the door. Oh well, there will always be another excuse, and people will continue to exercise a presumption of guilt.
Oh, and yes, Atkins is a SF law firm. Kind of like Emerson is an Allstate Firm and McGaha is an AmFam firm. No, they are not like the Zurich in-house, but it is still an SF firm. Would anybody like to venture any guesses as to the size of Ruth Cohen's signing bonus?
The presumption of innocence is a great legal construct and I'm all for it when considering a person's life or liberty. But outside of the criminal court system we can use our brains, make connections from overwhelming circumstantial evidence, and make conclusions for ourselves. Just because these dirt bags may not be found "legally" guilty does not mean they are innocent.
ReplyDeleteEither way, that was an incredibly interesting read. (I don't practice on either side of the med mal bar).
I've got to wonder just how sour are those grapes the defense attorneys are eating? I mean... Awand has been gone for a few years now but I don't see the verdicts getting any smaller. In fact, I would venture to say that attorneys like Eglet and Vannah, ironically, have been MORE successful on cases referred to them by other attorneys who never even met Howard Awand than on cases they have worked up from the beginning. Wouldn't it be refreshing to a hear Cohen, Hall or any other defense attorney admit that, just maybe, Robert Eglet and Bob Vannah are actually damn good trial lawyers? Even better, isn't it time for insurance companies to recognize that spinal injuries are serious, life changing events and settle them accordingly? Honestly, does anybody really feel bad for Allstate when they are given a chance to settle a case for the policy limit when an MRI shows a 5 mm disc herniation with nerve root impingement but, in their infinite wisdom, they low ball a claimant? When, if ever, do the insurance companies shoulder any of the blame?
ReplyDelete@ 9:55 PM
ReplyDeleteBob, stop jackin' around and get back to work. You are being too funny.
I'm pretty sure that most every attorney in town knows that Eglet & Vannah (and many others) are good at trial. That is not the issue here you nit.
This is not an insurance company issue. I've practiced both sides of the fence since long before Blawgs & and the Internet. This scheme has always been crooked. If you think otherwise, you are either involved or you've never really practiced in Las Vegas (I'm not restricting that to just this area of law, everyone who is anyone in Las Vegas knows what is going on here).
I agree with 9:55.
ReplyDeleteAn "LU," you are wrong-this is an insurance issue. It is all intertwined, and if you don't believe that, then you are either involved in the insurance scheme, or you have never practice insurance law.....nit.
Why is it that anybody who is critical of the attack against the so-called medical mafia demonized as having no idea what's going on? Why has nobody answered the question posed by the poster above about how all these bystanders know so much more than the government, who has investigated this matter for several years?
Keep in mind that I'm not necessarily saying that Vannah, Eglet and company are innocent. All I'm saying is that people should look at this thing objectively, from both sides. I see very little of that going on.
Okay, let's assume nothing Eglet or Vannah or even Gage did was technically "criminal"? (big assumption, but for argument's sake . . . )
ReplyDeleteCan we all at least agree that sharing fee money with Awand violated ethics rules and should have been handled by the State Bar?
@11:16
ReplyDeleteAbsolutely (and I am the one that is not completely sold on the medical mafia)
George Knapp has put forth the best logic, pushing a little common sense forward in a mist of attorney argument:
ReplyDelete"If Thalgott and Venger are this bad, what words and insults will we use for the people on trial, now and in the future? As my colleagues have pointed out, the courtroom is packed much of the time with other lawyers. Some of the lawyers are known targets of the FBI investigation. Some are there representing the interests of prominent doctors who also received federal subpoenas. This jury and future juries will hear stories that will curl their hair, of atrocious things that were done to patients and outrageous steps that were taken to fleece legal clients of money that was rightfully theirs. Are Thalgott and Venger the bad guys because they admit what they did was wrong and that amends need to be made, or are the other potential defendants the real bad guys, since they have not admitted any of it was wrong and are probably still participating in it to one degree or another? You tell me."
@ 9:52 AM
ReplyDeleteSure, it is an insurance issue, you are right, to the extent it is insurance fraud. The main issue is whether the collusion and unnecessary surgeries occurred. Clearly they did.
LU:
ReplyDelete"clearly they did." So you are the judge, jury and executioner? Impressive. Sorry, pal, try North Korea.
George Knapp-nice source. This is the guy who does the reports on the UFOs, isn't he? He is clearly objective in his reporting (sarcasm).
As for Venger and Thalgot-both of them were strong-armed by threats of federal tax evasion charges. Don't think they have "flipped" out of the goodness of their hearts. If you think so, you are extremely naive.
"The main issue is whether the collusion and unnecessary surgeries occurred. Clearly they did."- an issue on which the jury failed to convict. Try again.
@1:27 = Bob Vannah
ReplyDeleteEven if the half of it is true, it raises the ire of all of us. Where is the outrage on the other side of the coin? What AUSA is out there investigating adjusters and defense counsel who deny, delay, lowball, rule 35 exam, denovo everything, and all the other abuses which occur on a daily basis? They are rigging the system as well. CSC should be indicted for creating COLOSSUS.
ReplyDelete2:17= Nelson Cohen
ReplyDelete(see, I can do it to. neet-o)
Very interesting how instead of answering a question, some posters instead decide to use very creative responses, such as:
ReplyDelete"@1:27 = Bob Vannah"
"LU" if you have practiced on the both sides of the bar as you suggested, then you should know better than to say "The main issue is whether the collusion and unnecessary surgeries occurred. Clearly they did." That is just an incredibly ignorant argument to make. Why? Because I would be willing bet dollars to doughnuts that the MRI films and ct scans post discogram will arguably justify the need for surgery. If the objective findings arguably support the need of surgery, it would seem quite presumptuous for another to unequivocally argue the surgeries were really "unnecessary." Again, it just screams of more sour grapes.
ReplyDeleteAnd, I've got to believe that if those plaintiffs were really coerced into unnecessary surgeries, one of those poor suckers would have come forward and alleged a fraud/conspiracy claim against all of the so-called "medical mafia." Such a claim would dwarf the settlements and/or verdicts they recovered for having the surgery. And you know what? There would be no shortage of attorneys who would be thrilled to take such a case. I know if one of those plaintiffs came into my office and said he/she was coerced into a needless surgery and was promised a big pay day in return by one of the "conspirators," I would most likely take it.
10:00 pm has a point. Afterall, even the plaintiff at the center of the Gage case didn't testify that she was coerced.
ReplyDeleteIf all these plaintiffs had been coerced into "unnecessary" surgeries, then there would be countless med mal suits.
3:30 am -
ReplyDeleteThe plaintiff at the center of the Gage case - Ms. Simon - had a legitimate malpractice case against Kabins and Thalgott which Gage opted to drop after Awand "allegedly" steered several other lucrative cases Gage's way. A young doctor who wasn't part of the clique got thrown under the bus. Her situation was very different than Ms. Johnson's.
And as for your assertion that this can't be happening because there would be countless malpractice cases if patients were coerced into unnecessary surgeries - part of the alleged "agreement" is that the attorneys won't sue the participating docs.
The problem with that is that there are hundreds of lawyers who haven't made the "agreement." For example, I'm sure LU would gladly take a med mal where a doctor performed an unnecessary surgery.
ReplyDeleteI never comment on these things but I would like to get other peoples thoughts. I've practiced in both med mal defense and plaintiff med mal. I can honestly say that I've won a med mal case that I probably should have lost when my client practically admitted error. My expert argued that there was not a clear standard of care even though my client seemed to disagree.
ReplyDeleteI've also done several plaintiff med mal cases and one trial which I was lucky enough to win. The fact of the matter is that med mal plaintiffs only have a 10% chance of winning by the numbers. And, it is also a fact that local doctors typically will not testify adverse to another local doctor.
I use that as background to my Gage question. Based on my understanding of the facts, he was considering suing 3 doctors (Thalgott, Kabins, and Burkhead). 1 of the 3 doctors (Kabins) was more of a bystander in the first surgery. As such, Kabins really that much of a target (he wouldn't be by target anyway). Now, if I was Gage and Kabins/Thalgott approached me and said "if you don't sue us, we will spill the beans on Burkhead; if you do sue us, we will fight along with Burkhead," I would probably make the deal. Why? Because without there help, I would only have a 10% chance of winning the case without there help. With them, I would have nearly a 100% chance of winning. Granted, I definitely would have advised my client of the arrange and I don't if Gage did that or not. But, I do know that his client testified that she did not feel that she was a victim of a scheme to defraud her.
And, even more to the point, nobody stopped Burkhead from filing a third party complaint against Thalgott and Kabins. If they truly did something wrong and Burkhead was being unjustly accused, wouldn't any defense attorney have filed the 3rd party complaint against them? I know I would have. And, again, based on my understanding of the case, there is sufficient evidence of Burkhead's wrongdoing. My understanding is that there is a very significant difference between the nurse's operative report than Burkhead's relating to Burkhead's treatment. According to the nurse, the patient was screaming out in pain when Burkhead began anesthesia.
I consider myself an ethical attorney. Yet, based on my experience, I think I probably would have done the exact same thing Gage did under the circumstances. So here is my question... Can lawyers use their best judgment to figure out which defendants to target? Is this really a crime?
I don't know why anyone acts as though this is some sort of Vegas phenomena. It's normal to find people at or well beyond the fringes of ethical behavior when there are massive piles of money at stake. The same kinds of money are at stake in most markets, and mark my words, in those markets the PI/MedMal/CD/PL game is played the same way. Evil trial lawyers have made millions making it impossible for the average joe to buy his own airplane, and evil defense lawyers have billed millions of dollars helping their corporate clients poison babies and get away with it.
ReplyDeleteEveryone everywhere pushes as many limits as they can to achieve the highest ratio of legal/ethical/financial risk to reward as they can tolerate for themselves as an individual. If that threshold is very very low for you, rest assured that a colleague whom you like, admire and respect more than compensates for you, and the same is true for those you're opposed to.
The constant for all of these players is that very, very few consider themselves to be cheating anybody, and most probably think they're "leveling the playing field", and some may even be.
This is not evil greedy people at evil work, it's just people at work.
Conspiracies...REAL conspiracies...require smarter and more disciplined people who are better at keeping their mouths shut. This case seems more like beer buddies who skated the edge of referrals and cross-referrals and fee sharing (which I predict will eventually be the only thing anyone ever actually gets penalized for) and happened to have the advantage that the primary force opposed to them (the insurance industry) has for some time been displaying incompetence at every level that simply boggles the mind.
I completely agree with the last two comments-6:19
ReplyDeleteI have yet to see a non-partisan report on this topic in any venue and the Fortune advertisement...excuse me....article, is no exception. Starting with Ms. Morrison and Mr. Knapp and moving on up to the national media every single thing I've seen in print has dripped with sarcasm when it uses the word "allegedly" and simply reiterated the statements of people other than the accused (Johnson, or the various insurance industry parrots for example) as if they had no agenda and thus could be trusted to speak only truth.
ReplyDeleteLE, LU and all other claimant's of sure knowledge that "this is how things are here": You're either involved, or you're aware of "what's been going on" because Jane Ann Morrison, some defense lawyer that got his ass kicked, or some other *partisan* told you so and for *no* other reason. (Otherwise, I certainly hope you're talking to the U.S. Attorney).
Even if you think you have some other source, the odds that you've applied your critical skills to that sources' reports are nil. Their desire to tell you all about what they know (which is probably taken from or inspired by the press reports anyway) means they have an agenda, even if it's just to sound like they know more than you.
If the U.S. Attorney had half the people available to them who claim sure knowledge of this matter as I do (and I'm a NOBODY), they wouldn't have to leak details to the press to pressure the few witnesses they have to speak on command.
"....they wouldn't have to leak details to the press to pressure the few witnesses they have to speak on command."
ReplyDeleteI agree, and they wouldn't have to threaten doctors with tax evasion charges/prison time to get them to testify.
MAXIDEX DEXAMETHASONE WARNG
ReplyDeleteI had eye surgery and in the post-op pack was MAXIDEX(dexamethasone) drops by ALCON LABS.
Two days later I was BLIND
Use Google and enter EPOCRATES MAXIDEX rEACTION to verify
Or call 800-757-9195