Opinion
Civil Action No. 5:20-MC-00934-OLG
01-04-2021
IN RE: INTERVENTIONAL PAIN ASSOCIATES, P.A., Movant.
Thomas J. Henry, Law Offices of Thomas J. Henry, San Antonio, TX, for Melinda Tijerina. Harold L. Buddy Socks, Ray, Pena & McChristian, P.C., San Antonio, TX, for Isidro Guerra, Molano, Inc. Adriaan Tieleman Jansse, Jansse Law, San Antonio, TX, for Movant.
Thomas J. Henry, Law Offices of Thomas J. Henry, San Antonio, TX, for Melinda Tijerina.
Harold L. Buddy Socks, Ray, Pena & McChristian, P.C., San Antonio, TX, for Isidro Guerra, Molano, Inc.
Adriaan Tieleman Jansse, Jansse Law, San Antonio, TX, for Movant.
ORDER
ORLANDO L. GARCIA, Chief United States District Judge
On this day, the Court considered the Motion for Protective Order of Movant Interventional Pain Management, P.A. (docket no. 1) and Defendants’ Motion to Compel Interventional Pain Management's Answers to Deposition by Written Questions and Production of Documents (docket no. 2). Having considered the motions and the record, the Court finds that the Motion for Protective Order should be GRANTED and the Motion to Compel should be DENIED.
BACKGROUND
Movant Interventional Pain Management, P.A. ("Interventional"), a pain management medical practice, filed this miscellaneous action seeking a protective order against a nonparty subpoena pursuant to Federal Rule of Civil Procedure 45(d)(3)(a). See docket no. 1. The underlying lawsuit concerns a vehicular accident in which Plaintiff Melinda L. Tijerina ("Plaintiff") suffered injuries that required medical treatment from Interventional. Id. at ¶ 4. That lawsuit is currently pending in the Southern District of Texas under Civil Action No. 7:19-cv-00285. Id. at ¶ 2. The Defendants in that lawsuit, Isidro Guerra and Molano, Inc. ("Defendants"), noticed a Deposition by Written Questions and a Subpoena Duces Tecum to Interventional, seeking answers and documents related to Interventional's treatment of Plaintiff as well as its generic patient accounting and financial practices. Id. at ¶¶ 5-6. Specifically, Defendants’ subpoena requests "All Documents and Records Relating to Policies, Procedures, and Protocols or Patient Accounting and Financial Practices at Interventional Pain Management." Id. at ¶ 5. The deposition asks Interventional to testify as to its accounting and financial policies, both in general and in relation to its treatment of Plaintiff. Id. at Ex. 1. Many of these questions appear to be designed to compare the treatment costs between Plaintiff and unrelated patients and insurance providers. See id. at ¶ 21. Moreover, the deposition also asks about any potential agreements between Interventional and Plaintiff's counsel. Id. at ¶ 23.
Interventional initiated this action seeking to strike Defendants’ document requests and sustain its objections to the deposition questions. Id. at ¶ 26. Interventional primarily argues that the requests for information related to billing practices unrelated to Plaintiff's specific treatment are overly broad, burdensome, irrelevant, and nondiscoverable under the Federal Rules of Civil Procedure. Id. at ¶¶ 26-27. Moreover, Interventional argues that Defendants seek proprietary information and trade secrets. Accordingly, they move for a protective order and to quash the discovery requests
In response, Defendants filed their Motion to Compel, asking this Court to order Interventional to comply with the subpoena and the deposition. See docket no. 2. At the center of their argument is the reasonableness of the medical bills charged by Interventional and incurred by Plaintiff. See id. at ¶ 1.1. Because Plaintiff seeks past and future medical expenses as damages in the underlying lawsuit, Defendants argue that Texas law requires that those expenses be reasonable, thereby requiring the disclosure of Interventional's financial practices for other patients so that those costs can be compared to Plaintiff's medical bills. Id. Defendants note that their requests specifically exclude any patient identifying information. Id. at ¶ 2.2. Interventional responded to the Motion to Compel, disagreeing with Defendants’ assessment of Texas law. See docket no. 3. The Court turns to the merits of these arguments.
ANALYSIS
Federal Rule of Civil Procedure 26(b)(1) provides that parties "may obtain discovery regarding any nonprivileged matter that is relevant to any party's claim or defense and proportional to the needs of the case." Interventional moves for a protective order pursuant to Rule 45, which governs subpoenas served on nonparties. See docket no. 1. Defendants move to compel compliance with the subpoena for documents and the deposition pursuant to Rule 26. See docket no. 2. Rule 26 ’s relevance and proportionality requirements apply equally in the context of Rule 45 motions "so as to avoid imposing any undue burden or expense on the person or entity subject to the subpoena." Perez v. Boecken , 2019 WL 5080392, at *2 (W.D. Tex. Oct. 10, 2019) (citing MetroPCS v. Thomas , 327 F.R.D. 600, 610 (N.D. Tex. 2018) ).
As noted above, the parties dispute whether Texas law requires the disclosure of Interventional's reimbursement rates considering its treatment of Plaintiff. Defendants argue that such disclosures are required under a recent Texas Supreme Court decision, which held that a trial court did not abuse its discretion by permitting discovery of a hospital's reimbursement rates in an action brought by an uninsured plaintiff challenging the reasonableness of a hospital lien. See In re N. Cypress Med. Ctr. Operating Co., Ltd. , 559 S.W.3d 128, 137 (Tex. 2018). In North Cypress , the plaintiff alleged that the defendant hospital's charges were unreasonable, and thus the trial court did not abuse its discretion in allowing the discovery of the reimbursement rates. Id. (noting that there is "at least [a] potential connection between reimbursement rates and the reasonableness of billed charges."). Here, Defendants argue that because personal injury law requires medical expenses to be reasonable to be recovered as damages, North Cypress dictates that Interventional's financial practices and reimbursement rates are discoverable.
Defendant also cites two previous decisions by this Court. First, in Ochoa , this Court denied the plaintiff's objections to similar discovery requests served on a nonparty medical provider. See Ochoa v. Mercer Transportation Co., Inc. , 2018 WL 6220155, at *2 (W.D. Tex. June 8, 2018). Importantly, the plaintiff, rather than the subpoenaed nonparty, opposed the discovery requests in Ochoa , and the issues of trade secrets and confidentiality were not raised. See id. Then, in Eyer , this Court granted a defendant's motion to compel responses to similar discovery requests. See Eyer v. Rivera , 2019 WL 626140 (W.D. Tex. Jan. 7, 2019). The motion to compel in Eyer , however, was unopposed, nor did the nonparty preemptively move for a protective order, as Interventional does here. Instead, the nonparty served objections in response to the defendant, which this Court noted were unsubstantiated, particularly considering the motion was unopposed. See id.
On the other hand, Interventional argues that North Cypress does not apply in the context of a personal injury case in federal court or with respect to discovery from third parties. It points out that North Cypress concerned a suit over a hospital lien in which the reasonableness of the amount the hospital charged and sought to recover was the central issue in the case, and thus the reimbursement rates were discoverable. See North Cypress , 559 S.W.3d at 137. By contrast, this case is not a dispute between Interventional and its patient regarding the reasonableness of its charges. Instead, it is a personal injury suit between a plaintiff and two potential tortfeasors, with Defendants seeking broad discovery from a nonparty medical provider.
Additionally, Interventional cites to three decisions in this district which held that North Cypress did not apply to personal injury cases. See docket no. 3 at ¶ 12. In Rodriguez , a court in this district noted the distinctions outlined above in holding that North Cypress ’s holding should not be extended to this context. See Rodriguez v. Bryan Truck Line, Inc. , 2018 WL 7348032, at *3 (W.D. Tex. Sept. 18, 2018) ("To [extend North Cypress ] would set a troubling precedent where non-party medical providers would be required to produce proprietary information regarding their contractual terms with non-party insurers in any personal injury case where there was a dispute ... regarding how to calculate damages for the plaintiff's future medical care."). Likewise, the Lackey and Perez courts also held that North Cypress should not be extended to third party medical providers in personal injury cases. See Lackey v. Dement , 2019 WL 3238896, at *5 (W.D. Tex. July 18, 2019) ; Perez , 2019 WL 5080392 at *2-3.
The Court agrees with Interventional. As an initial matter, the Court notes again that both Eyer and Ochoa did not adequately brief North Cypress applicability to the personal injury context, and, importantly, the issue of trade secrets was not properly raised. See Eyer , No. 5:17-CV-01212-OLG ; Ochoa , No. 5:17-CV-01005-OLG. Moreover, in the two years since both decisions, Defendants do not cite to, nor is the Court aware of, any other Texas court extending North Cypress to personal injury cases where a defendant is using a nonparty's financial practices and billing history to contest the reasonableness of a plaintiff's damages.
Furthermore, the Court is persuaded by the reasoning in Rodriguez , Lackey , and Perez. Specifically, the "reasonableness" that Defendants rely on in a personal injury case is starkly different from the "reasonableness" in North Cypress. As the Lackey court noted, the Texas Supreme Court relied on its previous interpretations of the Texas hospital-lien statute as being "replete with language that the hospital recover the full amount of its lien, subject only to the right to question the reasonableness of the charges comprising the lien. " 559 S.W.3d at 131 (quoting Bashara v. Baptist Mem'l Hosp. Sys. , 685 S.W.2d 307, 309 (Tex. 1985) ) (emphasis added). In other words, the hospital-lien statute provided that the central issue in the case was the reasonableness of the hospital's charges. Perhaps most importantly, the hospital was a party to the case. Here, on the other hand, Defendants rely on the requirement that medical bills be "reasonable" to qualify as damages under Texas personal injury law. See Hamburger v. State Farm Mut. Auto. Ins. Co. , 361 F.3d 875, 887 (5th Cir. 2004) ("Under Texas law, a claim for past medical expenses must be supported by evidence that such expenses were reasonable and necessary."). However, Plaintiff bears the burden of proving the reasonableness of her medical expenses through expert testimony or affidavits, and, as Interventional notes, Defendants are free to offer their own expert evidence regarding the reasonableness of those expenses. See docket no. 3 at ¶ 14. Given that Interventional is not a party to this suit, the Court is persuaded that its financial practices and reimbursement rates with third parties are hardly relevant to the case and are certainly not proportionate to Defendants’ need to rebut the reasonableness of Plaintiff's medical expenses. What's more, as noted in Lackey , the Fifth Circuit has held that in cases involving uninsured plaintiffs, the reduced charges they "may have received had [they] participated in health benefits or insurance programs for which [they] may have been eligible are irrelevant. " Guzman v. Jones , 804 F.3d 707, 712-13 (5th Cir. 2015) (emphasis added). Thus, not only is there no Texas case law extending North Cypress to the reasonableness of past medical expenses as damages, the Fifth Circuit strongly suggests that the comparison of Plaintiff's actual charges to Interventional's reimbursement rates from other patients or insurance providers is not relevant to whether her damages are "reasonable."
Given the persuasive reasoning in Rodriguez , Lackey , and Perez , and the lack of Texas case law extending North Cypress to personal injury damages inquiries, the Court finds that North Cypress does not require Interventional provide Defendants with the requested discovery. Rather, Defendants’ Subpoena Duces Tecum and the Deposition by Written Questions are neither relevant nor proportional to the needs of the case. The Court therefore GRANTS Interventional's Motion for Protective Order and DENIES Defendants’ Motion to Compel. Interventional's objections to the Subpoena Duces Tecum and the Deposition by Written Questions are sustained.
CONCLUSION
IT IS THEREFORE ORDERED that the Motion for Protective Order of Movant Interventional Pain Management, P.A. (docket no. 1) is GRANTED , and Defendants’ Motion to Compel Interventional Pain Management's Answers to Deposition by Written Questions and Production of Documents (docket no. 2) is DENIED .
It is so ORDERED .