Written by
Robert McNamara, MD

The AAEM Physician Group suit against Envision (EmCare) is a momentous event for our specialty and our patients. (1) Every EM physician needs to understand this filing and to encourage their colleagues to join in the fight against corporate control. The future of EM is at stake. AAEM is our best hope as no one else in EM has stepped forward on this.
AAEM is asking the courts to invalidate the contractual scheme used by Envision to skirt the patient protections inherent to the prohibition on the Corporate Practice of Medicine (CPOM) as embodied in the CA Business and Professions Code §§ 2400 and 2052. This will be an expensive undertaking but it is the hill we must fight on for the soul of our specialty. Issues at stake include lay influence over the patient-physician relationship, as well as control of the fees charged, prohibited remuneration for referrals and unfair restraint of the practice of a profession. Simply put we are saying profits should not be put over patients.

AAEM has filed suits in the past against corporate interests with favorable results but this litigation is significantly DIFFERENT! In this matter, it is AAEM alone that is taking the risk. Unlike the prior cases, we do not have other parties involved who preferred settlement. In this matter, we are asking the court to weigh in on the need to protect the public by preventing lay control of medical practice. We are not seeking monetary damages, this is for you and our patients.

A key aspect of this filing is a challenge to Envision’s use of a sham professional association owned by a corporate physician executive to skirt the intent of the CPOM prohibition. We plan to argue that it is actually Private Equity (Kravis, Kohlberg and Roberts) that owns and controls the contract and believe the evidence will support that contention. In the recently concluded case of Brovont vs EmCare (2) it was revealed that Dr. Gregory Byrne, a former Texas ACEP President, admitted to holding 275-300 professional entities in 20 states at any given time to enable this scheme. Doctors are allowing their licenses to be used to aid and abet the CPOM. Sadly, other EM physicians have also been complicit in the corporate takeover of our specialty. In fact, EmCare, the forerunner to Envision, was founded by Leonard Riggs, MD the 1980 President of ACEP.

All those who have drank the Koolaid that Private Equity is “good for EM” because they can help us fight the insurers had better look in the mirror. The alignment with PE by major EM organizations has severely tarnished our reputation with the public and Congress. Disturbingly, many now see us as greedy. Furthermore, the insurers via Sound Physicians owned by Optum a subsidiary of United Healthcare already own EM practices. If we don’t take up the banner of CPOM just how do the PE apologists propose will we stop Optum/UHC or other insurers from owning us?

Our patients, our specialty. Now is the time for ALL of the bedside doctors to stand up and rally behind the AAEM. Let us not relegate the future of EM to control by Wall Street and the insurance industry. Any EM doc who is not a corporate leader should join AAEM now. Thank you to those who already have.



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