Brook Feerick Explains Cost Estimate Dispute Central to $1.4M Award in Slip & Fall Case

In a 2018 California slip-and-fall trial on damages against a subsidiary of grocery giant Kroger, life care planner Brook Feerick provides key testimony for the plaintiff on disputed costs of treatment.

The fall required the plaintiff to undergo a shoulder replacement. However, due to complications, she was expected to require a second replacement of the hardware.

With costs of care a key issue in the case, Feerick, a Certified Case Manager and Certified Life Care Planner from San Diego, emphasizes the difference in her methodology as opposed to the defendant’s life care plan.

The patient in this case would require three surgeries, Feerick explains. The first is a biopsy to get cultures, the second to remove the hardware, and the third to replace the hardware. These last two procedures would be performed as inpatient hospitalizations so that Ms. Bartholomew could receive intravenous antibiotics for days once the hardware is removed, and again when it is replaced.

 Feerick says that she drew her estimates of global hospital charges from the VA (Veterans Administration) Reasonable Charge Data  as well as Fair Health data source referring to inpatient hospitalizations. These sources give a daily room and board rate, as well as ancillary care rate. The former is the daily inpatient hospital charge, and the latter the charge for everything else (including nursing care, therapy, supplies, food). Using the 75^th percentile of data as her basis, the care planner added the daily room and board rate to the ancillary care rate, then multiplied by the number of days of plaintiff’s expected stay in the hospital to arrive at her cost estimates. For the prices of the surgeries, the expert used UCR or Usual, Customary, and Reasonable data, which is the standard of practice for her specialty.

The substantial difference between her values and defense life care expert’s estimates of surgical costs were then explored. Feerick points out that the defense expert used the 50^th percentile data point to obtain her figures from UCR data, substantially below the 75^th percentile data point Feerick herself used.

Additionally, the defense used a third source for their computations, called UCR Pay, which was totally unfamiliar to Feerick. This UCR Pay scale was said by the defense to have come from the American Hospital Directory, but the expert could not find anything labeled as such within that directory.

The cost estimates obtained by using the mysterious UCR Pay source resulted in pricing so low that Feerick doubted its veracity. For instance, Feerick estimated the cost of one procedure at $93,000. The defense, using the 50^th percentile data point, estimated it at $63,000. Then, when using the American Hospital Directory and UCR Pay, the defense estimated to the cost to be only $12,477. This, she emphasizes, is for a surgical procedure with surgeon and anesthesia billings, requiring a three-day hospital stay. This amount appears on its face to be extremely low and the expert questions its source.

Freerick speaks to the idea that the sources used for these estimates should be defined better if the numbers are to be accepted. When she investigated the American Hospital Directory’s very low hospital reimbursement estimates, she found that this was due to the inclusion of self-paying patients who do not pay. Because that number equals zero when figured into what hospitals are being reimbursed, it substantially lowers the overall actual reimbursement figures.

Freerick’s understandable and verifiable methods helped sway jurors, who awarded $1.4 million.

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Gary Gansar, MD, is residency trained and Board Certified in General Surgery. He previously served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Mercy Hospital and Touro Infirmary in New Orleans, LA. Dr. Gansar also served as Clinical Instructor and Professor of Surgery at Tulane University. He received his MD and served as Chief Resident at Tulane University Medical School. Dr. Gansar joined AMFS as a consulting medical expert in 2011 and has served as Medical Director since Nov. 2015. In this capacity, Dr. Gansar provides consultation, review and guidance to attorney clients.