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CONCURRENT RESOLUTION
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WHEREAS, Barbara Stegall, individually and as representative |
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of the estate of Joe Stegall, alleges that: |
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(1) in the spring of 2014, Joe Stegall began |
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experiencing fevers and a feeling of being unwell; |
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(2) Mr. Stegall was employed as the chief financial |
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officer for the City of Royse City, Texas, and as a city employee, |
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was eligible for, and participated in, the city's medical and |
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prescription drug insurance provided by the Texas Municipal League |
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and TML MultiState Intergovernmental Employee Benefits Pool, Inc.; |
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(3) the Texas Municipal League and TML MultiState |
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Intergovernmental Employee Benefits Pool, Inc., provided medical |
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and prescription drug coverage to Joe and Barbara Stegall, and UMR, |
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Inc., was the third-party administrator; |
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(4) in May 2014, Mr. Stegall felt ill, and was taken to |
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the hospital by Mrs. Stegall and was admitted, examined, and |
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informed that he had cholangiocarcinoma, more commonly known as |
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bile duct cancer; |
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(5) Mr. Stegall returned home to form a treatment plan |
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with his oncologist, Dr. Ahmer Younas at Texas Oncology in Rowlett, |
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Texas, and made an appointment with a second oncologist, |
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Dr. Douglas Orr at Texas Oncology in Dallas, Texas; |
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(6) in subsequent appointments, Dr. Younas and |
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Dr. Orr advised Mr. Stegall that he had cholangiocarcinoma, bile |
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duct cancer, and hepatocellular carcinoma, liver cancer; |
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(7) Dr. Younas advised Mr. Stegall to start |
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chemotherapy for the bile duct cancer first and add another form of |
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chemotherapy for the liver cancer at a later date, and Mr. Stegall |
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promptly began a chemotherapy regimen of gemcitabine and cisplatin |
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to treat the bile duct cancer; |
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(8) as a result of the positive response Mr. Stegall |
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exhibited to chemotherapy, on October 23, 2014, Dr. Younas |
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recommended that Mr. Stegall add to his chemotherapy regimen |
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another drug that would target the liver cancer; |
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(9) Dr. Younas prescribed sorafenib, known in the |
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United States by the brand name Nexavar, in tablet form to treat the |
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liver cancer, and sought authorization for the drug from the Texas |
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Municipal League and TML MultiState Intergovernmental Employee |
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Benefits Pool, Inc.; |
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(10) Nexavar is FDA-approved for the treatment of |
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hepatocellular carcinoma, from which Mr. Stegall suffered, and |
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Nexavar increases the survival rates and life expectancy of |
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patients with advanced liver cancer; |
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(11) the Texas Municipal League and TML MultiState |
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Intergovernmental Employee Benefits Pool, Inc., refused to |
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authorize the drug for Mr. Stegall, and on October 30, 2014, a |
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written denial signed by Carol Padgett, RN, BSN, CCM, Medical |
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Intelligence Care Management, on TML MultiState Intergovernmental |
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Employee Benefits Pool, Inc., letterhead was sent to Mr. Stegall, |
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at the address of Texas Oncology, citing as the basis for the denial |
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that, "The requested service was determined to be unproven."; |
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(12) Dr. Younas persisted in efforts to obtain |
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chemotherapy for Mr. Stegall and engaged in a telephone conference |
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with Dr. Philip Schulman, an employee or agent of the Texas |
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Municipal League, TML MultiState Intergovernmental Employee |
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Benefits Pool, Inc., or UMR, Inc.; |
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(13) Dr. Younas learned that Dr. Schulman, and by |
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extension, the Texas Municipal League, TML MultiState |
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Intergovernmental Employee Benefits Pool, Inc., and UMR, Inc., did |
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not believe that Mr. Stegall had liver cancer; |
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(14) due to the urgency of Mr. Stegall's need, |
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Dr. Younas and his staff immediately began efforts to procure |
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Nexavar for Mr. Stegall without insurance and at no cost to |
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Mr. Stegall through a Resources for Expert Assistance and Care |
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Helpline program; |
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(15) the Texas Municipal League and TML MultiState |
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Intergovernmental Employee Benefits Pool, Inc., acted |
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intentionally to discourage Mr. Stegall from obtaining Nexavar; |
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(16) on November 5, 2014, PMC Multistate Case Manager |
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Carol West, an employee or agent of the Texas Municipal League, TML |
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MultiState Intergovernmental Employee Benefits Pool, Inc., or UMR, |
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Inc., advised Dr. Younas's staff that the Texas Municipal League |
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and TML MultiState Intergovernmental Employee Benefits Pool, Inc., |
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would terminate all of Mr. Stegall's future coverage if he took |
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Nexavar and experienced complications from it; |
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(17) the communication caused Mr. and Mrs. Stegall to |
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believe that the Texas Municipal League and TML MultiState |
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Intergovernmental Employee Benefits Pool, Inc., were looking for |
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reason to cease payment for Mr. Stegall's treatment, and that any |
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attempt to circumvent coverage decisions by the Texas Municipal |
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League and TML MultiState Intergovernmental Employee Benefits |
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Pool, Inc., would be met with immediate termination of all |
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benefits; |
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(18) the attempt of the Texas Municipal League and TML |
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MultiState Intergovernmental Employee Benefits Pool, Inc., to |
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cease coverage for Mr. Stegall's treatment, and allow his death, |
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had a devastating impact on Mr. Stegall's demeanor and spirit, and |
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caused both Mr. and Mrs. Stegall severe mental distress; |
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(19) on November 11, 2014, Dr. Younas's staff was |
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contacted regarding difficulties verifying the status of |
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Mr. Stegall's insurance coverage, and Dr. Younas's office |
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responded by resubmitting the authorization request for Nexavar to |
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confirm the absence of coverage; |
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(20) on November 21, 2014, the Texas Municipal League |
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and TML MultiState Intergovernmental Employee Benefits Pool, Inc., |
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suddenly and without explanation, reversed course and authorized |
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the Nexavar; |
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(21) the coverage decision was conveyed in a telephone |
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call initiated by Dr. Younas's office, and the Texas Municipal |
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League and TML MultiState Intergovernmental Employee Benefits |
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Pool, Inc., did not take any affirmative steps to notify |
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Mr. Stegall of its change in decision; |
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(22) for Mr. Stegall and his family, the reversal came |
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too late, and over the course of four excruciating weeks, during |
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which time Mr. Stegall, Dr. Younas, and Dr. Younas's staff worked |
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tirelessly to obtain the Nexavar, Mr. Stegall's condition |
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worsened; |
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(23) Mr. Stegall was admitted to the hospital on |
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Friday, December 12, 2016, where he died four days later; |
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(24) the Texas Municipal League and TML MultiState |
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Intergovernmental Employee Benefits Pool, Inc., and its agents, |
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including UMR, Inc., denied Mr. Stegall access to Nexavar both |
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directly by denying coverage and indirectly by threatening to end |
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all coverage if he obtained Nexavar without the approval of Texas |
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Municipal League and TML MultiState Intergovernmental Employee |
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Benefits Pool, Inc., or UMR, Inc., thus denying Mr. Stegall |
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coverage to which he had a contractual right, as well as the medical |
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benefits of timely access to the Nexavar; |
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(25) the wrongful and intentional acts of the Texas |
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Municipal League, TML MultiState Intergovernmental Employee |
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Benefits Pool, Inc., and UMR, Inc., ultimately caused Mr. Stegall's |
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premature death on December 16, 2014, at the age of 60; |
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(26) the actions of the Texas Municipal League, TML |
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MultiState Intergovernmental Employee Benefits Pool, Inc., and |
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UMR, Inc., demonstrate gross negligence and a wilful intent to |
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deprive Mr. Stegall of the benefits of his coverage and of his life |
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for the sake of financial economy; and |
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(27) the Texas Municipal League, TML MultiState |
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Intergovernmental Employee Benefits Pool, Inc., and UMR, Inc., must |
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be held liable; now, therefore, be it |
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RESOLVED by the Legislature of the State of Texas, That |
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Barbara Stegall is granted permission to sue the Texas Municipal |
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League, TML MultiState Intergovernmental Employee Benefits Pool, |
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Inc., and UMR, Inc., for wrongful death, negligence, breach of |
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contract, breach of the duty of good faith and fair dealing, and |
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violations of the Texas Insurance Code and Texas Deceptive Trade |
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Practices-Consumer Protection Act, subject to Chapter 107, Civil |
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Practice and Remedies Code; and, be it further |
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RESOLVED, That if Barbara Stegall is successful in proving |
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her allegation against the Texas Municipal League, TML MultiState |
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Intergovernmental Employee Benefits Pool, Inc., and UMR, Inc., |
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Mrs. Stegall is entitled to an award of actual, compensatory, and |
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statutory damages and reasonable attorney's fees and costs |
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authorized by law; and, be it further |
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RESOLVED, That the suit authorized by this resolution shall |
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be brought in Dallas County; and, be it further |
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RESOLVED, That the attorney general, the Texas Commissioner |
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of Insurance, the executive director of the Texas Municipal League, |
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and the chairman of the board of TML MultiState Intergovernmental |
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Employee Benefits Pool, Inc., be served process as provided by |
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Section 107.002(a)(3), Civil Practice and Remedies Code. |