Porter Ranch Doctor Wins $3.8M in Anthem Blue Cross Lawsuit

A jury found that a Porter Ranch primary care doctor who was wrongly excluded by Anthem Blue Cross from its provider network sustained damages of about $3.8 million.

Dr. Jeffrey Nordella maintained he was a patient care advocate who angered the insurer with his criticisms of its medical care denials. A Los Angeles Superior Court jury deliberated over the course of three days before finding in his favor on Monday.

"He wanted his patients to have the care he felt they deserved," lawyer Theresa Barta said in her opening statement in the trial on Feb. 26. She told jurors that Blue Cross considered its profits more important than the care of its eight million members in California.

But Blue Cross attorney Kenneth Smersfelt denied Nordella was punished for his advocacy on behalf of patients.

"This case has nothing to do with putting profits ahead of patient care," Smersfelt told jurors. "Blue Cross denied Dr. Nordella for rational business reasons."

Nordella was not board certified when he tried to join the network in 2010 and he was not granted a waiver because there already were more than 130 primary care physicians like him in the surrounding area, Smersfelt said.

Nordella filed his suit in August 2010. He is the medical director of Porter Ranch Quality Care in California, which serves patients in Porter Ranch and Northridge.

Nordella was board certified for emergency medicine in 1998, Barta said. But the attorney said that as her client was preparing to take the second part of a recertification exam in May 2005, his wife Carole was beaten inside the couple's Ventura County home by a man on a two-day crime spree. The 48-year-old woman was pistol-whipped along with the couple's two children. She later died.

The assailant, Toby Whelchel of Thousand Oaks, killed two other people before shooting himself to death inside a  Walmart store in Simi Valley.

Barta said Nordella was a member of the Anthem Blue Cross network for 13 years until he was fired in 2003 for his advocacy on behalf of patients. The physician filed a wrongful termination suit against Blue Cross in 2003 that ended in 2009 in a a settlement in which he received no money, Barta said.

He filed his current suit because Blue Cross continues to hold his patient advocacy philosophy against him and has refused to allow him back into the network, even though all of the other medical care insurers have accepted him, Barta said.

The exclusion by Blue Cross, which has the highest subscriber membership of any medical care insurer in the state, has cost Nordella significant sums of money and denied patients with that carrier the ability to receive his services without paying out-of-network fees, Barta told the jury.

Barta disputed Smersfelt's claims there already are sufficient primary care physicians in the service area of his office. She said there is actually a shortage of doctors like him there.

Smersfelt countered that Nordella's first lawsuit went all the way to the U.S. Supreme Court on appeal and Blue Cross was vindicated in its decision to fire him. He also said Blue Cross is fair in its decision-making.

"These are good people doing their best to do their jobs," he said.