Veteran Attorney McAndrews Fights for Trigon Appeal Before Three-Judge Panel

ARLINGTON, VA — With his characteristic repertoire of blistering truths and colorful analogies, ACA General Counsel George McAndrews pulled out all the stops Feb. 24 to convince a federal three-judge appellate panel that insurance giant Trigon Blue Cross Blue Shield conspired to discriminate against doctors of chiropractic. During the hearing in Richmond, VA before the U.S. Court of Appeals for the 4th Circuit, McAndrews presented oral arguments laying out the reasons why he believes the case deserves to be sent back to the district court for trial. "Once in a while, everything needs to default to common sense," McAndrews implored the judges. "To say there is no conspiracy here ignores reality." During the hearing, McAndrews and attorneys for Trigon each had a total of 20 minutes to state their cases and respond to questions from the judges. McAndrews used 14 minutes of his time to present evidence that Trigon had altered the federal government's 1994 guidelines on acute low back pain to remove reference to chiropractic-style spinal manipulation — purely for economic reasons. Trigon's new "referral" guidelines, co-authored by representatives of most of the state's medical physician trade associations and medical schools, effectively directed low back patients away from chiropractors and to pharmaceutical treatment by medical doctors, he said. McAndrews then saved his six remaining minutes to use for rebuttal following Trigon's presentation. "They changed the critical definition of manipulation," McAndrews explained. "The evidence is that they weren't trained in [manipulation]. It was panic time." During their 20-minute presentation, Trigon attorneys contended there was no evidence of a conspiracy and that doctors of chiropractic were paid less than medical doctors because they are not as highly educated. According to Trigon attorneys, a for-profit company such as Trigon has every right to make business decisions that it feels make the best business sense. During his rebuttal time, McAndrews challenged the Trigon attorneys' assertion that doctors of chiropractic are less educated and should therefore make less money than medical doctors. McAndrews explained that, while the medical doctors controlling Trigon base their decisions to discriminate against doctors of chiropractic on monetary issues, professional pride also comes into play. McAndrews quipped that medical doctors/M.D.s see themselves as "Major Deities," but they sneer at other professionals with doctoral degrees, including judges and attorneys who have J.D. degrees, as merely "Just Docs" — a statement that elicited knowing chuckles from the judges. McAndrews concluded by emphatically reiterating that Trigon's and its medical physician co-conspirators' actions constituted medical fraud and were based on "pure economic greed." He reminded the court that every person who has ever been mistreated by under-educated medical doctors for musculoskeletal problems and has had to endure unnecessary pain, surgery or work or social disablement from the mistreatment were silent witnesses to this lawsuit. After the hearing, McAndrews had positive comments about the process. "We were impressed by the depth of knowledge shown by the panel," he said. "It is clear that they carefully read our briefs and were prepared to ask knowledgeable questions about the legal conflict that exists between medical doctors and chiropractic doctors. They questioned both sides fairly and I can only hope that common sense prevails. It appeared that the court was very bothered that the chiropractic doctors were left with no apparent recourse or remedy for a rather apparent series of wrongs perpetrated by Trigon and its co-conspirator medical trade associations." A full courtroom — with many supporters from the chiropractic profession — was on hand to witness this historic event. In addition to McAndrews' legal team, spectators included ACA President Donald J. Krippendorf, DC, ACA Chairman George B. McClelland, DC, ACA Executive Vice President Garrett F. Cuneo, ACA Legal Counsel Tom Daly, ACA Media Spokesperson Jerome McAndrews, DC, Former ACA Chairman Louis Sportelli, DC and ACA Vice President of Communications Felicity Feather Clancy. A decision about the case from the appellate court could be rendered within one to six months after the oral arguments. For a full copy of the appeal brief, click here. In addition, a full transcript of the Feb. 24 oral arguments will be available on ACA's Web site in approximately one week. The National Chiropractic Legal Action Fund (NCLAF) has been established to support ACA's federal chiropractic lawsuits on behalf of the profession. Doctors, patients and other concerned individuals may contribute to the fund by making a donation online or sending a check to NCLAF, P.O. Box 75359, Baltimore, MD 21275.