Judge Richard Story, U.S. District Court for the Northern District of Georgia (Photo: John Disney/ALM)

A surgeon and his practice have been ordered to pay almost $9,000 in fees related to a discovery dispute in a case a defense lawyer said throws a harsh light on the interaction between personal injury lawyers, healthcare providers and litigation funders. Spine Center Atlanta and its co-founder, Dr. James Chappuis, are not named parties in the litigation playing out in the U.S. District Court for the Northern District of Georgia, but their marketing, business model and communications with the plaintiffs lawyers in this and other cases have become a focal point of the case. The underlying litigation involves injuries suffered by Kelly Shure, now 40, who fell on ice-slicked steps when a handrail at a Marietta apartment complex broke as she leaned on it in 2014. motion McMickle, Kurey & Branch “Importantly, Dr. Chappuis and Spine Center Atlanta are not typical hometown doctors providing care to long-established patients. Nor are they surgical specialists receiving referrals primarily from fellow physicians,” the motion said. Rather, in conjunction with plaintiffs counsel, “they specialize in helping personal injury patients maximize their recovery” and are more analogous to medical funding companies whose relationships with testifying doctors should be disclosed to a jury. Chappuis and Spine Center had been represented by Jeffrey Daxe and G. Bowie Link of Moore Ingram Johnson until last week. But on July 17—four days after U.S. District Judge Richard Story levied the $8,970 fee award—they were replaced by a team of Dentons lawyers including, former Georgia Attorney General Thurbert Baker and fellow partners Nathan Garroway and Mark Trigg, and managing associates Mark Silver and Uchenna Ekuma-Nkama. On Monday, Baker provided a statement to the Daily Report defending Chappuis and Spine Center Atlanta, arguing that patients are the ultimate beneficiaries of their practices. "The fact that SpineCenterAtlanta cooperates in a helpful and highly-professional manner with its patients' attorneys, when applicable, has absolutely no bearing upon the quality of medical care provided to its patients," the statement said. "Dr. Chappuis and SpineCenterAtlanta remain strongly committed to their mission of providing the best possible medical care to their patients," it said. "In addition to ensuring the highest level of treatment, SpineCenterAtlanta also assists its patients by offering payment options best-suited to each patient's individual needs." Matthews said he has sought information on Chappuis' operation in several other cases, but the lid was pried open when—in delivering materials responding to discovery requests—a Spine Center employee mistakenly dropped off a package of marketing materials aimed at plaintiffs lawyers. Among the materials was a letter titled “To our Valued Attorney Business Associates” detailing how Spine Center's Personal Injury Department asks for client information including liability and uninsured/underinsured motorist coverage limits and a signed “letter of protection” guaranteeing payment for medical treatment from any resulting settlement or judgment, and regular 30- or 60-day status reports. “We took a deposition with Spine Center's [chief operating officer] and learned that they borrow money from a lender in Las Vegas to finance the treatment they provide,” said Matthews. “We took that material and information to the judge, and we argued that this represents an investment by Spine Center in these lawsuits.” “The court agreed and ordered Spine Center to produce the records we demanded,” he said. “When they didn't, he ordered the records be produced and made them pay our costs in getting them.” Spine Center's pecuniary interest in litigation has been an issue in other cases. In a May 31 opinion, the Georgia Court of Appeals ruled in Stephens v. Castano, A18A0100, that a trial judge should have allowed the jury to hear testimony about the doctor's financial stake in the case. “Dr. Chappuis' financial interest in the outcome of the case is highly relevant to the issue of his credibility and potential bias, as Dr. Chappuis has become an investor of sorts in the lawsuit,” the opinion said. or example, as recognized in the Shure case, many patients would be unable to receive the medical care that they require were it not for the payment options that SpineCenterAtlanta, as well as many other medical practices, offer,” their statement said. Regarding the Court of Appeals order in Stephens, it said, “the fact that a patient has a lien upon his or her potential litigation recovery, a common industry practice, does not turn the patient's litigation into a 'de facto business venture' with the medical provider. The lien does not extinguish the patient's ultimate responsibility for payment of the medical provider's fees and expenses, regardless of the outcome of the litigation, nor does it impact the medical provider's ethical obligations to its patients.” In its statement and court filings, Spine Center noted that the plaintiff, Shure, was not referred to the practice by an attorney, but “self-referred” to Chappuis for treatment. “Dr. Chappuis and SpineCenterAtlanta have always been, and will continue to be, motivated to act in the best interests of their patients at all times, in ensuring that they continue to receive the best medical care possible upon terms their patients can afford,” it said. Additionally, it said, “the trial court did not 'sanction' SpineCenterAtlanta in the Shure case. Rather, it granted a motion to compel certain third-party discovery, which was amended to order the production of significantly less information upon SpineCenterAtlanta's motion for reconsideration, and attorneys' fees assessed in an amount less than a third of the amount requested.” Shure is represented by T. Charles Blaska, Thomas Blaska and Dana Norman of Atlanta's Blaska Law Firm. In an interview, Charles Blaska and Dana Norman said they've been dragged into a dispute over litigation tactics that don't even apply in this case. “Our client made the decision that she needed surgery and found Dr. Chappuis on her own, on the basis of a lien,” said Blaska, noting that his firm has a general policy to refrain from recommending any particular care provider unless it's requested. Norman said Shure was in great pain from the fall and underwent two surgeries. The lawyers said they've also resisted the defense demands for information regarding the relationship with Chappuis and Spine Center in an effort to protect their attorney-client work product. “But there's really not a lot we can do about it because we don't represent Spine Center,” he said. Read Spine Center Atlanta and Chappuis full response below: