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Ethicon Media Monitoring 5/14/2018
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Gynecological Mesh: The medical device that has 100,000 women suing
May 14, 2018 | CBS News
By Scott Pelley
There is tremendous controversy about a surgical device implanted in more than two million American women. -
AUGS Responds to 60 Minutes on Mesh
May 11, 2018 | Mesh Medical Device Newsdesk
By Jane Akre
AUGS recently became aware that, on Sunday, May 13th, “60 Minutes” will be airing a segment on mesh injuries. -
Our perspective on the "60 Minutes" report on transvaginal mesh
May 13, 2018 | Boston Scientific
At Boston Scientific, our top priority is ensuring that all our products are safe and effective. We remain steadfast in our commitment to women’s health. -
60 Minutes to speak to Boston Scientific in coverage of pelvic mesh MDL
May 11, 2018 | Mass Device
By Fink Densford
CBS’s 60 Minutes will speak to Boston Scientific (NYSE:BSX) this week as the news program covers the massive multi-district litigation over gynecological pelvic mesh implants. -
How Wales plans to help nearly 7,000 women who have had a vaginal mesh
May 11, 2018 | Wales Online
By Mark Smith
Vaginal mesh or tape should only be used “as a last resort”, a report has recommended, after it was discovered more than 400 patients in Wales have had it removed over the past decade. -
How a Web of Slip-and-Fall Cases Puts a New Spin on an Old-Fashioned Scheme
May 11, 2018 | New York Times
By Matthew Goldstein and Jessica Silver-Greenberg
It sounded like an old school slip-and-fall scam with a modern-day financial twist.
Client Attorney Privileged/Attorney Work Product/At Request of Counsel
Online Sources
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Gynecological Mesh: The medical device that has 100,000 women suing
May 14, 2018 | CBS News
By Scott Pelley
There is tremendous controversy about a surgical device implanted in more than two million American women. It's a strip of plastic called gynecological mesh. The manufacturers and several medical societies say the implant is safe. But more than 100,000 women are suing. And together, they make up the largest multi-district litigation since asbestos. One of the largest manufacturers of gynecological mesh is Boston Scientific, a medical device maker with $9 billion in sales. Millions of patients benefit from its pacemakers, stents and other devices. But Boston Scientific has attracted 48,000 lawsuits which claim that its mesh can inflict life-altering pain and injury.
urgeons use Boston Scientific's gynecological mesh like a sling to relieve urinary incontinence and to lift organs that shift after pregnancy. Gwyn Madsen had a Boston Scientific implant in 2012.
Gwyn Madsen: It felt like a cheese grater inside of me.
Like thousands of others who have filed suit, she says she suffered pain, which in her case, left her hardly able to sit or play with her children.
Gwyn Madsen: It felt like the material was pulling on the muscles and I'd get shooting pains you almost felt like there was something inside of you that was like sandpaper back and forth, every time you'd walk.
Boston Scientific has fought allegations like Gwyn Madsen's for years. They declined an interview for our story but the company told us, "Nearly one million women have been successfully treated… We have extensively tested the [plastic] resin to confirm its composition, safety and performance." The American Urogynecological Society has also said that plastic mesh is "safe and effective." But that's not what many doctors are finding.
Dr. Michael Margolis: The mesh causes a chronic inflammatory reaction.
Dr. Michael Margolis is a surgeon who has removed 350 mesh implants. He's been a witness in lawsuits against Boston Scientific.
Dr. Michael Margolis: The slings I've removed are substantially altered in their architecture. They are shrunk by at least 50% in width; they are encased in scar tissue. The pores here, these openings here are shrunk substantially.
Dr. Margolis recently removed this type of Boston Scientific mesh. It had been implanted in his patient for life, but after two years, it looked like this.
Dr. Michael Margolis: It was folded, it was contracted, it was embedded in scar tissue, it was choking off the urethra. It was 50% the size of its original implant. I measured it, as I always do.
Scott Pelley: These are things that are not supposed to happen?
Dr. Michael Margolis: Of course not. This implant is not supposed to change.
The mesh is made of a plastic called polypropylene, a common material in packaging. Boston Scientific had clearance from the FDA to use a brand of polypropylene called "Marlex" made in Texas by a subsidiary of Chevron Phillips. But in 2004, Chevron Phillips became concerned about medical use of Marlex. It issued a warning that it must not be used for "permanent implantation in the human body." Duane Priddy is a leading plastics engineer and a fellow of the American Chemical Society.
Duane Priddy: I can't, in my wildest imagination, imagine anybody that's knowledgeable in the science of plastics ever deciding that it was appropriate to use polypropylene in the human body. It's well known that its oxidatively unstable.
Duane Priddy has been a witness in mesh lawsuits, but he is not part of any litigation against Boston Scientific. He explained to us that oxygen breaks up polypropylene. The plastic has antioxidant additives but they dissipate over time.
Duane Priddy: Once those antioxidants are consumed, they're no longer there to do their job, polypropylene will rapidly disintegrate and fall apart.
Scott Pelley: In layman's terms, oxygen eats plastic.
Duane Priddy: That's correct.
In 2005, Chevron Phillips cut off Boston Scientific's supply of Marlex. Later, when Boston Scientific appealed, Chevron Phillips replied, "We are simply not interested in this business at any price." Boston Scientific estimated that it would run out of Marlex by 2012. George Vialle, director of Global Supply Chain wrote, this plastic resin "supports a $120 million in annual revenue… I can not [sic] overstate the importance of getting more." Boston Scientific had to have Chevron Phillips Marlex because that plastic was already accepted by the FDA.
Chris DeArmitt: They looked everywhere. They looked at least 20 different companies all around the world. They were looking for stocks of material.
Chris DeArmitt is a plastics engineer who researched Boston Scientific for one of the women suing the company.
Chris DeArmitt: they really struggled. There was a big panic on because they had a big stockpile. They ran out. And they realized they were gonna have to source more.
That struggle is revealed in company documents that we found in court records. This report shows, in 2010, a second supplier refused to sell polypropylene "for use in medical device." Boston Scientific's global sourcing division decided to use a middleman with "no direct link to BSC" so the plastic makers wouldn't know the true buyer. But that plan failed.
Chris DeArmitt: They're looking for material and they're desperate. They can't find it locally so they find it in China. And they literally say, "We have to be careful here. Some of these look more credible than other ones." They are not convinced that it's real material.
A broker in China, called Emai, said it had tons of Marlex imported from Chevron Phillips in Texas. Boston Scientific's man in China wrote his superiors, "do we need to ask [Emai] if this material is supposed to be used in medical implantable?" Boston Scientific's director of materials management replied, "please don't tell them where we will use it. It could scare them away."
That same month, the FDA issued a damning report. Over five years, the FDA found that mesh supporting organs after pregnancy, had resulted in nearly 4,000 "reports of injury, death, and malfunction" and complications including "pain, infection, urinary problems, bleeding and organ perforation." "Serious adverse events," the FDA said, "are not rare." Now, Boston Scientific had even more reason to believe that if it switched plastics the FDA would require years of tests which might fail. The company's best hope appeared to be the plastic in China but then came the red flags.
Boston Scientific's own procedures required documents and import records that proved that the plastic was Marlex from Texas. But Chinese broker, Emai, didn't have any documents to verify authenticity. Boston Scientific checked the lot numbers on the bags and confirmed through Chevron Phillips, three times, that the numbers were fraudulent. Even the bags were fake. Chevron Phillips says the printing on the counterfeit bag, on the right, is full of errors from the color to the name of the Texas city where Marlex was made. Evidence was mounting that the plastic in China was counterfeit, so Boston Scientific ordered tests to compare it with original Marlex.
Chris DeArmitt: They analyzed 11 different parameters, looking at the two plastics side by side, done, the same tests. Nine of those were different. Two were the same, nine were different. And of those nine that were different, four of those parameters were very different. And somehow, from that, they concluded that it was the same material.
Scott Pelley: How did they come to that conclusion?
Chris DeArmitt: Well, I'm wondering that too. I mean, how can you look at two things side by side and say, "Yes, it's the same stuff."
In an email from the address of Ann Charest, manager for plastics in Boston Scientific's global sourcing division, there's speculation about the Chinese plastic's lack of documents. "It may not have been imported through proper channels" or it may have been "redistributed enough times, the original paperwork has been lost/forgotten…" Facing a deadline, with those test results, no documents and having learned the lot numbers were fake, Charest concludes, "I believe this is the right material." Boston Scientific bought enough of the Chinese plastic to last 30 years. We hired plastics engineer Duane Priddy as an independent consultant to analyze Boston Scientific's own tests of the Chinese plastic. We found the test results in court documents.
Duane Priddy: I would predict a significant difference in the antioxidant stability, or I should say the oxidation resistance of those products in the human body.
Scott Pelley: The Chinese product is inferior?
Duane Priddy: Absolutely. Yes.
Scott Pelley: Is the Chinese product something that you would imagine being placed inside the human body for 20, 30, 40 years.
Duane Priddy: Absolutely not.
Scott Pelley: How long would it likely last?
Duane Priddy: A few months.
Teresa Stevens: I started to have problems right away. I told the doctor while I was in the hospital, I couldn't feel my bladder, I couldn't feel when I had to go.
Teresa Stevens had a Boston Scientific mesh implant in 2014 after the company began using the Chinese plastic.
Teresa Stevens: Sometimes when I went to the doctor, I would have an infection, sometimes when I went I didn't. So, but I was having pain every time I would void. So, a lot of times I would have some blood. So, I knew something was wrong.
In 2016, she had her mesh implant removed by Dr. Michael Margolis who told us the Chinese plastic's lack of documents is a concern.
Dr. Michael Margolis: This is an experimental material. Implantation of this into anyone is human experimentation but without consent. Because this is novel material. We don't know how this affects humans, it's never been tested before.
Chris DeArmitt: I would say the material they're buying maybe is fine for making a park bench. Maybe it's fine for making a disposable cup. But that's a totally different situation when you're looking at something that will be in the body for 40 or 50 or 60 years. There's a whole different level of analysis and confidence that you need. And I don't see that here.
Scott Pelley: The FDA requires Boston Scientific and companies like it to understand every step in the supply chain. In other words, who made the material, who packaged it, who shipped it, et cetera. How much did Boston Scientific understand about that supply chain?
Chris DeArmitt: They don't seem to know where the material is coming from. Nobody knows who the original manufacturer is. Nobody knows and that's a big deal, right? You have to take a record of every lot, was it contaminated? Has it been tested? And they don't know any of those, any of those answers.
Boston Scientific also faced hurdles in getting the 16 tons of plastic out of China. The counterfeit bags were labeled "Texas." But, with no import records, Boston Scientific's man in China wrote, "If we don't get rid of the original bags… if it is caught by customs we will be in trouble." A plan to hide the bags in plain wrappers was approved in an email sent from the address of Charles Smith, a director in Boston Scientific's urology and women's health division. "We can over bag." The email reads. Pictures of the overbagging operation were then distributed to many company executives for their approval. On its declarations, Boston Scientific told the Chinese the plastic was made in China. It told U.S. Customs the plastic was made in the U.S.
Because of lawsuits by Teresa Stevens, Gwyn Madsen, and thousands of others, the FDA looked into Boston Scientific's experience with the Chinese plastic. The FDA declined an interview but wrote, "We… did not find any indication that the change in [plastic] resin led to an increase in adverse events. We have confidence in our… findings."
Scott Pelley: The FDA recently reviewed these same test results and they said that the Chinese mesh, quote, "does not raise new safety or effectiveness concerns." What do you make of that?
Duane Priddy: That's shocking. It's hard for me to imagine somebody looking at that data and generating an opinion that it is acceptable for use in the human body.
Scott Pelley: Is your analysis something that any other expert in plastics would see immediately?
Duane Priddy: Yes.
Scott Pelley: This is not a close call?
Duane Priddy: No.
As we said, Boston Scientific declined an interview but it wrote, "Any allegations continuing to question the integrity or legitimacy of our [plastic] resin are false and irresponsible." We wondered whether Boston Scientific mesh products still contain the Chinese polypropylene smuggled into the United States, so we purchased 15 Boston Scientific mesh kits and sent them to a leading plastics lab. All of them matched the Chinese plastic.
Produced by Oriana Zill de Granados and Michael Rey
https://www.cbsnews.com/news/boston-scientific-gynecological-mesh-the-medical-device-that-has-100000-women-suing/
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AUGS Responds to 60 Minutes on Mesh
May 11, 2018 | Mesh Medical Device Newsdesk
By Jane Akre
AUGS recently became aware that, on Sunday, May 13th, “60 Minutes” will be airing a segment on mesh injuries. We know that some of the content will include interviews with patients; beyond that, we don’t know what to expect. We should be prepared, however, for a public reaction, and another layer of anxiety that our patients bring with them into our offices. I wrote recently to provide an update about international activity in the mesh arena, in an effort to provide some clarity to our members as to what is, and what is not, changing on the international stage. But even here at home, there continues to be new echoes of the anxieties surrounding mesh.
Many of you will be aware of the New York Times (NYT) article from April 15 entitled, “How Profiteers Coax Women into Surgery.” Although we have been aware of it for some time now, the NYT shone a spotlight onto the practice, by some physicians, of accepting payment directly from legal firms to perform surgery with the primary goal of bolstering a legal suit against the manufacturer, even in cases where clinical indications are not met. AUGS decries this practice, as such triangulation introduces significant bias, and corrupts the fiduciary responsibility we hold for our patients. However, this difficult story casts further confusion into the conversation about mesh for pelvic floor repairs.
As surgeons we should endeavor to educate our patients, as part of the informed consent process about the risks of a planned procedure including any implanted devices.
https://www.meshmedicaldevicenewsdesk.com/augs-responds-to-60-minutes-on-mesh/
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Our perspective on the "60 Minutes" report on transvaginal mesh
May 13, 2018 | Boston Scientific
At Boston Scientific, our top priority is ensuring that all our products are safe and effective. We remain steadfast in our commitment to women’s health.
We reject the allegations made by “60 Minutes” which claimed our transvaginal mesh products contain counterfeited and smuggled materials. These claims are completely false.All of our products meet rigorous internal safety standards as well the standards of the FDA and other regulatory bodies. Leading physician societies have issued supporting statements on mesh, and the American Urogynecologic Societyrecently shared its perspective.At Boston Scientific, our top priority is ensuring that all our products are safe and effective. We remain steadfast in our commitment to women’s health.
Providing safe, effective treatment options for women
The majority of patients have benefited from our innovations and we remain dedicated to offering safe and effective products to help treat these and other conditions. We have and will continue to do what is right for patients.
One in three women globally is affected by a pelvic floor disorder. We recognize it is in the best interest of all to ensure that products are properly tested, safe and effective for patients who need them. In September 2017, the FDA completed a thorough review and concluded that the change in our resin supplier did not raise any new safety or effectiveness concerns.
Advancing important treatment options
We continue to invest in studies to provide the medical community with additional clinical evidence to support ongoing treatment decisions. There are more than 60 clinical publications available in support of our pelvic floor products. We currently have three 522 post-market clinical studies ongoing in the U.S. There are an additional 14 investigator-sponsored research studies on our pelvic floor products underway.
These mesh products contribute to only one percent of sales to Boston Scientific annually, so this is not about profits. It is about doing what is right for patients who have few treatment options for these debilitating conditions.
http://www.bostonscientific.com/en-US/medical-specialties/female-pelvic-medicine/perspective-on-60-minutes-vaginal-mesh-report.html
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60 Minutes to speak to Boston Scientific in coverage of pelvic mesh MDL
May 11, 2018 | Mass Device
By Fink Densford
CBS’s 60 Minutes will speak to Boston Scientific (NYSE:BSX) this week as the news program covers the massive multi-district litigation over gynecological pelvic mesh implants.
The program referred to the multi-district litigation over the implants as the largest such litigation since asbestos, according to a press release.
In early 2016, the FDA reclassified surgical meshes to treat pelvic organ prolapse in women as a Class III device, moving it up from a Class II classification.
Research has indicated that meshes used transvaginal procedures to treat pelvic organ prolapse can lead to complications including mesh erosion, pain, organ perforation, urinary issues and bleeding and infection.
60 Minutes will be speaking to Marlborough, Mass.-based Boston Scientific about the 48,000 lawsuits they’re facing, according to the release, nearly half of the more than 100,000 women who’ve filed suit against mesh makers. The episode is slated to air at 7:00 p.m. EDT on Sunday.
In February, Boston Scientific lost another bid as looking to overturn an $18.5 million loss in a product liability suit over alleged injuries caused by its Obtryx pelvic mesh.
https://www.massdevice.com/60-minutes-to-speak-to-boston-scientific-in-coverage-of-pelvic-mesh-mdl/
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How Wales plans to help nearly 7,000 women who have had a vaginal mesh
May 11, 2018 | Wales Online
By Mark Smith
Vaginal mesh or tape should only be used “as a last resort”, a report has recommended, after it was discovered more than 400 patients in Wales have had it removed over the past decade.
The Welsh Government, which set up a group to review the use of mesh , says patients should only be given the treatment when all other options have been exhausted.
Women across the UK have suffered serious complications as a result of having the polypropylene mesh inserted into them.
The implants, which include different types of plastic tape and slings, are used to ease incontinence and support the vagina, uterus, bowel, bladder or urethra which have prolapsed after childbirth.
Some have been left in permanent pain and unable to walk, work or make love to their partners.
Between 2007-08 and 2017-18, 6,859 patients had a vaginal mesh or tape procedure in Wales, with 426 having it removed and 10 experiencing “over-sewing” which needed repairing.
The new report has recommended that an “innovative new care pathway” be set up for these patients involving physiotherapy, pain management and, where appropriate, psychological therapy.
Speaking in the Senedd on May 8, Health Secretary Vaughan Gething said: “We need to have a fundamental change in the way that the NHS supports women with pelvic health problems, moving to a focus on prevention and conservative therapies, with surgical intervention as a last resort.
“At the same time we need to ensure there is early access to specialist support for those with treatment complications to prevent the worst outcomes.
“I’ve made funding of up to £1m a year available to support the improvements needed.
“There will, of course, be much that can be done within existing resources, through service redesign and potentially the shift of services from hospitals to communities, to ensure that a community-based pelvic health and wellbeing pathway is put in place in each health board across Wales.”
Mum-of-three Carolyn Churchill, from Nantgarw , had a mesh implanted into her in a bid to combat her stress incontinence – a condition which affects as many as 10% of women.
She said it left her in agonising pain, stopped her walking properly, and ruined a 14-year relationship with her partner.
The 58-year-old, who finally had the mesh removed in 2016 after six years of “torture”, said she was calling on the NHS to ban them.
“I feel absolutely traumatised by it all,” she said.
“I was left in horrendous pain. I was unable to walk properly, I couldn’t lie on my side for five years and I couldn’t bend as all the movement from my waist down was restricted.
“I’ve given birth to three children naturally and I would rather go through that 10 times over than go through the pain of the mesh again.”
Janet Finch-Saunders AM has called on the Welsh Government to implement a ban on the use of vaginal mesh.
She has also requested that Mr Gething undertakes a full audit into the effects of the implant which has caused such controversy.
She said: “I am aware of a number of patients who have had been treated with this mesh, or tape – almost as a ‘quick-fix’ measure – and experienced considerable pain and discomfort some months or years afterwards. In some cases it has become quite debilitating – severely impacting on their day-to-day life.
“My worry here is that the report simply doesn’t address the concerns raised by patients – many of whom have actually called for a ban in the use of this mesh.
“I do welcome some of the recommendations of the report in terms of the improved services for pelvic pain in health boards across Wales.
“However I am concerned that north Wales residents with more complex mesh complications will still be forced to travel to Manchester in the absence of the relevant uro-gynaecologist and urology specialists.
“I will continue to press the Welsh Government on improved recruitment and retention of specialist medical staff for north Wales.”
Owen Smith MP, chairman of the All-Party Parliamentary Group (APPG) on Surgical Mesh Implants, said: “The report asserts that 6.4% of women who have undergone mesh surgery in Wales have later had to have the mesh removed or repaired.
“This figure is significantly higher than previously thought and suggests that the proportion of women who suffer some form of complication after mesh surgery could be much higher.
“I would therefore urge the Welsh Government to now conduct a retrospective audit of mesh procedures and commit to undertaking a full prospective registry so we may have a better understanding of just how many women are suffering following mesh surgery.”
https://www.walesonline.co.uk/news/health/over-400-women-wales-forced-14640998
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How a Web of Slip-and-Fall Cases Puts a New Spin on an Old-Fashioned Scheme
May 11, 2018 | New York Times
By Matthew Goldstein and Jessica Silver-Greenberg
It sounded like an old school slip-and-fall scam with a modern-day financial twist.
Neighborhood scouts lined up victims willing to fall in potholes or deliberately trip outside of restaurants, bodegas and dry cleaners. Doctors treated patients for broken limbs, busted knees and internal injuries, including some that were fake. Sometimes they performed unnecessary procedures that drove up the potential value of the personal injury lawsuits that followed.
Lawyers filed those suits in state courts. Behind the scenes, their fees and the doctors’ were “usually paid for” by specialized finance firms, which provide high-interest loans to plaintiffs.
A federal indictment, which laid out those details, portrays a complex scheme, a sort of insurance fraud on steroids that lasted for five years and cost insurers and property owners $32 million. A group of five men orchestrated the fraud, recruiting people to stage so-called slip-and-fall accidents, and then organizing the legal and medical appointments that followed, the indictment says. Along the way, the group enlisted doctors, lawyers and finance companies.
Federal prosecutors in Manhattan have charged the five men with carrying out “a widespread mail and wire fraud scheme.” No doctors, lawyers or finance companies have been accused of wrongdoing. It is possible that the finance firms and other players were unwitting partners in the activities.
The indictment offers insight into the unregulated and opaque world of the litigation-finance business.
Such finance firms, many of them backed by hedge funds and private equity companies, typically bankroll lawsuits with large cash advances. The goal is to profit on the advances, some of which come with interest rates as high as 100 percent, from the proceeds of any settlements or jury verdicts.
But the level of due diligence performed by the firms before providing the cash advances is unclear. According to the authorities, one of the men who orchestrated the fraud “assisted in procuring the funding” for the plaintiffs’ medical treatment and “fraudulent lawsuits,” contacting the finance firms via email and cellphones. In one instance, he illegally used another person’s identification to “obtain the litigation loans.”
Starting late last year, federal authorities issued subpoenas to doctors, lawyers and several litigation firms, although it is not clear exactly what prompted the investigation. The findings, which are still being sorted through, led to the indictment.
The primary litigation-finance firm involved in the scheme was Fast Trak Legal Funding, according to four people familiar with the indictment who were not authorized to talk about nonpublic aspects of the case.EDITORS’ PICKSOn Social Media’s Fringes, Extremism Targets WomenA Simple Way to Improve a Billion Lives: EyeglassesAn Orchestra Adopts a City, One Kid at Time
Fast Trak, which is based in New Jersey, operates throughout the metropolitan New York area and has received financing in the past from Victory Park Capital, a private equity firm in Chicago, and J. Burke Capital, a Manhattan investment firm. Fast Trak was among the entities subpoenaed in the investigation.
A lawyer for Fast Trak, Larry Hutcher, said the firm had done nothing wrong and had potentially lost money through its involvement with the suits connected to the indictment.
“Our client has nothing to hide and is fully cooperating,” Mr. Hutcher said.
“Our client is confident that they have acted properly in all cases and in all instances,” he added. “If there was a fraud, we are a victim of this fraud.”
Several websites that Fast Trak has used to recruit customers have been inoperable for over a week. Mr. Hutcher said that the firm was still collecting on cases it had financed previously, but would not be financing new cases under the Fast Trak name. He said the move was unrelated to the indictment.
Unfettered by regulation in most states, litigation-finance firms have become entangled in past disputes. Some firms are being challenged for making high-interest advances to former professional football playerswaiting to collect awards in concussion litigation with the N.F.L.
Other firms worked with a cadre of doctors, lawyers and marketers in litigation involving pelvic mesh, paying for procedures for women involved in so-called mass tort cases against medical device manufacturers. Some women have said they were pressured into surgeries to remove pelvic mesh implants so that the lawsuits would be more lucrative.
The alleged slip-and-fall scheme has echoes of that approach. In the indictment, the authorities accuse the group of men of telling people that their personal injury suits would be dropped if they did not get medical treatments or surgeries. As an incentive, the people were “offered a payment after the completed surgery.”
One of the men indicted in the case is Peter Kalkanis, a 70-year-old former chiropractor who lost his license to practice in 2013 after a misdemeanor conviction for larceny.
In the indictment, prosecutors said Mr. Kalkanis, who is charged with conspiracy, mail fraud and wire fraud, was the scheme’s “organizer and leader.” He is accused of working with four younger men who acted as “scouts,” recruiting plaintiffs and helping to transport them to appointments with doctors.
The group also coached the plaintiffs on how to fake their injuries convincingly, according to prosecutors. Mr. Kalkanis, the prosecutors contend, also connected the plaintiffs with the litigation-finance firms.
Slip-and-fall cases are common in large cities, and the business of litigating such claims has a long history of abuse, with insurance companies spending large sums of money to detect fraud. But federal authorities say that the conduct they uncovered in this instance was more brazen than typical personal injury schemes.
In an unusual move, prosecutors identified eight doctors and lawyers by name in a court document, and specified that the defendants in the case should not contact them without their counsel present. It is unclear why the authorities attached the condition to the defendants’ bail; the doctors and lawyers in question are not accused of wrongdoing.
The extent of the alleged fraud and the network of players involved may not yet be fully known. Court filings and interviews with three people familiar with the indictment suggest that others connected to the alleged scheme are already cooperating with prosecutors and that hundreds of personal injury lawsuits could be at issue.
Defense lawyers who represent insurance companies have begun scouring their files in search of cases that may be connected to the alleged scheme. Christopher Fusco, a lawyer whose firm mainly represents insurers, said he found at least eight cases that seem suspicious because of the lawyers and doctors involved.
“While I can’t comment on specific litigation, if fraud is suspected in a case, we may move for a stay while the criminal allegations play themselves out,” Mr. Fusco said.
James Monroe, another lawyer who represents plaintiffs, said his firm was trying to get out of a number of cases it had recently taken on from one of the lawyers identified by prosecutors.
Prosecutors have not identified specific lawsuits as bogus. But a review of personal injury cases filed by two of the lawyers named by prosecutors — Marc Elefant and George Constantine — include some with plaintiffs who have checkered backgrounds.
In one case, a woman testified in a deposition that she had previously been convicted of driving the getaway car in an armed robbery. In another, the plaintiff said he had served time in state prison for murder.
Michael Bachner, a lawyer for Mr. Elefant, said his client “provided legal services only for clients he appropriately believed under all the circumstances were injured in accidents.”
Mr. Constantine, who mainly practices in State Supreme Court in Queens and has filed dozens of slip-and-fall suits in New York state courts, did not return repeated requests for comment.
Edward Sapone, a lawyer for Mr. Kalkanis, said his client “trusted that attorneys and funding companies carefully vetted the lawsuits.” Mr. Kalkanis, he added, “trusted that surgeons reviewed objective tests and looked inside injured bodies.”
The authorities have provided the defendants with emails, boxes of documents and several consensually recorded phone calls, presumably made by cooperating witnesses, said two of the people familiar with the matter who were not authorized to speak about information that has not been made public.
As prosecutors move ahead with their case, some of those cited in the court filings continue to go about their business. On Tuesday, Mr. Constantine was in a Queens courtroom. He was arguing against an insurance company in a slip-and-fall lawsuit.
Correction: May 12, 2018
Because of an editing error, an earlier version of this article misstated whose lawsuits litigation-finance firms support with large cash advances. It is plaintiffs’ suits, not defendants.
Reporting was contributed by Robert Gebeloff
https://www.nytimes.com/2018/05/11/business/dealbook/how-a-web-of-slip-and-fall-cases-puts-a-new-spin-on-an-old-fashioned-scheme.html
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