Vicarious liability claims against HMOs.
Health maintenance organizations can be held vicariously vi·car·i·ous
1. Felt or undergone as if one were taking part in the experience or feelings of another: read about mountain climbing and experienced vicarious thrills.
2. liable for their physicians' negligence under several long-standing legal theories.
In a tidal wave tidal wave, term properly applied to the crest of a tide as it moves around the earth. The wavelike upstream rush of water caused by the incoming tide in some locations is known as a tidal bore. of change, corporate America has altered the delivery of health care services in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. through managed health care. Managed care proponents say the system ensures higher quality care at less cost to the patient. But, in practice, patient care has suffered at the expense of increased profits for health maintenance organizations (HMOs) and health care providers.
This reduction in the quality of care has increased the potential for medical negligence. Ironically, when patients are injured by the negligence of managed health care providers, HMOs often deny responsibility, claiming the providers are independent contractors A person who contracts to do work for another person according to his or her own processes and methods; the contractor is not subject to another's control except for what is specified in a mutually binding agreement for a specific job. .
Despite these claims, HMOs can be held vicariously liable for their physicians' negligence under several long-standing legal theories: nondelegable duty by contract, nondelegable duty by statute, joint venture, agency, and apparent or ostensible Apparent; visible; exhibited.
Ostensible authority is power that a principal, either by design or through the absence of ordinary care, permits others to believe his or her agent possesses. agency.(1)
The starting point Noun 1. starting point - earliest limiting point
terminus a quo
commencement, get-go, offset, outset, showtime, starting time, beginning, start, kickoff, first - the time at which something is supposed to begin; "they got an early start"; "she knew from the in any claim against a health maintenance organization is to consider the question: What are HMOs? The answer is simple. HMOs are licensed health care providers.
HMOs contract with, or on behalf of, a "member" or "subscriber." The contract obligates the HMO HMO health maintenance organization.
A corporation that is financed by insurance premiums and has member physicians and professional staff who provide curative and preventive medicine within certain financial, to provide health care or health care services to the member and defines the services provided.
HMOs give services to members several ways. They may hire physicians as employees. They may enter into principal/agent agreements with physicians. Or, increasingly, they may enter into contracts with physicians who are labeled independent contractors.
HMOs wield significant authority over the details of how their physicians provide medical care. The organizations credential their physicians and create provider lists, selecting the doctors from whom their members must seek treatment and to whom they must be referred.
The doctors have little ability to negotiate their fees with HMOs; it's "sign up now or be left in the cold." These "contracts of adhesion" prohibit the doctors from seeking additional compensation from their patients, even when the HMO defaults or refuses to pay.(2)
HMOs generally retain the power to overrule The refusal by a judge to sustain an objection set forth by an attorney during a trial, such as an objection to a particular question posed to a witness. To make void, annul, supersede, or reject through a subsequent decision or action. doctors' decisions on treatment plans. They also control the health care that members receive by imposing financial penalties on doctors who "overrefer" or "overprescribe o·ver·pre·scribe
To prescribe medication excessively. ."
Member handbooks illustrate the control many HMOs have over the delivery of medical care. To receive the health care promised, these handbooks say, members must select primary care physicians (PCPs) from a list of HMO physicians. To obtain specialty care or to be admitted to the hospital, members must be referred by the PCP PCP
2. primary care physician
Pneumocystis carinii pneumonia (PCP) . Otherwise, the patients' medical bills (excluding emergency care as defined and approved by the HMO) will not be covered. Even then, the HMO's medical directors often retain the right to overrule recommended care.
Evidence of control can be found in the HMO's contract with its members, the HMO's contract with its health care providers, the member handbook, advertising brochures, physician lists, claims forms, and financial records detailing the method and amount of payments made to health care providers.
Additional evidence can be obtained through depositions of HMO corporate representatives who know about the contract with the members, the contract with the negligent health care provider, the amount and method of payments made to the HMO by or on behalf of the members, the amount and method of payments made to health care providers, and the HMO's advertising and marketing materials. The HMO medical director also may possess a wealth of knowledge concerning these issues.
Once the legal status and structure of the HMO are understood and the extent of its control over members and health care providers is established, one or more of five legal theories of vicarious liability The tort doctrine that imposes responsibility upon one person for the failure of another, with whom the person has a special relationship (such as Parent and Child, fall into place.
Nondelegable duty by contract
Nondelegable duty by contract is an underused theory of liability in cases against HMOs for their providers' medical negligence. If the duty is nondelegable, the amount of control maintained by an HMO is irrelevant. The HMO can be held vicariously liable pursuant to a nondelegable duty.
This principle holds that an entity that assumes a duty under a contract and then enters into another contract with an independent contractor to perform some or all of that duty is vicariously liable for the negligence of the independent contractors carrying out those duties.(3)
As one court explained--
Holding a particular undertaking to be nondelegable
means that responsibility, i.e., ultimate
liability, for the proper performance of
that undertaking may not be delegated. The
term nondelegable does not preclude delegation
of the actual performance of the task.
"Nondelegable" applies to the liabilities arising
from the delegated duties if breached.(4)
The principle was successfully applied to the health care industry more than three-quarters of a century ago. In the 1922 case of Jenkins v. Charleston General Hospital & Training School, the West Virginia West Virginia, E central state of the United States. It is bordered by Pennsylvania and Maryland (N), Virginia (E and S), and Kentucky and, across the Ohio R., Ohio (W). Facts and Figures
Area, 24,181 sq mi (62,629 sq km). Pop. high court ruled that a hospital's contract with an employer to provide "medical and surgical treatment [to] its employees" was nondelegable.(5)
Rejecting the hospital's attempts to insulate itself by labeling the negligent doctor as an independent contractor, the court held--
The defense of injury by an independent contractor
cannot be maintained. The radiologist
was employed and paid by the defendant to
perform work in discharge of its own contract
and undertaking to diagnose and treat the injury.
Farming out work to be done under a
contract never relieves from the obligation of
the contract. A man cannot avoid his contract
by devolving performance thereof upon a
It is no different for an HMO. It contracts with a patient to provide medical care. It then contracts with physicians to provide the care it must provide the patient. It does not matter if the contract contains the phrase "independent contractor." The HMO cannot escape responsibility by delegating its contractual duties.(7)
Thus, when a doctor negligently performs the duties assigned by contract to the HMO--providing health care--liability attaches to the HMO.
Nondelegable duty by statute
"An employer may generally not delegate the manner of performance of duties imposed by... ordinance or statute."(8) For example, the Supreme Court of Alaska has held that as a matter of public policy, where state law and regulations required acute care centers to provide emergency room physicians to the public, a hospital could not delegate this duty to independent contractor physicians.
Thus, a hospital ... may not shield itself from
liability by claiming that it is not responsible
for the results of negligently performed health
care where the law imposes a duty on the hospital
to provide that health care.
It is the hospital's duty to provide the physician,
which it may do through any means at its
disposal. The means employed, however, will
not change the fact that the hospital will be responsible
for the care rendered by physicians
it has a duty to provide.(9)
Because health maintenance organizations are generally highly regulated by state law, plaintiff lawyers should look for statutes governing HMOs that create a duty as health care providers to provide medical care to members.(10)
In Florida, for example, HMOs are required to obtain "Health care Provider Certificates" in order "to ensure that [they] ... deliver high-quality health care to their subscribers."(11) Further, HMO contracts with subscribers are statutorily defined as contracts "to provide comprehensive health care services."(12) These services are in turn defined as "medical... care... and any other care, service, or treatment of disease, or correction of defects for human beings."(13)
Although no case has construed these statutes, it would appear that an HMO operating in Florida must accept the duty to provide comprehensive health care services, which includes providing medical care. And, as with any other such duty imposed by statute, this duty should be deemed nondelegable.
Close examination of the HMO's contracts with its independent contractors may yield evidence sufficient to establish that the two are doing business as joint venturers.(14) Courts have applied this theory to the health care field to find vicarious liability.(15)
The joint venture theory is an excellent way to show a jury how a health maintenance organization establishes financial disincentives to discourage physicians from providing health care services. The joint enterprise of the HMO providing the patients and the doctors providing the care establishes the community of interest underlying the joint venture.
The theory also illustrates how an HMO controls the medical care to its members. For example, a doctor may decide that a patient needs a diagnostic X-ray, but the HMO usually either decides where the test will be performed or requires the patient to choose from a preapproved list of medical facilities.
The joint venture relationship between an HMO and its doctors is perhaps best illustrated by agreements that provide "capitation CAPITATION. A poll tax; an imposition which is yearly laid on each person according to his estate and ability.
2. The Constitution of the United States provides that "no capitation, or other direct tax, shall be laid, unless in proportion to the census, or fees." These are set fees an HMO agrees to pay a doctor per patient regardless of the frequency or cost of care required. These agreements allow the HMO to limit its financial risk to a predetermined pre·de·ter·mine
v. pre·de·ter·mined, pre·de·ter·min·ing, pre·de·ter·mines
1. To determine, decide, or establish in advance: figure per patient, at the same time also guaranteeing the doctor a steady monthly income.
If the patient is healthy, the HMO and the doctor both make a profit without rendering care. If the patient becomes seriously ill A patient is seriously ill when his or her illness is of such severity that there is cause for immediate concern but there is no imminent danger to life. See also very seriously ill. , however, and requires extensive and expensive medical care, the doctor works at a decreasing hourly rate, and the HMO, by having to pay specialists and hospitals, may spend more than the premium amount paid to provide the care. Thus, both joint venturers experience a loss.
One of the easiest ways to prove vicarious liability is to show that the tortfeasor A wrongdoer; an individual who commits a wrongful act that injures another and for which the law provides a legal right to seek relief; a defendant in a civil tort action. Cross-references
tortfeasor n. was the agent or employee of the defendant acting within the course and scope of the agency or employment when the negligent act occurred.
The Restatement (Second) of Agency [sections] 220 lists 10 factors for determining whether a party is an agent or an employee. All 10 factors need not be shown to demonstrate an agency relationship--the single overriding requirement is control.(16)
As previously discussed, control over the practice of medicine is the sine qua non [Latin, Without which not.] A description of a requisite or condition that is indispensable.
In the law of torts, a causal connection exists between a particular act and an injury when the injury would not have arisen but of the managed care industry.
Apparent or ostensible agency
An entity who represents that another is an employee or agent and thereby causes a third party justifiably to rely on the apparent agent's care or skill is liable to the third party for harm caused by the negligence of the apparent agent.(17) Evidence that can help prove an apparent agency relationship in an HMO case includes--
* HMO advertisements referring to the doctors in the plan;
* lists of approved doctors on HMO stationery given to members;
* signs at the doctor's office proclaiming an association with the HMO;
* patient forms at the doctor's office containing the HMO's name or corporate logo;
* a provision in the HMO plan that requires primary care physicians to select specialists for plan members; or
* the fact that the patient was seen at an HMO clinic.(18)
The patient must have relied on the representations of the agent for a claim to be successful.(19)
There are at least four advantages to bringing claims under the legal theories discussed above. They--
* are based on restatement-recognized or established common law principles available in most or all states;
* can fully compensate victims of malpractice committed by uninsured or underinsured un·der·in·sure
tr.v. un·der·in·sured, un·der·in·sur·ing, un·der·in·sures
To insure under a policy that provides inadequate benefits: Be certain that you are not underinsured against catastrophic illness. doctors;
* can be used in conjunction with comparative fault theories to hold an HMO liable for the negligence of all doctors under contract with it, even if they are not named as defendants;(20) and
* likely will defeat the managed care industry's claims that the Employee Retirement Income Security Act The Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C.A. § 1001 et seq. (1974), is a federal law that sets minimum standards for most voluntarily established Pension and health plans in private industry to provide protection for individuals enrolled in these plans. (ERISA See Employee Retirement Income Security Act.
See Employee Retirement Income Security Act (ERISA). ) pre-empts lawsuits against HMOs for medical malpractice Improper, unskilled, or negligent treatment of a patient by a physician, dentist, nurse, pharmacist, or other health care professional. .(21)
As use of managed care has become widespread in recent years, people have grown frustrated frus·trate
tr.v. frus·trat·ed, frus·trat·ing, frus·trates
a. To prevent from accomplishing a purpose or fulfilling a desire; thwart: and angry with the delivery of health care in this country. Patients resent the loss of control over medical choices and increased difficulty in getting specialty or emergency care that go along with the managed care system. Doctors, too, have become frustrated as HMOs have increased their control over the practice of medicine.
The climate is ripe for corporate accountability. Health maintenance organizations can and should be held liable for the negligence of their doctors. Using the vicarious liability theories discussed in this article, plaintiff attorneys can ensure justice for clients who have been injured by the malpractice of an HMO doctor.
(1.) State and federal lawmakers have considered HMO liability for medical negligence. In 1997, Texas passed several laws regarding the managed care system and HMO liability. See, e.g., TEX (tai epsion chi) A typesetting language developed by Stanford professor Donald Knuth that is noted for its ability to describe elaborate scientific formulas. Pronounced "tek" or the guttural "tekhhh" (the X is the Greek chi, not the English X), TeX is widely used for mathematical book . CIV JUS AQUAEDUCTUS, CIV. law. The name of a servitude which Lives to the owner of land the right to bring down water through or from the land of another, either from its source or from any other place.
2. . PRAC PRAC Practice
PRAC Parks and Recreation Advisory Committee
PRAC Pacific Rim Advisory Council
PRAC Parks and Recreation Advisory Commission
PRAC Petroleum Research Atlantic Canada
PRAC Prison Reform Advocacy Center
PRAC Project Rental Assistance Contract . & REM. CODE ANN. [sections] 88.002(b) (West Supp. 1998) (HMOs are liable for damages caused by their employees, agents, ostensible agents ostensible agent n. a person who has been given the appearance of being an employee or acting (an agent) for another (principal), which would make anyone dealing with the ostensible agent reasonably believe he/she was an employee or agent. , or those over whom they can or did exercise influence or control resulting in a failure to exercise ordinary care).
Several bills introduced in the 105th Congress eliminate ERISA preemption preemption
U.S. policy that allowed the first settlers, or squatters, on public land to buy the land they had improved. Since improved land, coveted by speculators, was often priced too high for squatters to buy at auction, temporary preemptive laws allowed them to acquire of lawsuits against HMOs or provide direct claims against HMOs.
For a discussion of direct claims against managed care entities, see, e.g., Thomas William Malone
Lieutenant Colonel William George Malone (born 24 January 1859 in London, England, died 8 August 1915 at Chunuk Bair in Turkey) served as a soldier in the New Zealand Expeditionary Force. & Deborah Haas Thaler THALER. The name of a coin. The thaler of Prussia and of the northern states of Germany is deemed as money of account, at the custom-house, to be of the value of sixty-nine cents. Act of May 22, 1846.
2. , Managed Health Care:A Plaintiff's Perspective, 32 TORT & INS INS
1. Immigration and Naturalization Service
2. International News Service
Noun 1. INS . L.J. 123 (1996).
(2.) See, e.g., FLA FLA Florida (old style)
FLA Macromedia Flash (file extension)
FLA Flash Files (file extension)
FLA Fair Labor Association
FLA Front Line Assembly . ADMIN. CODE ANN. r. 59A12.002(9) (1995).
(3.) See generally RESTATEMENT (SECOND) OF AGENCY [sections] 214 (1958).
(4.) Atlantic Coast Dev. Corp. v. Napoleon Steel Contractors, Inc., 385 So. 2d 676. 679 (Fla. Dist. Ct. App. 1980).
(5.) 110 S.E. 560,561 (W. Va. 1922); cf. Bagley v. Insight Comm. Co., 658 N.E.2d 584, 586 (Ind. 1995).
(6.) Jenkins, 110 S.E. 560, 562; accord Jar v. University of Miami This article is about the university in Coral Gables, Florida. For the university in Oxford, Ohio, see Miami University.
The University of Miami (also known as Miami of Florida, UM, or just The U , 474 So. 2d 239 (Fla. Dist. Ct. App. 1985), review denied, 484 So. 2d 10 (Fla. 1986); Irving v. Doctors Hosp. of Lake Worth, Inc., 415 So. 2d 55 (Fla. Dist. Ct. App.), review denied, 422 So. 2d 842 (Fla. 1982).
(7.) Cf. Mduba v. Benedictine Hosp., 384 N.Y.S.2d 527, 529 (App. Div. 1976) (holding that emergency room patients "are not bound by secret limitations as are contained in a private contract between the [doctor and] the hospital... [, which] held itself out to the public offering and rendering hospital services").
(8.) Fulton v. Anchor Say. Bank, FSB (FrontSide Bus) See system bus.
FSB - front side bus , 452 S.E.2d 208.214 (Ga. Ct. App. 1994); see also Mastrandrea v. J. Mann, Inc., 128 So. 2d 146, 148 (Fla. Dist. Ct. App.), cert. denied, 433 So. 2d 320 (Fla. 1961); Bagley, 658 N.E.2d 584, 586; cf. RESTATEMENT (SECOND) OF TORTS [sections] 424 (1965).
(9.) Jackson v. Power, 743 P.2d 1376, 1385 (Alaska 1987); cf. Ancata v. Prison Health Servs., Inc., 769 F.2d 700, 705 (11th Cir. 1985).
(10.) See, e.g., 42 U.S.C. [sections] 1395mm(b)(2)(B) & (C) (1994) (including HMOs in the definition of entities eligible to be compensated by Medicare "for the provision of health care services" who "provide physicians' services"); MO. REV. STAT. [sections] 538.205 (4) (Supp. 1997) (including HMOs under definition of health care providers).
(11.) FLA. STAT. ch. 641.48 (1993).
(12.) FLA. STAT. ch. 641.19(6) (1993)
(13.) FLA. STAT. ch. 641.19(2) (1993).
(14.) A "joint venture" is generally defined as a business relationship whose parties maintain most or all of the following: a community of interest in the performance of the common purpose; a joint control or right of control; a joint proprietary interest in the subject matter; a right to share in the profits; and a duty to share in any losses. See, e.g., Tanner Cos. v. Superior Court, 696 P.2d 693, 695 (Ariz. 1985); Arango v. Reyka, 507 So. 2d 1211, 1212 (Fla. Dist. Ct. App. 1987).
(15.) See, e.g., Arango, 507 So. 2d 1211, 1211; cf. Suarez Matos v. Ashford Presbyterian Comm. Hosp., 4 F.3d 47, 52 (1st Cir. 1993).
(16.) Schleier v. Kaiser Found. Health Plan of Mid-Atlantic States Mid-At·lan·tic States
See Middle Atlantic States.
Noun 1. Mid-Atlantic states - a region of the eastern United States comprising New York and New Jersey and Pennsylvania and Delaware and Maryland
U.S.A. , Inc., 876 F.2d 174, 177-78 (D.C. Cir. 1989); Arthur v. St. Peters Hosp., 405 A.2d 443, 445 (N.J. Super. Ct. Law Div. 1979); see, e.g., Mduba, 384 N.Y.S.2d 527, 529; RESTATEMENT (SECOND) OF AGENCY [sections] 220 cmt.d (1958).
(17.) RESTATEMENT (SECOND) OF AGENCY [sections] 267 (1958). The RESTATEMENT (SECOND) OF TORTS [sections] 429 (1965) sets forth an arguably ar·gu·a·ble
1. Open to argument: an arguable question, still unresolved.
2. That can be argued plausibly; defensible in argument: three arguable points of law. looser standard for apparent agency by requiring only a reasonable belief in rather than actual reliance on the representations of agency. See Jackson, 743 P.2d 1376.1380. For simplicity, only the RESTATEMENT (SECOND) OF AGENCY standard is discussed in this article.
(18.) See, e.g., Boyd v. Albert Einstein Med. Ctr., 547 A.2d 1229 (Pa. Super. Ct. 1988); see also McClellan v. Health Maintenance Org., 604 A.2d 1053 (Pa. Super. Ct. 1992).
(19.) See, e.g., Hoffman v. Moore Reg'l Hosp., Inc., 441 S.E.2d 567,570 (N.C. Ct. App.), review denied, 447 S.E.2d 391 (N.C. 1994).
(20.) Cf. United States Sec. Servs. Corp. v. Ramada ra·ma·da
n. Southwestern U.S.
a. An open or semienclosed shelter roofed with brush or branches, designed especially to provide shade.
b. An open porch or breezeway.
2. Inn. Inc.. 665 So. 2d 268 (Fla. Dist. Ct. App. 1995), review denied. 675 So. 2d 121 (Fla. 1996)(holding that hotel possessing nondelegable duty to provide reasonably safe premises is liable for its own percentage of fault and vicariously liable for independent contractor's percentage of fault).
(21.) In Dukes v. U.S. Healthcare U.S. Healthcare is a now-defunct healthcare company. The logo had an apple. The merger with Aetna
In 1996, the company merged with Aetna, calling it Aetna U.S. Healthcare. The U.S. Healthcare apple logo was next to the Aetna name, and U.S. Healthcare under it. U.S. , Inc., the Third Circuit rejected an HMO's invocation invocation,
n a prayer requesting and inviting the presence of God. of ERISA preemption in a medical malpractice claim alleging vicarious liability against the HMO. 57 F.3d 350 (3d Cir.), cert. denied, 516 U.S. 1009 (1995). The court dismissed the HMO's argument that the plaintiffs were seeking to hold the HMO liable for the arguably preempted direct claims of withholding benefits due or to enforce new rights under an ERISA plan. The court determined the plaintiffs were simply "attack[ing] the quality of the benefits they received," id. at 356. and "attempting to assert their already-existing rights under the generally applicable state law of agency and tort." Id. at 358; see also Rice v. Panchal, 65 F.3d 637 (7th Cir. 1995); Pacificare, Inc. v. Burrage, 59 F.3d 151 ( 10th Cir. 1995); In re Estate of Frappier, 678 So. 2d 884, 886-87 (Fla. Dist. App. Ct. 1996).
RELATED ARTICLE: Professional Negligence professional negligence n. See malpractice. Section has widespread appeal
Professional negligence cases tend to come with the territory for trial lawyers. Sooner or later, most will handle one. Wit that eventuality e·ven·tu·al·i·ty
n. pl. e·ven·tu·al·i·ties
Something that may occur; a possibility.
pl -ties in mind, ATLA ATLA Association of Trial Lawyers of America
ATLA American Theological Library Association
ATLA American Trial Lawyers Association
ATLA Air Transport Licensing Authority (Hong Kong)
ATLA Avatar: The Last Airbender created the Professional Negligence Section.
"Our section serves both experienced attorneys who concentrate their practice in professional negligence and lawyers who are handling their first negligence case," said Section Chair Charles Baumberger of Miami.
Attorneys practicing in this area litigate medical negligence claims and cases involving negligence in occupations such as dentistry dentistry, treatment and care of the teeth and associated oral structures. Dentistry is mainly concerned with tooth decay, disease of the supporting structures, such as the gums, and faulty positioning of the teeth. , psychotherapy psychotherapy, treatment of mental and emotional disorders using psychological methods. Psychotherapy, thus, does not include physiological interventions, such as drug therapy or electroconvulsive therapy, although it may be used in combination with such methods. , ministry, elder care, and accounting.
Baumberger said section members have an enormous networking advantage over other small-firm and sole practitioners. Members across the country work together, exchanging information on litigation An action brought in court to enforce a particular right. The act or process of bringing a lawsuit in and of itself; a judicial contest; any dispute.
When a person begins a civil lawsuit, the person enters into a process called litigation. strategies nd expert testimony Testimony about a scientific, technical, or professional issue given by a person qualified to testify because of familiarity with the subject or special training in the field. . "We also coordinate activities with ATLA litigation groups that share common interests with our section," he said.
The section also strives to educate its members. Each year at ATLA's Annual Convention, section leaders present programs and panel discussions.
The section is finalizing plans for this year's convention, July 10-14, in Washington, D.C. "Right now, we plan to offer sessions featuring medical doctors who have expertise in specialties frequently involved in medical malpractice cases. For example, this year's topics include neurologic neurologic /neu·ro·log·ic/ (-loj´ik) pertaining to neurology or to the nervous system.
Having to do with the nervous system. negligence in the emergency room, chest pain in the emergency room, discovery and proof of altered medical records, and discovery and use of hospital manuals and standards," Baumberger said.
Any ATLA member in good standing may join the Professional Negligence Section for $113 annually. Dues include a subscription to the Professional Negligence Law Reporter, an annual membership directory, and a biannual bi·an·nu·al
1. Happening twice each year; semiannual.
2. Occurring every two years; biennial.
bi·an newsletter. Lawyers who have been in practice for 10 years or less may join the section for $28, but they will not receive a subscription to the Law Reporter.
For more information, contact Sections Coordinator Nancy Dugan at (800) 424-2725, ext. 312.
Charles H. Baumberger is a partner with Rossman Baumberger & Reboso in Miami.