Hundreds of Richmond hospital patients lost their right to make medical decisions

Times-Dispatch investigation finds potential conflicts of interest between Richmond law firm and VCU Health.

VCU Health System has taken hundreds of low-income patients to court since 2009 to strip them of their right to make medical decisions, the Richmond Times-Dispatch found in the first of a three-part series on guardianship. That led to sick, elderly, and disabled patients getting transferred out of the hospital and into poorly-rated nursing homes, often at the objection of family members.

In hundreds of cases, VCU Health asked the court to grant the patient’s guardianship rights to an attorney from ThompsonMcMullan, a Richmond law firm. When granted, the attorney is ordered to make decisions in the patients’ best interests.

But medical ethicists say those decisions have a conflict of interest if the lawyer’s law firm has a long-term arrangement with the hospital, as ThompsonMcMullan had with VCU Health. The Richmond Times-Dispatch reports that VCU paid the law firm $1.1 million since 2007. This is a contrast to other hospitals in the Richmond area, which petition courts to have attorneys take over patients’ guardianships, but forbid the same attorney from bringing the case to court and then representing the patient.

“If [the law firm is] repeatedly representing the hospital, the concern is that they’re going to be more likely to make decisions that the hospital is happy with because it will ensure they get this continuous ability to represent the hospital in other cases,” George Cohen, a professor who teaches professional responsibility at UVA Law School, told the Richmond Times-Dispatch.

Three lawyers at ThompsonMcMullan have been involved in over 90% of the guardianship cases filed by health care providers in Richmond since 2014. One of those lawyers, R. Shawn Majette, has served as guardian for 120 people at the same time— six times the caseload allowed for the state’s public guardians.

A report from the Virginia Department for Aging and Rehabilitative Services found that hospitals are financially incentivized to initiate guardianship proceedings and get poorer patients discharged. Of the cases reviewed by Times-Dispatch, over 87% of the patients appointed a guardian by a healthcare provider were deemed “very poor” by the courts.

VCU Health System officials said finances do not play any role in their decision making process. Pam Lepley, a spokesperson for VCU, said the number of patients put into guardianship is so low, it doesn’t affect the hospital’s “financials in any regard.”