Present: All the Justices
WILLIAM C. STEVENSON
v. Record No. 990032 OPINION BY JUSTICE ELIZABETH B. LACY
November 5, 1999
COMMONWEALTH OF VIRGINIA
FROM THE COURT OF APPEALS OF VIRGINIA
William C. Stevenson, an Associate Professor of Surgery
and Director of Liver Transplantation at the University of
Virginia Medical School, was indicted by an Albemarle County
grand jury on one count of forgery and one count of uttering a
forged writing in violation of Code § 18.2-172. He pled not
guilty and, following a two-day trial, a jury convicted Dr.
Stevenson of forgery and recommended a fine of $1.00. The
jury acquitted Dr. Stevenson on the charge of uttering a
forged document. The Circuit Court of Albemarle County
entered judgment on the jury verdict. The Court of Appeals,
following a rehearing en banc, affirmed the judgment of the
trial court by an evenly divided vote without opinion.
Stevenson v. Commonwealth, 28 Va. App. 562, 507 S.E.2d 625
(1998).
The issue presented to us in this appeal is whether the
facts of this case establish beyond a reasonable doubt that
Dr. Stevenson committed forgery as charged in the indictment,
that is, whether "[o]n or about February 6, 1996, in the
County of Albemarle, WILLIAM C. STEVENSON did unlawfully,
feloniously and knowingly forge a cardiac stress test writing,
to the prejudice of Trigon Blue Cross/Blue Shield." The crime
of forgery requires not only that a writing be forged, but
that the forged writing prejudiced or could prejudice the
right of another. Terry v. Commonwealth, 87 Va. 672, 673, 13
S.E. 104, 104 (1891).
In this case, Dr. Stevenson admits that he produced a
forged writing by altering a date on his patient's cardiac
stress test report. However, Dr. Stevenson argues that when
he altered the stress test report, there was no possibility
that the altered document did or could prejudice Trigon's
rights. Therefore, Dr. Stevenson asserts he was not guilty of
the crime of forgery. We agree.
The evidence taken in the light most favorable to the
Commonwealth, the prevailing party at trial, showed the
following. In 1995, Leonard Kraditor, a patient of Dr.
Stevenson, began experiencing liver failure. Dr. Stevenson
sought to have Kraditor placed on the nationwide list of
patients needing organs, but was told by the University of
Virginia Medical Center (Medical Center) personnel that it
would not place Kraditor on the transplant list until
Kraditor's medical insurance carrier, Trigon Blue Cross/Blue
Shield (Trigon), pre-authorized payment for the transplant
operation.
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Dr. Stevenson was anxious to have Kraditor placed on the
transplant list before the Christmas holiday. Although he
submitted a letter explaining the medical necessity for the
liver transplant as part of the procedure for obtaining pre-
authorization from Trigon, and attempted to contact the
director of medical policy at Trigon, he was unable to secure
the pre-authorization before the Christmas holiday.
Nevertheless, the administrator of the Medical Center agreed
to place Kraditor on the transplant list without receiving
pre-authorization for the transplant procedure from Trigon.
A liver became available and Dr. Stevenson successfully
performed the transplant operation on January 21, 1996. The
next day, January 22, 1996, unaware that the surgery had been
performed, Trigon rejected the pre-authorization request
because Trigon considered Kraditor a high risk for the surgery
and needed the "results of his cardiac, renal and pulmonary
evaluations" before pre-authorization could be issued.
By January 28, Kraditor's body was rejecting the new
liver. When Dr. Stevenson sought to have Kraditor placed on
the transplant list again, he was told that the Medical Center
would not place Kraditor on the list again until the "pre-
authorization" for the now-completed transplant surgery was
received from Trigon. The only cardiac evaluation available
to Dr. Stevenson was a cardiac stress test performed on
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Kraditor in April 1994. On January 30 or 31, Dr. Stevenson
changed the date shown on the report for the administration of
Kraditor's stress test from April 1994 to October 1995. After
attaching a cover note to the altered stress test report, Dr.
Stevenson left the papers on his desk. Shortly thereafter,
Kraditor decided not to undergo further transplant surgery and
informed Dr. Stevenson of his decision. Kraditor died of
liver failure on February 2, 1996.
On February 6, 1996, the altered stress test report was
sent to Trigon. Relying on the altered stress test report as
an indication that Kraditor's cardiovascular system could
survive the transplant surgery and recovery, on February 12,
1996 Trigon issued the pre-authorization for Kraditor's now-
completed liver transplant. Trigon was unaware that the
surgery had been successfully completed at the time it issued
this pre-authorization.
While this evidence establishes that Trigon relied on the
altered stress test report in issuing its pre-authorization
for Kraditor's January 21 liver transplant operation, it does
not establish that this reliance and subsequent issuance of
the pre-authorization prejudiced or could have prejudiced
Trigon's rights. According to Trigon officials who testified
at trial, pre-authorization is a mechanism which allows the
medical provider to obtain a preliminary indication of whether
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Trigon will pay the costs associated with the medical
treatment to be performed, prior to incurring the expense of
performing the treatment. Pre-authorization, according to Dr.
Richardson Grinnan, Trigon's Senior Vice-president and Chief
Medical Officer, is a "service to physicians and subscribers
to prevent after-the-fact medical necessity denials."
Although some insurance plans require pre-authorization as a
condition for payment of a claim, Kraditor's health insurance
policy with Trigon did not. Therefore, any prejudice to
Trigon in terms of liability for the transplant procedure did
not include the existence or non-existence of pre-
authorization by Trigon for the procedure.
More importantly, assuming that issuance of the pre-
authorization could limit Trigon's ability to contest the
medical necessity of a procedure after the fact, Trigon did
not and could not have suffered such prejudice under the facts
of this case. Dr. Grinnan testified that when procedures are
not pre-approved, determinations as to payment are made on
information available after the procedure. In this case,
according to Dr. Grinnan, when Kraditor survived the liver
transplant without cardiac complications, the altered stress
test "would not have had an adverse determination on whether
or not [Trigon] would have paid that bill." Dr. Grinnan and
Dr. Lawrence Colley, head of Trigon's medical policy
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department, both testified that Trigon would have approved
payment for the procedure once it learned that Kraditor had
survived the operation even if there had been no stress test
report.
Our conclusion that potential prejudice to Trigon was not
established in this case is not based simply on the fact that
Trigon was liable for the cost of the procedure whether or not
the pre-authorization was issued. The controlling fact in
this case is that, at the time the forged writing was made, no
prejudice did or could attach to Trigon as a result of the
altered stress test report, because at that time the surgery
had been successfully completed and Trigon acknowledged that
its liability existed at that time. Accordingly, any
limitation on Trigon's right to contest the medical necessity
of the procedure imposed by the subsequent issuance of the
pre-authorization was immaterial. Because Trigon's liability
could not have been affected by the forged writing, no real or
potential prejudice to Trigon could result from the forged
writing. Therefore, in the absence of such prejudice to
Trigon, the crime of forgery was not established.
Accordingly, we will reverse the conviction and dismiss the
indictment.
Reversed and dismissed.
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