An allegation that Carilion Clinic makes decisions based on financial gains instead of patient well-being is at the crux of a malpractice lawsuit in Roanoke Circuit Court.

The lawsuit specifically charges that Carilion attempts to keep patient consultations and referrals in-house instead of going to doctors not employed by Carilion. Doing this keeps the health care dollars within Carilion and puts more money in the pockets of Carilion doctors, the lawsuit argues.

"Providing the best care to our patients is our top priority," said Carilion spokesman Eric Earnhart in an e-mail. "The suit is without merit."

Carilion's referral system is referred to in court documents as the health care provider's "leakage" policy because it seeks to prevent patients from being leaked to others in the medical community. In the past, the term "leakage" was used by vocal opponents of Carilion's physician hiring practices that began with the conversion to the clinic system.

Carilion has consistently said it willingly works with physicians it does not employ.

According to court documents, Carilion's policy states: "Because we believe that patients are best served when taken care of by an accountable group, whenever it is consistent with optimal clinical outcome, excellent patient service, and respectful of patient choice, it is expected that referrals for testing and consultation will be made within the Carilion Clinic system."

Ronald Burchett initially filed a malpractice complaint against Carilion and 13 other defendants in July. He is seeking a total of $10 million in damages, plus legal expenses and interest dating to March 2008.

Burchett was admitted to Carilion Roanoke Memorial Hospital in March 2008. He was septic, had severely low blood pressure and had respiratory failure, according to court documents.

Ultimately it was determined that he had acute colonic pseudo-obstruction, a condition in which the colon dilates significantly, and Burchett's colon burst.

A gastroenterologist was not initially called to examine Burchett.

The lawsuit suggests that the reason the specialist wasn't called was because Carilion offers a financial incentive to its physicians to keep referrals within the Carilion network of doctors. Specifically the lawsuit claims bonuses of up to 40 percent of a physician's salary are determined in part by a physician's following the referral policy.

Previously Carilion has openly discussed its efforts to improve communication by establishing referral agreements as guidelines for when and how a doctor should refer a patient to a specialist.

Last week, Burchett's attorney asked to amend the lawsuit to include that Carilion and its employed physicians conspired to prevent referrals and consultations outside of Carilion.

The amended complaint, if approved by the judge, would seek an additional $10 million in damages. The amended complaint also specifically names Carilion CEO Dr. Ed Murphy as a defendant.

A hearing is set for Wednesday in Roanoke Circuit Court before Judge Clifford Weckstein on several motions, including permission to amend the complaint.

Carilion has objected to amending the complaint, noting in a court document filed Monday that "the plaintiff's motion seeks to convert this case, without sound basis in fact, from a routine medical negligence case into a civil conspiracy claim."

Carilion contends that Burchett doesn't have the legal standing to file a conspiracy complaint and that it is legally impossible for entities within the same company to conspire.

"Given the total lack of good-faith basis for this claim, it is clear that plaintiff's goal is simply to harass and defame Carilion and its management, and to pointlessly drive up the costs of defense in this case," reads a portion of Carilion's Monday motion.

Prior to asking to amend the complaint, Burchett's attorney, Robert Hovis, had requested numerous internal Carilion documents that discuss the referral policy and other business practices. These requests have been made during discovery, the pre-trial phase of a lawsuit during which each party can ask the other for evidence.

Hovis, a medical malpractice attorney out of Annandale in Fairfax County, declined to comment on the case.

With each request, Carilion's lawyers have sought to block access to certain discovery documents.

Wednesday's hearing will also address a motion to force Carilion to hand over the documents.

Carilion has taken the unusual step of asking the judge to issue a protective order stating that Carilion does not have to hand over the documents. There are about 30 different items, including meeting materials, handbooks and other documents, that Burchett has requested and Carilion does not want to provide. That too will be argued on Wednesday.

Carilion's attorneys argued in court documents that the information is not relevant to the medical malpractice case.