DESELECTION: HMO, Physician Battle Over Dismissal Without Cause
The California Supreme Court is hearing a case that "could help decide whether managed care companies must give physicians dismissed from their programs a reason and a chance for an appeal," the Wall Street Journal reports. The case in question concerns Dr. Louis Potvin, who was dropped by the Metropolitan Life Insurance Co. in 1992 for what they called a "history of malpractice claims" ( see CHL 2/24). Potvin sued the company for its action, which he claimed caused two other HMOs he worked for to drop him. While one court rejected Potvin's claim, an appellate court last summer overturned the ruling, saying "California law gives special protection to individuals whose income depends on certain public and private organizations such as unions, hospitals and medical societies." But MetLife is arguing that "California law allows doctors to be dropped at will" and that Potvin "signed a contract with MetLife that allowed either party to terminate their relationship without cause." The California Association of Health Plans and the American Association of Health Plans have filed amicus briefs supporting MetLife, the Journal reports.
What's At Stake
"If the HMOs lose, the case could give the doctors an important victory in their struggle with the companies as the practice of medicine continues to shift to managed care," according to the Journal. The court's decision in favor of doctors could also force any business "to provide hearings for termination" or HMOs "to justify a decision not to hire a doctor in the first place," according to Lowell Brown, an attorney for MetLife.
Most doctors argue that they should have increased job protection because "deselection" in health care "creates disruptive turnover and threatens patient care." So to protect "patient care ... and their livelihoods," doctors think they should have the right to appeal an HMO's decision to drop them. But only about 15% of American workers have the "right to protest their boss' decision" to fire them, according to Lewis Maltby, director of the ACLU's Workplace Rights Project. And the managed care industry says "limiting their freedom to drop doctors would undermine the concept of managed care, which depends on scrutinizing care to control costs," the Journal reports.
Six State Salute
Six states have already passed laws requiring a doctor to at least "be given the reason for being dropped." Some of these states have laws that are even more stringent than this ordinance. The New Hampshire Supreme Court ruled in favor of a doctor in a deselection case in 1996, the Journal notes (Daerr, 4/13).