Family of Deceased Man Becomes First To Sue M+C Plan for Denial of Care Because of Cost
The widow and children of a man who died of lung disease three years ago are suing his doctor and HMO, PacifiCare, alleging that the family was not told he was a candidate for a lung transplant because of the cost of the surgery, the Los Angeles Times reports. The suit, which will go to trial in Santa Ana this week, is the first in which survivors are suing an HMO for denying "necessary but expensive treatments" that Medicare does not cover. Last year, the state Supreme Court ruled that the case may move forward; prior to that decision, complaints were considered in an administrative proceeding. The suit was filed on behalf of George McCall, who died in 1999 at age 58 three hours after undergoing lung transplant surgery. The lawsuit alleges that if the transplant had been recommended "years earlier" by PacifiCare and Dr. Lakshmi Shukla, McCall would have been healthy enough to survive the approximately $300,000 procedure. Instead, the suit alleges that Shukla and PacifiCare recommended McCall undergo experimental treatments intended to cost a total of $60,000. McCall, who was disabled by the lung disease alpha-1 antitrypsin deficiency, enrolled in Secure Horizons, PacifiCare's Medicare HMO, in 1992. According to attorneys for the family, there was no mention in McCall's medical records that Shukla ever recommended a lung transplant. "How can it not be sitting in the back of their mind that 'This is costing us $300,000?'" Carol Jimenez, one of the McCalls' lawyers, said.
Lawyers for PacifiCare and Shukla said that McCall made the decision not to have a transplant, citing his belief that such treatments had a low survival rate. According to a lawyer for Shukla, McCall said he would not consider a lung transplant "unless he was confined to bed rest and it was absolutely a last resort." Attorneys for the McCall family said that Shukla failed to provide correct information on the mortality rate associated with lung transplants and that the family did not consider a transplant until a nurse in 1997 informed them of the correct mortality figures (Gottlieb, Los Angeles Times, 11/11).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.