Family of Deceased M+C Patient Settles Lawsuit Against PacifiCare Over Denial of Care

The family of a Costa Mesa Medicare+Choice patient who died of lung disease three years ago has settled a lawsuit against the man's physician and his HMO, PacifiCare's Secure Horizons, alleging that the family was not told he was a candidate for a lung transplant because the surgery cost too much, the Los Angeles Times reports. The case was set to go to trial in Santa Ana Superior Court next week (Gottlieb, Los Angeles Times, 11/15). The case would have been the first in which survivors sued an HMO for denying necessary but expensive treatments that Medicare does not cover. The lawsuit was filed on behalf of George McCall, who died in 1999 at age 58 three hours after undergoing lung transplant surgery. The suit alleged 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 treatment. Instead, the suit alleged that Shukla and PacifiCare first recommended McCall undergo experimental treatments intended to cost a total of $60,000. Lawyers for PacifiCare and Shukla said that McCall made the decision not to have a transplant (California Healthline, 11/11). The terms of the settlement, reached late Monday, are confidential (Los Angeles Times, 11/15).