HMO LIABILITY: Managed Care Insider Says ERISA Should Be Reformed
In an Op-Ed in today's Los Angeles Times, a physician describes the moral and ethical pitfalls inherent in her former job as a medical director for a managed care company. Dr. Linda Peeno writes, "Keeping numbers low defined the success of my job. That meant denials -- surgeries, admissions to the hospitals, additional days once there, X-rays, lab tests, visits to specialists. And when I denied a service or a procedure that a treating physician requested, I did not have to look into the eyes of a frightened, suffering patient whose very life might depend upon the medical need I withheld with the stroke of a pen." Peeno argues that the "misleadingly titled" 1974 Employee Retirement Income Security Act allows HMOs to save money "at the expense of life and well-being of real people" by preventing patients from "collecting damages for denial of medical treatment that results in death, injury or economic loss." She concludes, "Let's be honest: The heart of managed care is the practice of medicine by corporations and their company doctors. Their distance from the patient does not mute the damage done when their medical decisions are negligent, dangerous or simply ignorant. To continue to allow them to practice behind the ERISA shield is like giving our physicians the freedom to do, or not do, whatever they want, with no recourse against them for our harm or death. Surely we will not continue to be that foolish." Peeno currently chairs the hospital ethics committee at the University of Louisville (KY) and is a consultant specializing in managed care operations (10/9).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.