HMO LIABILITY: Sac. Bee Editor Says Jury Shouldn’t Play Doctor

      An editorial in Saturday's Sacramento Bee argues that juries are ill-equipped to render verdicts in medical malpractice cases against HMOs. Associate Editor Tom Philp cites the case of a Kentucky woman whose health plan denied coverage for a hysterectomy that her doctor recommended for her cervical cancer. The insurer, Humana Inc., said it would instead cover a less invasive, less expensive procedure to remove only the cancerous portion of the cervix. The woman decided to pay for the hysterectomy out of pocket. Afterward, she sued the insurer and won a $13.1 million verdict despite the fact that a pathology report following the hysterectomy showed that the less invasive procedure would have removed the cancer. From this case, Philp concludes that the "drama of the courtroom setting can be a confusing place for even the fairest and most sophisticated of jurors to distinguish malpractice from an honest difference in medical strategies. Anger at greedy health insurers is a far easier feeling to grasp than, say, medical approaches to squamous cell carcinoma insitu (Johnson's version of cervical cancer). Yet it is precisely this level of medicine that jurors must comprehend." Noting that "in California, the case is far from closed as to whether the state should allow" consumers to sue their health plans and HMOs, Philp contends, "The question is whether the state's jury system is up to distinguishing real horrors from hoaxes" (Philp, 11/9). Click here for recent CHL coverage of the issue.