INTER VALLEY HEALTH PLAN: FOUND LIABLE IN MALPRACTICE CASE
Inter Valley Health Plan, a nonprofit, Pomona, CA-based HMO,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.
has been found liable in a malpractice case for denying a patient
access to tests and a specialist recommended by her doctor, Los
Angeles Times reports. Arbitration Judge John K. Trotter "found
that Inter Valley and its medical director, Dr. Alexander Bokor,
had repeatedly interfered with the recommendations of the
patient's primary care doctor, blocking a biopsy and other tests
and refusing to refer the patient to a kidney specialist." In
his decision, Trotter said the case provided a "compelling
picture of the problems and pitfalls of managed care," Times
reports. Trotter awarded $1.1 million to 69-year old Joyce
Ramey, a Medicare HMO recipient. Ramey's attorney said, "This
was a case about a medical director making a business decision."
BAD MOON RISING
The Times reports that the case "spotlights issues that are
being raised in the California Legislature and elsewhere about
whether [HMOs] and corporate medical directors, in addition to
physicians themselves, should be liable in malpractice cases."
California legislators are also considering "the extent to which
health-plan administrators are interfering in medical decisions."
There have been a slew of bills introduced by California
legislators largely in response to claims "by doctors that their
medical decisions are increasingly being denied or overruled by
HMO medical directors." OPPOSITION
HMOs argue "that they cannot be held legally responsible for
medical malpractice because they do not ... make medical
decisions; they only administer benefits." They also argue that
they are "protected against malpractice claims by a 1974 federal
law -- the Employee Retirement Income Security Act, or ERISA,"