Lawsuit Against Aetna Raises Questions about Insurers’ Liability for Medical Care

The family of a California man who died of cancer-related complications in 2000 has sued Aetna, alleging that the insurer discharged the man from a hospital prematurely and sent him to a nursing home that did not provide adequate care, the Los Angeles Times reports. According to the Times, Murray Rosenburg, who had multiple myeloma, a bone-marrow cancer, received four chemotherapy treatments at a Los Angeles-area hospital and was transferred to a nursing home covered by Aetna's Medicare+Choice plan. After Rosenburg's condition worsened, he returned to the hospital and subsequently died of congestive heart failure. The lawsuit alleges that Rosenburg was discharged from the hospital by a physician who headed a doctors group connected with Aetna and that the physician had a financial incentive to reduce costs by discharging patients early. The lawsuit also contends that while at the nursing home, Rosenburg did not receive all the medications prescribed to him and was not seen by a doctor. For its part, Aetna has denied any charges of negligence and said actions by its Medicare HMO are "approved by federal regulators or governed by federal law." The lawsuit addresses the question of whether health plans can "hand off responsibility for medical care ... and then avoid liability if something goes awry," the Times reports. In addition, if the lawsuit succeeds, it could "send a powerful message" to insurers that their contracts with doctors and hospitals do not "absolve HMOs of legal responsibility for bad clinical outcomes," M. Gregg Bloche, a professor at Georgetown University Law Center, said. According to plaintiff lawyer Michael Bidart, the case, which began in a Los Angeles courtroom Friday, will "expose how HMOs recruit Medicare patients to their name brand, then often cede total control to doctors and hospitals -- without any oversight," the Times reports. However, Aetna counsel John Swenson said, "It's pretty fair to say the responsibility for medical decisions should rest with the medical providers. The responsibility for coverage decisions, if we make them, should rest with us" (Ornstein, Los Angeles Times, 9/28).