PATIENTS’ RIGHTS: Davis Backs Measure to Limit Suits Against HMOs
The Assembly Judiciary Committee is expected Tuesday to hold its first public hearing on AB 2039, which would strip last year's HMO reform bill of a provision allowing patients who suffer "large personal losses" to bypass the state's new independent review process and sue their HMOs. The Los Angeles Times reports that Gov. Gray Davis (D) proposed the change because he wants to distinguish between physical injury, "which he believes merits direct access to the courts," and financial loss. When he signed the legislation last year, Davis wrote in an accompanying letter that he felt "uneasy" about the provision, especially in cases that involve "significant financial harm." He wrote, "The independent external review requirement is a meaningful tool to ensure consumers receive necessary treatment, rather than a process to be avoided in pursuit of a lawsuit. It is my understanding that the Legislature has made a commitment to address and clarify this issue next year." Davis spokesperson Hilary McLean added, "If someone is in imminent danger of losing a limb or there is an extreme threat to their health ... skipping the external review is designed to get that person treated as soon as possible." Assemblywoman Sheila Kuehl (D-Santa Monica), who co-authored the original legislation and is sponsoring AB 2039, admitted that she promised to "revisit the financial harm clause this year" in order to obtain Davis' signature, and said she "intends to keep her word." But state Sen. Liz Figueroa (D-Fremont), who wrote the original bill with Kuehl, said the two lawmakers did not receive Davis' letter until last month and noted, "I compromised a lot on [the reform bill] and I feel comfortable with the law as is. I did not make any agreement with the governor to change it at all."
Consumer advocates decried the governor's letter and AB 2039, saying it would gut the original reforms. Jamie Court of the Foundation for Taxpayer and Consumer Rights said, "From the consumer perspective, this is clearly a double cross; there was nothing said in public about this change." According to advocates, "making physical harm the only exemption from independent review penalizes patients who avoided injury by paying for denied treatment themselves" and "dilutes the intended deterrent effect of the legislation." Sara Nichols, legislative chair for the Consumer Federation of California, said, "What you want is the strongest possible incentive for the HMO to make the right decision the first time out." California Association of Health Plans President Walter Zelman, however, said it is too easy to accumulate financial loss, arguing, "You're denied coverage and, rather than appeal it, you immediately go out and spend money and then you can sue" (Pyle, 5/7).