High Court to Rule on Claim That State Forced Amputation

The California Supreme Court agreed Thursday to decide whether the state can be sued for damages by a patient who claims that its effort to control health care costs forced the amputation of her leg.

The case is the first to reach the justices on the question of the potential liability for an agency accused of negligence when an injury to a patient is attributed to its cost-containment measures.

Lawyers representing the state Medi-Cal program and their supporters contend that if the state can be held liable it will undermine efforts to control the spiraling costs of health care. The plaintiff in the case, backed by the California Hospital Assn. and the California Medical Assn., argues that the state should be held accountable when its efforts to limit costs interfere with proper treatment.

The case was brought in Los Angeles Superior Court by lawyers for Lois J. Wickline, a Medi-Cal patient who claimed that doctors were forced to amputate her leg after the state refused to approve additional hospitalization.

The woman had been admitted for surgery and when problems resulted after the operation, her surgeon recommended an additional eight days of hospitalization.

However, a consulting physician employed by Medi-Cal to review such requests in advance approved payment for only an additional four days in the hospital. According to court records, Wickline’s physician discharged her from the hospital after four days. Later, she developed an infection, forcing amputation of her right leg.

A jury awarded Wickline $500,000 in damages against the state in 1982 but earlier this year the award was overturned by the state Court of Appeal.

The appellate court, recognizing that the case dealt with “issues of profound importance” to health care providers and recipients alike, said state law did not permit the state program to be held liable in such circumstances.

The court said the woman’s physician could have made additional efforts to keep her in the hospital longer. Both her surgeon and two other physicians who testified at trial agreed that her discharge met the standard of care at the time.

The case is likely to be set for argument and then decided next year.