Doctor Defends Treatment of Cancer Victim : Lawsuits: Elvin Gaines of Simi Valley testifies money was not a factor in the decision not to refer Joyce Ching to a specialist.

Dr. Elvin Gaines of Simi Valley testified Friday that he never thought about losing money when an ailing Joyce Ching asked to be sent to a specialist, and that her symptoms were consistent with many ailments other than the colon cancer that eventually killed her.

Gaines took the stand in his own defense in a landmark medical malpractice trial that is questioning the way managed care companies pay doctors.

Gaines conceded under cross-examination that his medical group stood to make more money if he and his colleagues cut back on the number of patients they referred to medical specialists.

“If there’s no referral, there’s no money spent,” he said. But Gaines insisted that every patient that needed a referral to a doctor outside the Simi Valley Family Practice medical office got one.

David Ching and his 5-year-old son are suing Gaines and one of his partners, Dan Engeberg, over Joyce Ching’s death last year of colon cancer at the age of 35.

David Ching alleges that the two doctors refused the couple’s request to send her to a medical specialist for 11 weeks because it cut into their profits.

The doctors’ payment plan with the Metropolitan Life health maintenance organization--a payment system called capitation--offers financial incentives to primary care doctors who hold down medical costs and cut back on referrals to medical specialists.

But Gaines said Friday that Joyce Ching’s initial symptoms and complaints led him to believe other ailments were causing her discomfort. Joyce Ching told Gaines’ nurse on her first visit to the office that she had had fibroids removed from her uterus in 1990. She said the pain she was experiencing in 1992 was similar to the pain two years earlier.

Further, Gaines testified that cancer was a rarity in someone as young as Ching. Other problems, such as ulcers, seemed far more likely, Gaines said. His initial diagnosis was bolstered by an ultrasound test that revealed several fibroids in Joyce Ching’s uterus.

Gaines told the jury that the couple only asked him once to refer her to a specialist.

He further testified that in 1992 he and his five partners often met to discuss the payment policies of insurance companies and the effect it had on referring patients outside the clinic. But he said Joyce Ching’s case was never discussed at any of those meetings.

He also denied David Ching’s account of a mean-spirited Gaines yelling at the couple during an office visit one Monday.

Ching testified earlier that after a weekend of persistent telephone calls, Gaines told the couple that “we don’t need your crap” and suggested they find another primary care physician.

But Gaines had a markedly different account of that office visit. He denied telling the Chings to find another doctor, and said, “Crap is not even in my vocabulary.”

Ching’s attorney, Mark Hiepler, attacked Gaines with a question that echoed an infamous exchange from the O.J. Simpson murder trial:

“Have you ever used the word crap in the last 10 years?” Hiepler asked, which brought a vehement objection from defense attorney Michael Gonzalez.

“Is this Mark Fuhrman on trial?” Gonzalez said. But Superior Court Judge Ken Riley allowed the question to be asked, and Gaines answered with a simple no.

The trial is scheduled to resume Oct. 31. No reason was given for the delay. Riley issued a gag order earlier in the trial and attorneys are barred from discussing the case with the press.