Doctor Says He Was Ousted by HMO Over Criticisms

A doctor says he was dropped by a health maintenance organization for violating his loyalty oath by criticizing the HMO on “Donahue” and at an industry conference.

US Healthcare Inc. disputed that, saying Dr. David Himmelstein was dropped because of cutbacks unrelated to his criticism.

Himmelstein complained last month at a health-care conference in New York and again on television talk show “Donahue” on Nov. 28, that HMOs boost their profits by discouraging doctors from referring patients to expensive specialists.

On Dec. 1, he received a letter notifying him that the HMO was dropping him as a primary-care physician.

“What this says to doctors is that you can’t actually tell people about their health care or you might not be able to practice medicine,” Himmelstein, a Harvard Medical School professor, said Tuesday.

While denying Himmelstein was punished for his criticism, the Blue Bell, Pa.-based HMO defended a clause in its contract with doctors barring them from making statements that might undermine their patients’ confidence.

Himmelstein’s patients who belong to US Healthcare have until Feb. 26 to find another doctor. He said he doesn’t know how many patients are affected.

The doctor complained that under HMOs, financial considerations affect medical decisions.

“What happens is that in the close calls, the situations where you might order a test or get a referral but you’re not really sure that it’s needed, these incentives push the doctors’ judgments,” he said. “It’s hard enough making good decisions in medicine.”