Doctor Gets $2.5-Million Settlement

Dr. Thomas W. Self, a San Diego children’s doctor who struck a nerve with critics of managed care by charging that he had been fired for spending too much time and money on his young patients, has won a $2.5-million settlement.

Attorneys for the Children’s Associated Medical Group, Self’s former employer, announced the settlement late Monday, two days before a trial was set to begin on whether the medical group should be forced to pay Self punitive damages. A San Diego County Superior Court jury already had awarded Self $1.75 million in compensation for wrongful termination and defamation and had concluded that the medical group acted with malice. The same jury was set to consider the punitive damages claim.

Self’s principal attorney hailed the verdict not just as a victory for Self, a Yale- and UCLA-trained children’s digestive specialist, but for managed care patients nationwide.

“This result is a vindication for [Self] on every possible level,” said Sherry Bahrambeygui of San Diego. “It brings closure to a very difficult battle. . . . Hopefully, it will cause other doctors to stand by their oath and stand up for their patients.”

A spokesman for the medical group, comprising 77 specialists in children’s care, said the group did not agree with the jury verdict and that the settlement did not amount to an admission of wrongdoing.

“We feel it’s in the best interests of our organization to put this behind us and go forward,” said Dr. Michael Segall, a neonatologist and vice president of Children’s Associated Medical Group.

“Rather than spending the energy in an appeal process . . . the best interest of our organization is to continue the focus on what we do best: providing care for sick children.”

But even David Noonan, one of the lawyers for the group, acknowledged in a statement that the earlier jury verdict “may have been influenced by public sentiment regarding managed care.”

The case coincided with a public and political backlash against HMOs. In California, in other states and at the federal level, bills are pending that seek to curb the managed care industry’s powers and protect physician and patient rights. Attorneys for the medical group tried as best they could to distance themselves from that backlash. They argued that the case was never about managed care. It was, Segall said, a “contractual dispute” between Self and the physician group.

The group is not an HMO, though it does contract with managed care organizations “on a limited basis,” he said, adding that more than half its business consists of Medi-Cal patients.

Although the case did not involve an HMO as a defendant, many HMOs provide care to patients through contracts with medical groups--making such groups important parts of the managed care system.

Health industry experts, doctors and attorneys who followed the progress of the case said it contained a warning for managed care entities: Don’t let cost control take precedence over patient care.

The case received nationwide attention, inspiring one Chicago lawyer to describe it as “a shot across the bow of the ship called managed care.”

Self, 58, contended in his 1995 lawsuit that he was fired by the group for advocating the best possible care for his young patients. He said he was chastised for ordering too many tests and spending too much time with youngsters. It was one of the first cases to invoke a 1992 California law protecting physicians from such retaliation and is believed to be among the first victories of its kind in the country.