Lawsuit Over HMO Care

Re “Patient Who Had Stroke Sues Over HMO Care, July 17.

This article described a lawsuit filed against an Oxnard managed care group and its director for failing to allow a requested brain scan of a patient to be performed. The patient subsequently suffered a stroke. The doctor had requested the scan based on his personal expertise and evaluation of the patient.

Unfortunately, this happens far too often in our managed care environment.

Recently I had the opportunity of seeing a patient who had obvious signs and symptoms of a severely herniated disc. As I suspected the severity of this immediately, I requested an MRI from the patient’s “managed care” insurance provider. I was informed by my X-ray technician later that the MRI had been denied. I spoke to the case consultant, who is not a physician. She informed me that the criteria I provided to her did not fit their guidelines and therefore the MRI was denied. Nevertheless, I informed the patient he should proceed with the study as I strongly suspected a serious disc herniation. The MRI indicated a 12 millimeter disc in the lower spine, markedly compressing the spinal cord and nerve roots. This situation frequently demands surgical intervention.

In the case cited by your article, the doctor truly advocated for the patient. Unfortunately, the medical manager denied the study based on arguable guidelines established to control costs. This, in my opinion, puts the medical manager in the situation of practicing medicine. As the final arbiter of whether a patient will receive diagnostic studies or treatment he is, in effect, consulting on the patient and therefore providing a medical opinion. He should therefore be held liable to the same standard as any physician practicing medicine and liable for malpractice damages.

I applaud the attorney who filed the action for choosing to seek damages from the medical director and managed care group rather than the physician.

I hope the public will write to their congressmen concerning this ever-increasing situation of medical arrogance being forced on a public that deserves better treatment.

STEPHEN J. GOMBERG, M.D., Westlake Village