2 Who Altered Newborns’ Stays Hit HMOS Anew

The couple who helped end “drive-through” hospital births after their 2-day-old daughter died are on a new crusade, this time to hold HMOs accountable for their medical decisions.

Steve and Michelle Bauman hope to crack the shield of a federal law that has protected health maintenance organizations from lawsuits by patients who were harmed by the denial, delay or poor quality of care.

They’re suing Aetna U.S. Healthcare, saying its former policy of discharging newborns from hospitals after 24 hours led to the death of their first baby, Michelina, a day after she was sent home in May 1995.

Their testimony to Congress and the New Jersey Legislature, detailing Michelina’s death from an infection that would have been detected in the hospital, led to a federal law and many state laws requiring a minimum 48-hour stay for newborns and their mothers.

Now the Baumans are trying to win financial damages from Aetna. In a precedent-setting ruling last June, the U.S. Supreme Court upheld a federal appeals court ruling that the couple could sue the HMO for malpractice in state court. They’re preparing for a trial next summer.

Until now, HMOs routinely got state malpractice lawsuits moved to federal courts, where the most plaintiffs can recover is the cost of care denied them.

“The ultimate thing we’re looking for is . . . making it safer for other newborns and their mothers,” Steve Bauman said. “Somebody’s got to be held accountable so they know they can’t get away with this anymore.”

Other efforts seeking the same goal include pending federal class-action lawsuits attacking the way HMOs manage care, and attempts to pass federal and state laws giving at least 125 million patients the right to sue HMOs.

The House passed a Patient’s Bill of Rights this year, but it failed in the Senate by one vote. John Stone, spokesman for the House sponsor, Rep. Charlie Norwood (R-Ga.), predicts it will pass early in the next Congress because more Republican senators now back it.

Seven states--including California, Texas and Maine--have passed such laws since 1997 and 27 others debated them this year, according to the National Conference of State Legislatures. Many bills died or were withdrawn but will be reintroduced in January.

The American Medical Assn., its state affiliates and many consumer groups have lobbied hard for such laws, while HMOs and the Health Benefits Coalition, representing 3 million employers, oppose them.

“What you’re looking at is something that’s going to drive up coverage costs, encourage defensive medicine, do nothing to improve the quality of care and benefit trial lawyers more than anyone else,” said Susan Pisano, spokeswoman for the American Assn. of Health Plans.

However, in Texas, where the first such law was enacted, only a handful of malpractice suits have been filed.