Suit Focuses on Delays by Medi-Cal

Times Staff Writer

Poor patients are suffering serious pain and complications because the state has repeatedly failed to process Medi-Cal insurance eligibility in a timely fashion, according to a lawsuit filed Tuesday on patients’ behalf.

One woman died of liver cancer this summer, shortly after the state authorized coverage for treatment. The suit claims the authorization took six months to come through instead of the 90 days set forth by state law. The lawsuit, filed in San Francisco Superior Court, contends that in a sample of 2,188 Medi-Cal applicants from 2005, not one was processed on time.

The lawsuit seeks an injunction requiring the state to process applications within 90 days, as well as a court order to speed up services to those who have been waiting for care. Medi-Cal, the state’s program for providing health services to poor families with dependent children and elderly, blind and disabled people, has about 6.7 million beneficiaries.


State officials said they had not seen the lawsuit and could not comment on its claims.

The lawsuit was filed on behalf of three plaintiffs.

Ivana Zelaya, 34, of Santa Clara, who was severely injured in a car accident in August 2005, said she had to wait 10 months for her Medi-Cal authorization. During that time, she had to forgo follow-up neurological testing even as she experienced memory loss, problems concentrating and severe pain.

Zhong Wu, 25, of Oakland said he has to wear a colostomy bag that is too loose because he did not receive his authorization on time.

Ana Penate, 44, of San Francisco, who was disabled by a back injury in 2001, said she had to file for bankruptcy last year because of mounting medical bills that should have been paid by Medi-Cal.

And then there is the case of Eva Baez, who died earlier this year as a result of complications from untreated liver tumors.

She is not a plaintiff in the case, but the lawsuit said her story provided “a graphic example of the potentially fatal consequences that may result from these illegal delays” in processing Medi-Cal authorization.

Baez was diagnosed with a liver tumor in January. Unable to work because of her illness, she filed for Medi-Cal benefits. She could not afford to start chemotherapy until her application was approved, according to the suit. That did not happen until June -- and then only after her lawyer intervened.


Later this summer, Baez died.

Kimberly Lewis, a lawyer with the Western Center on Law and Poverty, an advocacy group for low-income Californians that filed the lawsuit along with Bay Area Legal Aid, said the state has known for at least two years about the problems in processing Medi-Cal applications.

She said she hoped the suit would prompt change.