>Well said, Kathy. My fear is that the final decision could be made
>by a worker at an HMO computer terminal!
What surprises me is that disgruntled patients have not attempted
to prosecute non-MD HMO administrators for "unlicensed practice
of medicine." If the administrator is telling a physician what, or
what
not, to do with a patient, it would seem that the administrator is
"practicing medicine."
>Think about it: "This
>"Jones" person has cost us a lot of money, and according to the
>printout, is past middle age, and only has a few kids...we could
>save THOUSANDS of dollars if we put him out of our..I mean HIS
>misery before the end of this fiscal month." If anyone thinks that
>is not a possible scenario, let me know the last time your
>employer, or whoever provides your medical benefits sent you a
>letter about improving or giving you MORE coverage, or REDUCING
>your expenses for whatever coverage you have? Maybe in dreams, but
>not in real life. Anytime I see an envelope from the "Human
>resources" dept, I get nervous. If HMO's were such a wonderful
>idea, they would not need to spend millions of dollars in
>advertising, to convince them how great it is to have a lesser
>choice of medical providers, and possibly have to pass local
>hospitals to travel miles to the nearest approved facility! The
>worst part is gagging the doctors right to suggest further
>treatment and tests. ANYTIME the bottom line of a financial report
>is considered more important than the best possible medical care,
>I feel it is immoral.
The doctor is in a bad position... if he/she does not recommend
appropriate treatments or tests, the doctor is exposed to charges of
malpractice, or unprofessional conduct. If he violates the gag
order, the HMO can fire him. But I would think that a hard-nosed
attitude by patients might help: "If the HMO takes action against you
for practicing the best medicine you can, I will bring the HMO's
conduct to the attention of the district attorney (unlicensed
practice
of medicine by the administrator), the state board that licenses
hospitals,
etc. and so on.
Then there's "raising the stakes." E.g. an HMO wants to discharge
a
woman the day she has her baby, or perform an "outpatient
mastectomy."
The patient should place her objections on record with witnesses and
a personal injury lawyer, and make sure the HMO knows it. Now the
stakes have gone up. If there are no complications, all well and
good.
(Who wants to spend extra time in the hospital?) If there are, the
HMO
has been set up for negligence charges, malpractice suits and, if the
patient dies, possible criminal prosecution for manslaughter- with
all
the ensuing publicity. The military term is "collateral damage."
It adds outcomes to the HMO's "decision tree." Instead of "Save
$3000 by discharging the patient early," it becomes, "Save $3000
by discharging the patient early. If something goes wrong, though,
we assume unknown risks of losing our accreditation, losing
hundreds of thousands in a lawsuit, or even going to jail. Bad
publicity is a near certainty." The HMO may now be willing to make
the extra effort to assure a favorable outcome.
I am not a lawyer and this is not legal advice, but I would think
the
presence of a lawyer at the HMO might make the HMO's bureaucrats
much more circumspect.
-Bill
