® Patient’s Medical History: Mary Wardlow had a deadly cervical problem for over 18 years that her HMO failed to treat. Instead, the company forced Mary to have a cervical fusion that has left her suffering from continual spinal pain. The fusion is very close to the spinal cord and Mary presently takes epidural spinal injections for nerve blocking, just to endure the pain she must live with. Mary’s husband, Robert, lives with constant stress and fear that Mary will either die or become paralyzed from the neck down as a result of her condition.
Over the 18 years Mary has suffered with her condition, her HMO has denied her tests and specialist referrals, ignoring the fact that she was in danger of death due to spinal cord constriction and severe infection. Mary even found out that her HMO doctor himself has had 12 other cases, besides hers, filed against him, yet continues to care for patients at the HMO.
RIALTO, CA- "When the Wardlows decided finally to file their own suit against her HMO, they were unaware of the battle they were to face. They were first hit with the news that, unknowingly, Mary had signed a binding arbitration clause when she enrolled in her health plan. Therefore, it was mandatory that Mary have her dispute settled in a private, binding arbitration hearing with her HMO. Knowing this now, the Wardlows say they would never have agreed to the terms of arbitration. The way the HMO’s enrollment works, the Wardlows would have been denied coverage if they refused.
When the Wardlows began the arbitration process, they also were unaware the time spent getting a hearing would be drawn out by the HMO for five years.
During the hearing, the Wardlows complain the arbitrator and the process were biased in favor of the HMO. The Wardlows also claim that the HMO’s lawyers skillfully manipulated the hearing and purposefully delayed the proceedings, because Mary was handicapped and her husband was unable to contribute, because he had suffered a stroke. Mary feels the HMO knew these circumstances and planned on dragging the case out to her disadvantage.
Mary also claims the HMO attorney and the arbitrator planned the whole legal proceeding, including dates, yet she was unable to voice her opinion at any time. This led to hearing dates being set when Mary’s attorney could not be present, forcing Mary to represent herself, though she had no legal background and was under the effects of Valium and pain killers during the whole proceeding, due to her condition.
Mary claims the HMO attorneys and the arbitrator were allowed to be intimidating and unprofessional. Mary claims the HMO insinuated, based on falsified records, that Mary was mentally impaired. Mary also states the HMO’s lawyers did not depose one HMO doctor involved, including Mary’s primary car physician of 18 years. Overall, Mary feels there was collusion between the arbitrator and the HMO’s attorneys.
Mary also complains of the fact that no one will ever know what truly happened at the arbitration hearing because only parts of it were recorded and the arbitration proceedings are secret, with no public record.
In the end, Mary lost her arbitration claim after the attorneys deliberately drug the hearing out for an additional two years on top of the five years spent getting a hearing date. Mary was left with no remedy and large court costs.
— Mary Wardlow reports her own story.
FTCR will continue to fax daily a story of HMO Arbitration Abuse to educate the public on the need for reform. AB 1751 (Kuehl) makes HMO binding arbitration voluntary rather than mandatory.