Editorial – Patients and the law

Published on

The San Francisco Chronicle

A key skirmish in the campaign to protect Californians from abusive use of mandatory arbitration — and from denial of necessary medical care — is scheduled Tuesday before the Assembly Health Committee. At issue is a Senate-passed measure securing a patient’s right to allege in a court of law that a health maintenance organization has caused substantial harm by denying doctor-recommended treatment.

Most enrollees in managed-care health plans are required to submit disagreements to HMO-dominated arbitration procedures rather than seek redress by lawsuit. But this contradicts the intent of California’s 1999 patients’ bill of rights to make HMOs legally accountable for providing essential care.

SB458 by Sen. Martha Escutia, D-Whittier, would remove such life-or-death questions from the HMOs’ mandatory arbitration system, though patients could voluntarily arbitrate rather than go to court. The bill is needed to level the field between highly organized health-care providers, which set rules for handling complaints, and patients who have no leverage with arbitrators beholden to the HMOs.

Critics of the legislation fail to show that mandatory arbitration is a fair or proper way of holding down health care costs. So poor is the record of forced arbitration in issues of medical services that the American Arbitration Association announced in March that it would no longer participate in such cases unless arbitration is voluntary on both sides. On the possible increased cost of litigating more disputes, proponents of the Escutia bill say a similar change in Texas law resulted in only six lawsuits since 1997, and made HMOs readier to approve necessary medical care.

The Assembly committee should approve the bill in the interest of the state’s health-care consumers, and send the clearly justified measure on to the governor.

Consumer Watchdog
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