Family Asks for Speedy Arbitration Hearing, HMO Delays & Forces Settlement

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® Patient’s Medical History: Frank Picerno’s HMO denied him tests to investigate his heart problem. Frank now suffers from congestive heart failure and has only 8% of his heart functioning. Frank and his family were forced into binding arbitration when they tried to hold the HMO accountable for Frank’s care.

SACRAMENTO, CA– "On the 21st of April 1997, a demand for arbitration was sent to my father’s HMO from our attorney. Months went by as, per my parents attorney, the HMO would not respond for an earlier arbitration hearing even though my father’s condition was deteriorating.

In August of 1998, my parents were notified of the deposition date for the arbitration. My parents gave their depositions on the 28th of September 1998. The depositions from the doctors were taken sometime mid March in 1999.

On June 10, 1999, the HMO’s lawyer received a letter from my parent’s lawyer asking that a certain judge be selected as a neutral arbitrator. On the 18th of June, 1999, the HMO’s lawyer agreed to the neutral arbitrator my parents had chosen.

I have a letter from my parent’s lawyer to the HMO’s lawyer from this time, again requesting the HMO expedite the arbitration process. The HMO’s lawyer replied the HMO would attempt to set the arbitration hearing in October. That date came and went. I truly believe the HMO was hoping my father would die.

For many months, when my father went to his appointments at the HMO’s cardiology department, his file was missing. On subsequent appointments, when it was available, my parents observed that the file had on it "Legal Department." Obviously, not a surprise, this case was being followed closely.

The 17th of December, 1999, was the motion cutoff date and the mandatory settlement conference. We did not attend that. However, we were informed that the HMO had requested my parents lower the amount of their demand. We refused. The HMO then demanded that my father attend the arbitration hearing that was to be held in San Francisco the first week of January 2000. The company refused to change this date or location, even knowing that my father suffers from congestive heart failure and has only 8% of his heart functioning.

We met with our attorney at the end of December 1999 and told him to tell the HMO we would not jeopardize my father’s delicate condition. My parents were basically forced to settle with the HMO, for less than I believe they deserved. It was not worth taking my father to San Francisco. Money was never the issue.

The HMO represents that arbitration is a fair approach to protecting the rights of its members. However, it is still a self-administrated process which delays for its own benefit. It is still a dysfunctional system that needs court supervision. I have watched what this has done to my parents. My father was determined to live to see justice done.

As I wrote earlier, this was never about money. Since arbitration is not public record, how do we know that the doctor treating us has not had problems before? It is time for HMOs to stop forcing their members to give up their trial rights in order to obtain health coverage.

AB1751 is a long overdue bill that is desperately needed. I can tell you that my parent’s cost to their attorney came to around $40,000. I checked all the costs and it would not have been anymore if we were allowed to litigate. For, this was pretty much a clear cut case for trial."

— Frank Picerno’s story is reported by his daughter, Kathleen Mashburn.

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.

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