‘ Patient’s Medical History: HMO doctors misdiagnosed Wilfredo Engalla’s lung cancer as colds and allergies. By the time he was diagnosed properly five years later, the cancer was terminal.
HAYWARD, CA — "My dad was a patient of an HMO. In January 1991, after being told for several years that he had chronic allergies, we learned that he had lung cancer, and that it had become inoperable.
To say it was a shock is an understatement. We continue to feel that if the diagnosis had been correct from the beginning, Dad would still be with us today.
We contacted an attorney, because we felt that the care given my dad had been substandard, and we wanted to get some answers from the HMO. That was when we found out that enrollment in the HMO restricted us to ‘binding arbitration.’ This meant that we were at the mercy of the HMO arbitration program. We did not have the right to seek recourse in a courtroom.
Initially, arbitration appeared to be an acceptable solution. We knew that Dad had very little time left and that he wanted to settle his affairs before he died. According to the HMO, the program would work speedily. An arbitrator would be appointed within 80 days. We expected that the case would be resolved within a few months, which is what the HMO had promised.
Our lawyer knew of Dad’s wish for a speedy resolution. He continually asked the HMO to uphold their contractual obligation, reminding them that we had fulfilled our part of the process and were just wafting for them to do the same.
The months sped by quickly and Dad grew sicker in both body and spirit. This unfinished business weighed terribly on his mind. He wanted to have his case heard and to ask the HMO why they had made such a terrible mistake.
My dad died on October 23, 1991. The next day, more than 5 months after we filed our case, we received notice that the HMO had finally appointed an arbitrator.
It was not until after his death that my family fully realized how inherently biased against us the HMO’s arbitration program was. The amount of the damages we might have been awarded was significantly reduced once Dad passed away. It explained, with chilling clarity, the reasons behind the HMOs stall tactics.
The information we unearthed about the program was horrifying. Instead of taking 50 days to appoint an arbitrator, the HMO’s data showed that it averaged 674 days. Those statistics make a mockery of the purpose of arbitration. It would have been much faster to go to court.
At that time, the HMO’s arbitration program had been in place for almost 20 years. One can only imagine how many other families had suffered as ours had. Our dad’s HMO, like other HMOs that require binding arbitration as a condition of coverage, has been able to hide their mistakes because arbitration, unlike a courtroom, is private.
My family supports the bill written by Assembly Member Sheila Kuehl, AB 1751, because we don’t want other families to suffer as we have."
— Wilfredo’s story is reported by his daughter, Aina Engalla-Konold.
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.