® Patient’s Medical History: "I went to my HMO for an ear infection and the HMO nurse practitioner prescribed a 21-day treatment of Bactrim for me. The prescription was signed by an HMO doctor even though I had not been seen by one. On the fifteenth day of the treatment, while attending a work-related convention in Las Vegas, Nevada, I became severely ill and was rushed to an emergency room. Several days later, the doctors at the hospital diagnosed the illness as Stevens-Johnson Syndrome, an allergic reaction to the sulfa-based Bactrim drug I had been prescribed at the HMO.
I was hospitalized for one week in Nevada, with burns over approximately 50% of my body from the allergic reaction. Upon my release from the hospital (which was okayed because the HMO representative wouldn’t approve a further stay), I experienced severe discomfort on my skin and in my eyes, excessive bleeding from my lips and mouth, and an inability to sit in any position comfortably for any amount of time.
Five months after getting the wrong prescription, I had an abnormal pap smear for the first time in my life and my HMO doctor informed me that this was one result of the Stevens-Johnson Syndrome. I realized then that this one allergic reaction will continue to be a threat to my life."
VICTORVILLE, CA- "I decided to seek compensation from my HMO. I received a letter from a lawfirm representating my HMO, demanding to depose me. In a nutshell, I’ve been treated as a criminal. The HMO treated me like I was making a false claim, even though my pain and suffering was documented and apparent, even to the deposing attorney.
A few months later, I received a letter about arbitration from the HMO’s lawyers. I was completely unaware that I only had arbitration as an option in trying to hold the HMO accountable. I had never even signed an arbitration clause in my HMO enrollment contract, it was simply put in when my employer updated our plan. I would never have signed it if I had been asked to, but now I have no other options because of it.
My husband and I talked to scores of attorneys to represent me at the arbitration hearing, but many of the lawyers, including a retired judge, told me that they wouldn’t waste their time and money because the process is weighted in favor of the HMO. In the meantime, I was still suffering.
It took four years to find an attorney and begin the arbitration hearing. The hearing would take another year to get a decision.
The whole hearing was skewed in the HMO’s favor. To begin with, the HMO dictated who the ‘neutral’ arbitrator would be. They completely intimidated our attorney who had litttle arbitration experience. The ‘neutral’ arbitrator and the HMO lawyer knew each other and made inside jokes, indicating prior experience together.
It does not take a genius to figure out that if an arbitrator rules against an HMO too often the company will take their business elsewhere. There is an incentive for the arbitrator to rule for the HMO and become a repeat player at arbitration hearings. There is no protection for consumers, period. These private hearings are set up to protect the interest of the HMO.
At the end of our hearing, the arbitrator ruled in favor of the HMO. The whole process cost us nearly $50,000.
I believe that arbitration is intended to prevent the filing of unscrupulous claims, and not to serve as a cover for denying legitimate claims. I went to my HMO with an ear infection, believing that the care I was receiving was trustworthy, and I’ve come away with chronic Stevens-Johnson Syndrome. This is not right."
— Holly Effiom 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.