Patient’s Medical History: Ina Hobson died in her HMO’s emergency room. She could have been saved if her HMO had been willing to let her stay at the facility where she was taken by Fire Department paramedics.

Instead, her HMO insisted she be transferred to its E.R., where she was incompetently attended to. The HMO’s emergency room doctor was untrained in emergency room medicine: he was a resident in plastic surgery who subsequently failed even his board examination in plastic surgery.

With an unqualified HMO E.R. doctor, it was never determined that the cause of Ina’s severe pain was a small tear in her spleen, a medical condition which was capable of being remedied by a simple procedure.

Instead, for six and a half hours, Ina remained untreated with no HMO surgeon available because of inadequate staffing. Her nurses tried desperately to locate a surgeon while Ina’s condition worsened and her abdomen filled up with blood.

Finally, Ina’s nurses found an HMO surgeon at home who, upon arriving, examined Ina and ordered her transferred to Intensive Care to "await surgery."

At 12:30 a.m., the HMO surgeon cancelled the surgery and ordered the nurses to start a morphine drip. Only after the nurses started the morphine drip, had they "discovered" that Ina was allergic to morphine, although the patient’s admissions record clearly stated her allergy to morphine. The HMO doctor, even when questioned by the nurse, ordered the nurses to continue the drip.

At 1:00 a.m., Ina’s records show that she believed she was going into surgery. But the HMO surgeon nevertheless ordered the drip continued which caused Ina’s death at 3:15 a.m., less than 12 hours after she arrived at the HMO hospital.

SAN DIEGO, CA- Shocked and suspicious upon hearing of her death, Ina’s family hired a lawyer to investigate what happened in Ina’s final hours. Ina’s subscriber agreement contained a mandatory, binding arbitration clause, which prohibits her family from taking her case to court. Instead, the family had to go to arbitration alleging wrongful death, fraud, cover-up, and violation of the elder abuse law. Though Ina died in 1991, the Hobsons did not get to an arbitration hearing until 1997.

Upon receiving Ina’s medical records, the family found no mention of abdominal bleeding, yet the autopsy showed massive amounts of blood in her abdomen. The HMO surgeon claimed that Ina wanted to die and that he only accommodated her final wishes. The Hobsons state that the records revealed a doctor for the HMO had changed Ina’s chart long after her death, by adding the word "hemorrhage" to her original diagnosis. The Medical Board of California would also find this to be the case and require the HMO doctor to take an ethics course as a result. Documents also indicate that the HMO withheld a part of Ina’s medical record that showed that she had never consented to die, but thought that she was authorizing pain relief and surgery.

The Hobsons lost on all counts of their arbitration except a breach of standard of care charge stating the HMO negligently failed to assess Ina’s condition in a timely manner and that she would have consented to surgery and survived if they had. The HMO was not found to have committed fraud or elder abuse.

Yet, since the arbitration, the Hobsons have had various California regulatory agencies, including the Department of Health Services and the Medical Board, review the case and they have found significant evidence to begin legal proceedings against the HMO physicians.

David Hobson, Ina’s son, feels the arbitration process was neither fair nor neutral for the family. He states, "In actual fact, ‘neutral’ arbitrators are afraid to offend [the HMO] and be barred from participating in future panels. $2000 a day is a pretty strong incentive for a retired judge…the fact that the panel only faulted the HMO for not providing a surgeon in a timely manner when all other agencies supported all of our allegations is, in my opinion, a clear example of bias."

— Ina’s story is reported by her son, David Hobson, D.D.S., M.S.

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.