Wife Dies After HMO Denies Life-Saving Surgery, Husband Fights Forced Arbitration to Get Day in Court

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Patient’s Medical History: "Two and a half years ago, my wife died as a result of malpractice by her physician, malpractice which was encouraged and endorsed by her HMO. A necessary surgery, one that she was entitled to receive under the provisions of her policy, was withheld because the system set up by the HMO offered financial incentives to her medical group to withhold expensive care. Ultimately, that decision allowed her cancer to spread, causing her years of extreme pain and suffering while she battled to hang on to her life."

VAN NUYS, CA — "Prior to her death, in an an effort to prevent others from becoming victims of similiar abuses, my wife decided to go public with what happened to her, and we filed a lawsuit against the doctors and the HMO. And unlike most Americans, I was allowed to bring this lawsuit, because I am a government employee, and that makes me exempt from the provisions of ERISA (the Employee Retirement Income Security Act). After the lawsuit was filed, we discovered that there was a mandatory arbitration clause attached to the HMO policy. We were never told about it when we were required by the County of Los Angeles to take the policy, and to my surprise, I discovered after the fact that when I signed a form allowing the County to automatically deduct the premium payments from my paycheck, that buried in the small print on that form was an agreement to submit claims to mandatory arbitration.

I’ve spent almost five years now fighting that clause, and so far the lower courts have twice upheld my family’s right to get a jury trial. But the HMO has appealed both times, and next week, we will once again litigate at the appellate level the question of whether or not we must submit to forced arbitration.

Arbitration is touted by the HMO as an inexpensive, quick way to resolve disputes. It’s supposed to be consumer friendly and a way to keep down the costs of medical premiums and medical care. The truth is, it is a system that insulates the HMOs from accountability for their abuses.

In my family’s situation, they are willing to delay and to do anything they can to prevent us from exercising our right to a jury trial, because they know they have liability and that a jury will punish them for what they’ve done.

Their only chance to cover up the abuses inherent in the system they’ve created and forced upon the consumers in this state is to keep the litigation proceedings secret… and to do that, they have to get our case and others like it to arbitration… where quality of care violations are concealed from public scrutiny.

Arbitration is unfair in all cases where the HMO has been in collusion with the physicians to withhold patient care. It is unfair because injured parties only have one case in a lifetime while the HMO is in a position to select arbitrators on a regular basis. It doesn’t take a genius to recognize the obvious… that if an arbitrator wants to make a living by handling these cases, then the arbitrator will have to side most often with the HMO if they want to be selected again. That unfairness taints the system, and routinely results in small judgments against the HMO, even in the most egregious cases. HMOs have no fear about losing in arbitration, because the judgments tend to be so small that they are written off as the cost of doing business, and that eliminates any incentive for them to correct their abuses.

The proposed bill, AB 1751, would eliminate pre-dispute, binding arbitration. That will insure that those cases which go to arbitration are the ones that truly belong there. Those cases which are serious, the ones that the public needs to know about, would then be free to be litigated in open court, with the potential for damages that would force the HMOs and their doctors to be accountable for their actions."

— Peter Berman reports his 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.

Consumer Watchdog
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