Woman Mistreated by HMO Doctor, Claims HMO-Biased Arbitration

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® Patient’s Medical History: Maureen Alexander was mistreated by her HMO neurosurgeon during a routine office visit. Among other issues, the HMO doctor physically abused Maureen, including taking her gown off and exposing her breasts without permission, and sticking her breasts and pelvic area with a safety pin, without medical purpose.

Following the disturbing encounters with the HMO doctor, Maureen decided to file a complaint with her HMO to have the company investigate, review and discipline the doctor for his actions. The HMO, however, refused to act against the doctor. The reason given by the HMO for its inaction was that any investigation and enforcement would have a negative effect on the doctor’s career.

NORTHERN CALIFORNIA- Maureen proceeded to go through arbitration against her HMO for the doctor’s actions and the company’s own lack of pursuit of her original complaint. During the arbitration hearing, Maureen and her attorneys claim they discovered many disturbing facts about the HMO’s handling of the situation and its handling of the arbitration.

First of all, the HMO has a duty, by law, to review its physicans and credential them every two years with a file on each. However, the HMO was unable to produce a file on the HMO doctor during arbitration. Maureen’s attorneys state that not having a file on the doctor shows a serious breach of duty for patient safety by the HMO. Even when an HMO representative, during the arbitration, agreed there was no reason to doubt Maureen’s truthfulness of the doctor’s actions, the company still chose to cover up what the doctor had done.

Maureen’s attorneys further claim the HMO helped the doctor and his counsel prepare the doctor’s testimony, as well as provided the HMO doctor with private information received from Maureen during discovery. This information allowed the HMO doctor to "shape his testimony to facts already in evidence."

Maureen’s attorneys state, "this pattern of [the HMO] assisting the physician, while working against the insured, was pervasive. [The HMO] acts to deny subscribers their rights under the agreement, and then actively works against their insureds in the arbitration process. After forcing all cases into binding arbitration, [the HMO] then acts to prevent their insureds from utilizing discovery rights specifically provided in arbitration by statute."

Maureen’s attorneys also claim the arbitrator exceeded his own powers of arbitration. They claim that the HMO stonewalled the discovery portion of the arbitration, while Maureen acted promptly through discovery. The HMO refused to answer any questions or requests of discovery. This greatly hindered Maureen’s ability to prepare her case and meet the HMO’s defenses. The HMO enjoyed the "ultimate benefit" of leaving Maureen ignorant of facts and witnesses, therein denying her the "material needed to prove her case." In light of all of these actions by the HMO, the arbitrator followed "his own form of ‘discretion and flexibility,’" instead of acting in accordance to the rules of superior court, to which he was bound by law and under the arbitration agreement.

Maureen’s attorneys state the arbitrator rejected the rules of the superior court because "[the HMO] urged the arbitrator to decide his own way, playing on the bias of the arbitrator for future work from a large corporate entity, urging him to overlook the refusal to respond." Maureen’s attorneys further claim, "the large entities that build binding arbitration clauses into their agreements use their financial clout to lure arbitrators to treat them lightly for refusing to respond to discovery, knowing that some pittance of a monetary sanction is an extremely small price to pay for their billions in profit, and the real benefit is the denial of information that would allow their opponents to have an even chance of prevailing."

Maureen’s attorneys continue, "the arbitrator allowed his bias in favor of [the HMO] to shape the outcome of the case. The arbitrator lost his impartiality and neutrality by making decisions based on who the result wov´ú effect; the arbitrator denied [Maureen]’s rights rather than enforce the applicable law when the enforcement would harm [the HMO]."

— Reported according to court documents.

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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