® Patient’s Medical History: Maria Russo had a small lump her right earlobe in the jaw area. It was determined by her HMO that she had a non-malignant vascular tumor wrapped around her parotid gland. Maria’s HMO doctor explained that since the tumor was in a very rare place it would be very risky to do surgery. He also said that Maria would be better off just leaving it alone since it was non-malignant. The HMO doctor said that surgery would put Maria at risk, because there would be a great chance of cutting her facial nerve and the possibility of severe loss of blood. Maria and her husband, Peter, both agreed that surgery would be a last resort.
A few months later, the lump became so painful and enlarged that the Russos again talked to the HMO doctor and decided on doing the surgery. The HMO doctor said that in order to lessen the risk of surgery he wanted to send Maria to an out-of-network facility, where an expert could do a pre-op procedure to "clog her vessels." The pre-op procedure would stop the bleeding long enough to help the HMO doctor have a better "field of vision" when doing the surgery.
However, the transfer out-of-network was denied and another HMO doctor, with little experience doing the procedure, was to perform it at the HMO.
On the day of the surgery, Maria was told by the performing surgeon there was only a 1% chance for complications. However, during the procedure, Maria suffered a massive stroke and was in a coma for three days.
Maria now has no use of her left hand, has numbness on her entire left side and lives with constant headaches.
Nine months later, Maria had the surgery done successfully without the pre-op procedure. Peter Russo began to wonder why the pre-op was necessary in the first place. He felt it was an undue risk, particularly when done at the HMO by inexperienced HMO doctors and staff.
TEMECULA, CA- "We hired a lawyer shortly thereafter. We had also found out that we could not take the HMO to court. I thought that arbitration was just an out of court type of settlement. But then it became evident that we were caught in a system which would benefit only the HMO and not us at all.
Just two weeks prior to the arbitration, we found out some other disturbing information [along with the performing HMO doctor’s lack of experience]. Gelfoam, the substance used to clog Maria’s vessels, is not approved by the FDA. My wife and I thought that the HMO had really gone over-board and didn’t stand a chance now. Again, we would find out that it really didn’t matter with the arbitration system that the HMO had.
At the hearing, the arbitrator, before the opening statements were made, questioned the HMO about where his paycheck was. The HMO attorney laughed and said, ‘don’t worry, it’s in the mail.’ The retired judge, gets $10,000 per week for hearing these arbitrations and it appeared that he was more interested in the money than he was in the arbitration case. In fact, this arbitration seemed to be just a means for old friends to get together to have some fun and reminisce. There seemed to be no seriousness to the case about to be presented.
I noticed the arbitrator physically didn’t look too well. As a matter of fact, I saw his right hand shaking and realized that he had Parkinson’s disease. As he took notes, he wrote very slowly and seemed to have a hard time writing. Then I noticed he was falling asleep through most of the testimonies. I thought to myself, ‘is this man going to decide our fate?’
When it was the performing HMO doctor’s time for testimony, our attorney asked questions. I noticed again that the arbitrator was falling asleep and that he was missing an important part of testimony. This HMO doctor was stepping all over himself. I couldn’t believe what I was hearing and neither could anyone else. By this time, I thought there was no way we could lose.
The next afternoon our attorney called and told us we had lost. I called our attorney and he told me that he found out the arbitrator ‘had been having some problems with his ex-wife and he was not totally focused.’
Our biggest argument is with an arbitration system known as ‘binding.’ It doesn’t allow you to appeal your case. Once the decision is made, that’s it. No mistrial, no nothing. No one, but one person, is there to decide your fate.
Our arbitrator handed out his ‘bio’ the first day of arbitration. Of his 6 previous cases with the HMO, 5 of them he awarded to the HMO, the other one he awarded to the plaintiff for only $25,000. So it was evident that he was biased toward the HMO. Had we known this before the case started we would have never picked him. I guess he knows that every time he awards for the HMO, the company will pick him again and he’ll get another $5,000. So I guess he goes to where the money is."
— Maria Russo’s story is reported by her husband, Peter.
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.
