Sunday, June 13, 1999
The wrong 'outcomes'
BY PETER BRONSON
The Cincinnati Enquirer
If oil companies designed our cars, we'd all drive Cadillac Extravagants and Lincoln Terminators that get 4 MPG — highway. So why do insurance companies design our health care? And why can't we sue them when an HMO Pinto blows up and someone gets hurt?
Surprise: Some customers can sue.
Managed care companies are immune to lawsuits in most states. Their powerful lobby surgically removed malpractice liability from Ohio's new Patient Bill of Rights.
But the lawsuit shield has a hole in it: Government employees can sue HMOs. “The government never passes laws that apply to itself,” Holly Spraul explained.
She and her husband, Daniel, are medical malpractice lawyers who are handling a rare lawsuit against a managed care company, Community Mutual Insurance (CMI), now Anthem.
The facts they presented to the Ohio Appeals Court begin:
“MacKenzie was healthy at birth.”
In those five words are a story about courts that operate on a Stonehenge clock, politicians who use “health-care reform” threats to squeeze donations from the managed care lobby, and HMOs that think people are “outcomes.”
MacKenzie was born on July 15, 1993, to a Cincinnati couple insured by CMI. She is one of the disasters of managed-care cost cuts that changed Ohio law in 1998 to prohibit “drive-through” deliveries.
Mothers and newborns now can stay in the hospital for 48 hours before being discharged, ready or not. MacKenzie was sent home after 24 hours, before doctors could detect and easily cure a bad blood match that caused quadriplegic cerebral palsy.
The lawsuit alleges: Contrary to professional standards and its own policies, CMI cut off reimbursement to the hospital at 24 hours, and concealed that policy from patients; CMI refused to pay for home-care or follow-up visits for MacKenzie. “For lack of an extra day in the hospital ... MacKenzie, although intellectually intact, has lost her life as a fully functional person and is trapped in a body that contorts and spasms and does not respond to her commands to walk, talk, stand, sit, roll, grasp, feed herself, toilet herself or other voluntary motion.”
Because her father is a city employee, MacKenzie's parents were able to sue CMI. After nearly four years of litigation, the case was handed off to a visiting judge — who quickly dismissed it.
Laura Green-Caldwell of Anthem said, “It's a very sad situation this family has faced, but the courts have consistently ruled that there were no facts upon which to base a lawsuit against us. The case was dismissed, not because we could not be sued but because after four years of litigation and fact finding, there was no factual evidence on which to base a case against Anthem.”
Mrs. Spraul says the visiting judge was clueless. “In one sentence from the hip, he completely obliterated years of litigation.”
The lawsuit seeks $10 million to care for MacKenzie — and perhaps $20 million for pain, suffering and punitive damages.
So who pays if they win?
Mrs. Spraul says CMI/Anthem has its own malpractice insurance. “Although they deny they are making medical decisions, they had a medical policy to protect them.”
She says $30 million is “a drop in the bucket for a company that pays one CEO $11 million a year.”
But we all know corporate bosses never pay for their own blunders. We all will suffer for such lawsuits, with higher premiums for reduced benefits.
Mrs. Spraul insists it's worth it to improve HMOs. “If a few cases like MacKenzie's are successful, they will reassess what is medically necessary for newborns. Economic penalties will outweigh profit-driven decisions to deny health care.”
What we have now “is a very insidious way of rationing health care,” Mrs. Spraul said. Nurses, doctors, hospitals and patients assume all the risks, while the managed care cartel assumes all the profits.
But using lawsuits to reform health care is like using napalm to toast a marshmallow. Everyone gets scorched.
And expecting government to mandate benefits, one law at a time, is like asking the Postal Service to deliver a cure for cancer without a ZipCode.
Politicians won't do it. If the system is fixed, they can't bill us for a complete overhaul every time they look under the hood.
That leaves it to us. There's a way to put consumers in charge again: Give individuals — not employers — tax deductions to shop for health insurance and let the market work. Letting our employers and HMOs do it for us is like asking Shell Oil to design an electric car: It can give you quite a shock.
Peter Bronson is editorial page editor of The Enquirer. If you have questions or comments, call 768-8301, or write to 312 Elm Street, Cincinnati, Ohio 45202.
Peter Bronson is editorial page editor of The Enquirer. If you have questions or comments, call 768-8301, or write to 312 Elm Street, Cincinnati, Ohio 45202.
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