One of those things that was in my inbox and I wanted to forward, sorry
for cross postings.
Bob
David B. Goldstein wrote:
>
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> From
> Hippocrates
>
> Clippings: Confessions of an HMO Medical Reviewer
>
> "My clinical goal was to avoid payment. The outcome was a death
> sentence."
>
> [Hippocrates 11(12): 88, 1997. © 1997 Time Publishing Ventures Inc.]
>
>       -----------------------------------      Peer Discussion
>
>  Charges that health maintenance               Read Forum Comments
>  organizations put profits before patients
>  have dogged the managed care industry in      Submit Your Comment
>  recent years. Consumer groups make many of
>  the accusations, but some of the most
>  disturbing reports have come from former      Related Specialties
>  managed care insiders like Kentucky
>  physician Linda Peeno (pictured below). She   Medical Practice
>  testified last spring before a California
>  assembly committee that she had caused a      AIDS
>  California man's death by denying him a
>  heart transplant, a refusal that saved her    Managed Care
>  HMO half a million dollars.
>                                                Primary Care
>  "Everyone was thrilled that I denied that
>  coverage," she told reporters in Sacramento.  Surgery
>  "If I had approved [the transplant], I would
>  have been gone the next day."
>
>  Peeno was in Sacramento to testify in favor
>  of bill AB 794, sponsored by Representative
>  Liz Figueroa, which would require any
>  California physician authorized to deny
>  health care to examine the patient before
>  issuing a denial. As a former medical
>  director or medical reviewer of three HMOs,
>  Peeno says she saw enough cases to know it's
>  dangerous for physicians to decide whether
>  to allow treatment for unknown patients in
>  faraway states. (The bill, passed by the
>  California assembly, was vetoed by governor
>  Pete Wilson in October.) The following is an
>  excerpt from Peeno's testimony.
>
>  Good afternoon. My name is Linda Peeno. I am
>  a physician. I've come here today to tell
>  you how I, as a physician, reached the
>  heights of modern medicine.
>
>  Exactly one decade ago my office was on the
>  23rd floor of a marble building in
>  Louisville, Kentucky. My patient was a piece
>  of computer paper less than half full. My
>  patient's history included a couple of lines
>  of information about a medical condition,
>  and many more about coverage and market
>  data--all passed to me through persons with
>  little or no medical training.
>
>  The physician's exam that I did involved a
>  quick assessment that this was an
>  authorization for an expensive service made
>  worse by its occurrence at a hospital with
>  whom we did not have a contract. My clinical
>  goal was to figure out how to avoid payment.
>  And my diagnosis ultimately was a denial.
>  And the outcome was that a man in
>  California--whom I never saw or touched,
>  much less examined--faced a death sentence.
>  Once I stamped "Denial" on that man's form,
>  his life's end was as certain as if I had
>  pulled a plug on his ventilator. And if I
>  knew his name, it was only for a fleeting
>  second: I remember the details only because
>  of the accolades it brought me from my
>  employer.
>
>  This event dramatically represents what I
>  came to do as a company doctor. Eventually I
>  made many more decisions, some of which, I
>  am equally certain, caused additional pain,
>  suffering, even death for other patients.
>  Hardly the work, I believe, of a physician.
>
>  All of my positions shared a simple goal: I
>  used my medical expertise for the financial
>  benefit of the company whose name appeared
>  on my check. In doing so, I soon realized
>  that I was making decisions that endangered
>  patients. Under this sham process, I acted
>  like a doctor, but I was not. For I was
>  making medical decisions without ever having
>  complete or accurate information, in areas
>  of medicine about which I knew nothing, with
>  no monitoring or follow-up on outcomes and
>  with no responsibility or accountability for
>  my medical decisions. Although I repeatedly
>  was told that I was not denying care, I was
>  only denying payment, that rationalization
>  did not comfort me.
>
>  It is important that I emphasize that I am
>  not anti managed care. However, we do not
>  need a system in which the patients can be
>  put at risk by the distant and dehumanized
>  actions of physicians and other health care
>  employees with [conflicts of interest]. If
>  care is to be limited or denied, it should
>  be done only by a physician who is licensed
>  in the state of the practice, who gathers
>  his or her own information through a
>  thorough hands-on history and physical
>  examination of the patient, who can make
>  decisions in the best interest of the
>  patient without any divided allegiances, and
>  who can inform the patient directly of those
>  decisions--especially when it is a denial.
>
>  The very practice of medicine is at stake. I
>  urge you to support this bill in order to
>  keep the art of medicine at the personal
>  level of patients--the ones who bear its
>  life-and-death consequences.
>
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