In the latest case putting managed care on trial, opening arguments were heard last week in a California suit charging primary-care physicians with causing the death of a cancer patient by refusing to refer her to a specialist.
The suit was being heard by a jury in Ventura County Superior Court in Ventura, just north of Los Angeles. It names two physicians as defendants but not Metropolitan Life's HMO, which covered the patient, Joyce Ching. The suit blames capitation for giving physicians an incentive to refer patients to specialists "as little as possible" to increase profits.
The plaintiffs' attorney, Mark Hiepler, previously argued a case that led to what is considered a landmark judgment against an HMO. In 1994 a jury found that Woodland Hills, Calif.-based Health Net wrongfully denied Hiepler's sister, Nelene Fox, coverage for an autologous bone marrow transplant. Fox got the transplant several months later, but theLegal
suit said the delay caused her death. The jury awarded the family $89 million, but that award was reduced in a settlement.
In the current suit, Hiepler is representing Ching's husband and son. The woman died at age 36 of rectal cancer. The suit charges that her primary-care physicians refused six requests to refer her to a specialist.
Defendants Elvin Gaines, M.D., and Dan Engeberg, M.D., principals at Simi Valley Family Practice, had been treating Ching for three months for "severe stomach and abdominal pain, abnormal bowel movements and rectal bleeding," according to the suit.
The suit charges that Gaines did not order tests although in August 1992 he "detected a palpable mass in Mrs. Ching's abdomen" and that he and Engeberg refused six requests for referrals to a colorectal specialist. When the referral was granted in October 1992 tests revealed cancer and surgery was performed on Ching the next month. But the suit charges the delay caused Ching's bowel to perforate, and she died on April 4, 1994.
Michael Gonzalez, the attorney for the defendants, could not be reached at press time. The Los Angeles Times reported that Gonzalez told the jury that the physicians did their utmost to help Ching but that she contributed to a delay in her diagnosis by twice refusing to come to their office to be examined. Gonzalez also said that at one point Ching refused to submit to an uncomfortable procedure that may have revealed the cancer.
A specialist called by Hiepler to the stand conceded under cross-examination that Ching's initial complaints weren't necessarily symptoms of cancer, the Times reported.
An assistant to Hiepler said the HMO was not named as a defendant in the suit because contractual issues made the physicians the appropriate parties to sue and not the HMO itself.
The suit seeks unspecified damages.