In October, MODERN HEALTHCARE reported on a suit charging that a cancer patient died because her HMO physicians delayed referring her to a specialist (Oct. 9, p. 30).
A California jury late last month Nov. awarded $2.9 million to the family of the patient, Joyce Ching, who died of rectal cancer last year at age 35. The jury's award is expected to be substantially reduced because of a state law that limits damages for medical malpractice.
A ruling by Ventura County Superior Court Judge Ken Riley relegated the suit-which was closely watched by the managed-care industry as a trial of the capitation system-to a simple medical malpractice case.
Mark Hiepler, the attorney representing Ching's husband and son, argued that Ching's physicians, Elvin Gaines and Dan Engeberg, principals at Simi Valley Family Practice, didn't refer her to a specialist because they had a financial incentive to limit referrals to specialists. The medical group had a captitation contract with Metropolitan Life's HMO, which wasn't named as a defendant.
Hiepler contended that the doctors breached a fiduciary duty to their patient in trying to save money out of their capitation fee.
But Riley said he wouldn't allow the jury to consider Hiepler's arguments that the physicians acted out of a profit motive when they refused to refer Ching to a specialist six times. The physicians' attorney argued that they did their best to help Ching but that she contributed to the delay in her diagnosis and treatment.
Hiepler said he hasn't yet decided whether to appeal the judge's ruling on the breach of fiduciary duty charge. Hiepler said the jury award, though it will be reduced, will "help other patients and consumers. I think the message from the jury was very clear: You can't place doctors in a conflict-of-interest position" and expect them to make the right decisions for their patients.