Escalating its war against physician "deselection" by managed-care plans, the American Medical Association is financing a Texas physician's fight against his ouster with a new weapon: the Americans with Disabilities Act.
Jorge Zamora, M.D., claims he was harassed and fired from HealthTexas Medical Group in San Antonio because he "refused to allow concerns of cost-effectiveness to override quality healthcare," according to a complaint filed with the Equal Employment Opportunity Commission.
Named in the complaint are the medical group and its management service organization, PrimaryCare Net of Texas, which is owned by Santa Rosa Healthcare in San Antonio. Also named are Humana Health Plan of Texas, PacifiCare of Texas and their Medicare HMOs.
The 1990 Americans with Disabilities Act prohibits discrimination against disabled people and those who associate with them.
"The heart of our case is that these physicians suffered because of the relationship they had to patients with disabilities," Austin attorney Robert Provan said.
Zamora included 11 of his former patients by name, plus other unnamed patients, in the complaint. Provan said many are poor, elderly and suffering from chronic illnesses.
Provan said he intends to file complaints with the U.S. Justice Department on behalf of Zamora and Martin Geurrero, M.D., who was employed at HealthTexas until May 1995. Geurrero is vice president of the Bexar County (Texas) Medical Society.
The ADA has been used against employers to argue for the inclusion of benefits such as AIDS and HIV treatment in company health plans. But the argument that a health plan or medical group violates the ADA by restricting care is unusual.
The AMA considers this a test case and has made managed-care deselection a priority issue, AMA staff attorney Cynthia Kulkarki said. The AMA is lending expertise and funds through the 2-year-old AMA-State Medical Society Litigation Center, which is funded by the AMA and 42 state medical societies.
Doctors have brought a smattering of cases against managed-care plans, with mixed results.
Last year, the 5th U.S. Circuit Court of Appeals in New Orleans ruled that five Texas doctors had no legal standing to challenge their deselection from a PPO panel by Aetna Life Insurance Co. That case and others involve provider panel termination, while Zamora's involves employment termination, but the issues are similar.
Zamora alleges he was warned by his employers that he was requesting too many tests and making too many referrals to specialists.
"His medical decisions were subject to extraordinary review. He also was humiliated at weekly staff meetings, attended by HMO `health coordinators,' who had offices in the clinic where Dr. Zamora worked," the complaint said. It also said he "would not participate in `turfing and surfing' practices used by some members of the managed-care industry to drive off patients who require expensive care."
Jeffrey Puckett, PrimaryCare Net's chief executive officer, denied any harassment and said Zamora has been unable to substantiate his charges under oath.
Puckett also denied the implication that the medical group drove off sick patients. He said the group had never heard the term "turfing and surfing."
Humana declined to comment on the complaint. A spokeswoman for PacifiCare flatly denied any discrimination and said the plan does not have offices in the clinic.
Zamora had a brief and rocky career at HealthTexas, according to records filed by HealthTexas in Bexar County court. He was hired in August 1995 and submitted his resignation less than eight months later. Before the resignation became effective, however, Zamora was fired after he became "hostile and verbally abusive" in an encounter with HealthTexas President Richard Reyna, M.D., and refused to follow unspecified HealthTexas policies.
Several weeks later, HealthTexas sued Zamora for allegedly violating a noncompete agreement by trying to access patient records. Provan said Zamora was only trying to make sure his patients were receiving proper care, but the court issued a temporary restraining order against Zamora.
Bob Cook contributed to this story