Physicians are using a new weapon in their battle against physician "deselection" by managed-care plans: 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 services 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 Guerrero, M.D., who was employed at HealthTexas until May 1995. Guerrero 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 Kulkarni 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.
Zamora alleges he was warned by his employers that he was requesting too many tests and making too many referrals to specialists.
Jeffrey Puckett, PrimaryCare Net's chief executive officer, denied any harassment and said Zamora has been unable to substantiate his charges under oath.
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.
Bob Cook contributed to this story.