Some may remember there was discussion about Peter Singer and infanticide which turned to a discussion about health care rationing and the impact of that on disabled people. I suggested that disabled(or ill) people were being cut out of the herd under present health care economics that had shifted the way providers and hospitals get paid from fee for service to HMO profiteering off a set fee. Those in need of care are now viewed as liabilities by health care conglomerates. Profits are being made by rationing care under restricting the definitions of terms like "medical necessity." Several large HMOs have recently dumped disabled people on Medicare from their rolls.
Here is an example of one HMO doctor's confession before congress that she caused the death of a patient by denying care for financial reasons.
Marta Russell
This "Dear Colleague" was sent to Members of Congress a couple of days ago by Rep. Greg Ganske (R-Iowa):
Dear Colleague:
On May 30, 1996, a small, nervous woman testified before the House
Commerce Committee. Her testimony was buried in the fourth panel at the end of a long day about the abuses of managed health care. The reporters were gone, the television cameras had packed up, most of the original crowd had dispersed.
She should have been the first witness that day, not one of the last. She told about the "choices" that managed care companies and self-insured plans are making everyday when they determine "medical necessity." Linda Peeno had been a claims reviewer for several HMOs. Here's her story:
"...I wish to begin by making a public confession. In the spring of 1987, as a physician, I caused the death of a man.
"Although this was known to many people, I have not been taken before any court of law or called to account for this in any professional or public forum. In fact, just the opposite occurred: I was 'rewarded' for this. It brought me an improved reputation in my job, and contributed to my advancement afterwards. Not only did I demonstrate I could do what was expected of me, I exemplified the "good" company doctor: I saved a half million dollars!"
As she spoke, a hush came over the room. The representatives of the trade associations who were still there averted their eyes. The audience shifted uncomfortably in their seats, both gripped and alarmed by her story. Her voice became husky and I could see tears in her eyes. Her anguish over harming patients as a managed care reviewer had caused this woman to come forth and bare her soul.
She continued, " . . . Since that day I have lived with this act, and many others, eating into my heart and soul. For me, a physician is a professional charged with the care, or healing, of his or her fellow human beings. The primary ethical norm is: do no harm. I did worse: I caused death. Instead of using a clumsy, bloody weapon, I used the simplest, cleanest of tools-my
words. This man died because I denied him a necessary operation to save his heart. I felt little pain or remorse at the time. The man's faceless distance soothed my conscience. Like a skilled
soldier, I was trained for this moment. When any moral qualms arose, I was to remember: I am not denying care; I am only denying payment."
By this time, trade association representatives were staring at the floor. The Congressmen who had spoken on behalf of the HMO's were distinctly uncomfortable, and the staff, several of whom subsequently became representatives of HMO trade associations, were thanking God that this witness came at the end of the day.
Dr. Peeno's testimony continued, "...at the time, this helped me avoid any sense of responsibility for my decision. Now I am no longer willing to accept the escapist reasoning that allowed me to rationalize this action. I accept my responsibility now for this man's death, as well as for the immeasurable pain and suffering many other decisions of mine caused."
She then listed the many ways managed health plans deny care to patients. But she emphasized one particular issue--the right to decide what care is medically necessary. "There is one last activity that I think deserves a special place on this list, and this is what I call the smart bomb of cost containment, and that is medical necessities denials . . .Even when medical criteria is used, it is rarely developed in any kind Of standard, traditional, clinical process. It is rarely standardized across the field. The criteria is rarely available for prior review by the physicians or members of the plan. . . ." "We have enough experience from history to demonstrate the consequences of secretive, unregulated systems that go awry . . . "
After Exposing her own transgressions, she closed by urging everyone in the room to examine their own conscience. " . . . One can only wonder: how much pain, suffering, and death will we have before we have the courage to change our course? Personally, I have decided even one death is too much for me."
The room was stone-cold quiet. The Chairman mumbled: "Thank you, Doctor." snip