HMO incentives cited in Massachusetts lawsuit

The plaintiff's case centered on the role managed care might have played in a patient's treatment.

By Andis Robeznieks, AMNews staff. Sept. 27, 2004.

A Massachusetts jury recently decided to award $1 million to the widow and son of a 46-year-old Massachusetts man after finding that the man's doctor had been negligent in failing to diagnose gastric cancer.

Max Borten, MD, attorney for the estate of Kimiyoshi Matsuyama, said that after the lawsuit was filed in June 2000 and records were subpoenaed, he decided to argue that Neil S. Birnbaum, MD, failed to order tests or prescribe medications for Matsuyama's stomach pains during four years of treatment because he was paid bonuses by the HMO to which Matsuyama belonged to keep costs down.

Michael Goldrich, MD, chair of the AMA Council on Ethical and Judicial Affairs, would not comment on the case specifically but said market forces have a potential impact on utilization of health care resources in general.

Although the managed care environment might be better than it was in 1999, Dr. Goldrich said there really hasn't been "reform."

He added that there has been positive movement in the managed care marketplace through government action and advocacy campaigns such as the AMA's fight against gag clauses.

"More freedom has been restored to the system and fewer restrictions remain on a physician's ability to practice inside of systems," he said. "The problem is that individual physicians are still not empowered in the marketplace."

Dr. Goldrich said AMA policies approved in the past several years could be summarized as stating that "physicians, ultimately, have responsibility for the patient before them."