In 2015, a woman in Torrance suffered a novel and heartbreaking kind of medical malpractice. Laurie St. Clair, 53, died from liver cirrhosis. The cause of her death was not the lack of an available liver but was in fact due to her insurance company, which disputed who should pay for the entire process of the liver transplant procedure for so long. St. Clair passed away not just before a donor could be found or an operation could take place, but before she had even been able to consult a doctor.
The attorney for the family, Travis Corby has called the behavior of the two HMOs responsible for this tragedy suggested they were “callously indifferent” to the fate of St. Clair.
The HMOs in this case, Health Net of California and HealthCare LA spent months negotiating a contract for an out of network liver transplant, a situation Corby says should not be legal.
“No person in this country should be forced to wait months just to receive an initial consultation for life-saving treatment,” he told the Daily Breeze. “HMOs like Health Net and HealthCare LA should not be permitted to make patients wait in perilous condition while it spends months “negotiating” a contract and looking to save itself money on care that should be immediately available to its insureds.”
He added that such behavior amounted to “death by bureaucracy.”
The situation, it appears was even worse. Not only were the HMOs slow to negotiate a contract, they ignored weeks of phone calls from the family begging for a resolution.
According to Corby, St. Clair’s situation is unfortunately not at all unique. He said he often saw cases like St. Clair’s in which insurance companies were responsible for the severe injury or death of its clients.
St. Clair’s situation raises a question about American insurance and how it should also be included amongst any debates about medical malpractice suits. While suits are usually assumed to be due to a doctor or hospital error, the definition may have to be expanded to include the “death by bureaucracy” situations Corby describes and St. Clair tragically experienced.
Lawyers like Corby and other firms see too many cases in which death and injury would have been avoidable if only for a faster insurance process.
While the country debates health care options, more should be said about the problems within the insurance companies themselves, and not just how rates can be controlled. Whether it is through greater government incentives or the so-called “public option” which would allow for a government-run insurance to counter the private industries, more should be done to decrease the number of cases similar to St. Clair’s.
Until then, too many people will worry not just whether donors can be found but whether their insurance will work fast enough to save their lives.Read More