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Patient
rights advocates Jacquelyn Finney (Plaintiff, In Pro Per*) and
Robert Finney, Ph.D. have won a new right to sue a State, State
officials, an HMO, an HMO Medical Group and a coalition of large
corporations for breach of contract and RICO. Named
defendants and affiliate entities include:
- California
Department of Managed Health Care (DMHC)
- Daniel
Zingale, DMHC Director
- Andrew
George, Senior Legal Counsel, DMHC, HMO Help Center
- Kaiser
Foundation Health Plan/Kaiser Permanente Medical Group
- Pacific
Business Group on Health (PBGH)
THE
GOVERNMENT'S CONTRACT WITH HMO PATIENTS
Dr.
and Mrs. Finney convinced a Superior Court Judge that a state
managed care regulatory agency has a "contract" with
patients and must not fail to allow them the benefits mandated
by patient rights laws.
THE
RULING
On
February 20, 2003, San Diego Superior Court Judge Thomas P.
Nugent ruled that Mrs. Finney had pleaded sufficient facts to
overrule the Department of Managed Health Care's demurrer and
allowed a cause of action for breach of contract to proceed
to summary judgment or trail.
The
lawsuit, Finney v. California (Case No. GIN024734) states facts
that defendants:
- Conspired
to "gag" and coerce Dr. and Mrs. Finney to prevent
them from communicating with the HMO and its physicians about
their rights prior to and during the course of their physician
patient relationships.
- Retaliated
by denying a second opinion from the specialist of their choice
within the HMO Medical Group (a legally mandated benefit),
unless they expressly waived all their rights.
- Demanded
that they waive their right to informed consent in medical
decision making and waive other rights fundamental to the
doctor-patient relationship.
Judge
Nugent allowed a future RICO cause of action to be pleaded.
Defendants did not rebut the lawsuit's allegations that they
are acting in conspiracy under color of state law to violate
patients' Constitutional rights, harming the public health and
safety.
He
granted the State's attorneys ten days leave to answer. Pleadings
and Progress Reports can be viewed on www.hmohardball.com.
UPDATE
Subsequent
to the lawsuit's filing (10/11/2002) and prior to the Judge's
ruling (02/20/2003):
- Governor
Gray Davis (D-CA) summarily removed Daniel Zingale from his
position as Director of the Department of Manage Health Care.
- The
California Patient Advocate, Dr. Martin Gallegos, resigned.
- DMHC
deleted the State-sponsored Patient's Rights Enforcement Guide
from its website, which had been featured on the home page
for two years. The California Office for the Patient Advocate
(patient rights advisor to DMHC's Director) was deleted from
DMHC's organization chart.
- DMHC
lawyers denied the existence of the "rights" identified
in the State-sponsored Guide, upon which patients are
instructed to rely in order to obtain medically necessary
health care.
On
March 7, 2003, Governor Davis, Jim Tucker (DMHC Acting Director)
and the State's attorneys were notified of Mrs. Finney's intent
to file a Request for Entry of Default Judgment, as an Answer
to her Complaint had not been receive within ten days of the
Notice of the Judge's Ruling.
SUPPLEMENTAL
INFORMATION
Mrs.
Finney was a federal health care fraud investigator. Dr. Finney
was Hewlett-Packard Company's Manager, Health Care Cost Containment.
They are not lawyers. They acted in Pro Per * and were neither
advised nor assisted by lawyers.
*
In Pro Per means acting in one's own person without the assistance
of an attorney.
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Copyright 1998-2003, CounterPoint Communications
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