Word: goodrich
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Dates: during 1990-1999
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...Though Goodrich died in March 1995, at age 44, Aetna insists that it had approved all the necessary treatments and acted promptly and responsibly throughout. His widow Teresa felt otherwise and sued; Aetna, she said, in effect hastened her husband's death. In a decision with national resonance, a jury in San Bernardino County Superior Court agreed. Strenuously. In the stiffest such penalty ever imposed on an HMO, the jury two weeks ago awarded Goodrich's estate almost $750,000 in compensatory damages for medical costs and $3.8 million for "loss of companionship and support." In a separate decision last...
Although the award is likely to be trimmed on appeal, its significance remains. The Goodrich family found justice where few can. Under the 1974 Employment Retirement Income Security Act, more than 125 million Americans currently covered by their employer's HMO programs cannot sue their provider for punitive damages. It doesn't matter if the HMO manager is a bumbling idiot or a devious scrooge. It doesn't matter even if the patient dies or loses a limb to negligence...
Originally designed to shield employee benefit plans from frivolous but potentially crippling lawsuits, ERISA evolved over time to protect HMOs from liability suits by anyone--except Medicare and Medicaid recipients, church officials and government employees like Goodrich. Others can go to court, but at most they are entitled to recover the cost of the care that their HMO refused to reimburse. Not much consolation...
Some HMOs are attempting their own limited reforms. Just a month before the Goodrich award, all HMOs in California agreed to submit to review by an outside panel of doctors. Fifteen states allow patients to appeal HMO decisions to a state board, though critics say the panels almost always side with the insurer...
...this political to-and-fro-ing doesn't impress Goodrich's widow Teresa much. "He was incensed by the way he was treated," she recalls. "It offended his sense of justice." To her, the obvious solution lies in the simple maxim that her husband lived by: Do right by people...