Eye on San Diego
HMO horror stories are far too common in this age of managed healthcare. Inconvenience seems standard practice: It takes forever to see a specialist; a particular doctor isn’t included in your company’s new plan. But woe to us all if health maintenance organizations and doctors are in the widespread practice of putting bottom lines ahead of proper patient care.
A recent San Diego court case suggests that could be the case. In a verdict that could have far-reaching effects on managed care, a jury ruled in April in favor of pediatrician Thomas Self in a lawsuit against the Children’s Associated Medical Group (CAMG). Dr. Self contended the group wrongfully terminated him because he put patient care ahead of profits. He was awarded $1.75 million in compensatory damages. Days before punitive damages were to be determined, Self settled for a total of $2.5 million.
With the jury apparently steamed at the medical group, why didn’t Self hang on for what might have been punitive damages in the tens of millions? “Because I got what I wanted—I was vindicated,” he says. “And rather than have to worry about appeals for another three years, I can go back to practicing medicine full time.
”Self’s trouble started three years ago. He says he was repeatedly told by CAMG members to spend less time with patients and prescribe fewer costly tests. He did neither. In July 1995, after 12 years with the group, he received a letter informing him he was being dropped. Immediately, Self lost his malpractice insurance and was not allowed to contact his patients. Parents with sick children were informed Self had left town without explanation, or that “something terrible had happened, and they couldn’t say what.”
A critical part of Self’s case against his former medical group was a letter from an HMO to the CAMG board stating that Self ordered too many tests and didn’t understand managed care, according to Sherry Bahrambeygui, a lawyer with the local firm Monaghan & Warren.
According to David Noonan, legal counsel for CAMG, the case simply stemmed from a contractual dispute. “We were surprised and disappointed with the outcome of this suit,” says Noonan. “We do not agree with the verdict or that the jury award was warranted.” Noonan believes the final outcome—which will not be appealed —may have been influenced by public ire regarding managed care.
Adds Michael Segall, senior physician and director of neonatology with CAMG: “Our commitment to treating children who come to us, regardless of payer source, is second to none. CAMG is not a managed-care organization. We are not an HMO.
”But CAMG and health maintenance organizations were both on the hook in this case, says Bahrambeygui. “This was a case against a medical group that contracted with managed-care groups,” she says. “And the influence of managed care clearly affected this situation.”Self’s suit hinged on a California law passed in 1992 that shields doctors from retaliation for advocating appropriate medical care for patients.
Bahrambeygui, teamed on the case with Brian Monaghan, predicts “more and more medical groups are going to be held accountable for their actions.” She says a month after the court decision, her firm had received more than 500 calls and letters of support from the public and from doctors who believe they’ve encountered similar situations with HMOs.
By all accounts, Self’s three-month trial was grueling. Defending CAMG and its president, Irvin A. Kaufman, were teams from three local law firms: Neil, Dymott, Perkins, Brown & Frank; Lewis, D’Amato, Brisbois & Bisgaard; Post, Kirby, Noonan & Sweat. CAMG lawyers painted Self as lacking in confidence, one who ordered unnecessary tests and may have become senile.
Not at all, argued Bahrambeygui. She describes Self as being right out of a Norman Rockwell painting. “He’s a quiet, caring and conscientious individual with great courage,” she says.
Self says medicine wasn’t his first career choice. At 14, he had his heart set on being an airline pilot. He meticulously constructed model planes, some motorized by rubber bands. Then fate intervened.
Rieve Cary was an older neighborhood boy the kids looked up to, recalls Self. “He took me to the medical school at Emory College [in Atlanta] where he was studying,” he says. “We went into the anatomy lab, and I practically passed out when I saw a cadaver. Then we went to a pediatric clinic. I immediately noticed the physicians in starched white coats moving around patients. They looked so professional and soothing and impressive. I was full of respect and awe.
”Self went home, put away all his model planes, got out the science books ... and eventually became embroiled in a lawsuit that rocked the nation’s medical community. In June, the Association of Trial Lawyers of America picked Self, Bahrambeygui and Monaghan as recipients of the Steven J. Sharp Public Service Award. Named after a young man who lost both arms to a defective hay baler, the award is given in cases that best embody “the story of American civil justice.” After receiving the ATLA award in July, Self was scheduled to speak before a Senate panel in Washington, D.C., in favor of a bill advocating a patient’s bill of rights.“
There is certainly a need for some sort of managed care in this country,” says Self. “What I don’t like is when it becomes rationed care. There are situations where a physician needs to say, ‘Mrs. Brown, your son needs this test, and your insurance company won’t pay for it.’ It’s not fair to not give necessary care. It’s just not fair. Yes, tests cost money. But these aren’t numbers or cost units we’re talking about. These are people.”
The Schooling of Ted Williams
According to San Diego Unified School District spokesperson Norma Trost, Williams has been added to a list of 97 names approved for schools. Although there have been exceptions, most approved names are of deceased individuals. Also on the list: Ludwig Von Beethoven, Sir Isaac Newton and Harriet Tubman.
Williams sends word he’s honored by the idea, says San Diego Municipal Court Judge Robert Coates, but is opposed to a renaming of his alma mater, Hoover High. None of San Diego’s 166 schools is named after a ballplayer (though Albert Einstein Junior High was renamed in honor of late Padres owner Ray Kroc). But there is a dubious precedent: A school in Los Angeles honors the paternity-challenged life of former Padre and Dodger Steve Garvey.
Yee-Ha! A Board Game for Women!
Players answer questions in order to move their horses down a two-dimensional trail. The winner is the first to reach Paradise Ranch. But first, ladies must mosey past landmarks like Emotion Ocean and Pregnancy Pass. Questions are not for the prudish. Sample: “What is my favorite foreplay activity?” The point is not necessarily to finish first but to enjoy the stories along the way. Info: 888-7COWGIRL.
More than a decade after voters removed the name of Martin Luther King Jr. from a San Diego street, artwork is being selected for a park that memorializes the slain civil rights leader. Dedicated in 1991, the Martin Luther King Jr. Promenade is a half-mile-long linear footpath. It runs parallel to Harbor Drive on the other side of the railroad tracks from the convention center. On the ground along the walkway are 30 granite pavers inscribed with inspirational King quotes.
“People don’t notice [the pavers] unless I point them out,” says pedicab driver James Vandenbrink. One couple who did notice: William and Beverly White, an African-American couple from Atlanta, in town to attend the American Public Transit Convention. Beverly says the park is “tremendous—it brought back a lot of memories.”
The president of the San Diego Urban League is not as big a fan. John Johnson wishes the memorial were more visible and respectful. “The man should not have his memory stepped on,” says Johnson. “History calls for a street named in his honor, one populated with African-Americans. The promenade is less than the right memorial. It is a guilt park.”
Johnson was part of a Centre City Development Corporation committee formed to pick public art to be added along the promenade. Johnson says proposed pieces “include some very appropriate works.”
Will works of art enhance the spirit of the park? “That would be lovely,” says downtown resident Amy Brandt, who walks her Lhasa apso along the promenade three times a day. She adds, “Of course, my doggie will probably pee on them.”
Occasionally the jokes fall flat; others take the low road. But there are some rib-ticklers included in The Skeptic’s Dictionary (Queenstown Press, San Diego, $17). Self-published by San Diegan Bob Simmons, the book hits the mark with entries like “Developer (n): Someone who cuts down trees, then names streets after them.”
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