Study Faults Los Angeles County-USC Hospital for Delays in Care, Not Deaths, -AND- Aetna Confirms Settlement With 700,000 Physicians in Class-Action Lawsuit

CAL/AAEM News Service pottsbri@yahoo.com
Thu, 5 Jun 2003 11:22:38 -0700 (PDT)


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-----Original Message-----

From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] 





Study Faults Los Angeles County-USC Hospital for Delays in Care, Not Deaths 

06/02/2003 

Los Angeles County-USC Medical Center is responsible for staffing shortages, overcrowding, incomplete medical charts and delays in care, according to the final 43-page report from a <http://www.dhs.ca.gov/lnc/default.htm> Department of Health Services team of inspectors, the <http://www.latimes.com/news/local/la-me-usc31may31,1,237881.story> Los Angeles Times reports. However, the report did not address charges that the delays led to patient deaths (Weber, Los Angeles Times, 5/31). In April, the team visited the hospital to investigate claims by the medical center's doctors that patients died while waiting for treatment. The inspections followed several articles in the Times earlier in the month citing statements from County-USC doctors who said four patients died because they did not receive timely care. In papers filed in federal court, the doctors said that delays in medical care because of overcrowding at the hospital have been fatal for some patients who might have surv!
 ived otherwise. The seven inspectors looked into conditions in the psychiatric emergency room, laboratory and ER, as well as at patient records. They also looked into the circumstances surrounding the deaths to determine whether the incidents should have been reported to the state ( http://www.californiahealthline.org/members/basecontent.asp?contentid=48594&collectionid=3&program=1 California Healthline, 4/30). The investigators examined the charts of three of the patients who were said to have died because of delayed care -- the fourth case could not be identified -- and did not find that the deaths were because of long hospital waits, Lea Brooks, a DHS spokesperson, said. She added, "These people were sick. They were very sick." Much of the report concentrated on staffing shortages throughout the hospital that caused delays in patient care, including having nurses change bed linens because of a shortage of housekeeping staff and not having enough nurses to use all the hos!
 pitals' operating rooms. 

Response 

"There are some issues in terms of how many nurses are available at any time. It's not a surprise. We know there are some times we have to close off beds when there's not enough nurses," Dr. David Altman, the hospital's chief medical officer, said. He added that the hospital would submit a written plan of correction for the problems cited in the report within 10 days. A report on laboratory conditions will be released separately, according to county officials (Los Angeles Times, 5/31). 

============================

-----Original Message-----

From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] 

Aetna Confirms Settlement With 700,000 Physicians in Class-Action Lawsuit 

05/23/2003 

As expected, <http://www.aetna.com/> Aetna officials yesterday confirmed that the company will pay $170 million to settle a class-action lawsuit in which approximately 700,000 physicians alleged that Aetna improperly denied and reduced reimbursements, Bloomberg/Philadelphia Inquirer reports (Snider, Bloomberg/Philadelphia Inquirer, 5/23). Aetna Chair Dr. John Rowe yesterday said that the company has agreed to pay $100 million to the physicians, $20 million to establish a foundation to improve the quality of health care and $50 million to cover the cost of the legal fees of the plaintiffs. The settlement also will provide an estimated additional $300 million to the physicians through improved automated systems that will eliminate some reimbursement reductions and expedite payments. Under the settlement, Aetna will establish an independent "Billing Dispute External Review Board" to resolve disputes with physicians ( http://www.californiahealthline.org/members/basecontent.asp?c!
 ontentid=48789&collectionid=3&program=1 California Healthline, 5/22). The settlement also calls for Aetna to accept general treatment guidelines developed by the <http://www.ama-assn.org/> American Medical Association that require care decisions to be based on physicians' clinical judgment, rather than on the least expensive approach among scientifically accepted procedures, the <http://www.nytimes.com/2003/05/23/business/23INSU.html> New York Times reports (Treaster, New York Times, 5/23). Aetna does not admit wrongdoing in the settlement, which will involve about 18 medical societies and associations nationwide. The settlement is part a larger class-action lawsuit filed by physicians in U.S. District Court in Miami against several large health insurers. The lawsuit alleges that Aetna, <http://www.unitedhealthcare.com/> UnitedHealthcare, <http://www.cigna.com/> Cigna, <http://www.cvty.com/> Coventry Health Care, <http://www.wellpoint.com/> WellPoint Health Networks, <http:!
 //www.humana.com/> Humana Health Plan, <http://www.pacificare.com/> Pa


cifiCare Health Systems and <http://www.anthem.com/> Anthem Blue Cross Blue Shield delayed or denied reimbursements for health services and rejected claims for medically necessary treatments as part of a racketeering conspiracy (California Healthline, 5/22). The settlement requires approval from Federal District Judge Federico Moreno, who is presiding over the class-action suit (New York Times, 5/23). The class action will continue against the remaining insurers, the <http://www.miami.com/mld/miamiherald/business/5924531.htm> Miami Herald reports. 

Reaction 

Several physicians groups yesterday called the Aetna settlement a "historic action" that will allow doctors to spend more time with their patients and improve the likelihood that patients will receive coverage for treatments recommended by their physicians. AMA President-elect Donald Palmisano said, "The AMA expects this settlement to raise the bar for the entire health insurance industry." Aetna CEO John Rowe called the settlement "a sea change in relations ... that will lead to greater cooperation on critical aspects of quality, availability and affordability of care." <http://www.prudential.com/index/> Prudential Securities yesterday issued an analyst's opinion that the Aetna settlement could "lea[d] the way" for the other health plans in the class action to come to similar agreements because the settlement was "reasonably inexpensive" and could help Aetna in the future by improving relations with health providers and insurance purchasers (Dorschner, Miami Herald, 5/23). !
 However, Kent Jarrell, a spokesperson for the remaining insurers in the class action, said, "Today's announcement of a settlement by Aetna does not alter the remaining companies' resolve to defend the case vigorously" (Yu, http://www.dallasnews.com/sharedcontent/dallas/business/stories/052303dnbusaetna.f0bc.html Dallas Morning News, 5/23). Bill McKeever, a <http://www.ubswarburg.com/> UBS Warburg analyst, said it is "unnecessary" for the other insurers to settle "because the providers have a weak case. Aetna is just pulling a big PR stunt" (Singer, http://www.sun-sentinel.com/business/local/sfl-rxaetna23may23,0,6699840.story Fort Lauderdale Sun-Sentinel, 5/23). 

BCBS Insurers Added to Class Action 

In related news, a group of providers filed a lawsuit yesterday against <http://www.bcbs.com/> BlueCross BlueShield insurance companies, making similar allegations to those made in the class-action lawsuit against insurers, the <http://www.ctnow.com/business/hc-bluecross0523.artmay23,0,6034059.story> Hartford Courant reports. According to the 90-page complaint filed by Connecticut surgeon Kenneth Thomas, Florida oncologist Michael Kutell and the <http://www.csms.org/> Connecticut State Medical Society, the BCBS insurers used automated computer programs to systematically deny or delay payments. The complaint also accuses BCBS insurers of racketeering for using their "economic power to force doctors into unfavorable contracts," the Courant reports. The suit seeks class-action status and was filed in the Miami court in which the other lawsuits against insurers have been consolidated (Gosselin, Hartford Courant, 5/23). 

==============================

 



Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC-Irvine

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<DIV><FONT size=2><FONT size=2>
<P>-----Original Message-----</P>
<P>From: California Healthline [</FONT><A href="mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM"><U><FONT color=#0000ff size=2>mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM</U></FONT></A><FONT size=2>] </P>
<P></P>
<P></P>
<P>Study Faults Los Angeles County-USC Hospital for Delays in Care, Not Deaths </P>
<P>06/02/2003 </P>
<P>Los Angeles County-USC Medical Center is responsible for staffing shortages, overcrowding, incomplete medical charts and delays in care, according to the final 43-page report from a &lt;</FONT><A href="http://www.dhs.ca.gov/lnc/default.htm"><U><FONT color=#0000ff size=2>http://www.dhs.ca.gov/lnc/default.htm</U></FONT></A><FONT size=2>&gt; Department of Health Services team of inspectors, the &lt;</FONT><A href="http://www.latimes.com/news/local/la-me-usc31may31,1,237881.story"><U><FONT color=#0000ff size=2>http://www.latimes.com/news/local/la-me-usc31may31,1,237881.story</U></FONT></A><FONT size=2>&gt; Los Angeles Times reports. However, the report did not address charges that the delays led to patient deaths (Weber, Los Angeles Times, 5/31). In April, the team visited the hospital to investigate claims by the medical center's doctors that patients died while waiting for treatment. The inspections followed several articles in the Times earlier in the month citing statemen!
 ts from County-USC doctors who said four patients died because they did not receive timely care. In papers filed in federal court, the doctors said that delays in medical care because of overcrowding at the hospital have been fatal for some patients who might have survived otherwise. The seven inspectors looked into conditions in the psychiatric emergency room, laboratory and ER, as well as at patient records. They also looked into the circumstances surrounding the deaths to determine whether the incidents should have been reported to the state ( </FONT><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=4"><U><FONT color=#0000ff size=2><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=48594&amp;collectionid=3&amp;program=1">http://www.californiahealthline.org/members/basecontent.asp?contentid=4</U></FONT></A><FONT size=2>8594&amp;collectionid=3&amp;program=1</A> California Healthline, 4/30). The investigators examined!
  the charts of three of the patients who were said to have died becaus


e of delayed care -- the fourth case could not be identified -- and did not find that the deaths were because of long hospital waits, Lea Brooks, a DHS spokesperson, said. She added, "These people were sick. They were very sick." Much of the report concentrated on staffing shortages throughout the hospital that caused delays in patient care, including having nurses change bed linens because of a shortage of housekeeping staff and not having enough nurses to use all the hospitals' operating rooms. </P>
<P>Response </P>
<P>"There are some issues in terms of how many nurses are available at any time. It's not a surprise. We know there are some times we have to close off beds when there's not enough nurses," Dr. David Altman, the hospital's chief medical officer, said. He added that the hospital would submit a written plan of correction for the problems cited in the report within 10 days. A report on laboratory conditions will be released separately, according to county officials (Los Angeles Times, 5/31). </P></FONT>
<P>============================</P>
<P>-----Original Message-----</P>
<P>From: California Healthline [</FONT><A href="mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM"><U><FONT color=#0000ff size=2>mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM</U></FONT></A><FONT size=2>] </P>
<P>Aetna Confirms Settlement With 700,000 Physicians in Class-Action Lawsuit </P>
<P>05/23/2003 </P>
<P>As expected, &lt;</FONT><A href="http://www.aetna.com/"><U><FONT color=#0000ff size=2>http://www.aetna.com/</U></FONT></A><FONT size=2>&gt; Aetna officials yesterday confirmed that the company will pay $170 million to settle a class-action lawsuit in which approximately 700,000 physicians alleged that Aetna improperly denied and reduced reimbursements, Bloomberg/Philadelphia Inquirer reports (Snider, Bloomberg/Philadelphia Inquirer, 5/23). Aetna Chair Dr. John Rowe yesterday said that the company has agreed to pay $100 million to the physicians, $20 million to establish a foundation to improve the quality of health care and $50 million to cover the cost of the legal fees of the plaintiffs. The settlement also will provide an estimated additional $300 million to the physicians through improved automated systems that will eliminate some reimbursement reductions and expedite payments. Under the settlement, Aetna will establish an independent "Billing Dispute External Review !
 Board" to resolve disputes with physicians ( </FONT><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=4"><U><FONT color=#0000ff size=2><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=48789&amp;collectionid=3&amp;program=1">http://www.californiahealthline.org/members/basecontent.asp?contentid=4</U></FONT></A><FONT size=2>8789&amp;collectionid=3&amp;program=1</A> California Healthline, 5/22). The settlement also calls for Aetna to accept general treatment guidelines developed by the &lt;</FONT><A href="http://www.ama-assn.org/"><U><FONT color=#0000ff size=2>http://www.ama-assn.org/</U></FONT></A><FONT size=2>&gt; American Medical Association that require care decisions to be based on physicians' clinical judgment, rather than on the least expensive approach among scientifically accepted procedures, the &lt;</FONT><A href="http://www.nytimes.com/2003/05/23/business/23INSU.html"><U><FONT color=#0000ff size=2>http://www!
 .nytimes.com/2003/05/23/business/23INSU.html</U></FONT></A><FONT size=


2>&gt; New York Times reports (Treaster, New York Times, 5/23). Aetna does not admit wrongdoing in the settlement, which will involve about 18 medical societies and associations nationwide. The settlement is part a larger class-action lawsuit filed by physicians in U.S. District Court in Miami against several large health insurers. The lawsuit alleges that Aetna, &lt;</FONT><A href="http://www.unitedhealthcare.com/"><U><FONT color=#0000ff size=2>http://www.unitedhealthcare.com/</U></FONT></A><FONT size=2>&gt; UnitedHealthcare, &lt;</FONT><A href="http://www.cigna.com/"><U><FONT color=#0000ff size=2>http://www.cigna.com/</U></FONT></A><FONT size=2>&gt; Cigna, &lt;</FONT><A href="http://www.cvty.com/"><U><FONT color=#0000ff size=2>http://www.cvty.com/</U></FONT></A><FONT size=2>&gt; Coventry Health Care, &lt;</FONT><A href="http://www.wellpoint.com/"><U><FONT color=#0000ff size=2>http://www.wellpoint.com/</U></FONT></A><FONT size=2>&gt; WellPoint Health Networks, &lt;</FONT><A!
  href="http://www.humana.com/"><U><FONT color=#0000ff size=2>http://www.humana.com/</U></FONT></A><FONT size=2>&gt; Humana Health Plan, &lt;</FONT><A href="http://www.pacificare.com/"><U><FONT color=#0000ff size=2>http://www.pacificare.com/</U></FONT></A><FONT size=2>&gt; PacifiCare Health Systems and &lt;</FONT><A href="http://www.anthem.com/"><U><FONT color=#0000ff size=2>http://www.anthem.com/</U></FONT></A><FONT size=2>&gt; Anthem Blue Cross Blue Shield delayed or denied reimbursements for health services and rejected claims for medically necessary treatments as part of a racketeering conspiracy (California Healthline, 5/22). The settlement requires approval from Federal District Judge Federico Moreno, who is presiding over the class-action suit (New York Times, 5/23). The class action will continue against the remaining insurers, the &lt;</FONT><A href="http://www.miami.com/mld/miamiherald/business/5924531.htm"><U><FONT color=#0000ff size=2>http://www.miami.com/mld/mia!
 miherald/business/5924531.htm</U></FONT></A><FONT size=2>&gt; Miami He


rald reports. </P>
<P>Reaction </P>
<P>Several physicians groups yesterday called the Aetna settlement a "historic action" that will allow doctors to spend more time with their patients and improve the likelihood that patients will receive coverage for treatments recommended by their physicians. AMA President-elect Donald Palmisano said, "The AMA expects this settlement to raise the bar for the entire health insurance industry." Aetna CEO John Rowe called the settlement "a sea change in relations ... that will lead to greater cooperation on critical aspects of quality, availability and affordability of care." &lt;</FONT><A href="http://www.prudential.com/index/"><U><FONT color=#0000ff size=2>http://www.prudential.com/index/</U></FONT></A><FONT size=2>&gt; Prudential Securities yesterday issued an analyst's opinion that the Aetna settlement could "lea[d] the way" for the other health plans in the class action to come to similar agreements because the settlement was "reasonably inexpensive" and could help Aetna !
 in the future by improving relations with health providers and insurance purchasers (Dorschner, Miami Herald, 5/23). However, Kent Jarrell, a spokesperson for the remaining insurers in the class action, said, "Today's announcement of a settlement by Aetna does not alter the remaining companies' resolve to defend the case vigorously" (Yu, </FONT><A href="http://www.dallasnews.com/sharedcontent/dallas/business/stories/052303d"><U><FONT color=#0000ff size=2><A href="http://www.dallasnews.com/sharedcontent/dallas/business/stories/052303dnbusaetna.f0bc.html">http://www.dallasnews.com/sharedcontent/dallas/business/stories/052303d</U></FONT></A><FONT size=2>nbusaetna.f0bc.html</A> Dallas Morning News, 5/23). Bill McKeever, a &lt;</FONT><A href="http://www.ubswarburg.com/"><U><FONT color=#0000ff size=2>http://www.ubswarburg.com/</U></FONT></A><FONT size=2>&gt; UBS Warburg analyst, said it is "unnecessary" for the other insurers to settle "because the providers have a weak case. Aet!
 na is just pulling a big PR stunt" (Singer, </FONT><A href="http://www


.sun-sentinel.com/business/local/sfl-rxaetna23may23,0,6699840"><U><FONT color=#0000ff size=2><A href="http://www.sun-sentinel.com/business/local/sfl-rxaetna23may23,0,6699840.story">http://www.sun-sentinel.com/business/local/sfl-rxaetna23may23,0,6699840</U></FONT></A><FONT size=2>.story</A> Fort Lauderdale Sun-Sentinel, 5/23). </P>
<P>BCBS Insurers Added to Class Action </P>
<P>In related news, a group of providers filed a lawsuit yesterday against &lt;</FONT><A href="http://www.bcbs.com/"><U><FONT color=#0000ff size=2>http://www.bcbs.com/</U></FONT></A><FONT size=2>&gt; BlueCross BlueShield insurance companies, making similar allegations to those made in the class-action lawsuit against insurers, the &lt;</FONT><A href="http://www.ctnow.com/business/hc-bluecross0523.artmay23,0,6034059.story"><U><FONT color=#0000ff size=2>http://www.ctnow.com/business/hc-bluecross0523.artmay23,0,6034059.story</U></FONT></A><FONT size=2>&gt; Hartford Courant reports. According to the 90-page complaint filed by Connecticut surgeon Kenneth Thomas, Florida oncologist Michael Kutell and the &lt;</FONT><A href="http://www.csms.org/"><U><FONT color=#0000ff size=2>http://www.csms.org/</U></FONT></A><FONT size=2>&gt; Connecticut State Medical Society, the BCBS insurers used automated computer programs to systematically deny or delay payments. The complaint also accuses B!
 CBS insurers of racketeering for using their "economic power to force doctors into unfavorable contracts," the Courant reports. The suit seeks class-action status and was filed in the Miami court in which the other lawsuits against insurers have been consolidated (Gosselin, Hartford Courant, 5/23). </FONT></P>
<P><FONT size=2>==============================</FONT></P>
<P><FONT size=2>&nbsp;</P></FONT></DIV><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC-Irvine<p><hr SIZE=1>
Do you Yahoo!?<br>
Free <a href="http://us.rd.yahoo.com/mail_us/tag/*http://calendar.yahoo.com">online calendar</a> with sync to Outlook(TM).
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