SCHWARZENEGGER'S GIFT TO INSURANCE COMPANIES COULD HARM PATIENTS (HEALTHCARE JOURNAL OF NORTHERN CALIFORNIA, Jan/Feb, 2009), sequel to HOW TO PRACTICE MEDICINE WITHOUT A LICENSE (SAN FRANCISCO CHRONICLE, 8/29/08)
On 26 February 2009 The Hon. Paul Fong introduced AB 933 which will require any doctor who does utilization review in California to be licensed for medical practice in California. Last year the Hon. Sally Lieber introduced AB 2969 to accomplish this objective. The bill passed the legislature and was vetoed by the Governor. This year we'll give our Governor another chance to see the light and sign the legislation.
Check out the following stories:
"Schwarzenegger's gift to insurance companies could harm patients," Healthcare Journal of Northern California, Jan/Feb 2009, www.hcjnc.com, click on "breaking news,"
"Review Adds Insult to Injury," TRADE WINDS, The Newsletter of the International Association of Machininists and Aerospace Workers," V. 56, #1, Winter 2008, www.local1781.org or google www.Local1781.org/TRADEWINDSJan08.pdf
"Insurance Industry Sabotages Injured Workers in California," www.californiaprogressreport.com/2008/10/insurance_indus.html, 5 October 2008
"How to practice medicine without a license," San Francisco Chronicle, 8/29/08 (just google the title as per above)
UTILIZATION REVIEW IS A TOOL INSURANCE COMPANIES MAY USE TO RESTRICT INJURED WORKERS FROM ACCESS TO CARE including diagnostic testing and actual treatment. In this way corporate profits and executive compensation are enhanced. Because the Hon. Paul Fong introduced AB 933 the issue is heating up in Sacramento, but it's not yet as hot as it's going to get. Here's what Russell Wyllie, Mountain View, wrote in the letters section of the San Jose Mercury News on 3/28/09:
"The Mercury News (Editorial, March 23) describes how the 2004 workers' compensation reform has 'worked wonders,' but it hasn't been so wonderful for injured workers ... the lower costs of workers' compensation insurance has come at the expense of employees injured on the job ... "
See www.mercurynews.com for Wyllie's complete letter-to-the-editor
WHILE THE ISSUE HEATS UP, INJURED WORKERS CONTINUE TO GET THE PROVERBIAL SHAFT. HERE'S A CURRENT EXAMPLE OF HOW IT'S DONE:
One year ago an injured worker was prescribed care. When the doctor who made the recommendation was asked to see the patient for follow-up one year later, he found that the recommended treatment had not been done because the insurance company and its utilization company had not authorized it. In the meantime, the injured worker hired an attorney. We then discovered that the insurance company did not authorize the treatment because a utilization review doctor rejected it. Next we learned that the utilization review doctor was licensed in Florida, but not in California. This point is important because it means that negligence by the Florida doctor re utilization review of an injured worker in California is not subject to discipline by the Medical Board of California. Neither is the Florida-licensed doctor subject to discipline by the Medical Board of Florida since that medical board doesn't have jurisdiction in California. It appears that the Florida doctor has a pass-go for malpractice since his utilization review decisions aren't under the jurisdiction of any state medical board. Meanwhile, the patient has gone without treatment.
Some say this system is made in heaven for the insurance companies and their bought-and-paid-for utilization review companies. Others would say that by mentioning heaven this writer is pointing in the wrong direction.
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Politics of health care with emphasis on California legislation including workers compensation and utilization review and federal legislation in Washington, DC
CA Workers Comp System and The State of Injured Workers: Interview with Dr. Robert Weinmann
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- Robert Weinmann
- San Jose, California, United States
- Writing in Neurology Today, Vol. 3 (8), August 2003, Dawn Antoline writes "Robert L. Weinmann, MD, has never been one to shy away from controversy. Whether he is writing muckraking editorials about HMOs that deny physician claims or ... billing practices ... he has committed himself to a life of activism. At the heart of his advocacy is a passionate regard for his patients -- and the ability of physicians to provide unfettered optimal care."
You could get really angry about this sort of thing out of a sense of unfairness to the injured worker and because of the lack of integrity by the examining Florida physician. Why would a physician refuse benefits to the worker just because he/she can get away with it? What happened to the oath of Hippocrates? Do physician need oversight by medical boards in order to do the right thing?
ReplyDeleteLooks like it, CrabDoc! Some insurance companies want it this way, a few do not, and some rely on the scam. State Comp Insurance Fund and the Zenith do not use doctors without California licenses. As for the Florida doctor for whom you used the word, "examining," that's the key -- he isn't obliged to examine the patient, only to review the records, then to make decisions based on ACOEM, 2nd ed, and the AMA Guides, 5th edition, as is required in California in industrial medicine.
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