Life, Death and the Bottom Line

As portrayed in movies and television, HMOs are heartless corporations concerned only with profits. Now, HMOs are stepping up to combat the perception if not the reality.

by Colleen Dougher
CityLink Magazine
September 8, 2004

In the film As Good As It Gets, Helen Hunt plays the mother of a chronically ill child. In a pivotal scene, she learns that her health maintenance organization has just turned down the costly tests she thought might lead to a cure for her son.

"Fucking HMO bastards, pieces of shit," she rages.

"Actually," her son’s doctor replies, "I think that’s their technical name."

In this year’s John Q, Denzel Washington plays a father who takes an emergency room hostage when his HMO refuses to pay for his son’s life-saving heart transplant. Damaged Care, a film that recently aired on Showtime, provides a not-so-glowing portrait of HMOs as seen through the eyes of a real-life former HMO medical reviewer.

Television shows have gotten their digs in, too, as evidenced by a recent study from the Henry J. Kaiser Family Foundation, which examined 75 episodes from four hospital dramas in the 2000-2001 television season and found that HMOs were consistently portrayed negatively.

The common theme among these portrayals is that HMOs are cold and heartless deniers of care.

Last month, pointing out that ER gets three times as many viewers as NBC Nightly News, the American Association of Health Plans, a trade group that represents 1,000 HMOs, retained William Morris Consulting to help show Hollywood a more humane side of managed care.

"I think that we have seen, over the years, some misrepresentations of our industry," says Geoff Freeman, spokesman for the American Association of Health Plans (AAHP). It’s ironic, he says, that in As Good As It Gets, health plans were attacked because of the way they treated Hunt’s character, whose son had asthma.

"Health plans," he says, "are widely regarded as leaders in asthma treatment and in making some incredible strides in improving asthma care, diabetes and other diseases people live with. … It’s important to share these things, and we’ll see how open Hollywood is to that information."

Linda Peeno, the Louisville doctor upon whom the movie Damaged Care is based, calls the AAHP’s recent efforts "inverse thinking," and says that Hunt’s HMO-bashing dialogue in As Good As It Gets reflected the public’s opinion about these organizations. "It’s resonating somewhere with people’s perceptions," she says, "that this is an industry that’s gone too far."

This sentiment also has been reflected in recent court cases in which juries have ruled against HMOs and awarded plaintiffs as much as $120 million. Some people even believe the AAHP’s real intention is to change the perceptions of those people who may one day decide their fate in court.

"History thus far," says Ted Leopold, an attorney with the Palm Beach County law firm Ricci, Leopard, Farmer and McAfee, "has shown us that jurors, our peers in our community, don’t think much of the managed care companies when they deny care to catastrophically ill children, or people who need heart transplants or other medically necessary types of treatment.

"Instead of addressing those issues, how to best care for those individuals, they’re going to a PR company to try to massage what comes out in the public domain, so that they perhaps won’t be slapped too hard on the wrist."

Bottom line, top priority

Leopold represented Mark Chipps, a Palm Beach County Sheriff’s deputy in his lawsuit against Humana Health Insurance Co. of Florida. In 1995, Chipps’ daughter Caitlyn, who was born with cerebral palsy, was released from a medical case management program that offered catastrophically and chronically ill patients therapies over and above what their regular policies covered.

According to court documents, Humana’s literature stated that qualified subscribers who entered this program could only be terminated if they did not wish to accept the recommended treatment, coverage under their policy had ended or the individual’s lifetime maximum benefit had been reached.

Caitlyn needed frequent therapy, and this program sold Mark and Barbara Chipps on Humana’s PPO plan in 1994. But a year after his 5-year-old daughter was accepted into the program, she was ousted via an unsigned letter that said Caitlyn no longer met criteria for the program, but didn’t explain why.

The story that unfolds is not unlike the portrayals of HMOs seen in the movies and on television.

Chipps contacted Humana’s on-site representative and made numerous calls to its regional and corporate offices, but got no straight answers as to why his daughter no longer met the criteria. He was told he could appeal the decision and was given the name of the person said to have the final say in his appeal. But Chipps says that when he spoke with this person, she made it clear that Caitlyn would not be readmitted to the program, and that if he needed assistance, he should contact Easter Seals.

Instead, he called a lawyer.

In 1996, Mark Chipps sued Humana for, among other things, breach of contract, unfair claims practices and intentional infliction of emotional distress.

Leopold says Caitlyn was one of more than 100 children terminated from Humana’s medical case management program seven years ago as part of an effort to save the company $78.5 million. A legally blind quadriplegic who suffered frequent seizures and a child who had been comatose for 14 years were also ousted.

In addition to Caitlyn’s being cut from the program, Humana had fallen behind in paying bills for her regular coverage, Chipps says, and it reached a point where he had to beg providers for the leg braces, wheelchairs and services his daughter needed.

Left in a lurch, Chipps maxed out his credit cards, cashed in vacation leave and took out a second mortgage. But because Caitlyn’s therapies were reduced to what he could afford, her condition worsened.

After 10 months, Humana readmitted her to the program, a move that Pamela Gadinsky, Humana’s director of media relations for Florida, later described as "a business decision."

The way Chipps’ lawyers see it, booting Caitlyn from the program was a business decision, too. The medical case management supervisor who recommended Chipps contact Easter Seals testified that Humana’s chief medical director’s decision to terminate Caitlyn and others from the program was a global one based on financial consideration rather than medical necessity.

Peeno, who served as an expert witness in the case, testified that Humana was terminating children from the program because "they couldn’t squeeze the savings from these little kids any more like you could [from] the congestive heart failure patients you can keep out of the hospital."

The care and treatment of congestive heart failure patients, end-stage renal disease patients and diabetics requires enormous sums of money, she explained during the trial, and Humana felt that if it more closely monitored these patients, their treatments and hospital stays would diminish and Humana would be more profitable. But for this to work, Humana was required to terminate chronically and catastrophically ill children from the program so staff and resources could be devoted to the supervision and management of these groups.

Not surprisingly, the terminations prompted complaints from parents, and when advised of those complaints, Humana’s chief medical director, according to the plaintiff’s memo, responded by saying: "If you give a dog a steak, and then you take it away and you give it hamburger, it’s not going to be happy."

In March 1999, after Humana repeatedly failed to turn over documents requested by Chipps’ lawyers, a Palm Beach County judge entered a default judgment. The following January, a jury, after hearing three weeks of trial testimony, awarded Chipps $1.1 million in compensatory damages and $78.5 million in punitive damages — one of the largest managed care verdicts in United States history.

In summarizing his findings, Judge James T. Carlisle wrote: "The verdict appropriately expresses the outrage on the part of the jury at the greed and arrogance of the defendant and the result of its conduct — actual and threatened physical and emotional injury to catastrophically ill children whose care and treatment Humana had contractually assumed and then abandoned."

Afterwards, juror Diane Leininger told a reporter for The Dallas Morning News, "We were stunned by the testimony. The company sent bonus checks to claims reviewers who saved the company money by denying the most medical claims for patients."

She said the company also made its claims process more difficult in order to increase the chance that families would eventually give up seeking reimbursement for treatments. The most disturbing revelation, she said, was that the practice was not limited to Humana.

"That’s when we decided we had to send a message that would not only get Humana’s attention," she says, "but the attention of every HMO out there."

Last fall, the Fourth District Court of Appeal noted that the trial judge made "glaring errors," including characterizing and summarizing the evidence rather than let the jury make up its own mind; failing to tell the jury that it could opt not to assess punitive damages; and allowing the parents of catastrophically ill children from other states to testify, since only Humana’s Florida subsidiary was named as a defendant.

The appellate court, unable to discern whether the judge’s mistakes contributed to the jury’s verdict, remanded the case for a new trial on damages.

Chipps, worried that litigation efforts could drag on for another six years, opted to try to work something out with Humana.

Within 20 minutes of their settlement talks, he says, "Their corporate attorney made it real clear that since they had prevailed on the appeal, they were going to make the Chipps family responsible for over $400,000 they had spent on court expenses for the appeal process."

"At that point, my wife and I just looked at each other and we kind of smirked, because we were living paycheck to paycheck. I mean, there was nothing more that they could possibly take from us unless they wanted our daughter."

In January, Chipps settled with Humana for $2.2 million.

Incentives to deny

Critics of managed care practices say Hollywood’s portrayals of HMOs as deniers of care aren’t so far-fetched and that the public would benefit from knowing more about how these organizations routinely make decisions regarding their care.

Leopold says this issue is at the core of the National Managed Care Class Action Lawsuit currently being litigated in federal court in Miami.

Documents uncovered during the discovery stage of the Chipps case helped lay the foundation for these suits, which accused Humana and other managed care giants of conspiring to deny care and withholding information about how financial concerns influence medical decisions.

Leopold and attorney Ed Ricci told the Web magazine Safetyforum that HMOs systematically delay or deny payments to providers for approved treatment, allowing the HMO to pocket substantial profits by retaining and investing the millions of dollars owed to hospitals, nursing homes and doctors, and give financial incentives to reviewers who deny claims or limit hospital admissions and stays regardless of medical necessity.

Health plan subscribers, Leopold says, want Humana and other big HMOs to reveal how their concern for profit affects their decisions on medical coverage, so consumers can make informed decisions when choosing health plans.

As it is, Leopold says, subscribers are "paying X number for insurance, but getting a smaller safety net, if you will. In other words, they’re purchasing a policy with a safety net of 8 by 10, but in actuality with what they’re purchasing, they’re only getting a 4 by 6, because the industry and the particular companies aren’t disclosing that they’re using internal criteria to deny that care, even though they’re making disclosures that they’re going to provide medically necessary care."

Humana says it will vigorously defend itself, and that it has long supported an external review process by independent physicians with no connection to a health plan to determine whether a requested service is appropriate.

Damaged Care focuses on some of these internal criteria HMOs have been accused of using in making healthcare decisions. Peeno’s managed care career began in 1987, nine years after she obtained a degree in internal medicine from the University of Louisville. Humana hired her as a medical reviewer.

At this time, Peeno says the company had centralized its pre-certification services, and her job was to review requests for hospital admissions and continued stays. The preliminary screening for these requests, she says, was done by pre-certification nurses who would presumably assure the patients’ membership and eligibility.

If they couldn’t automatically approve the case based on the criteria in the computer, Peeno says, it was referred to her or another physician to determine medical necessity.

In 1987, a heart transplant case was referred to Peeno. The member’s doctor explained that the patient, a man in his 40s, had never fully recovered from viral myocarditis and had continued to deteriorate. The doctor, she says, told her that this patient, who had become an invalid, had been put on the heart transplant list and was transferred from California to a Nevada hospital.

Seeing no medical reason to deny coverage, Peeno approved it. Afterwards, she says, "One of the pre-certification nurses came running in and says ‘Oh my God, you didn’t approve the heart transplant, did you?’"

Peeno hadn’t realized that the man had been admitted to a nonparticipating hospital. The nurse, she says, informed her that she had already called the benefits department to see if they could find a contractual reason to avoid paying for the transplant.

Moments later, Peeno says, someone from benefits told her that the member’s contract with his employer excluded heart transplants, and that she should call back and explain the technicality. She did, and afterwards, the vice president of medical affairs attached a yellow Post-It note to the back of the claim denial that read, "Good job."

It was while dealing with this incident, she says, that she first heard the mantra, "We’re not denying care, we are only denying payment."

Peeno says that while working at Humana, she was told that she was expected to deny payment on 10 percent of claims and "that the person with the highest denial rate was going to get the Christmas bonus."

While working for health insurers, she says, the corporate line was always: "The money we save by not paying for benefits we’re not supposed to can go for other kinds of care."

She began to doubt this theory when a huge sculpture was placed in Humana’s rotunda. At the time, she had heard that the artwork had cost half-a-million dollars, roughly the same as a heart transplant at a non-contracted hospital.

To say that Peeno doesn’t subscribe to the theory that money saved from denying coverage lowers premiums or makes more care available would be an understatement. She refers to this theory as "bullshit."

The only way such a system could work, she says, is if there were a national or state-based health care system with a common pool of money and assurances that legitimate savings would return to the pool to benefit the whole of society.

Peeno says that when she left Humana, 10 months after she started working there, she began to think that denial rates and the denial of that heart transplant were not a good thing.

After leaving Humana, she continued to work in managed care, only to learn that the practices that had begun to disturb her were more widespread than she had thought and that nonprofit organizations were just as driven by numbers as for-profit companies.

In search of answers, she began reading up on everything from ethics to organizational theory to sociology. By the time she left a six-figure job in managed care in 1991, she was able to articulate her dissatisfaction with the industry’s practices.

In 1996, she testified before Congress that "In the spring of 1987, as a physician, I caused the death of a man [the heart transplant patient]. Although this was known to many people, I have not been taken before any court of law or called to account for this in any professional or public forum."

During her years working in the health insurance industry, she made decisions while sitting hundreds or thousands of miles away from patients, some of which she is certain caused additional pain and suffering and perhaps even death. She says that her behavior was rewarded and contributed to the advancement of her career.

Peeno is bothered that many people don’t understand the factors that go into the decisions that are made concerning their health care. She regularly reads contracts, policy and procedure manuals and other internal documents from nearly every major insurance company and managed care organization, and points out that there "are no expectations of understanding by the American public that you are turning decision making over to a corporation to decide among various and competing groups of people who is more worthy of expenditures.

"It’s like all of us going to Circuit City and purchasing new TVs, and then Circuit City making decisions that somebody doesn’t deserve a TV and somebody else does," Peeno says.

There’s no doubt that some of the people who paid for — but didn’t get — televisions, would make some noise about it. Not surprisingly, so do people denied coverage for health care.

As a medical director, Peeno encountered the squeaky wheel phenomenon. "And depending on how hard somebody screamed and who they knew … we’d give in. Otherwise, we basically counted on the fact that most people don’t appeal, don’t know how to appeal, don’t know how to raise the questions, and that’s a shame.

"We shouldn’t have a health care system that’s so capricious that just depending on how hard you fight for something you’ve already paid for, determines whether or not you get it."

Moore justice

Three years ago, Christopher Donahue of Boynton Beach was one of two South Florida men who sued their HMOs over the denial of coverage for pancreas transplants. Both men were candidates for kidney and pancreas transplants, but Humana had agreed to pay only for the kidney transplants, saying pancreas transplants were experimental and not covered. Doctors reportedly argued, however, that without a pancreas transplant, new kidneys in these diabetic patients would fail.

After learning of Donahue’s predicament, activist and documentary filmmaker Michael Moore (Roger & Me, The Big One) decided to tackle the issue on the debut of his Bravo program The Awful Truth. In early 1999, Moore and Donahue (wearing a T-shirt that read, "I signed with Humana and all I got was this lousy T-shirt and no pancreas") went to Humana’s Louisville headquarters, where they staged Donahue’s mock funeral, complete with bagpipers, mourners and a hearse. A meeting with Humana’s vice president had been arranged, but while Moore and Donahue waited in a conference room, corporate spokesman Greg Donaldson arrived to say that the meeting would have to be rescheduled.

Moore handed Donaldson a funeral invitation featuring an image of the Grim Reaper and announced that without a pancreas operation, Donahue would soon die. Then, he whipped out photos of caskets and asked Donaldson to help select one. "I think that would be inappropriate for me to do," Donaldson responded.

The unrelenting Moore continued his line of questioning, asking what sort of wood he preferred and telling Donaldson about Donahue’s children. As Donaldson urged them toward the exit, suggesting they leave so he could research Donahue’s case, Moore reminded him that each day that passes while he investigates this matter was a day closer to Donahue’s funeral. "You know we won’t take no for an answer," he told him. "You know we’re not gonna stop until you let him live. It’s that simple. We’re gonna be all over you, man."

At the segment’s end was a note telling viewers that a week after their visit, Humana agreed to pay for the transplant

Pamela Gadinsky, Florida media relations director for Humana, says their decision had nothing to do with Moore and his "ambush-style ‘journalism,’ " and that "Humana had already decided to pay for the transplants before Moore came to Louisville with his cameras and theatrics."

But Peeno, who met with Moore in the Humana building before that segment was filmed, believes the media and the lawsuit certainly played a role in the decision. She agrees that media coverage, as well as movies like John Q, help people to understand the health-care system.

"One of the things that always happens in managed-care cases," Peeno says, "is that they come back and say, ‘Oh, it was a runaway jury, and the jury was just responding to HMOs are bad.’ And yet, the six or seven trials now that I’ve been in, the jury sits there for days or weeks on end. They hear detailed information. They see on the inside in a way that the public doesn’t. I can watch their faces, and they’re outraged when they see some of the evidence that comes out of these cases. And from my perspective, it’s not just one case. It’s multiplied by dozens, and you begin to see that it’s a pretty systemic problem."

When Showtime approached her about doing a movie based on her efforts, she saw it as an opportunity to bring an understanding to others. Peeno says she has had more than 1,000 responses since the movie aired — two-thirds from people with their own HMO stories, and the remainder from people who work in the industry, thanking her "for making the system’s failure public."

"I had an interesting experience a couple of months ago when I came to Florida for a deposition," Peeno says. "I got up at 4 a.m. to catch a plane, and this cab driver picked me up. … Anyway, he was talking and asking me what I was there for, and I was telling him, and he says, ‘Aw, man, you’ve got to see this movie’ .. and he proceeds to tell me every single scene from Damaged Care."

Damage control

Two months before hiring William Morris to "create a conversation with the entertainment industry," the American Association of Health Plans posted a statement on its Web site in response to Damaged Care, dismissing it and movies like it as a poor substitute for "the real debate about health care we ought to be having. How do we get health care to 40 million Americans who are uninsured? How do we control skyrocketing health care costs that rob working families of health care? How do we solve health care disputes like the one portrayed in the movie quickly and fairly without resorting to expensive lawsuits?"

Humana also addressed its concerns about the movie on its Web site, stating that Peeno was a part-time medical reviewer and pointing out that Damaged Care featured a disclaimer that "certain composite, fictional and representative scenes and characters have been used for dramatic purposes."

"Of course," Humana continues, "the movie fails to point out which portions are loosely based on the truth and which are total fiction."

The company also wasn’t impressed with the movie’s portrayal of the Chipps case. According to Humana: Caitlyn Chipps and others "were removed from the program following a determination that they did not need the additional benefits"; the company portrayed in the movie was not Humana; and "it is ludicrous to assert that a denial would be greeted with congratulations."

Humana also argued that Peeno doesn’t know whether the heart patient ever received a transplant, and that he didn’t die right away, as depicted in the movie, but 28 months later, which is true.

"He never did get a heart transplant," Peeno counters. "And the heart failure that he had before, when he first came up for transplant was so bad he couldn’t walk from one room to another without going into failure. So, I can’t imagine what those 28 months were like for him."

Humana characterized Damaged Care’s accounts of "certain events in 1987" as a gross misrepresentation of the facts, and says, "Humana recognizes that America and its citizens make more progress when we work together to understand the underlying issues of health care, rather than sensationalize and manufacture fiction that isn’t representative of what we do."

Peeno, however, says she took great pains to present the story fairly and spent much time agonizing over details. Among them, whether that sculpture really cost $500,000. She eventually learned the answer. "I actually have a document in a safe," she says, "that shows the cost of the sculpture. Do you want to venture a guess? It’s $3.8 million."

Despite her efforts, Humana has dismissed Peeno as someone whose experience in this industry is outdated. Peeno acknowledges that there have been changes in the industry. For starters, she says, many health insurers say they no longer provide bonuses for denying claims.

"But they still have bonuses," she says, "and most managed care plans have bonuses, particularly for high-level executives and top management, that’s based on earnings per share."

Payments going out for claims affect the bottom line. "So, there’s a lot of pressure placed on the person in the medical department," Peeno says, "because everybody else, including nonmedical people, are looking at this guy and saying, ‘You’re costing us money. You’re costing us our bonuses.’ "

The managed care industry is unique, Peeno says, in that it is the only market-based industry that benefits more from withholding its product than from making it available.

"Every dollar paid in medical claims is viewed as a loss," she says. "It’s just amazing to me that in pre-managed care, less than 10 percent of insurance premiums went to administration. … And now, I’ve seen some plans with medical loss ratios as low as 60 percent, which means that 40 percent of the premium dollars are going towards subsidizing and creating the machinery that is figuring out increasingly sophisticated and convoluted ways how not to pay claims."

Peeno says HMOs have become more insidious. "They have discovered all kinds of ways," she says, "to limit care without actually issuing a piece of paper that says you’ve been denied hospitalization or an EKG or a referral."

One of the most successful means of denying care, Peeno says, is capitation, in which doctors get a flat monthly fee per patient, whether they see the patient that month or not. Not seeing them, she points out, becomes economically beneficial. Under such arrangements, doctors are sometimes penalized for referring patients to specialists.

Humana argues that health plans do not seek to persuade doctors to behave contrary to the dictates of their training and conscience, and that capitation is recognized as appropriate by Congress, the Center for Medicare and Medicaid Services and the Supreme Court of the United States in the case Pegram vs. Herdrich. In that case, Cynthia Herdrich of Illinois argued that the Carle Clinic’s use of financial incentives created a conflict of interest for her doctor. Herdrich said that when she needed an emergency abdominal ultrasound, her doctor and HMO wanted to save money by sending her to the HMO-owned clinic instead of a nearby hospital, but the facility was booked, so Herdrich had to wait eight days. In the interim, her appendix ruptured and burst and she developed peritonitis.

Herdrich sued her doctor under state malpractice laws, claiming financial incentives offered by the HMO encouraged cost-cutting mechanisms that resulted in substandard care. She recovered $35,000, but believed she also had a remedy against the HMO under the Employment Retirement Income Security Act of 1974 (ERISA).

A lower court agreed and sent the case to trial. But the Supreme Court dismissed it, ruling that patients cannot use federal law to challenge the use of financial incentives by managed care companies and pointing out that to declare cost-containment mechanisms illegal would be to eliminate for-profit HMOs.

Justice David Souter noted, "No HMO organization can survive without some incentive connecting physician reward with treatment rationing."

Peeno says she recalls a time when, as a medical director, she didn’t even know what ERISA meant. "But everybody down to our customer service reps in the HMOs, as early as 1988 and 1989, knew that we sat under a protective bubble known as ERISA, and that we were virtuously impervious to any consequences of the decisions we made."

The gist of ERISA, Peeno says, is that people who obtain health insurance through their employers can only sue in federal court and can only recover the cost of the denied service. In other words, if someone visits a doctor for chest pain and is denied coverage for an $85 EKG, then walks out and has a heart attack, there can be no suit for negligence, only for the cost of the denied service. The only exceptions to this rule are people who contract privately for health insurance, those who get coverage through a church group and government employees such as Chipps. For this reason, Peeno says, "I think any legal case we do come to know about is like a snowflake at the tip of the iceberg."

Peeno says the answer is to eliminate the legal immunity managed-care plans have from ERISA and to not allow caps on punitive damages. Some people working within managed care have suggested independent review boards as an alternative to legislation.

Seventeen years ago, Florida established a Statewide Subscriber Assistance Program to review unresolved grievances over what HMOs should cover. The panel, which consists of representatives from the Agency for Health Care Administration and the Department of Insurance, as well as a doctor and consumer advocate, meets three times a month and its decisions are binding. According to the Kaiser Family Foundation, decisions by the Florida board are overturned about half the time.

But the program, funded by fees paid by HMOs, only accepts complaints after the complainant has undergone the HMO’s formal grievance process, which is supposed to take no more than 60 days. HMOs are required by law to tell members whose grievances are upheld that this program is an option, but the panel is reportedly underused and critics have complained that HMOs don’t always tell people who go through the internal grievance process about this option.

Serious image problem

A recent DecisionQuest Juror Outlook Survey published four months ago in the National Law Journal showed that seven out of 10 people interviewed felt that HMOs try to get out of paying legitimate claims. And it appears that they didn’t get this idea from watching too many movies or television shows.

In 1999, the National Opinion Research Center surveyed 1,821 randomly selected doctors and nurses. Nine out of 10 said they had patients who had been denied health care by their insurers and that the problem was so severe that half the doctors surveyed admitted exaggerating the severity of the illness to get an insurer’s approval.

Given such findings, it’s difficult to imagine that portrayals of HMOs as organizations that too often deny coverage for medically necessary care don’t have some truth to them.

Peeno says that when she learned that AAHP had retained William Morris to build a better relationship with Hollywood, she was "livid."

AAHP spokesman Geoff Freeman says that his group and William Morris have no intention of dictating programming and aren’t naive enough to think they could. Their goal, he says, is to provide information.

Asked whether the people behind movies like Damaged Care would be a target for their informational campaign, Freeman says, "Damaged Care is a movie that has already come out, it’s done and widely forgotten. People quickly recognized that that was a 17-year-old story about things that depicted a health care system that did not, and does not, exist today. Our focus is on future programming."

The announcement of AAHP’s campaign to "reposition itself among the creative community," closely followed the publication of the DecisionQuest survey. The survey found that more than half the 1,007 adults interviewed last October said that in a case where an HMO or hospital was being sued for a medical mistake, they would likely vote for the plaintiff. Only 8 percent said they would be likely to favor the defendant.

More respondents said they were likely to side with the plaintiff in cases against HMOs than in cases against tobacco or drug companies. The only group respondents said they might be more likely to side against than HMOs was asbestos manufacturers. And 81 percent of those polled thought it was important that people have the right to sue doctors, hospitals and HMOs if they have been the victim of malpractice, while 53 percent thought there should be limits on those rights.

Johnny Levin, senior vice president of William Morris, says the AAHP recognizes the powerful influence of entertainment and that his agency looks forward to helping them engage the creative community in a way that benefits the public and the HMOs. That being the case, it would seem that AAHP and William Morris have their work cut out for them. Last season, an episode of ABC’s Gideon’s Crossing focused on a woman whose leukemia was misdiagnosed by her overworked HMO doctor, while ER portrayed a woman with terminal breast cancer whose HMO wouldn’t cover her admission to the hospital for pain management.

Meanwhile, this fall brings more medical dramas into the lineup. CBS has scheduled Presidio Med, a show about a tight-knit group of doctors that sets bureaucracy aside and puts patients first. ABC, meanwhile, will air a show that Freeman says AAHP will be monitoring: MDs. The show reportedly follows two renegade doctors who battle the HMOs and struggle to find loopholes in their ongoing quest to treat patients at a hospital run by a "mega-sized, mega-frugal HMO."

The hospital’s motto: "Medicine could be a lucrative business if it weren’t for all those sick people."

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