HMO & Medical Malpractice Cases in Georgia

With the proliferation of health maintenance organizations (HMO’s) and managed care, the delivery of medical care to the American public has undergone a precipitous decline. 40 million people people have no health insurance and frequently receive substandard care from doctors and hospitals concerned about the “bottom line.” Some HMO’s and managed care organizations have instituted financial incentives which prevent primary care doctors from referring patients for needed specialty diagnostic testing or referrals to some specialties beyond the specialty of the internal medicine or general practice or pediatric physician.

Increasingly, the quality of medical care is being decimated because profit driven corporations have replaced the individual physician as the decision maker on the medical team. Some HMO’s have rules that patients must obtain approval before even visiting an emergency room or the medical treatment will not be covered. HMO and managed care rules have created a recipe for disaster and disasters are ensuing more and more frequently in our culture. Physicians struggle with managed care organizations to obtain the care their patients need.

The number of citizens who are now members of HMO’s or PPO’s in America has increased dramatically over the years. Employers who provide health insurance benefits have frequently insisted on employee’s being covered by HMO’s or PPO’s rather than more costly traditional insurance plans as a cost-saving measure. The HMO’s are for-profit corporations and strive, above all else, to increase profits for shareholders. Quality of care frequently suffers. Patients frequently are injured and die as the consequences of cost-saving measures. Therapies are not given and patients are sent home from the hospitals prematurely.

Against this backdrop, the public cries out for reform against the well paid lobbyists of the HMO and managed care organizations who lobby politicians and stonewall efforts to reform the system. Under the ERISA laws, patients frequently cannot sue their HMO when the HMO refuses to refer a patient for needed specialty diagnostic work or care under the guise of some word game such as “that procedure is experimental.” Efforts to change the rules so that citizens can sue an HMO for such policies and procedures have been callously thwarted in Congress, which is controlled by monied interests.

Some HMO practices resemble a high volume factory. Sometimes the policies and procedures are ineffective and important diagnostic data never reaches the physician.

Mr. Davis has handled cases where blood cultures, that would have told the treating physician that a family’s child was suffering from treatable bacterial meningitis, never reached the physician and the child became horribly brain damaged. In another case, a woman became paraplegic because the HMO did not pass on to the treating physician blood count values which would have shown that the patient suffered from pernicious anemia, an easily treatable Vitamin B12 deficiency. Multi-million dollar settlements occurred in these cases.

Mr. Davis has devoted considerable time and energy to successfully litigating HMO and medical malpractice cases in Georgia and has gleaned much career satisfaction in helping clients who were the victims of HMO malpractice.