Archive for Thursday, September 30, 1999

IMMUNITY

September 30, 1999

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The state's doctors need to take the lead on making health maintenance organizations liable for their harmful health care decisions, says the state insurance commissioner.

Kansas Insurance Commissioner Kathleen Sebelius criticized state and federal laws that exempt health maintenance organizations from being sued for decisions that limit access to health care.

"HMOs should be just as liable as a doctor who's making these kinds of health care decisions every day," Sebelius said Wednesday at a Lawrence Chamber of Commerce luncheon.

Sebelius' comment came in response to a question by Donald W. Tiffany, a Lawrence clinical psychologist, who wanted to know why he is liable for his treatment decisions and HMO personnel are not.

Many times, Tiffany said, HMO decisions affect patients' actions and wellness as much as his diagnoses and treatment.

"If I have a patient who's suicidal and I say -- based on my 40 years experience -- that we're looking at treatment for the next six months, and then a HMO only OKs three sessions, the responsibility for that person's well-being falls back on me," Tiffany said afterward.

"I have to maintain my liability," he said. "The HMO doesn't. I can't understand that."

Sebelius said the lack of HMO liability is the subject of a debate now before Congress.

"It's my understanding that the House is generally for it and the Senate is against it," she said, referring to efforts to make HMOs liable for their health care decisions.

If the measure fails, Sebelius said she would support -- but not lead -- a similar effort in Kansas.

"That movement needs to come from outside the Insurance Commissioner's Office," Sebelius said. "We're the regulators, and this would need to come from the interested parties, which, in this case, would be the doctors.

A former state representative, Sebelius said that if her office took the initiative, it "wouldn't be considered long by the Legislature," noting that "the first thing they'd want to know is 'What do the docs think?'"

Attempts to reach the Kansas Medical Society for comment were unsuccessful.

Responding to other questions, Sebelius reminded chamber members that "you pay more in insurance than you do in state taxes. It's about 1 1/2 times as much, in fact."

Sebelius encouraged anyone shopping for insurance to call her office -- 1-800-432-2484 -- for free copies of price guides on home, health, car and life insurance. The information also is available on her office's Web site: www.ink.org/public/kid.

-- Dave Ranney's phone message number is 832-7222. His e-mail is dranney@ljworld.com.

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