Fighting With Care

HMO REPORT

Psychologists are getting creative in their battle against managed care.

Unhappy that HMOs have cut into their income and autonomy, psychologists have affiliated with a union for the first time ever. In October. the New York State Psychological Association agreed to join the American Federation of Teachers. an organization with over 140,000 members, in hopes of utilizing their tremendous lobbying clout.

Others are taking on managed care companies individually.

Psychologist and lawyer Bryant Welch, Ph.D.. is pioneering a legal fight against the federal laws that protect managed care companies. He argues that private managed care companies have a strong financial incentive to deny care to patients, which ultimately costs too many patients their lives.

The first two of Welch's 27 cases went to, court over the last few months--with encouraging results. One case involved Kansas teen-ager Blake Hanson, who became depressed when his mother was diagnosed with a life-threatening medical disorder in 1995. Though he repeatedly begged doctors to send him to a mental institution, the state-run system diverted his care to outpatient clinics after only a few days of hospitalization. Still very sick, Hanson finally bought a gun and killed himself in the bathtub.

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Hanson's family felt that the health care managers were directly responsible for their son's death. The jury on Hanson's case agreed, awarding the family $600,000 for "grief." While in Kansas, the most one can get for such a claim is $100,000, Welch says it's "a beginning."

Welch has been active on this issue since 1986 when, as executive director for professional practice at the American Psychological Association. he lobbied Congress to legislate laws that would hold insurance companies liable for harm done when appropriate psychiatric care was denied.

Before the law was finally amended in 1995, it was impossible to get beyond the 1974 federal statute that protected insurance companies from lawsuits over medical care decisions. "Now at least we've opened that door," Welch says. "We've won the right to sue."

Tags: american psychological association, autonomy, bathtub, clout, financial incentive, health care, health care managers, HMO, hospitalization, insurance, legislation, managed care, medical disorder, mental institution, professional practice, psychiatric care, state psychological association, teen ager