Good Samaritan Laws, Managed Care, Medical Practice
New Jersey doctors who assist in hospital emergencies cannot use Good Samaritan laws as protection against malpractice suits, the state's high court has ruled. The law isn't intended to protect physicians who care for patients in fully equipped and staffed hospitals, the court said.
In the case before the court, complications arose during a delivery, and the attending physician called for assistance. The doctor who responded specialized in maternal-fetal medicine but had no prior relationship with the patient, whose child was born severely brain damaged and died before age 3. His parents sued both doctors, the medical center, and others. All but the specialist settled before the trial. The responding doctor unsuccessfully contended in the ensuing malpractice suit that she was immune under the Good Samaritan Act because she acted in the absence of duty to do so and that the location of the emergency was irrelevant.
New Jersey is among 29 states whose Good Sam laws don't explicitly address whether in-hospital care can be shielded from liability. For more on the subject, see "Do Good Samaritan laws protect you in the hospital?," May 10, 2002.
By the end of last year, most states and the District of Columbia had enacted external review laws that allow patients to appeal denials by health plans. But some HMO enrollees may still not be getting the coverage they're entitled to.
A Consumers Union review of appeals filed with the Texas Department of Insurance found that Independent Review Organizations (IROs) fully or partially overturned more than half the treatment denials they considered. Moreover, HMOs consistently denyand are overturnedon treatment decisions involving mental illness, gastric bypass for obesity, and substance abuse. In fact, the study found that 70 percent of treatment denials for mental illness are overturned on appeal.
Despite the strong likelihood that denials will be overturned, Consumers Union says, Texas' five-year-old independent appeals process was used to settle only 587 disputes last year. CU analysts believe that the number of appeals is low given the thousands of coverage decisions Texas HMOs make each week. They speculate that patients may not be aware that they have the right to appeal to an outside party or that their experience with the HMO's internal appeal process is so frustrating they simply give up.
Still, Texas appears to be doing a better than average job. A recent Kaiser Family Foundation study of 41 states and the District of Columbia with independent review laws found that only about 4,000 patients nationwide appeal HMO treatment decisions each year.
America is becoming increasingly dependent upon itinerant providers, says Staff Care, a locum tenens physician recruiting firm. Once considered a way for older doctors to ease into retirement, locum tenens is now drawing younger physicianseven those right out of residency.
While doctors with 11 or more years of practice experience still make up the largest proportion of temporary physicians, new doctors made up 11 percent of all locum tenens practitioners last year (up from 1 percent in 1997). There have been other changes in the industry as well: For instance, the demand for FPs and other primary care physicians is abating. Overall, FPs, GPs, and internists were the targets of just 21 percent of all searches last year, down from 65 percent in 1997.
Joan Rose. Practice Beat. Medical Economics 2002;14:11.