Health

Paying Doctors Not To Care?

By CBSNews.com staff CBSNews.com staff

July 20, 1998 / 7:12 PM EDT / CBS

In the last few weeks of her life, Jane Hutton, who had already survived one heart attack, knew her heart was acting up again.

"My wife was experiencing heart palpitations and shortness of breath," says her husband, Joe.

When she died after a second heart attack, Mr. Hutton accused his wife's HMO of being responsible because he said it was paying doctors to limit care, reports CBS News Correspondent Wyatt Andrews.

Mr. Hutton says there is something sinister in the way his wife's HMO, Harris Methodist -- the largest managed care company in north ern Texas -- paid her primary care physician, Dr. Allison Hendrickson.

Two years ago Harris put in a system that paid doctors bonuses if they came in under budget, which is typical of HMOs, but then, coupled that with an unusual plan to penalize doctors who came in over-budget.

Doctors knew they could lose money the more they sent patients to specialists, and hospitals, and by writing expensive prescriptions.

Joe Hutton's lawyer, Kent clay, showed CBS News Jayne Hutton's medical records. No diagnostic tests, not even an EKG are noted.

When Mrs. Hutton repeatedly asked to see a cardiologist, Dr. Hendrickson -- who under the HMO's rules, had to approve all visits to specialists -- refused.

Six weeks later she is dead from a heart attack.

Dr. Hendrickson declined requests to speak to CBS News, but in court papers, she has denied wrongdoing.

Joe Hutton believes she made a financial -- and fatal -- decision in not sending his wife to a specialist.

"They're paying them to withhold care and there is something drastically dangerous and wrong with that whole idea," says Mr. Hutton.

Harris' medical director, Dr. Robert Cluck says the payment plan is necessary to hold down costs and premiums. He admits the aim is to limit care -- but never, he insists, to the point of harming patients.

But CBS News found doctors who were fined by Harris for delivering care they saw as essential.

In fact, Dr. Kendra Belfi says she and her partners were fined $90,000 in only one year for writing too many prescriptions. Ironically, the HMO's own expert later testified the drugs she prescribed were necessary.

"We were doing the right thing and getting penalized for it. I really started dreading seeing those patients who walked in the door. ..and that should never be the situation," says Belfi.

The Texas department of insurance says Harris' payment contract is illegal and has moved to fine the HMO $800,000. A state court calls it probably illegal and has suspended the system, until one of several lawsuits against Harris reaches trial.

"If it hadn't of been for these incentive bonuses, I'd still have my wife,"says Mr. Hutton. "And after 24 years we were looking forward to a silver anniversary and it never happened."