04.12.00

By Artis Gordon

Carmen Puryear, a service representative for the Virginia Credit Union's downtown Richmond branch, went to her doctor's office for her monthly checkup in January. In the waiting room, she was jolted by a sharp cry from a little boy fighting in his mother's arms.

When the front desk called the mother's name, it wasn't so her child could get medical attention, however. It was because the mother didn't have a referral from her managed care provider to see that particular physician.

The mother, holding her ailing child, had to look up her provider's phone number and get permission to see the doctor.

"I thought that was ridiculous," Puryear said. "I hope I never have to go through that situation."

She and many others believe patients should get to choose their doctors instead of being assigned a physician by an insurer or health care plan. But they will not get that opportunity this year. This was evident when the smoke cleared after the Virginia General Assembly’s recent 60-day session.

During the session, Democratic legislators lost a two-round battle with issues concerning health maintenance organizations:

• Lawmakers killed a bill that would have allowed HMO members to pick their physicians. The proposal – called the "Patients’ Bill of Rights" – died in the House Corporations, Insurance and Banking Committee.

• The General Assembly also rejected a bill to permit patients to sue HMOs for harm caused by their policies.

The Patients’ Bill of Rights was sponsored by the House Minority Leader C. Richard Cranwell, D-Roanoke County. The House Corporations, Insurance and Banking Committee voted 14-11 to delay the bill indefinitely. The 11 committee members who favored the bill included 10 Democrats and one Republican.

The bill’s opponents said giving HMO patients freedom of choice would increase the cost of health insurance. If that happens, they fear that some employers will drop their group policies or require employees to pay a greater share.

"If this is the case," Puryear said, "I am willing to pay more. I want to be able to go to see who I want, when I want, even if it will cost me a little more to do so."

House Democrats took their second blow on HMO issues when lawmakers spiked a bill sponsored by Delegate Donald McEachin, D-Richmond. It would have allowed patients to sue their managed care providers for any injury or death caused by the refusal of treatment.

The bill had a rough going since the session’s start: It was killed by the House Courts of Justice Committee in January.

But a month later, McEachin brought the proposal back as a floor amendment, and the House voted 50-48 to revive the bill. Soon after, the Senate killed the bill again. Many Republicans believe that allowing people to sue HMOs will raise the cost of insurance.

The measure was defeated on a party-line vote last year, when the House was evenly split between Democrats and Republicans.

This session, a few Republicans sided with McEachin. They included Delegates Jo Ann S. Davis of Yorktown, James H. Dillard II of Fairfax and Robert C. Marshall of Prince William. The only Democrat to vote against the bill was Delegate Whittington W. Clement of Danville.