HMO successfully sued

A jury has awarded $13 million to the widow and daughter of a man who died days after an HMO forced him out of a skilled nursing facility. The 83-year-old man was back in the hospital the next day and died five days after that.

George Parker Young, a Fort Worth lawyer who represented the family, said the jury was outraged by evidence that Cigna's medical director and utilization review nurse received bonuses for reducing inpatient stays.

"It was clear that Cigna put cost-cutting ahead of patient safety at a time when the patient most needed care," said Young.

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In addition to finding Cigna was grossly negligent, the Dallas jury said that the company caused serious bodily injury to Pybas, a violation of the state's criminal law against elder abuse. Young said that finding negated otherwise applicable caps on punitive damages.

According to the lawsuit, [Herschel] Pybas was in and out of the hospital from Oct. 6, 1998, until his admission to the skilled nursing facility on Dec. 31, 1998. He was forced out of the facility on Jan. 22, 1999.

Dr. Nathan Watson, who was treating Pybas, testified that he wanted to keep his patient in the nursing facility but Cigna was pushing to get him out.

Pybas suffered from congestive heart failure and progressive renal failure as well as a bedsore. He had a history of stroke, anemia, upper respiratory infection and malnutrition.

Young said evidence showed that Cigna officials never reviewed Pybas' medical records before deciding he should be sent home. Although Pybas required oxygen, he was not provided any when an ambulance took him home from the nursing facility.

This is the first such jury award in Texas, which was the first state to allow people to sue HMOs. The bill became law without then-Governor Bush's signature. Bush vetoed the earlier law, refused to sign this one, then crowed about his achievements in health care reform on the campaign trail in 2000.

About 20 to 30 lawsuits have been filed since the Health Care Liability Act was passed in 1997 over the objection of conservatives who swore that it would lead to a flood of such suits. That's four to six filings per year in a state of 20 million people. Some flood.

Posted by Charles Kuffner on June 29, 2002 to Legal matters