March 2, 2001 - Cigna Settles Wrongful Death Suit
Cigna Corp., the second-largest health plan in North Texas, has settled a lawsuit filed by a Hurst man who alleged that his wife died after her doctor refused to hospitalize her because he was induced by her HMO to cut medical care costs.
The case was filed in 1999 by Chuck Barley, whose wife, Janet, died of a heart condition in September 1997. A nurse for 22 years, she had been a member of Healthsource North Texas, an HMO that was bought by Cigna in March 1997.
Court documents filed in the case show that Healthsource held back 10 percent of its fees to Consultants in Cardiology until the end of the year, and then awarded them as a "bonus" if doctors were able to keep costs down.
In addition, the contract between Healthsource and the cardiology practice contained a "gag" clause that prevented patients from finding out about the financial incentives for holding back medical services, the documents show.
The family alleged that Dr. Pugh did not hospitalize his wife in September 1997 even though she was showing symptoms of valvular heart disease. Instead, the doctor - named one of the city's top cardiologists in a survey of area doctors published recently by Fort Worth, Texas magazine - prescribed a drug called Betapace, which regulates the heartbeat.
The terms of the settlement are confidential and Cignaís spokeswoman, Tania Graves, declined to disclose details. However, the portion of the lawsuit against Fort Worth cardiologist Dr. Pugh and his practice, Consultants in Cardiology, is proceeding.
Wrongful death cases against HMOs are rare despite a 1997 Texas law that allowed patients to sue health plans for medical malpractice. One Fort Worth attorney who specializes in cases against managed care plans and helped with the 1997 law, said fewer than 20 such HMO lawsuits have been filed statewide.
In court documents, Cigna denied that the managed care agreement had any effect on Barley's treatment. Pugh testified in a deposition that the contract with Healthsource did not affect his professional judgment regarding her care.
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