The Senate yesterday announced that it had reached a bipartisan agreement resolving one of the thorniest issuessurrounding debate over the patients’ bill of rights currently before Congress. The agreement would limit theability of patients to sue their employers when HMO’s deny care. Doctors have long charged that HMO’s used”arbitrary definitions of medical necessity” to deny necessary medical procedures.
Much of the debate in Congress and in the press over the patients’ bill of rights has centered on the right to sueHMO’s. Critics of the patients’ bill of rights–and the debate surrounding it–argue that the broader issues ofaccess to health care for the poor and 43 million uninsured have largely been ignored.
For Robert Belfon, a pediatric dentist in New Mexico, patients’ rights is about who gets care and who doesn’t in ahealth care system dominated by for profit corporations.
Belfon moved to New Mexico in 1997 to practice dentistry in a poor and under served area of the state where themajority of his patients were children on Medicaid. Two months after Belfon moved to New Mexico, the state privatizedmost of its health care system including Medicaid and farmed out the state’s dental services to Doral, a managed careorganization based in Wisconsin and one of the fastest growing HMO’s in the country.
Doral terminated Mr. Belfon’s contract a year after he joined the HMO, briefly reinstated him following a lawsuit byMr. Belfon, then refused to renew his contract in 1999, alleging fraud and “quality of care concerns.”
Robert Belfon says he was just trying to practice good medicine, and that Doral cut him because he refused to skimpon the care he provided to his patients. He is still prevented from treating the nearly 4,000 children he previouslycared for in one of the poorest parts of New Mexico.
- Robert Belfon, pediatric dentist practicing in New Mexico.