The escalation of threatened violence and the angry rhetoric does not come just from doctors and patients. Dr. Linda Peeno, who quit her job as the medical director of an HMO to become a whistleblower and expert witness for patients, said that she is on the "hit list" of a managed-care industry that regards her with "sheer hate."
Her first threatening phone call came after she appeared on Dateline NBC, in a piece about a boy in Atlanta with meningitis who was directed by a Kaiser nurse to an emergency room forty-two miles from his home when he needed immediate care. He became severely ill and later had to have his hands and feet amputated. The family was able to sue because the boy's mother was a federal employee. A jury came back with a $45 million verdict.
"After it aired, I got this call from a gravelly voice, 'You better stop doing this stuff,'" Peeno recalled.
In March of 1998, after she published a testimonial in US News & World Report about the real decision-making processes of HMOs, she got another call: "It was a male, very nice, professional-sounding voice: 'I am calling to tell you that if you make any more media appearances or testify in any more legal cases, harm will come to you.'"
But it was not until an anonymous woman called her husband on his private line, an hour before his office opened, and warned of harm "to her or someone in your family," that she got scared.
The Peenos put in a security system and worked with the local police. But the calls kept coming, often catching her in places where she thought no one would know the number. Peeno, who describes managed care as "an industry bigger than tobacco," says, "What they can't deal with is that I've read more contracts and policies and procedures, and have become one of the most knowledgeable people in the country."
But it is not just her own hard-earned knowledge that chills managed-care executives. It is the fact that moles inside their companies who "hate what they do" feed her information, she said. These sources are crucial to fighting managed care in court. "[HMOs] use and misuse the law," said Peeno. "You can't get documents. They tie up the process by either fighting you tooth and nail or they shower you with useless paper. Sometimes, you can't even get the policy and procedure manual." Peeno noted that many of the job descriptions for claims reviewers at HMOs say, "Must be able to endure extreme stress."
Physicians for a National Health Program, which advocates a single-payer system like Canada's and is one of the country's most radical doctor groups, would like to see these brushfires of conflict organized into a national movement. Their members have joined in high-concept protests against HMOs, dumping managed-care literature into the Boston Harbor, marching to the Canadian Embassy in Washington, DC, to seek asylum from our healthcare system and descending on the Chicago Stock Exchange to demand that patients be put before profit.
But some members are impatient for more. At an annual PNHP meeting, the co-founder, David Himmelstein, asked, "Is this the time for civil disobedience? How long do we go on with this system and maintain peace? My children are getting to the age when I could spend some time in jail." Johnathon Ross proposed that the group burn their medical licenses en masse, akin to burning draft cards. But the group deemed this to be an empty symbol. Someone else suggested that they block the lobby of a managed-care company and refuse to move.
The problem, said Ross, is that "you've got the golden handcuffs. If you commit a felony in the state of Ohio, you lose your license." When doctors feel their livelihoods are on the line, their courage to resist often falters. And at times the resistance itself seems to arise more from self-interest than anything else. "When the medical profession has come together, by and large it's been about their pocketbooks," said Sandra Hernandez, San Francisco's former public health director. "Patients have not been put at the center."