Chapter 17 : A Claim of a Right to Health Care

Section 5. Case Study  HMO

Name: Samantha Sparta

Case Title: Pegram v. Hedrich

Description of the case: Cynthia Hedrich had insurance coverage with Carle Clinic Association through her husband?s job at State Farm Insurance. Mrs. Hedrich went to see her doctor, Dr. Pegram, with complaints of pain in her abdomen. Dr. Pegram palpated a large mass in Mrs. Hedrich?s abdomen but told her that she would have to wait eight days and drive 50 miles to the nearest clinic that was covered by her HMO to get an ultrasound. In the meantime, Mrs. Hedrich?s appendix burst and has since sued both Dr. Pegram and her insurance provider.

URL?s for the articles describing case:

Supreme Court opinion in the case of Pegram v. Hedrich

http://www.harp.org/pegram.htm

CNN article describing some of the case

http://www.cnn.com/2000/HEALTH/06/21/ethics.matters/

Proposed patient protection legislation

http://www.patients.org/showart.php3?idx=45&rtn=/articles.html&showsubj=1&mcat=3

American Dental Association?s fight for patient protection

http://www.ada.org/prof/govt/dentistryworks/pat-pro.html

URL?s for articles with ethical position:

American Medical Women?s Association position on ethics and managed care

http://www.amwa-doc.org/publications/Position_Papers/managedcareethics.htm

National Coalition of Mental Health Professionals and Consumers ethical view on managed care

http://www.nomanagedcare.org/eleven.html

Article written by Dr. Ronald Bronow, Vice President of Physicians Who Care

http://www.hmopage.org/ethics.html

Christian (Natural Law) bioethics and managed care

http://www.llu.edu/llu/bioethics/llethup113a.htm

Kristina Nicolosi

case studies : uncovered medical services

description: You may find that there is a pattern of claim denials for a particular usage of a certain drug. Many onocologists can exert considerable influence of new treatment. Efforts involves may effect reimbusement policies both locally and nationally.

url address: http://www.pbmi.com/V6N3Legal.html

url address etical articles:

http://www.phen.ab.ca.materials/intouch/Vol4/intouch4-10.html

www.hmopage.org/ethics.html

http://www.bcm.tmc.edu/ethics/ethics~news-1-96-02.html

www.ethics.com/medical?/ethics

 

 

Proceed to the DECISION SCENARIO section of the chapter by clicking here> section.

Copyright Philip A. Pecorino 2002. All Rights reserved.

Web Surfer's Caveat: These are class notes, intended to comment on readings and amplify class discussion. They should be read as such. They are not intended for publication or general distribution.

Return to:                 Table of Contents for the Online Textbook