A jury ordered a health maintenance organization to pay $89.1 million for denying a breast-cancer patient an experimental bone marrow transplant. Lawyers said it was biggest verdict of its kind.
Lawyers for Nelene Fox had argued that the HMO's refusal to cover the procedure cost the woman her life.A Superior Court jury agreed and on Tuesday ordered Health Net, California's second-largest HMO, to pay $77 million in punitive damages to the woman's family. The jury awarded $12.1 million in compensatory damages last week.
"The purpose of this was never to get money, or else we would have settled already," said Fox's husband, Jim. "The message is that an HMO can't have a financial incentive to withhold treatment in order to make money."
Health Net attorney Steven Meadville said the award in the breach-of-contract case was "outrageous, inconsistent and rendered solely on the basis of emotion." He said it would strip Health Net of its entire net worth, which he put at $57 million.
Meadville said the HMO will appeal.
Attorneys on both sides said it was the biggest verdict ever against an insurer for refusing to provide health coverage benefits.
Fox was diagnosed with breast cancer in 1991 at age 38. Despite three months of chemotherapy, the cancer spread to her bone marrow. Doctors said her only hope was a bone marrow transplant - an expensive and unproven treatment that might allow Fox to tolerate very high doses of chemotherapy.
Health Net said it would not pay because it considered the procedure experimental.
Neighbors and friends of the Temecula woman eventually raised more than $200,000 for the treatment, but she died in 1993, four months after undergoing the procedure.
Fox's case is part of a continuing battle around the country between patients seeking costly, experimental treatments and insurance companies struggling to contain rising health care costs.