CHERRY HILL, N.J. — The couple who helped end "drive-through" deliveries after their two-day-old daughter died are on a new crusade — this time to hold HMOs accountable for their medical decisions.
Steve and Michelle Bauman hope to crack the shield of a federal law that has protected health maintenance organizations from lawsuits by patients who were harmed by the denial, delay or poor quality of care.
They're suing Aetna U.S. Healthcare, contending its former policy of discharging newborns from hospitals after 24 hours led to the death of their first baby, Michelina, a day after she was sent home in May 1995.
Their testimony to Congress and the New Jersey Legislature, detailing Michelina's death from an infection that would have been detected in the hospital, led to a federal law and many state laws requiring a minimum 48-hour stay for newborns and their mothers.
Now the Baumans are trying to win financial damages from Aetna. In a precedent-setting ruling last June, the U.S. Supreme Court upheld a federal appeals court ruling that the couple could sue the HMO for malpractice in state court. They're preparing for a trial next summer.
Until now, HMOs routinely got state malpractice lawsuits moved to federal courts, where the most plaintiffs can recover is the cost of care denied them.
"The ultimate thing we're looking for is . . . making it safer for other newborns and their mothers," Steve Bauman said Thursday in an interview at their attorney's Cherry Hill office. "Somebody's got to be held accountable so they know they can't get away with this anymore."
Other efforts seeking the same goal include pending federal class-action lawsuits attacking the way HMOs manage care, and attempts to pass federal and state laws giving at least 125 million patients the right to sue HMOs.
The House passed a Patients Bill of Rights this year, but it failed in the Senate by one vote. John Stone, spokesman for the House sponsor, Rep. Charlie Norwood, R-Ga., predicts it will pass early in the next Congress because more Republican senators now back it.
Seven states — including California, Texas and Maine — have passed such laws since 1997 and 27 others debated them this year, according to Molly Stauffer of the National Conference of State Legislatures. Many bills died or were withdrawn but will be reintroduced in January, she said. A New Jersey bill passed the state Senate 38-0 but is tied up in the Assembly.
The American Medical Association, its state affiliates and many consumer groups have lobbied hard for such laws, while HMOs and the Health Benefits Coalition, representing 3 million employers, oppose them.
"What you're looking at is something that's going to drive up coverage costs, encourage defensive medicine, do nothing to improve the quality of care and benefit trial lawyers more than anyone else," said Susan Pisano, spokeswoman for the American Association of Health Plans.
However, in Texas, where the first such law was enacted, only a handful of malpractice suits have been filed.
Jamie Court, executive director of the watchdog group Foundation for Taxpayer and Consumer Rights, said he hopes the laws will "put some fear into HMOs."
The Baumans, who have moved from Williamstown, N.J., to Spring Hill, Fla., with their young daughter Alanna and son Steven, say the HMO nurse who was to visit Michelina the day after discharge never came, and their pediatrician told them not to worry about the baby's moaning, strange rash and other symptoms.
Aetna said it has no legal liability because all care decisions were made by the couple's doctor, who also is a defendant.
The current restrictions on lawsuits against HMOs are based on the 1974 Employee Retirement Income Security Act, or ERISA, which was interpreted in early court rulings as exempting all HMO plans sponsored by private employers from lawsuits claiming harm from denial of care. ERISA was meant to guarantee that employees get the benefits employers promise them.
Now patients' lawyers are arguing that HMOs provided substandard medical care, because those cases are governed by state laws.
"Our case is one of the few cases, and the only one that's gone through a federal appeals court, where we're challenging HMO policies that cause malpractice to occur," said Josh Spielberg, the Baumans' lawyer. "It has already, I think, opened up (the way for) more of these cases."