ide Fifi isnt worth the cost, the needed care is not given. Managed care is perverse. It destroys patient choice. It leaves the ethics of our profession in ruins. (Jane Orient, MD). Dr. Linda Peeno testified before the U.S. House of Representative Committee on Commerce on May 30, 1996. She began her testimony. In the spring of 1987, as a physician, I caused the death of a man. Although this was known to many people, I have not been taken before any court of law or called to account for this in any professional or public forum. In fact, just the opposite occurred: I was rewarded for this. It brought me an improved reputation in my job, and contributed to my advancement afterwards. Not only did I demonstrate I could indeed do what was expected of me, I exemplified the good company doctor. I saved a half million dollars. The man died because I denied him a necessary operation to save his heart. I felt little pain or remorse at the time. The mans faceless distance soothed my conscience. Like a skilled soldier, I was trained for this moment. When any moral qualms arose, I was to remember: I am not denying care, I am only denying payment. At the time, this helped avoid any sense of responsibility for my decision. As a medical director, Dr Peenos priority was to protect the interests of the business, not the patients. There is no code of ethics for the company doctor. The physician code of ethics addresses clinical physicians, not physician executives. On previous occasions Dr. Peeno was reprimanded for not denying enough care. She was even told by the HMO to use data which was known to be inaccurate to justify a denial. At one point she was assigned the task of presenting to a group of 500 medical directors and nurse reviewers how her plan had used the denial process to get specialists costs down. If physicians do not play the game they can be labeled unsuited for managed care. So, while HMOs are advertising that you and your doctor, not a...
