THE ARIZONA PATIENT PROTECTION ACT

By Paul Johnson

HMO reform proposals have sprung up all over the United States. Most of these reforms address specific areas where profit-motivated HMO decision-making results in the denial of proper treatment. The Paul Johnson plan changes the way treatment decisions are made by subjecting HMOs to legal liability for negligent treatment decisions.

Patients' Rights

• The right to hold HMOs accountable. Paul Johnson's Patient Protection Act will make health plans directly accountable to patients for "health care treatment decisions" to ensure that health care providers, not health plans, are legally responsible for patient care. Paul Johnson will allow patients to hold health plans liable for damages for harm caused by a failure to exercise ordinary care and specify that a health plan is not a health care provider for purposes of health care treatment decisions.

• The right to information. Paul Johnson will ensure that all HMO patients have all the information they need regarding their HMO. He will revise the current HMO Disclosure Form to make it clear and concise, and see that it is distributed to all HMO patients. He will also give patients the right to access all correspondence between the HMO and their doctor regarding their care within 72 hours.

• The right to an advocate in state government. As governor, Paul Johnson will put an end to the cozy relationship between the Arizona Department of Insurance and the very insurance industry it is supposed to regulate. The Department must function as a consumer watchdog in regulating managed care plans, beginning with the creation of an independent patient advocate to assist patients in understanding insurance options and in filing appeals and grievances.

• The right to quality care for women and children. Paul Johnson's plan would allow women to designate their OB/GYN as a primary care provider and better protect breast cancer patients from "drive-by" mastectomies. Access to pediatric specialists for covered children must be a feature of every managed care plan. Additionally, the ability to take a child to the closest emergency room and keep the same doctor through a long-term illness or pregnancy are critical to Arizona's families.

• The right to greater protection from retribution. Paul Johnson will protect doctors who report quality problems to the authorities from any HMO retribution.

• The right to protection from financial bribes and penalties. Paul Johnson will prohibit plans from providing financial incentives and penalties to providers to limit medically necessary services.

• The right to due process. Paul Johnson will provide doctors with due process, including reasonable notice of termination, the right to review any information behind the termination, and to appeal adverse determinations within the plan.

• The right to an anti-gag rule with teeth. There isn't a physician in Arizona who believes that Arizona's anti-gag rule statute - protecting doctors who discuss the full range of treatment options with their patients from HMO retribution - actually offers any meaningful protection. Paul Johnson's Patient Protection Act will strengthen our statute so that it actually protects the right of doctors to fully disclose to their patients the full range of treatment options without HMO interference or retribution.