Dr Linda Peeno, a former medical reviewer and medical director for three managed care organizations, testified before the House of Representatives Subcommittee on Health. She stated: “I will begin by making a public confession: In the spring of 1987, as a physician, I caused the death of a man. No one held me accountable for this–for this was a half million-dollar savings to my employer. In fact, this act secured my reputation as a “good” company doctor and insured my advancement in the health care industry. In fact, in a little more than a year I went from making a few hundred dollars a week to an annual six-figure income. In all my medical work, I had one primary duty: to use my medical expertise for the financial benefit of the organization. According to the managed care industry, it is NOT an ethical issue to sacrifice a human being for a “savings.” I was told repeatedly that I WAS NOT DENYING CARE, I WAS ONLY DENYING PAYMENT.”

She concluded her testimony pointing out that every managed care plan establishes the plan as the final authority for determining medical necessity. “What that means is that there is some physician like me NOT practicing or seeing patients, but is sitting behind a desk making decisions completely removed from the consequences of his or her decision who is getting paid to make those decisions for the benefit of a health plan, not the patient. This job is defined by how much they saved the company; by meeting a certain denial quota. This position has no CODE OF ETHICS for it is a hybrid role between executive and physician. This administrative physician receives a lucrative income for adding to the suffering of patients; haunted by the thousands of pieces of paper on which she has written the deadly word: DENIED; and in one case DIED. That is the evidence that managed care is inherently unethical. We need to get that message out to all physicians and patients.”

Dr Peeno presented this message to the national convention of the Association of American Physicians and Surgeons in Raleigh, North Carolina. We enjoyed meeting her and subsequently speaking with her again when she came to Sacramento for the premier of the movie about her story, Damaged Care, shown on Showtime and in some theaters. Linda is someone from the inside of an HMO with the courage to say I made a mistake–I did a terrible wrong by doing what the HMO wanted me to do. Watch for the movie.