[Congressional Record (Bound Edition), Volume 145 (1999), Part 2]
[Extensions of Remarks]
[Pages 2252-2256]
[From the U.S. Government Publishing Office, www.gpo.gov]




          WHAT AETNA ISN'T TELLING YOU ABOUT THE GOODRICH CASE

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Wednesday, February 10, 1999

  Mr. STARK. Mr. Speaker, in recent weeks, Aetna has sent Members' 
offices criticisms of a recent California court case in which a jury 
has awarded $120 million to a widow for the economic loss and pain and 
suffering caused by the Aetna HMO's treatment of her husband, David 
Goodrich. Aetna is saying the facts do not support--and argue against--
allowing HMO members to sue their HMO.
  Ex parte communications about a lawsuit--and Aetna says it is 
appealing--are always questionable.
  Aetna, of course, has a ton of money to lobby Congress. The Goodrich 
family has no Washington lobbyist. Therefore, I asked the Goodrich 
attorney to comment on Aetna's mailing to us.
  Guess what? There is another side to the story.
  Following is a side-by-side prepared by the plaintiffs. Also, I am 
including in the Record a press release from California's Consumers for 
Quality Care, which makes the excellent point that the CEO of Aetna, 
who loves to write long editorials about quality, has thrown a temper 
tantrum, blaming the ``not intelligent enough'' jurors. It would be far 
better for him to look within to the quality of his operations. Is this 
really the kind of CEO we would want as head of the nation's largest 
health insurance company?


[[Page 2253]]

  Aetna Misled Congress About Facts of Goodrich Case: Investigations, 
               Withdrawal of Federal Contracts Called for


      board of aetna also asked to fire c.e.o. huber over remarks

       Consumers For Quality Care, the national health care 
     watchdog group, today called upon Congress to convene 
     hearings and suspend Aetna's government contracts over the 
     HMO's attempts to mislead Congress about the facts of the 
     landmark Goodrich vs. Aetna case in order to prevent HMO 
     reform.
       Aetna recently sent a statement to Congress distorting the 
     facts of the case, in which a San Bernardino jury issued a 
     $120 million rebuke of the HMO's conduct toward District 
     Attorney David Goodrich. Goodrich died of stomach cancer 
     after a two and one half year ordeal trying to get Aetna to 
     approve cancer treatment recommended by his Aetna doctors.
       In a letter to members of the United States House of 
     Representatives and Senate today, Consumers For Quality Care 
     urged action against Aetna because ``Aetna's conduct . . . 
     shows a contempt both for the Court, the American justice 
     system and for Congress.'' A point-by-point refutation of 
     Aetna's statement to Congress about the case, based on the 
     court record, was also released. (Available upon request)
       ``We intend to make a federal case out of Aetna's 
     misrepresentations and remorseless defiance of the civil jury 
     and their authority,'' said Jamie Court, director of 
     Consumers For Quality Care, a health care project of the 
     Foundation for Taxpayer and Consumer Rights. ``It should be 
     federal case when the nation's largest HMO misleads Congress 
     and thumbs its nose at the civil justice system. Aetna's 
     defiance of civil society's dictates should bolster the case 
     for giving to all patients the right to sue that Mrs. 
     Goodrich has.''
       The Goodrich case exposed the disparity in federal law 
     between government workers, like the Goodrich family, who can 
     sue their HMO and private sector workers, who are prevented 
     from suing for damages unless Congress changes the Employee 
     Retirement Income Security Act of 1974 or ERISA.


                         Huber Should Be Fired

       Consumers For Quality Care also wrote Aetna's Board of 
     Directors asking it to fire Chief Executive Officer Richard 
     Huber over his remarks attacking Goodrich's widow.
       Huber responded in the Hartford Court to the verdict. 
     ``This is a travesty of justice. You had a skillful 
     ambulance-chasing lawyer, a politically motivated judge and a 
     weeping widow.'' Later, a Los Angeles Times columnist 
     reported, ``he [Huber] expanded his complaints, telling me 
     that juries are customarily not intelligent enough to 
     consider complicated contractual issues and that this one in 
     particular was too ill-informed, as a result of the judge's 
     evidentiary rulings, to render a sound verdict.''
       ``We have been astounded at your Chief Executive Officer's 
     lack of remorse over the handling of David Goodrich's care 
     and ask you to act immediately to remove him,'' wrote Court. 
     ``If Aetna is dedicated to making things better for patients, 
     Mr. Huber does not belong as your C.E.O. The true travesty of 
     justice would be if Mr. Huber remains at the helm of Aetna 
     and company policy continues to be indifference to its dying 
     patients and to juries that condemn such policies.''
       The Foundation for Taxpayer and Consumer Rights is a tax-
     exempt, nonprofit, nonpartisan organization dedicated to 
     advancing and protecting the interests of consumers and 
     taxpayers.


     
                                  ____
                                       The Foundation for Taxpayer


                                          and Consumer Rights,

                               Santa Monica, CA, February 9, 1999.
     The True Travesty of Justice,
     Aetna Inc.,
     Hartford, CT.
       Dear Members of the Board of Directors: The origin of 
     change is regret. We have been astounded at your Chief 
     Executive Officer's lack of remorse over the handling of 
     David Goodrich's care and ask you to act immediately to 
     remove him.
       As you may know, Goodrich, a district attorney who risked 
     his life by prosecuting gang violence, died of stomach cancer 
     after a two and one-half year ordeal trying to get Aetna to 
     approve cancer treatment recommended by his Aetna doctors. A 
     San Bernardino County jury issued a $120 million rebuke of 
     your company's handling of Goodrich's treatment.
       Unfortunately, your C.E.O., Richard Huber, responded to the 
     verdict without remorse: ``This is a travesty of justice. You 
     had a skillful ambulance-chasing lawyer, a politically 
     motivated judge and a weeping widow.'' (The Hartford Courant, 
     January 22, 1999)
       Does Mr. Huber really deny the right of a widow to weep for 
     her husband?
       Later, a Los Angeles Times columnist reported, ``he [Huber] 
     expanded his complaints, telling me that juries are 
     customarily not intelligent enough to consider complicated 
     contractual issues and that this one in particular was too 
     ill-informed, as a result of the judge's evidentiary rulings, 
     to render a sound verdict.'' (Kenneth Reich, ``Verdict 
     Against Aetna Is An Omen Of Clash Over HMOs,'' Los Angeles 
     Times, Thursday, January 28, 1999, p. B5.)
       Is Aetna really this contemptful of the civil justice 
     system and its ethic of responsibility, or are these Mr. 
     Huber's own views?
       We had hoped that $116 million in punitive damages might be 
     enough to cause Aetna to reconsider how it deals with 
     patients like David Goodrich. The message from the jury was 
     that Aetna must do better. But Mr. Huber's remarks suggests 
     that in the future Aetna's patients will get no better 
     treatment at Aetna than David did.
       The Goodrich jury felt that Aetna did not respond quickly 
     when a patient's life hung in the balance and that Aetna 
     ignored its own doctors' recommendations for Mr. Goodrich's 
     care. In one instance, it took Aetna four months to approve 
     high-dose chemotherapy and Goodrich could no longer benefit. 
     Company and industry standards claim a 24 to 48 hour turn-
     around time.
       Is this the appropriate standard of care at Aetna?
       When it was clear Mr. Goodrich could wait no longer, 
     Goodrich's doctors ultimately acted without approval. The 
     public servant died believing he had left his wife with 
     $750,000 in medical bills. While Aetna claimed, in a letter 
     to Congress, that the treatment was paid for by ``another 
     insurance company,'' in fact the taxpayers picked up the 
     bill. Mrs. Goodrich was a Yucaipa school teacher and the 
     school district paid $500,000 of David's bills, only under 
     the threat of litigation and with the understanding the cost 
     would be repaid out of any Aetna verdict.
       If Aetna is dedicated to making things better for its 
     patients, Mr. Huber does not belong as your C.E.O. The true 
     travesty of justice would be if Mr. Huber remains at the helm 
     of Aetna and company policy continues to be indifference to 
     its dying patients and to juries that condemn such policies.
       We urge you to remove Mr. Huber as a signal that pro-
     patient reforms at Aetna will be forthcoming and that no 
     other family will have to endure what the Goodrich family 
     has.
           Sincerely,
                                                      Jamie Court.


     
                                  ____
                                       The Foundation For Taxpayer


                                          and Consumer Rights,

                               Santa Monica, CA, February 9, 1999.


                Aetna Has Mislead Congress & The Public

       Dear Member of Congress: Attempting to stymie HMO reform, 
     Aetna, the nation's largest HMO, has misled you in a recent 
     communique defending its treatment of cancer patient David 
     Goodrich. The San Bernardino County district attorney died 
     after a two and one half year ordeal trying to get Aetna to 
     approve cancer treatment recommended by his Aetna doctors. 
     Goodrich died believing he had left his wife with $750,000 in 
     medical bills. A San Bernardino County jury awarded $120 
     million in the case--including $116 million in punitive 
     damages for malice and oppression--to the widow.
       Attached is a detailed refutation, based on court records, 
     of Aetna's false and misleading statements to you. We urge 
     you to immediately convene hearings regarding Aetna's conduct 
     in this matter, which shows a clear contempt both for the 
     Court, the American justice system and for Congress.
       As you know, 125 million Americans with private sector, 
     employer-paid health care cannot sue their HMOs for damages 
     due to the Employee Retirement Income Security Act of 1974 or 
     ERISA. Aetna's remorseless conduct bolsters the case for 
     reforming ERISA and allowing all patients the same right to 
     sue that government workers, like the Goodrich family, now 
     have. Aetna has yet to accept the message that the Goodrich 
     jury sent--that it must respond more quickly to its patients 
     and defer to its doctors' recommendations. Civil remedies for 
     all patients are clearly needed to force Aetna to behave more 
     responsibly.
       In his remarks in the Hartford Courant, Aetna's C.E.O. 
     Richard Huber responded to the verdict: ``This is a travesty 
     of justice. You had a skillful ambulance-chasing lawyer, a 
     politically motivated judge and a weeping widow.'' In fact, 
     the judge was a former insurance defense attorney. Aetna's 
     own lawyers' questioning caused Mrs. Goodrich to cry on the 
     stand. The family's attorney was also a long-time friend of 
     Mr. Goodrich who only took the case at the behest of the head 
     San Bernardino District Attorney, who himself could not 
     compel Aetna to pay for Goodrich's treatment.
       Later, a Los Angeles Times columnist reported, ``he [Huber] 
     expanded his complaints, telling me that juries are 
     customarily not intelligent enough to consider complicated 
     contractual issues and that this one in particular was too 
     ill-formed, as a result of the judge's evidentiary rulings, 
     to render a sound verdict.''
       Aetna's lack of remorse and the unwillingness to accept 
     responsibility in this case is a symptom of the company's 
     larger defiance of civil society's mandates. Such a company 
     should not be entitled to federal contracts. We urge you to 
     investigate Aetna's handling of this matter and are ready to 
     assist.
           Sincerely,
                                                      Jamie Court.


[[Page 2254]]



    THE GOODRICH CASE: THE TRUE FACTS THAT AETNA DIDN'T TELL YOU \1\
------------------------------------------------------------------------
Aetna's false and misleading statement:  The truth (court records show):
------------------------------------------------------------------------
The statements attributed to the         The facts given by the
 plaintiff's attorney in press coverage   plaintiff's attorney in the
 give an incorrect impression of the      press coverage were the same
 facts in the Goodrich case. The          facts that the jury heard, the
 pertinent facts are.                     same facts that the judge--who
                                          was formerly a partner in an
                                          insurance defense firm--
                                          allowed the jury to hear after
                                          repeated consideration of
                                          Aetna's motions regarding the
                                          evidence, and the same facts
                                          that led the jury to believe
                                          that Aetna would not listen
                                          unless the punitive damages
                                          imposed on it were
                                          sufficiently high.
In June 1992, Mr. Goodrich sought        Aetna's statement that it
 emergency medical treatment after        ``paid the bills'' for David's
 collapsing at work. He was admitted to   emergency treatment despite
 the hospital and treated. Although the   the fact that ``the hospital
 hospital was not in his Aetna HMO        was not in his Aetna HMO
 network, Aetna paid the bills due to     network'' is a clumsy attempt
 the emergency nature of the treatment.   to make it sound as though
                                          Aetna was doing David a favor
                                          by paying for his emergency
                                          care and, to that extent, is
                                          patently misleading: Under
                                          both federal and California
                                          law, Aetna was required to pay
                                          for all emergency treatment
                                          received by a member,
                                          including David, whether the
                                          treatment was provided at a
                                          network facility or not.
                                         And, notably, Aetna did not
                                          approve that payment until
                                          September 4, 1992--three
                                          months after the charges were
                                          incurred.
Mr. Goodrich's primary care physician,   Again, Aetna's statement
 Dr. Richard Brown, referred him to a     implies that it did David a
 specialist, Dr. Joseph Dotan, who        favor by paying for Dr.
 performed surgery on June 25, 1992 to    Dotan's surgery bills. In
 remove a mass from Mr. Goodrich's        fact, Dr. Dotan was an in-
 stomach. This procedure was covered by   plan, network provider under
 Aetna. A biopsy revealed Mr. Goodrich    contract to Aetna. Aetna was
 had a rare form of stomach cancer.       required under Aetna's
                                          contract with Primecare
                                          Medical Group of Redlands, the
                                          medical group David was
                                          assigned to to pay for that
                                          treatment.
On July 28, Dr. Dotan referred Mr.       There are many problems with
 Goodrich to an out-of-network            Aetna's statement on this
 hospital, City of Hope, for a            issue:
 consultation regarding his cancer.      Dr. Dotan, David's in-plan
 Aetna approved the out-of-network        surgical oncologist told David
 referral, and Mr. Goodrich scheduled     and his wife, Teresa, that
 an appointment at City of Hope for       David's form of cancer was
 Sept. 3, 1992.                           very rare and he did not have
                                          ``vast experience'' with it.
                                         Dr. Dotan submitted David's
                                          case to the Redlands Community
                                          Hospital Tumor Board, the
                                          Chairman of which was also an
                                          Aetna in-plan oncologist. The
                                          Chairman of the Tumor Board
                                          also concurred that David's
                                          cancer was very rare and
                                          expressed the opinion that
                                          there was not a single doctor
                                          in the Redlands medical
                                          community who was qualified to
                                          treat it.
                                         Dr. Dotan and the Tumor Board
                                          recommended that David be sent
                                          to City of Hope for
                                          consultation about how to
                                          treat the tumor. But Dr. Dotan
                                          could not simply authorize
                                          David's referral to City of
                                          Hope. Instead he was required
                                          to obtain authorization for
                                          the referral from Aetna,
                                          through the medical group,
                                          Primecare. To that end, on
                                          July 28, 1992, Dr. Dotan
                                          requested a referral for David
                                          to see a doctor at the City of
                                          Hope. The referral for a
                                          consultation was approved on
                                          August 5, 1992. David was not
                                          told that the consultation had
                                          been approved until August 11.
                                          At this point, David was more
                                          than two months post-collapse
                                          and nearly one month post-
                                          diagnosis.
On Sept. 3 at City of Hope, Dr. James    Dr. Raschko did not tell David
 Raschko met with Mr. Goodrich and told   that he ``might be a
 him he might be a candidate for a        candidate'' for a bone marrow
 treatment program combining highdose     transplant. As reflected in
 chemotherapy with a bone marrow          Dr. Raschko's medical records,
 transplant that, for his condition,      Dr. Raschko considered David a
 was considered experimental. City of     ``perfect candidate'' for the
 Hope scheduled him to be evaluated on    proposed treatment.
 Oct. 2, with the first stages of the    Whether the bone marrow
 bone marrow transplant procedure to      transplant was considered
 begin on Oct. 28.                        ``experimental'' or not is
                                          irrelevant. Under California
                                          law, every HMO is required to
                                          issue an ``Evidence of
                                          Coverage and Disclosure Form''
                                          to each of its members. The
                                          ``EOC,'' as it is commonly
                                          called, is required to set
                                          forth all the benefits
                                          provided and must disclose all
                                          of the exclusions from
                                          coverage and limitations on
                                          coverage. Aetna's EOC did not
                                          contain an exclusion for
                                          experimental procedures. Thus,
                                          even if the treatment were
                                          considered ``experimental,''
                                          Aetna was required to cover
                                          it.
                                         If Aetna, Primecare and the
                                          plan doctors had sent David to
                                          City of Hope earlier, he
                                          obviously would have been able
                                          to begin the treatment process
                                          before the cancer
                                          metasticized.
On Oct. 6, 1992, Dr. Raschko informed    Aetna did not ``first'' receive
 Mr. Goodrich that a CT scan performed    the request for the bone
 on October 2 showed he was not a         marrow transplant on October
 candidate for the proposed treatment     8. Under its contract with
 as his cancer had metastasized to his    Aetna, Primecare was obligated
 liver. By the time Aetna received the    to process treatment requests
 request for experimental treatment two   and was therefore Aetna's
 days later, on Oct. 8, the request for   agent for that purpose.
 coverage was moot because plans for      Primecare--and thus Aetna--
 the treatment had been canceled. Dr.     first received the request for
 Raschko testified that no time delay     authorization of the treatment
 had any negative effect on Mr.           no later than September 29. At
 Goodrich's ability to qualify for the    that point, David's request
 high-dose chemotherapy. Unfortunately,   for treatment was forced
 at no time did Mr. Goodrich ever         through a nightmarish
 become a candidate for this treatment.   consideration process that
                                          would be subsequently repeated
                                          later with regard to other
                                          treatment requests:
                                         David's primary care physician
                                          (``PCP'') had to refer David
                                          to an in-plan oncologist for
                                          assessment of whether the
                                          treatment was appropriate.
                                         The in-plan oncologist
                                          supported the use of the bone
                                          marrow transplant for David's
                                          condition, believed that it
                                          made ``good therapeutic
                                          sense,'' noted that there was
                                          no ``standard'' therapy
                                          available and that bone marrow
                                          transplants had been utilized
                                          for years and were not
                                          experimental.
                                         The in-plan oncologist had to
                                          refer David back to the PCP.
                                         The PCP then had to submit an
                                          authorization request to
                                          Primecare.
                                         Primecare's utilization review
                                          nurse was not authorized to
                                          approve treatment at an out-of-
                                          plan facility and so had to
                                          refer the treatment request to
                                          Primecare's medical director.
                                         Primecare's medical director
                                          also was not authorized to
                                          approve this treatment at an
                                          out-of-plan facility and so
                                          was required to refer the
                                          request to Aetna's local
                                          medical director.
                                         Aetna's local medical director
                                          was uncertain about approving
                                          the treatment request and
                                          referred the request to
                                          Aetna's home-office medical
                                          director in Hartford,
                                          Connecticut.
                                         Aetna's home-office medical
                                          director considered the
                                          procedure ``experimental''--
                                          even though there was no
                                          experimental exclusion in
                                          David's plan and even though
                                          the in-plan oncologist did not
                                          consider it experimental.
                                          Under Aetna's own internal
                                          policies, the home-office
                                          medical director was required
                                          to send any treatment requests
                                          to Aetna's home-office
                                          Technology Assessment
                                          Department before denying a
                                          treatment request on the basis
                                          that it was experimental. The
                                          treatment request was,
                                          therefore, sent to the
                                          Technology Assessment
                                          Department.
                                         The head of Aetna's home-office
                                          Technology Assessment
                                          Department reviewed the
                                          request and, because of his
                                          uncertainty as to whether the
                                          treatment would provide a
                                          medical benefit to David,
                                          referred it to the Technology
                                          Department's consultant.
                                         The consultant opined that the
                                          treatment was experimental and
                                          not covered--even though there
                                          was no experimental exclusion
                                          in the EOC.
                                         The head of the Technology
                                          Assessment Department then
                                          sent the treatment request to
                                          an outside medical consultant
                                          group, Medical Care Ombudsman
                                          Program (``MCOP'').
                                         The MCOP then sent the
                                          treatment request to three
                                          oncology consultants for
                                          review.
                                         The three oncology consultants
                                          concluded that the treatment
                                          was experimental and sent
                                          their recommendation that it
                                          not be approved to MCOP.
                                         MCOP sent its recommendation
                                          that the treatment be denied
                                          to Aetna's Technology
                                          Assessment Department.
                                         The Technology Assessment
                                          Department issued a memorandum
                                          that it would deny the
                                          treatment as being
                                          experimental, and then
                                          requested that the coverage
                                          language of the plan be
                                          provided.
                                         The Technology Assessment
                                          Department sent its denial of
                                          the treatment to the Aetna
                                          home office medical director.
                                         The home office medical
                                          director sent the denial to
                                          the Aetna local medical
                                          director.
                                         The local Aetna medical
                                          director sent the denial to
                                          the Primecare medical
                                          director.
                                         The Primecare medical director
                                          sent the denial to the
                                          Primecare utilization review
                                          nurse.
                                         The Primecare utilization
                                          review nurse sent the denial
                                          to David Goodrich--on November
                                          18, 1992. This was two and one-
                                          half months after David's
                                          original consultation at the
                                          City of Hope, nearly a month
                                          after he was to have started
                                          the bone-marrow transplant
                                          procedure, and four months
                                          after his diagnosis.
                                         The denial was based on the
                                          fact that the treatment was
                                          deemed ``experimental''--even
                                          though there was no exclusion
                                          in the plan precluding
                                          coverage for experimental
                                          treatments.
                                         During this entire period of
                                          time, Aetna/Primecare's own
                                          standards required a 48-hour
                                          turn-around time for these
                                          determinations, as did the
                                          National Commission for
                                          Quality Assurance (NCQA).
Nevertheless, Aetna went forward with    It is nonsensical for Aetna to
 the original request and had it          say that despite the fact that
 reviewed by independent medical          David's cancer had
 experts selected by Grace Powers         metastasized and he could no
 Monaco, a well-known patient advocate.   longer qualify for City of
 They found that there was no hope of     Hope's bone marrow
 the experimental procedure benefiting    transplantation protocol, it
 Mr. Goodrich.                            decided to ``nevertheless'' go
                                          forward with the original
                                          request for treatment. As
                                          evidenced by the above outline
                                          of the process, the process
                                          had been started before the
                                          metastasis was discovered and
                                          the cumbersome and snail-like
                                          procedure merely lumbered its
                                          way along its pre-determined
                                          path. Aetna's communications
                                          with its own doctors were
                                          simply so lacking that it did
                                          not know that the proposed
                                          treatment was no longer
                                          viable.
Between October 1992 and January 1993,   It is false to say that David
 Mr. Goodrich chose to pursue             simply ``chose'' to pursue
 conventional chemotherapy treatment      standard chemotherapy to treat
 with City of Hope--the out-of-network    his metastatic cancer. In
 facility--without authorization. City    fact, Aetna broke its specific
 of Hope never charged Mr. Goodrich for   promises to David by failing
 this treatment. The same courses of      to discover any other
 treatment were approved by Aetna for     potential treatments for him.
 coverage at in-network facilities, but  In its marketing materials and
 Mr. Goodrich declined to avail himself   in its EOC, Aetna specifically
 of that treatment.                       promised David, as well as
                                          other plan members, that it
                                          was dedicated to keeping David
                                          healthy, and helping to cure
                                          him when he got sick; Aetna
                                          promised ``to do more;'' it
                                          promised that it would provide
                                          David with ``comprehensive
                                          health services'' ``designed
                                          with [his] personal health in
                                          mind;'' that Aetna and its
                                          physicians would ``coordinate
                                          all necessary medical
                                          services. . . . ``that they
                                          would be ``directing and
                                          arranging [his] health care
                                          services;'' that they would
                                          ``coordinate all [his] health
                                          care needs.'' Even more
                                          significantly, Aetna
                                          represented to its members in
                                          the EOC that the ``Primary
                                          Care Physician listed on each
                                          member's card has accepted the
                                          responsibility for that
                                          member's health care.''
                                          Similarly, in defining
                                          ``Primary Physician,'' the
                                          disclosure form states that
                                          the Primary Physician ``has
                                          overall charge of medical
                                          rendered to Members . . . and
                                          . . . directs the majority of
                                          health care services provided
                                          to such Members.''
                                         Although there was another
                                          option for treating David's
                                          liver metastasis--cryoablation
                                          (freezing) of the liver
                                          lesions--neither Aetna nor its
                                          doctors ever did anything to
                                          find out about that, or any
                                          other, alternative. Despite
                                          its promises, Aetna did not
                                          ``direct and arrange'' David's
                                          care or ``coordinate'' his
                                          health care needs. Aetna
                                          abdicated its responsibility
                                          for David's care.

[[Page 2255]]

 
                                         David's treating doctor, Leland
                                          Foshag, M.D., who is a
                                          nationally renowned specialist
                                          in treating cancers that have
                                          metastasized to the liver and
                                          who eventually performed the
                                          cryoablation surgery on David,
                                          testified that if David had
                                          received the cryoablation
                                          surgery six to nine months
                                          sooner, David would have lived
                                          15 to 20 months longer than he
                                          did. But Aetna stripped him of
                                          that chance by not even
                                          bothering to find out how to
                                          treat David's condition.
                                         Aetna's own in-plan oncologist
                                          recommended that David receive
                                          the standard chemotherapy
                                          treatment at City of Hope--in
                                          order to assure the continuity
                                          of David's care. And under
                                          California law, Aetna was
                                          required to do just that. But
                                          Aetna ignored its own doctor's
                                          recommendation and ignored its
                                          duty to assure that David had
                                          continuity of care and,
                                          instead, refused to authorize
                                          or pay for that treatment.
                                         Since City of Hope--charitably--
                                          provided the treatment to
                                          David and did not charge David
                                          for the treatment, Aetna
                                          insisted that the cost of that
                                          treatment not be included as
                                          any part of the damages in the
                                          lawsuit. Thus, the City of
                                          Hope could not be reimbursed
                                          for the services it provided
                                          to David and its good deed was
                                          punished by Aetna--and Aetna
                                          escaped payment for treatment
                                          it actually owed under its
                                          contract.
On August 5, 1993, Mr. Goodrich          Cryoablation was not an
 consulted with his primary care          experimental treatment, even
 physician, Dr. Wang, regarding an        in 1993.
 experimental procedure called           The request for the
 cryosurgery. Dr. Wang referred Mr.       cryoablation had to go through
 Goodrich to an in-plan oncologist, Dr.   the nightmarish approval
 Jack Schwartz, who recommended           process and took months to do
 approval for the procedure at an out-    so.
 of-network facility, St. John's         ``Mr. Goodrich's other
 Hospital, with Dr. Leland Foshag. A      insurance company'' was a self-
 request for approval also was sent to    funded benefit plan operated
 Mr. Goodrich's other insurance           by his wife's employer--the
 company, which indicated it would pay    Yucaipa-Calimesa Unified
 for the procedure. Mr. Goodrich          School District, under which
 underwent the cryosurgery at St.         he was covered as his wife's
 John's on Sept. 21, 1993. Aetna again    dependent. In other words, the
 had this request for experimental        taxpayer's program. But Aetna
 treatment reviewed by independent        was the primary insurer and
 medical experts selected by Grace        whether the school district
 Powers Monaco. This time, one            would be willing to cover the
 specialist thought the cryosurgery       procedure was totally
 might help Mr. Goodrich, so Aetna        irrelevant to Aetna's duty to
 approved the treatment and paid for it.  provide coverage to David in
                                          the first instance.
                                          Primecare, on behalf of Aetna,
                                          actually denied the treatment
                                          request for the cryoablation
                                          after David had already had
                                          the surgery.
                                         Aetna finally paid some, but
                                          not all, of the bills from the
                                          cryoablation six months after
                                          the surgery.
                                         Aetna never paid for the
                                          original consultation with Dr.
                                          Foshag.
In October 1993, Mr. Goodrich again      Aetna's primary defense at
 began receiving conventional             trial--and its argument to the
 chemotherapy treatment without           jury centered on--Aetna's
 authorization at an out-of-network       claim that it should not be
 facility, this time at St. John's. Mr.   liable for either the bills or
 Goodrich was notified by Aetna that      David's premature death
 self-referred, out-of-network            because they resulted from
 treatment that was available in-plan     David's failure to follow
 could not be covered. He was offered a   Aetna's ``rules.'' Aetna even
 nurse case manager whose job would       insisted that the jury be
 have been to assist him in               instructed that it could
 coordinating his care with the           allocate some or all of the
 appropriate providers to get the         fault to David. On the verdict
 maximum coverage available under his     from, the jury allocated 0% of
 health plan, but he did not respond.     the fault to David and 100% of
                                          the fault to Aetna.
                                         Much of the chemotherapy
                                          treatment received by David
                                          after the cryoablation was not
                                          standard chemotherapy. In
                                          fact, there were only two
                                          places in California that were
                                          equipped to provide some of
                                          the chemotherapy treatments--
                                          USC and UCLA. Since David
                                          could not obtain that
                                          treatment from ``in-plan''
                                          facilities, Aetna was required
                                          under California law to pay
                                          for it at out-of-plan
                                          facilities.
                                         Requiring David to receive even
                                          the standard chemotherapy or
                                          to obtain even the lab tests
                                          or x-rays through in-plan
                                          facilities despite the fact
                                          that the treatment was being
                                          coordinated by Dr. Foshag and
                                          the medical oncologist working
                                          with him, Dr. Chawla, breached
                                          Aetna's obligation to assure
                                          that David had continuity of
                                          care as required under
                                          California law.
                                         Even when David tried to comply
                                          with Aetna's demands, Aetna
                                          rejected his treatment
                                          requests. Many, many times
                                          David asked his PCP to submit
                                          an authorization request to
                                          Primecare and Aetna for
                                          approval of a CT scan, blood
                                          test or chemotherapy treatment
                                          that Dr. Foshag or Dr. Chawla
                                          needed to have done and
                                          requested that those services
                                          be provided at in-plan
                                          facilities. The PCP signed
                                          those authorization requests
                                          and submitted them to Aetna.
                                          Aetna routinely denied those
                                          requests because they had been
                                          requested at the behest of the
                                          ``out-of-plan'' doctors, even
                                          though the requests were
                                          signed by the plan doctor
                                          assigned to David. At one
                                          point, Teresa asked David's
                                          PCP why Aetna was denying even
                                          the requests for treatment to
                                          be provided in-plan and the
                                          doctor's only response was
                                          ``HMOs are fine as long as you
                                          don't get sick.''
                                         David did utilize the services
                                          of a nurse case manager.
                                          Sharon Hopkins, R.N.,
                                          Primecare's utilization review
                                          nurse assigned to David's
                                          case, actually spoke with
                                          David ``for hours'' during
                                          this time period. She looked
                                          forward to David's calls
                                          because he was ``such a nice
                                          man'' and was ``so
                                          interesting'' and ``so easy to
                                          talk to.'' Even though she had
                                          to keep denying his claims,
                                          she liked talking to him
                                          because he never made their
                                          relationship seem adversarial.
                                          He explained to her that he
                                          simply had to do whatever was
                                          necessary to try to stay alive
                                          as long as possible. Ms.
                                          Hopkins even visited David
                                          when he was in the hospital.
This pattern continued throughout 1994,  Since David did, in fact,
 as Mr. Goodrich received out-of-         request that the CT scans, x-
 network, unauthorized conventional       rays, blood tests and
 treatment at St. John's, and he          chemotherapy treatments that
 ignored repeated warnings that out-of-   could be done in-plan be
 network treatment could not be           approved, and since Aetna
 covered. Mr. Goodrich's out-of-network   routinely denied those
 treatment was covered by his wife's      requests, what else was David
 health insurance--a fact that was        supposed to do?
 withheld from the jury by a court       The trial judge ruled that
 ruling. Suggestions that he died         Aetna could not introduce
 without knowing these bills would be     evidence of the existence of
 taken care of are not true. At no time   coverage, if any, under the
 did he take any action to question,      school district's plan
 protest or appeal any coverage denials   because, as the judge put it,
 by Aetna.                                whether anyone else agreed to
                                          pay the bills was irrelevant
                                          to Aetna's responsibility to
                                          pay the bills. It is revolting
                                          and repugnant that Aetna would
                                          try to defend its own wrongful
                                          conduct by trying to foist its
                                          legal obligations onto a small
                                          school district.
                                         Aetna delivered its final
                                          denial letter to David when he
                                          was in intensive care the day
                                          after a final surgery in
                                          January, 1995. At that point,
                                          David did not know whether the
                                          school district would pay the
                                          bills. He died, still in the
                                          hospital, on March 15, 1995--
                                          knowing that there were more
                                          than a half million dollars in
                                          bills still outstanding and
                                          that neither, Aetna nor the
                                          school district would agree to
                                          pay them.
                                         Although the school district
                                          eventually paid the bills--
                                          over a year after David died--
                                          the payment of the bills
                                          depleted the school district's
                                          benefit fund so much that the
                                          school district's teachers
                                          were not able to receive their
                                          full raises the following
                                          year--evidence that the jury
                                          would have heard if Aetna had
                                          been allowed to tell the jury
                                          that the school district had
                                          paid the bills.
                                         The school district has a lien
                                          on any recovery by Teresa in
                                          the case and will be paid back
                                          out of the judgment for all
                                          the bills it paid.
                                         About the assertion that David
                                          never appealed Aetna's denial.
                                         The hospital itself repeatedly
                                          initiated appeals in response
                                          to Aetna's denials. All the
                                          appeals were rejected and the
                                          denials reaffirmed.
                                         The school district even
                                          appealed Aetna's denials of
                                          the bills. Aetna also rejected
                                          that appeal and reaffirmed the
                                          denials.
                                         After David's death, Teresa,
                                          through the PCP, also
                                          initiated an appeal. That
                                          appeal, too, was rejected and
                                          the denials reaffirmed.
                                         Aetna demanded that Teresa
                                          mediate her claims against
                                          Aetna immediately after she
                                          filed her complaint in this
                                          action. She did so. Aetna
                                          never tendered any payment for
                                          the bills at issue in the
                                          lawsuit.
                                         Aetna litigated the lawsuit for
                                          three years and never once
                                          offered to pay any of the
                                          bills.
                                         So, what difference would an
                                          appeal by David before he died
                                          have made?
In January 1995, Mr. Goodrich entered    Requiring the surgery to be
 St. John's for surgery that had been     conducted in-plan would have
 precertified and approved by his other   violated Aetna's obligation
 insurance company. This was              under California law to assure
 conventional surgery that could have     the continuity of David's
 been conducted in-plan, so coverage by   medical care.
 Aetna was denied. Mr. Goodrich          The surgery was not precertifed
 remained hospitalized until his death    and approved by the school
 on March 15, 1995.                       district plan. In fact, the
                                          hospital did not call the
                                          right administrator and the
                                          school district's
                                          administrator later refused to
                                          cover the bills because of
                                          that mistake.
                                         Aetna had no right to rely on
                                          the school district's coverage
                                          since Aetna was the primary
                                          carrier.
                                         Aetna did not deny coverage for
                                          the surgery until after it was
                                          completed, in violation of the
                                          time standards Aetna was
                                          supposed to follow.
All of Mr. Goodrich's medical bills      The abject falsity of this
 were covered by Aetna--when treatment    statement is evidenced by the
 was provided in-plan or authorized in    facts, set forth above,
 accordance with plan requirements--or    demonstrating that even when
 by Mr. Goodrich's wife's health          David requested, through his
 insurance, although the jury was not     in-plan PCP, that he be
 permitted to hear about the secondary    provided with in-plan
 coverage. During the course of his       treatment at in-plan
 treatment, the total out-of-pocket       facilities, the requests were
 cost to the Goodriches was less than     denied by Aetna.
 $2,000.                                 Aetna had no right to foist its
                                          contractual obligations off
                                          onto the school district, or
                                          to force the school district's
                                          teachers to forgo their raises
                                          in order to provide Aetna with
                                          an even greater cost savings
                                          and profit margin.
                                         Teresa Goodrich--a kindergarten
                                          teacher--was faced with over
                                          $500,000 in bills for over a
                                          year after David died because
                                          both Aetna and the school
                                          district refused to pay the
                                          bills.
At no time did Mr. Goodrich fail to      As testified to by Dr. Foshag,
 receive any treatment recommended by     Aetna should have discovered
 in-plan or out-of-plan doctors, and      and provided David with the
 all treatment was obtained without       cryoablation at least six
 delay due to the timing of coverage      months earlier and, if it had,
 approvals or denials.                    David would have lived longer.
 
------------------------------------------------------------------------
\1\ Statements are from Aetna's response of January 29, 1999 to
  Congress. Attorneys for the Goodrich family, Sharon Arkin and Michael
  Bidart, prepared the factual response (909-621-4935).

                       SENATE COMMITTEE MEETINGS

  Title IV of Senate Resolution 4, agreed to by the Senate on February 
4, 1977, calls for establishment of a system for a computerized 
schedule of all meetings and hearings of Senate committees, 
subcommittees, joint committees, and committees of conference. This 
title requires all such committees to notify the Office of the Senate 
Daily Digest--designated by the Rules committee--of the time, place, 
and purpose of the meetings, when scheduled, and any cancellations or 
changes in the
meetings as they occur.
  As an additional procedure along with the computerization of this 
information, the Office of the Senate Daily Digest will prepare this 
information for printing in the Extensions of Remarks section of the 
Congressional Record

[[Page 2256]]

on Monday and Wednesday of each week.
  Meetings scheduled for Thursday, February 11, 1999 may be found in 
the Daily Digest of today's Record.

                           MEETINGS SCHEDULED

                              FEBRUARY 12
     9:30 a.m.
       Budget
         To hold hearings on national defense budget issues.
                                                            SD-608

                              FEBRUARY 22
     1 p.m.
       Aging
         To hold hearings to examine the impact of certain 
           individual accounts contained in Social Security reform 
           proposals on women's current Social Security benefits.
                                                            SD-628

                              FEBRUARY 23
     9:30 a.m.
       Health, Education, Labor, and Pensions
         To hold hearings on Department of Education reform 
           issues.
                                                            SD-430
     10 a.m.
       Foreign Relations
         To hold hearings on the President's proposed budget 
           request for fiscal year 2000 for foreign assistance 
           programs.
                                                            SD-419

                              FEBRUARY 24
     9 a.m.
       Environment and Public Works
         To hold hearings to examine the President's proposed 
           budget request for fiscal year 2000 for the 
           Environmental Protection Agency.
                                                            SD-406
     9:30 a.m.
       Armed Services
       Readiness Subcommittee
         To hold hearings on the National Security ramifications 
           of the Year 2000 computer problem.
                                                            SH-216
       Health, Education, Labor, and Pensions
       Public Health and Safety Subcommittee
         To hold hearings on antimicrobial resistance.
                                                            SD-430
     2 p.m.
       Armed Services
       Personnel Subcommittee
         To hold hearings on proposed legislation authorizing 
           funds for fiscal year 2000 for the Department of 
           Defense and for the future years defense program, 
           focusing on recruiting and retention policies within 
           DOD and the Military Services.
                                                            SR-222
       Energy and Natural Resources
       National Parks, Historic Preservation, and Recreation 
           Subcommittee
         To hold oversight hearings on the President's proposed 
           budget request for fiscal year 2000 for National Park 
           Service programs and operations.
                                                            SD-366

                              FEBRUARY 25
     9 a.m.
       Energy and Natural Resources
         To hold oversight hearings on the President's proposed 
           budget request for fiscal year 2000 for the Department 
           of Energy and the Federal Energy Regulatory Commission.
                                                            SD-366
     9:30 a.m.
       Veterans' Affairs
         To hold joint hearings with the House Committee on 
           Veterans' Affairs to review the legislative 
           recommendations of the Military Order of the Purple 
           Heart, the Fleet Reserve, the Retired Enlisted 
           Association, the Gold Star Wives of America, and the 
           Air Force Sergeants Association.
                                               345 Cannon Building
       Health, Education, Labor, and Pensions
         To hold hearings on protecting medical records privacy 
           issues.
                                                            SD-430
     10 a.m.
       Foreign Relations
       East Asian and Pacific Affairs Subcommittee
         To hold hearings to examine Asian trade barriers to 
           United States soda ash exports.
                                                            SD-419
     2 p.m.
       Judiciary
       Antitrust, Business Rights, and Competition Subcommittee
         To hold hearings to review competition and antitrust 
           issues relating to the Telecommunications Act.
                                                            SD-226
       Energy and Natural Resources
         To hold oversight hearings on the President's proposed 
           budget request for fiscal year 2000 for the Forest 
           Service, Department of Agriculture.
                                                            SD-366

                                MARCH 2
     9:30 a.m.
       Veterans' Affairs
         To hold joint hearings with the House Committee on 
           Veterans' Affairs to review the legislative 
           recommendations of the Veterans of Foreign Wars.
                                               345 Cannon Building
       Energy and Natural Resources
         To hold oversight hearings on the President's proposed 
           budget request for fiscal year 2000 for the Department 
           of the Interior.
                                                            SD-366

                                MARCH 4
     9:30 a.m.
       Veterans' Affairs
         To hold joint hearings with the House Committee on 
           Veterans' Affairs to review the legislative 
           recommendations of the Veterans of World War I of the 
           USA, Non-Commissioned Officers Association, Paralyzed 
           Veterans of America, Jewish War Veterans, and the 
           Blinded Veterans Association.
                                               345 Cannon Building

                                MARCH 10
     9:30 a.m.
       Armed Services
       Readiness Subcommittee
         To hold hearings on the condition of the service's 
           infrastructure and real property maintenance programs 
           for fiscal year 2000.
                                                            SR-236

                                MARCH 17
     10 a.m.
       Veterans' Affairs
         To hold joint hearings with the House Committee on 
           Veterans' Affairs to review the legislative 
           recommendations of the Disabled American Veterans.
                                               345 Cannon Building

                                MARCH 24
     10 a.m.
       Veterans' Affairs
         To hold joint hearings with the House Committee on 
           Veterans' Affairs to review the legislative 
           recommendations of the American Ex-Prisoners of War, 
           AMVETS, Vietnam Veterans of America, and the Retired 
           Officers Association.
                                               345 Cannon Building

                              SEPTEMBER 28
     9:30 a.m.
       Veterans' Affairs
         To hold joint hearings with the House Committee on 
           Veterans' Affairs to review the legislative 
           recommendations of the American Legion.
                                               345 Cannon Building