Statement of American Psychological Association

Madame Chairwoman and members of the subcommittee, the American Psychological Association (APA) writes to clarify our understanding of the position of the Patient Access Coalition on the subject of legal accountability. The APA alone represents within the Coalition more than half of the individuals who are non-physician providers, and we have served on the Coalition's steering committee for many years. In this capacity, we feel it necessary to clarify that the Coalition has never taken any position on the issue of legal accountability other than neutrality.

We believe that the Coalition's testimony will be misinterpreted as the Coalition is critical of liability and could live without it. This is not the position of the Coalition. The position of the Coalition is, and has always been, neutral on the subject of legal accountability due to the differing opinions of our member organizations and their different priorities.

In fact, many individual members of the Coalition - including the APA -- do indeed strongly support the inclusion of liability protection in the Patients' Bill of Rights. We believe that reform must embody both internal and external appeals rights to ensure that patients are able to obtain quality and timely health care. The vast majority of disputes between managed health plans and patients should be resolved without the need for judicial intervention through a strong, independent external appeals process.

Although a strong and independent appeals process is essential, it will not always suffice. Even under an expedited appeals process, such as a 72-hour deadline, patients can sustain injuries that warrant appropriate compensation. Consider the following scenarios where an appeals process alone would not prevent the negligent denial or delivery of treatment:

A patient is admitted to a community hospital complaining of paralysis and numbness in his extremities. The hospital concludes that the gravity of the patient's neurological condition is beyond the scope of the hospital's expertise, necessitating his immediate transfer to an academic hospital, which the hospital promptly arranges. The health plan, however, denies authorization for transfer to the selected hospital and instead recommends three others that are part of the health plan's network. By the time one of the health plan's hospitals accepts the patient three hours later, the patient has sustained permanent quadriplegia.

A patient with major depression is actively threatening suicide. Her treating psychologist recommends immediate hospitalization, which the managed care plan denies and continues to deny after an internal appeal. The psychologist immediately requests expedited external review of the managed care plan's denial. While the review is pending, the patient kills herself, leaving behind a surviving spouse and two children.

The incidents described above can and do occur in real life. Consequently, we believe that reform must include the ability of a patient injured as a result of negligence by a health plan to seek redress for his or her injuries in a court of law. We also believe that the deterrent effect of health plan legal accountability will lead to better, more appropriate care up front, thus reducing the possibility of lawsuits.