Alliance for Patient Safety

                            All that is necessary for the triumph of evil...
                                                                ... is for good men to do nothing.

                                                                                                   Edmund Burke

Retaliation Against Physicians - Louis E. Potvin, MD

Potvin v. Metropolitan Life Insurance Company
(whether physicians have a right to fair hearing prior to termination from health plan) Issue: Dr. Potvin’s lawsuit charged that his “without cause” termination from MetLife’s managed care networks constituted a violation of his common-law right to fair procedure and a circumvention of the notice and hearing requirements pursuant to Business and Professions Code §§805 et seq., because it allegedly was a result of his malpractice history. The trial court issued judgment in favor of MetLife and Dr. Potvin appealed. On April 30, 1997, CMA filed an amicus curiae brief with the California Court of Appeals (2nd Dist.) on behalf of itself and the AMA. Consistent with the CMA’s position, the California Court of Appeals (2nd Dist.) ruled that physicians have a common-law right to fair procedures, including the right not to be expelled from participation in a health plan, for reasons which are arbitrary, capricious, and/or contrary to public policy, notwithstanding an “at will” termination provision in a health plan contract. MetLife filed a petition for review by the Supreme Court which was granted. On March 16, 1998, CMA filed an amicus curiae brief with the California Supreme Court on behalf of CMA and AMA, arguing that physicians terminated from managed care plan panels are entitled to fair hearing rights, just like physicians terminated from hospital medical staffs or medical professional societies.

Outcome: In a huge victory for CMA, all physicians and their patients, on May 8, 2000, the California Supreme Court, siding with the Amici Curiae brief filed by the CMA and AMA, concluded that a managed care plan should not be able to arbitrarily and capriciously terminate physicians from provider panels without notice or an opportunity to be heard. In making this ruling, the Supreme Court, consistent with 100+ years of precedent, ruled that managed care plans, like other entities in health care controlling access to patients, such as medical staff and medical societies, must afford fundamental fairness to their contracting physicians. The Defendant sought rehearing by the California Supreme Court which was denied on June 28, 2000.