The insurance giant, Aetna, Inc., is reeling after a recent verdict in the case brought against it by Teresa Goodrich, the widow of a former Deputy District Attorney in California who died in 1995 at the age of 44.

The jury’s decision reflected both the broad alienation consumers feel from the business of health care, and especially a rage with managed care procedures that seem designed to frustrate rather than help patients get needed treatments.

The case focuses new attention on how to manage the demand for unproven or experimental procedures—especially from desperately ill patients for whom no other options apparently exist. Mr. Goodrich died of a rare form of stomach cancer after being denied coverage for such treatments.

Richard L. Huber, Aetna’s chief executive, said the company intends to defend itself in public as it argues against providing patients the legal right to sue their HMO. He called the case “an egregious miscarriage of justice.”

Such an issue was not on the minds of the jurors who acted on the evidence in the Aetna case. “The most overwhelming piece of evidence was the health-plan handbook,” said Marilyn Amaral, a member of the jury and retired legal secretary who once worked for a law firm that defended insurance companies. “Nowhere in the 20 pages was there a single mention of experimental treatment. Yet all of the letters of denial...were based on that.”

Consumer advocates and physician groups believe managed care companies should be liable in patient-care litigation because their policies influence decisions about the care that is ultimately delivered.

SOURCE: The Wall Street Journal, February 22, 1999.