AMA BACKS DISCLOSURE OF HMO GAG CLAUSES.

Byline: Brenda C. Coleman Associated Press 

The American Medical Association rebelled Thursday against HMO gag rules that prevent doctors from telling patients about expensive tests and treatments that insurance companies won't pay for.

The doctors group voted to push for legislation requiring doctors, if their speech to patients is curtailed by clauses in their agreements with health maintenance organizations, to tell patients that such clauses exist.

``Gag clauses strike at the heart of the physician-patient relationship,'' Dr. John C. Nelson, an AMA trustee, said before the vote.

Gag rules erode trust and open the physician to malpractice lawsuits, Nelson said.

In Washington, a bill outlawing gag clauses advanced from a House subcommittee Thursday.

The AMA was already on record as wanting a ban on gag clauses. Until there is such a ban, patients should be told in plain language that gag rules exist when they do, the group's policy-makers said.

Dr. Robert E. McAfee, immediate past AMA president and a member of the board of trustees, called the vote an interim step encouraging doctors ``to do everything we can to eliminate gag clauses from contractual relationships with the managed care industry.''

Health maintenance organizations and insurance company representatives deny prohibiting doctors from discussing clinical information. They just say doctors can't criticize the companies or disclose proprietary financial information.

``The Health Insurance Association of America always maintains that patients should be able to have access to all the relevant information that they need to make their health-care decisions,'' said Michael Fortier, associate director of the group, based in Washington, D.C.

He said the AMA's real intent is to prohibit contract provisions that say doctors can't disparage the health plan or criticize it.

``In any business arrangement, you have that; you cannot disparage your employer,'' Fortier said. ``You can't say, `Well, this is a good product but the fellow down the street has a much better product.' ''

Don White, a spokesman for the American Association of Health Plans, which represents HMOs and other managed-care groups, agreed.

``What you're not going to find in HMO contracts are provisions that limit clinical communications, like treatment options,'' he said by telephone from Washington, D.C. ``We agree wholeheartedly that patients need to know everything about their treatment options and their clinical options.''

But Dr. Brian J. Eades, an obstetrician-gynecologist, said an HMO with which he has a contract gagged him from talking about the possible medical consequences of one of its policies.

He said he had put a sign up in his waiting room notifying his patients that the HMO had changed its rules, prohibiting women from seeing obstetrician-gynecologists as general-care doctors and telling them to consult him if they wanted more information.

Patients complained to the HMO. He was called before the HMO board that has a contract with the physicians' group to which Eades belongs. Eades said a senior member of the physicians' group asked him to resign, even though Eades said he had expressed no opinions about the HMO.

The AMA's annual five-day meeting ended Thursday.