Local Forces Playing Key Roles in Patient Rights Issue.

Michael J. Bidart

Title: Managing Partner

Organization: Shemoff Bidart & Darras

Background: Started law career in general practice... Emphasis on personal injury/insurance... Started partnership in 1986... Practice focused on insurance bad faith... Growing popularity of Health Maintenance Organizations led firm to extend law of insurance bad faith to HMOs... First HMO case in 1993... Represented an older person who converted from Medicare to an HMO... HMO refused to pay for rehabilitation after one month... Had patient remained on Medicare, costs would have been covered... Client settled confidentially for seven-figure amount.

Role In Patient Rights Issue: Won landmark $120 million verdict in January 1999 against Aetna U.S. Healthcare over its refusal to pay for care recommended by the health plans' own physicians... Largest jury verdict ever rendered against HMO... Following victory, sued Aetna for defamatory remarks after verdict... Aetna executive was quoted as calling Bidart an "ambulance-chasing lawyer"... Suit was dismissed... Continues to be involved in a variety of cases involving denial of care on grounds that care is "experimental or investigative."

E. Richard Brown 

Title: Director

Organization: UCLA Center for Health

Policy Research

Background: Professor of public health at UCLA but has never taken a public health course... Received doctorate in education and sociology... Joined UCLA faculty in 1979... Through study of sociology of professions became interested in public health... Began doing research on issues related to health care access... Subsequent research turned him into "the insurance data guru"... Has served on several National Academy of Science study committees... Past president of the American Public Health Association.

Role In Patient Rights Issue: Founded UCLA

Center for Health Policy Research... Center has become primary source of information for legislators and advocacy groups... Extensively involved fit analysis and development of public policies... Particular emphasis on health care reform... In 1993, served as full-time senior consultant to President Clinton's task force on national health care reform... Served as health policy adviser to two members of the Senate... Research is centered on issues related to health care access for low income and disadvantaged patients... Is the principal investigator for California Health Interview Survey, one of nation's Largest ongoing health surveys.

Kathy Carder

Title: Patient Rights Advocate

Organization: California Nurses

Association

Background: Longtime suffer who grew up in California... Began career by volunteering at a free clinic in Los Angeles... Took night classes at Venice Adult School 'to be a certified nursing assistant... First job was in a nursing home, which she quit after finding her name had been being forged on papers showing she had given physical therapy to patients... Worked at Santa Monica Hospital from 1977 to 1998... When UniHealth American bought the hospital in the early 1990s, Carder claimed it started making dangerous cuts in staffing and allowing unlicensed nurses to do invasive procedures... Brought the California Nurses Association' s list of equipment each hospital was required by law to have in an ICU unit to hospital management... Administrators listened to Carder and other nurses and put in the necessary equipment... Helped organize nurses to join the CNA in 1992... Joined the staff of the CNA in 2000.

Role in Patient Rights Issue: Helps teach classes on new laws, how to prevent medication errors, how patients can to protect their rights and how to be a patient advocate and how staff uses laws to protect patients... Has helped promote passage of several state patient rights laws such as the Safe Staffing Ratio Law, or AB394, which was signed into law in 1999... First part went into effect Jan. 1, 2000... Law limits the kinds of procedures unlicensed personnel are allowed to do unless supervised by a registered nurse.... The second part of the law, which goes into effect next year, sets up nurse-to-patient staffing levels for all hospital units.

Maria Contreras-Sweet

Title: Secretary

Organization: Business, Transportation and Housing Agency; State of California

Background: A native of Guadalajara, Mexico, who emigrated with family to United States in 1960 when she was five... Raised and still lives in Baldwin Park... Attended Cal State L.A. and began working for local legislators, including former state Sen. Joseph Montoya in 1975... Entered public relations, working for Westinghouse Beverage Corp. and 7-UP/RC Bottling Co. as their vice president of public affairs... In 1995 formed own company Contreras-Sweet Communications... Got involved in health care with election to the board of Blue Cross of California... When company converted to for-profit status and created The California Endowment in 1996, became member of its board.

Role in Patient Rights Issue: Appointed by Gov. Gray Davis in 1999 to be his Secretary of Business, Transportation and Housing and given task of overseeing HMO reform package... Conducted meetings with key players, including patient rights advocates, doctors, insurers and labor groups... Helped develop statement of five principles that led Davis to sign a 15-bill package... Among key provisions of legislation are an expanded right to sue insurers, the right to an independent review and the right to a second opinion... The package also mandated certain coverage, such as for mental illness, diabetic supplies and various cancer screenings. Package created the Department of Managed Health Care within her department to oversee insurers... Fought to have the department's Office of Patient Advocate report directly to her to ensure future independence... Currently overseeing preparation first HMO report card focusing on health of plan membership to spur better preventive services to members.

Jamie Court

Title: Executive Director

Organization: Foundation for Taxpayer and Consumer Rights (formerly Californians for Quality Care)

Background: Pomona College graduate who started out as a community advocate and advocate for the homeless.. In late 1980s, turned to consumer advocacy as he joined Harvey Rosenfield's group on the Proposition 103 auto insurance initiative:., Got on health care track when Ralph Nader suggested the group look at universal health care during the great health care coverage debate of 1993-94... Named consumer educator of the year by the national Consumer Attorneys Association in 1998.

Role in Patient Rights Issue: Began in 1994 heading up Californians for Quality Care out of Rosenfield's Santa Monica offices... Launched daily "HMO patient horror story" feature that grabbed national attention... Took ballot measure requiring right to sue to state ballot in 1996... Measure defeated, but many of its provisions adopted by state Legislature in 1999... Says state legislative package is working as intended... Consumers getting disputes with HMOs resolved more quickly... 1996 ballot measure attracted national attention that Court says helped launch the federal patients' rights legislation in 1997-98... Says national bill has more limitations on right to sue, but it still gives patients more leverage.

Martha Escutia

Title: State Senator, D-Montebello; chair of Sen. Judiciary Committee

Organization: California State Senate 

Background: Native of East L.A... Received bachelor's in public administration from USC and law degree from Georgetown University... Served as senior research attorney for L.A. County Superior Court and then went into private practice... Also served as public policy director at United Way of Los Angeles... Entered state Assembly in 1992, where she was on Assembly Health Committee... Moved up to state Senate in 1998... Made chair of Senate Health and Human Services Committee for 1999-2000 session... Currently chairs state Senate Judiciary Committee... Termed out in 2006.

Role in Patient Rights Issue: Introduced bill in 1998 mandating health plans to provide access to specialists for chronically ill patients... Bill signed into law by outgoing Gov. Pete Wilson... Introduced bill in 1999 requiring health plans and insurers to offer Medigap coverage to Medicare beneficiaries whose coverage had been terminated by a managed care plan... Bill passed Legislature but vetoed by Gov. Gray Davis... Has introduced the only major patients' rights bill this legislative session... SB 458 would limit ability of HMOs to require enrollees to sign mandatory arbitration clauses... Bill stalled in committee and is dead for this year... Whether Escutia reintroduces bill next year depends on status of national patients' rights legislation.

Dr. David A. Goldstein

Title: Co-director

Organization: Pacific Center for Health Policy and Ethics

Background: Graduate of State University of New York-Downstate Medical School... Did residency at Kings County Hospital in Brooklyn, N.Y., before coming to County-USC Medical Center in 1975 as a specialist in kidney disease... Remained a specialist at the hospital until 1982... Began teaching full time at USC Keck School of Medicine... Became the school's first associate dean for curriculum in 1985... Co-founded the Pacific Center for Health Policy and Ethics in 1990 with Alexander Capron to promote access to health care in California... Currently chief of general internal medicine and vice chair for clinical affairs at the USC Keck School of Medicine and Chief of Staff at County-USC Medical Center.

Role in Patient Rights Issue: Co-founder of the Pacific Center for Health Policy and Ethics, a think tank formed by the USC Law School and the USC Keck School of Medicine for health policy and ethical issues... One of the center's first tasks was to draft an advance directive form that patients fill out appointing someone to make medical decisions for them if they are incapacitated... Directive has become prototype for similar directives across the country... Involved in educating physicians on ethical issues and developing conferences on cuttingedge medical issues such as genetic engineering... Tries to educate physicians on the principles of medical ethics, such as making sure patients are given truthful disclosure on medical procedures that will be performed... Working on teaching young physicians how to impart news of imminent death to a patient and family members.

Maura Kealey

Title: Health Care Coordinator

Organization: Service Employees International Union, Western Region

Background: Career began in history... After graduating from the University of Wisconsin in Madison, taught comparative social history of Europe and the United States for 10 years at institutions such as the University of California, Berkeley; the University of California, Santa Cruz; and California State University, San Francisco... Decided to change careers... Began studying public policy, doing a one-month internship at the SEIU office in San Francisco, which represents workers at San Francisco General Hospital... Later took a full-time job with the San Francisco chapter of the SEIU in 1980... From 1986 to 1989, was the union's legislative director for the state in Sacramento. Included being the chief legislative strategist in health care for the SEIU's 450,000 California members... In 1994, moved to Paris to study... Later was a health care lobbyist for three years for Public Citizen, a non-profit founded by Ralph Nader... Returned to Los Angeles last year to resume work with the SEIU.

Role in Patient Rights Issue: An SEIU strategist for health care issues in Sacramento in the late 80s... Worked on Proposition 99, the state initiative taxing tobacco products for antismoking education and indigent medical care... Helped cobble together legislation that mandates a nurse-to-patient ratio in hospitals... Also helped lobby for health benefits for many of the state's home-care workers... Now working to make sure that hospitals meet their deadlines for seismically retrofitting their structures.

Dr. Marie G. Kuffner

Title: Immediate Past President

Organization: California Medical Assn.

Background: Began medical school at age 31 after having four children... Received medical degree from University of Texas at Houston... Is currently full-time faculty member at UCLA... Professor of Anesthesiology... Served as chief of staff of UCLA Medical Center from 1994 to 1996... Outgoing chair of the Practicing Physicians Advisory Council to the Health Care Financing Administration.

Role in Patient Rights Issue: Served as president of California Medical Association in 2000-2001... Concentrated efforts on issue of underfunding of health care... Filed suit against three of the state's biggest HMOs... Alleged that Blue Cross of California, PacifiCare Health Systems and Foundation Health Systems used power in the marketplace to deny or delay payments to doctors... Instead of monetary award, suit asked for federal courts to outlaw or regulate common practices such as when a patient can be referred to a specialist or guidelines that determine whether a procedure or test is necessary... Also convinced legislators to increase Medical payments to physicians by 16 percent... It was the first increase in 15 years... Currently pushing for AB 1600, which would increase leverage physicians have by giving them negotiating power with HMOs... Also pushing passage of AB 1461, setting up central medical reporting system asking physicians to confidentially report errors in their hospitals.

Leonard Schaeffer

Title: Chairman, Chief Executive

Organization: WellPoint Health Networks

Background: Born in Chicago in 1945... Graduated from Princeton University... Since 1992, has headed the country's fourth-largest health insurer, based in Thousand Oaks... Helped turn WellPoint around from a money loser to a consistent earner focusing on insurance plans that give customers more choice... Tried to acquire No. 1 U.S. health insurance Aetna Inc., but failed... Has also been chief executive of Blue Cross of California since 1986... Known as a person who likes to win... Victorious in a bidding war last November for Cerulean Health Co., raising his offer from $500 million to $700 million, which was accepted... That topped off profitable year in 2000 for WellPoint, with earnings rising more than 20 percent... Trying to hold down pharmaceutical costs by asking Food and Drug Administration to make the allergy drug Claritin available over the counter, which would save HMOs money and reduce doctor visits by patients.

Role in Patient Rights Issue: Shaeffer-led Blue Cross of California announced last week that it is ending its incentive program to HMO doctors who control costs... Instead, monetary incentives will be based on patient satisfaction... Serves as chairman of the Coalition for Affordable Quality Healthcare, an alliance of 24 major U.S. health plans created in 2000 to alleviate patient distrust of HMOs and repair relationships with physicians... Coalition has improved patient access to care by guaranteeing direct access to OB/GYNs and pediatricians... Pushing for HMOs to agree to pay for any emergency care that a "reasonable" person would consider necessary... Advocating a standard complaint-review process under which an independent physician would consider patient grievances about treatment denials and other problems... Working to institute a single credentialing application for doctors that all member health plans could use to evaluate and approve physicians for their networks... Pushing to expand Web-based comm unications with patients, doctors and hospitals.

Adam Schiff

Title: Representative, D-Pasadena, member House Judiciary Committee

Organization: U.S. House of Representatives

Background: A Framingham, Mass., native with a political science degree from Stanford University and law degree from Harvard Law

School... Six-year stint as criminal prosecutor in U.S. Attorney's Office... Tapped in 1992 to head mission to reform Czech Republic's criminal court system. ... Ran for state Assembly in 1994, but was defeated by James Rogan... Elected to state Senate in 1996, where he chaired Judiciary Committee... Got his revenge on Rogan last year, defeating him in costly, bitter race for Congress that attracted national attention because of Rogan's role in the Clinton impeachment... Now serves on House Judiciary Committee.

Role in Patient Rights Issue: As state Senator, was asked by Gov. Gray Davis to join managed care task force... Co-authored bill with Assemblywoman Carole Migden, D-San Francisco, setting up the independent external review process that is pre-requisite for filing lawsuits... Says process is working well in initial stage, with HMOs winning majority of cases and no big avalanche of litigation... In Congress, immediately co-sponsored the Norwood-Dingle-Ganske Patients Bill of Rights package that is being debated this month... Says next project is expanding access to care for children under the Healthy Families Initiative.

Lois Wellington

Title: Immediate Past President

Organization: Congress of California Seniors

Background: Worked for city of Burbank in Public Service department... Took early retirement... Went to work for Retired Public Employees Association as a volunteer... Eventually became president... Left to become president of International Senior Citizens Association (now defunct due to lack of funding and end of grant)... Began at Congress of California Seniors... Worked up to president and served for eight years... Organization has an affiliate membership of 600,000... Supports various legislation designed to increase health care... Also supports universal health care bill... Final of four terms ended last April.

Role in Patient Rights Issue: Has worked toward comprehensive benefits for public employees statewide... Mounted effort to educate Southern California seniors about Medicare... Efforts aimed primarily at lower-income people... Known for being active on the front lines... Has written letters and visited legislators... Still holds a position on the California Commission on Aging... Said there is more work to be done but much has been accomplished... "It's been an uphill, unhappy battle, it wasn't fun and games"... Continues fight for the Patients Bill of Rights.

Walter Zelman

Title: President, chief executive

Organization: California Association of Health Plans, an HMO industry group

Background: Received Bachelor of Arts degree in political science from University of Michigan, Ann Arbor; earned doctorate in American politics and master's degree in international relations from UCLA... Professor of political science at UCLA in early 70s... Director of California branch of Common Cause consumer group in the 80s... Served as health care deputy in California Department of Insurance in 1991-92 under first elected Insurance Commissioner, John Garamendi... Senior health care adviser to President Clinton in 1993-94... Instrumental in formulating the Clinton health care plan that went down to defeat in 1994... Took formal health care policy post in Clinton administration and also took teaching post at Harvard University's School of Public Health... Turned heads in 1998 by accepting top job at California Association of Health Plans, the statewide HMO lobbying group... Some HMO critics accused him of selling out.

Role in Patient Rights Issue: Main job has been playing defense, trying to stop or blunt more radical patient rights legislation... Successful in tying up HMO reform package in 1998... Won numerous compromises in 1999 reform package, including setting up of mandatory external review process before patient can file suit and maintaining right of HMOs to have mandatory arbitration clauses for enrollees... Says external review process is working as intended so far, with most cases being decided in favor of HMOs... Successfully tied up bill by Sen. Martha Escutia to eliminate the right of HMOs to set up mandatory arbitration clauses... The bill is dead for this year... Wary of "right to sue" legislation in national Patients' Bill of Rights, saying it will slow down delivery of care and increase costs.