A San Luis Obispo doctor is suing the medical group that fired him last year, saying he was punished for putting patients ahead of profits.
In a lawsuit filed in San Luis Obispo County Superior Court, John S. McGee said the defendants, Heritage Provider Network, fired him for approving needed care to patients and for “his refusal to participate in an unlawful scheme to compromise patient care for profits.”
McGee’s attorney, Don Ernst, said he hopes the suit will compel the defendants to change the way they do business, which he says currently puts 20,000 locals in managed care at risk.
“This isn’t managed care,” he said. “This is managed profits.”
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Claims made in civil suits represent only one side of a case that has to be proven in court. But Ernst said he’s seeking other physicians and patients to come forward on McGee’s behalf.
Seth Gerber, an attorney for the defendants, said he was not authorized to comment on the lawsuit. The company issued a statement, saying it was company policy not to comment on pending litigation, but added, “Heritage Provider Network is focused on providing quality, affordable, accessible healthcare to all its members throughout communities in California and has been nationally recognized for doing so."
McGee was the medical director for the Coastal Communities Physician Network and Bakersfield Family Medical Center — both Heritage affiliates — which are medical groups that serve as intermediaries between managed health plans and physicians. Such medical groups make decisions on whether to approve or modify ordered medical services.
By law, Ernst said, those medical decisions have to be made by doctors.
The suit alleges the following:
McGee, who practiced internal medicine for 20 years and had “extensive experience” in managed health care, began working for the defendants in 2010 and was fired 19 months later. While McGee had a long history of increasing company profits — and helped increased profits for the defendants — he and his staff were repeatedly undermined and overruled, “seriously jeopardizing the health, safety and lives” of patients. Even company CEO Bob O’Keefe, who had no medical training, challenged McGee and his staff several times on patient care.
O’Keefe died in October at age 61.
The suit makes several specific charges, saying the defendants pressured medical professionals to reduce hospital admissions and hasten discharges while increasing the rates of denials for outpatient medical services.
The suit also alleges the defendants directed McGee, also 61, to limit inpatient, non-emergency surgeries to no more than three per day. Such cost-cutting actions, the suit alleges, put cardiovascular patients at risk.
Despite getting a pay raise seven months earlier, McGee was fired June 27, 2012.
“Dr. McGee was terminated because he advocates for patients’ rights and quality health care,” Ernst said.
The suit seeks unspecified general and punitive damages.