An elderly man claims that his penis eroded because his insurance plan, Kaiser Foundation Health Plan, would not let care providers remove his catheter. He sued the insurance company for negligence, elder abuse, and unfair business practices.
The man claims that he was a patient at Napa Valley Care Center when problems developed with his penis, which had a catheter in it. On July 21, 2013, a nurse sent a fax to his insurance company. The fax said that his penis was red and swollen with a cut, and that it had a Foley catheter in it. The nurse asked the company if they could remove the catheter for a trial to give the penis a chance to rest and heal. The insurance company denied the request to remove the catheter. The man claims that no doctor from Kaiser ever personally examined the problem.
As a result, the catheter was left in, and the penis began to have more and more problems. Two days later, there was a conference about the situation, but no representative from Kaiser came. On July 30, another nurse sent a fax to Kaiser requesting permission to remove the catheter, but that was also denied. On July 31, the man’s daughter examined the situation and was horrified – the man’s penis was completely split in half, from the tip all the way down to the scrotum.
The man’s daughter asked that a third nurse contact Kaiser, but Kaiser continued to deny there was a problem. Kaiser told the nurse that penis erosion is normal and will heal on its own. Finally, the daughter managed to get her father evaluated by a Kaiser urologist on August 2. The urologist told the patient that if he had been treated earlier, the penis could have properly healed. However, at that point it was too late to save it, and reconstructive surgery was not an option.
The man alleges that because of Kaiser’s poor business practices, he has suffered permanent genital mutilation. He is alleging that Kaiser’s business practices exist because Kaiser believes that they can mistreat the elderly, disabled, and vulnerable customers it has with no consequences. The man is seeking an unspecified amount of damages.
In most cases, when a person is harmed as a result of a medical procedure, the patient sues the doctors or medical facility for malpractice. This case is unique because the plaintiff is not suing the medical providers for his damages; he is suing the insurance company. According to the plaintiff, he suffered his damages not because of malpractice by his health care providers, but because his insurance company repeatedly refused coverage for a procedure that it should have covered.
Insurance companies have a duty to act in good faith. In general, they must cover procedures and treatments that are medically necessary. In this situation, we can see that in all likelihood, removing the catheter was medically necessary. It is unclear why Kaiser denied the treatment.
Health insurance companies are notorious for protecting their bottom lines at the expense of their patients. Although many of them seem to be improving, there are still an abundance of medical claims that should be paid that are not. Most of these patients give up and do not have the necessary treatment they need, or they work out some type of payment plan with the doctor or hospital.
At Liberty Law, Micha Star Liberty believes that customers of insurance companies, many of whom are paying astronomical rates, should get the medical treatments to which they are entitled under the policy. If your insurance company is refusing to pay for necessary medical treatments and you were harmed as a result, call Micha Star Liberty, San Francisco personal injury attorney, at 415-896-1000 or 510-645-1000. She will help you pursue a claim against your insurance company for damages.