In a brief filed in the Illinois Supreme Court, the American Medical Association and the Illinois State Medical Society contend that physicians should have no legal duty to inform patients of managed care financial incentives to limit care.
The two physician groups argue that doctors may have an ethical obligation to make such disclosures, but not a legal duty. Imposing such a legal requirement, they say, would create "insurmountable burdens" for physicians who, themselves, may not be fully aware of all the provisions in managed care contracts.
AMA and ISMS filed their friend-of-the-court brief in connection with Theresa Neade vs. Steven Portes, M.D., and Primary Care Family Center, a case that, at press time, was before the Illinois Supreme Court.
In the case, Therese Neade, widow of Anthony Neade, alleged that Dr. Portes had breached his fiduciary duty to her husband by not telling him that the doctor’s medical group of which he was president received a 60 percent share of any funds not used on referrals to specialists.
The plaintiff argued that if she and her husband had known about the incentive, they would have questioned Dr. Portes’ refusal to approve an angiogram for Mr. Neade, who later died of a heart attack.
In their brief, AMA and ISMS underscore their belief that "the physician has a legal duty to provide services to patients within the standard of care, and an ethical duty to disclose matters pertinent to the care and treatment of the patient that affect care, and even a further duty to advocate for medically necessary care for a patient."
Beyond that, however, "a physician should have no legal duty as a fiduciary to disclose incentives to limit care in the context of the compensation for health care services by the patient’s chosen managed care organization."
In a 1997 opinion, the AMA’s Council on Ethical and Judicial Affairs observed that "physicians must assure disclosure of any financial inducements that may tend to limit the diagnostic and therapeutic alternatives that are offered to patients or that may tend to limit patients’ overall access to care."
The AMA and ISMS insisted in their brief that the council’s standard does not impose a legal obligation.
