During his campaign for the Alabama Legislature last year, now-state Sen. Larry Stutts, a Sheffield Republican and OB-GYN, vowed to get the government out of the middle of the patient-physician relationship. He made no mention of the fact that what he really had in mind was putting insurance companies back in the middle of that relationship.
Stutts, who until a few days ago was considered a rising-star in the state Republican party, made national news because of the furor caused by what might go down in history as the most ill-advised bill any lawmaker could possibly sponsor.
Did he really think no one would notice that the law he wanted to get rid of was enacted because of the death of one of his patients?
By the end of last week, this former up-and-comer, whose bill would once again allow insurance companies to decide when a mother and her newborn would have to leave the hospital, had been labeled a pariah. Alabama political reporter Bill Britt wrote this about him: “Stutts is arrogant and careless and now we know he is evil.”
In 1998, Rose Church, a 36-year-old nurse who was one of Stutts’ patients, died of a heart attack soon after giving birth to a baby girl. An autopsy revealed that she had developed severe bleeding and that a part of the placenta had been left in her womb.
Rose was discharged just 36 hours after she gave birth. Gene Church believes that had his wife not been sent home so soon, at the insistence of their insurer, she might still be alive.
With his baby daughter in his arms, Gene spent many hours in Montgomery trying to persuade legislators that insurers should not be allowed to make medical decisions. He argued that they should be required to pay for at least a 48-hour stay in the hospital following a normal delivery and a 96-hour stay following a Cesarean section or complicated delivery. His efforts paid off. The Alabama Legislature in 1999 unanimously approved what came to be called “Rose’s Law.”
Alabama was not the first state to pass such a law. In fact, it was one of the last. In the mid-1990s, dozens of states began passing similar bills following a backlash against what was perceived to be inappropriate interference by insurance companies in the patient-physician relationship.
In the early 1990s, HMOs and other insurers began implementing hospital length-of-stay policies based on guidelines developed by an actuarial firm, Milliman & Robertson (now called Milliman). As a consequence, employees of managed care companies were calling the shots on how long mothers and their newborns could stay in the hospital.
The early discharges came to be called “drive-through deliveries” and were the subject of countless media stories. I’ll never forget that time because I was on the front lines of the backlash. As a spokesman for Cigna, I had the unenviable responsibility of responding to a seemingly endless stream of calls from reporters seeking comment about the company’s discharge guidelines.
It wasn’t long before politicians of both parties were condemning drive-through deliveries. Two of the U.S. Senate’s most conservative members, Republicans Jesse Helms of North Carolina and Mike DeWine of Ohio, denounced drive-through deliveries as “unconscionable.”
By 1997, more than 40 states had enacted bills to force insurers to end the practice. In Washington, Congress passed the “Newborns’ and Mothers’ Health Protection Act.” The Senate version had more than 50 cosponsors, including Helms and DeWine.
Among the most vocal advocates of the legislation were doctors who were outraged that managed care companies were able, for all practical purposes, to tell them how to practice medicine.
"I think that the decision for when a newborn and their family needs to go home is a mutual one that should be decided between the family and their provider,” Dr Lenna Liu, a professor of pediatrics at the University of Washington, told CNN in 1997. “It's not a decision that administrators or managed care people should be making.”
Liu was quoted in the CNN story about a study that found that newborns discharged early were more vulnerable to several conditions including jaundice, dehydration and sepsis and consequently more likely to be re-admitted to the hospital.
I couldn’t find any stories from the 1990s quoting Larry Stutts about drive-through deliveries, but I did find a number of recent stories in which he attempted to conflate Rose’s Law with Obamacare. During his campaign last year, he promised voters that if they helped him defeat Roger Bedford, the Democratic incumbent, he would be “standing against OBAMACARE and all interference in the doctor-patient relationship.”
When Gene Church found out what Stutts was up to a few weeks ago, he made certain that it would not go unnoticed that the law Stutts was trying to get rid of was the very one named 16 years ago for one of Stutt’s patients. A patient who might be alive today had it not been for the “unconscionable” interference in the doctor-patient relationship — not by government, as Stutts would like us to believe, but by insurance companies.
Wendell Potter is the author of Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans and Obamacare: What’s in It for Me? What Everyone Needs to Know About the Affordable Care Act.