$14.42 Million Verdict Against Health Net For Patient’s Opioid Addiction: On December 12, 2022, a California jury returned its verdict in favor of plaintiff Elaine Courtney in the amount of $14.42 million ($6.92 million in compensatory damages and an additional $7.5 million in punitive damages) against health care giant Health Net, Inc. for her alleged addiction to opioid pain medication due to the unnecessary months-long delay in receiving a referral to a medical specialist.
The Underlying Facts
Courtney was experiencing extreme pain due to pelvic prolapse in 2017 for which she needed immediate medical care. She received an urgent referral to a colorectal specialist for a surgical consult, but was told that the correct specialist was not available to her under her Health Net Medi-Cal plan. She was referred to a general surgeon that she had already seen who was not a specialist for her medical condition. Courtney’s lawsuit alleged that Health Net had 25 colorectal surgeons available in its Southern California network, but refused Courtney access to any of them until August 2017. When she was finally able to meet with an appropriate specialist, the specialist’s surgical requests were denied five times allegedly due to network issues.
By the time Courtney finally had the necessary surgery in December 2017, she was dependent on prescribed opioid pain medication. During the unnecessary delay in receiving needed medical care, Courtney allegedly was in extreme pain. She alleged that Health Net knew that she was unable to care for her four children during that time and that she needed help going to the bathroom due to her condition.
Health Net’s defense lawyers argued, “The fundamental defect in plaintiff’s claims is that Health Net Inc. was not responsible for providing or authorizing plaintiff’s care and, when plaintiff raised issues about her treatment through the grievance process of her health plan, Health Net … responded promptly and authorized the requested treatment.”
The plaintiff’s lawyer responded, “For too long health insurance companies have stood by, complacent that their insureds are prescribed dangerously addictive pain medication while waiting through managed care delays and access to timely specialist care … But Health Net did nothing to help her, and unfortunately, she is now another victim of the opioid epidemic … Hopefully this verdict sends a message to Health Net and other health plans.”
Health Net states on its website: “Health Net believes every person deserves a safety net for their health, regardless of age, income, employment status or current state of health. That’s why we provide health coverage for every stage of life and advance health equity with innovative approaches to care. Today, Health Net’s 2,600 employees and 90,000 network providers serve three million members throughout California. We offer an array of health plans, including Medi-Cal, Medicare and individual and family plans.”
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