Courtney v. Health Net

Travis Corby needed more than an hour for his opening statement to show jurors how his young client -- a trained paralegal with four children -- had become addicted to the opioids she'd been prescribed to manage pain while she waited 10 months for Health Net Inc. to approve surgery for a severe colorectal condition.

"The only way you can understand what Elaine [Courtney] went through is to hear every single detail about what happened to her," he told the jury.

In her lawsuit, she said that in February 2017, her doctor gave her an urgent referral to a colorectal surgeon to treat a pelvic prolapse. Courtney v. Health Net Inc., 18STCV05327 (L.A. Super. Ct., filed Nov. 16, 2018).

But the narrow medical group she belonged to through her Medi-Cal HMO insurance plan from Health Net had no such surgeons. Therefore, Corby said, the company should have sent her to one of the 20 specialists in its larger group as required by its Medi-Cal contract with the state. And she should have been given the appointment within 72 hours, he said.

Instead, Health Net bounced the problem back to her narrow HMO group, telling it to arrange for an out-of-network surgeon. The group's president testified that he had never once been allowed to send a patient directly to a specialist in Health Net's network.

That was a theme that ran through her dealings with the company, Corby said. The HMO group would send her to a gynecologist or other doctor in its network, who would find the same problem and seek a referral to a specialist urogynecologist or colorectal surgeon outside the network. Then Health Net would send the referral back.

He said the issue largely was a dispute about signing off on the out-of-network referral. "Which is not appropriate," Corby said. Under Medi-Cal laws, "fiscal and financial concerns cannot delay a member's care. They should have provided it and worked it out on the back end."

One colorectal surgeon she saw who didn't specialize in the procedure submitted a request five times for her to see one who did. Eventually, Health Net responded that she had to see a colorectal surgeon first.

In the summer, Courtney went to the emergency room. Her insurers had her transferred to an in-network hospital, where she was prescribed opioids for the pain.

Almost immediately after, she emailed Health Net twice, pleading for the surgery so she could stop taking the drugs. "But she's left on this pain medication in increasing dosage from July until December" when she finally received the surgery, Corby said. "To this day, she is addicted to opioid pain medication ... and the addiction has gotten increasingly worse over the years."

On Dec. 12 last year, the jury awarded Courtney $6.92 million in compensatory damages and $7.5 million in punitive damages.

Michael Maddigan and Alyssa Saviss, Health Net's trial attorneys, did not respond to a request to comment on the case. Immediately after the verdict, however, the company issued a statement saying it "believes the verdict is flawed" and is "exploring options to appeal."

- Don Debenedictis