THE SOUL OF AN HMO

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But some doctors in the room clearly had been placed in an uncomfortable position. "You must understand," Rosen said, "if insurance companies can differ on this, and doctors can differ, and I can differ even when I look at the data itself . I can't see how anybody can say, 'I've got it all figured out: this is investigational; this is not investigational.'" An impassioned Glaspy pointed one by one to other doctors in the room. "How can something that he does, and he does, and he does, and he does be unreasonable?" Neither Rosen's nor Glaspy's remarks were recorded in the official minutes of the meeting.

Soon afterward, Health Net's Ossorio telephoned Glaspy's boss, Dr. Dennis Slamon, the division chief of oncology at UCLA, in what the deMeurerses say was an effort to influence whether the center would perform Christy's transplant. Health Net's Lyle Swallow disputes this charge: "The idea that Health Net could somehow muscle UCLA into doing anything, given their size, given their reputation, given their budget, is really kind of laughable."

But last October an arbitration panel chosen by Health Net and the deMeurerses found nothing to laugh at. Here is what happened next, as reconstructed from depositions, court documents and direct interviews:

Ossorio identified himself to Slamon and with little preamble asked whether UCLA was still in accord with Health Net's guidelines. Slamon said yes. Then why, Ossorio asked, was UCLA going to transplant a Health Net subscriber named deMeurers?

The call struck Slamon as unusual. For one thing, he had never spoken to Ossorio before. For another, he was not Christy's doctor, a fact Ossorio must have known, given that Glaspy sat on Health Net's bone-marrow committee. Slamon said he knew nothing about Christy's case, but he offered to look into it. The following Friday, Slamon told Glaspy he had decided UCLA should pay for the treatment.

"I got outraged," Glaspy recalls. He believed he still had room to work the system and persuade Health Net to pay for the treatment. He felt guilty about costing the unit so much money and resented Slamon's interference in an area where he, Glaspy, was the expert. That night he wrote a letter of resignation. Later, however, he reconsidered. "It took me four or five days to cool off."

But Slamon says he made the decision to pay for the transplant after discovering that Christy by then had already undergone the initial marrow harvest. "We should not have taken her halfway into the stream without being prepared to take her all the way across," he says. He insists that the decision was his alone, and not the result of any coercion from Health Net.

Says Ossorio: "My intention was clearly that I wanted UCLA to follow the policy we agreed to. Was that pressure? Yes. To fulfill an obligation we had mutually agreed to." But he adds, "I swear to God, he volunteered to pay for it."

Things got still more complicated when, a few days later, on Wednesday, Sept. 22, Glaspy, at the request of Health Net's lawyers, signed a second formal declaration, this time opposing Christy's motion for an injunction. "I didn't view it as being against her," he said, in a deposition last April. "They were all truths in that declaration that I had already told Christine." And yet he knew, he said, that "this declaration could be used legally to stand between her and the transplant."

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