Their twin boys were born three months premature and struggled for two long weeks before they died. Tony and Sherra Lombardo had known that this was a high-risk pregnancy, requiring special attention from a doctor.
But Dr. Hatchet had a drug problem. On the night in 1997 that Sherra went into premature labor, when saving her twins meant stopping her labor, Dr. Hatchet had skipped town, leaving no one on call.
"I blame him for the death of my sons," Sherra says. "It was devastating to know that I trusted someone that much." She trusted someone who didn't show up.
Sherra also blames her HMO, Blue Cross Blue Shield of Texas. It turned out that Dr. Hatchet had a record of abandoning patients, and had been barred from her hospital, Columbia Plano Medical Center. Yet Blue Cross, without checking his status, gave the Lombardos a clearance for Hatchet to deliver the babies.
Long before the Lombardo twins died, Dr. Hatchet had lost his privileges at the hospital five times. His colleagues knew he had a drug problem. The Texas State Board of Medical Examiners had begun an investigation.
Somehow, Blue Cross had no idea that there was a problem. This despite a book for patients that, as Sherra quotes, says the "blue choice network of providers are carefully selected, credentialed and monitored."
HMOs always promise that their doctors are carefully monitored, but most states only require physician screening every two years. That may not be enough.
New York State health officials recently found 51 doctors who'd lostheir medical licenses for mistreating patients still listed in an HMO network.
"It's inexcusable that two years can go by," says Dr. Sidney Wolfe, of the watchdog group Public Citizen. He says it's easy for HMOs to check out their doctors online. They can access the government-run National Practitioner Data Bank, which tracks doctors without licenses or privileges. "If the HMOs wanted they could check every doctor on their rolls once a week, once a month, certainly more than once every two years," he says.
Blue Cross would not comment on the Lombardo case. But Susan Pisano, an industry lobbyist, says most HMOs screen doctors on an ongoing basis. Still she admits, the New York finding of 51 unlicenced doctors was a wake up call. "We need to work with all of those who are responsible here to make sure that practices are improved," she says.
Sherra would certainly agree. "We expect someone to be doing the job and no one's doing it," she says. "I mean, no one is out there making sure these doctors are safe."
The Lombardos believe their loss is a warning: There may be doctors in your HMO network without hospital privileges or a license to practice.