Once Health Regulators, Now Partners

Private Groups Limit Patient Access to Medical Files, Rarely Punish Doctors

By Gilbert M. Gaul
Washington Post Staff Writer
Tuesday, July 26, 2005; Page A01

Last of three parts

For four years the federal government was David Shipp's steadfast opponent, refusing to answer the former textbook salesman's questions and rolling out its attorneys to block his attempts to obtain information.

Shipp wasn't seeking classified secrets. He was simply trying to find out why his wife of 49 years had died.

In December 1999, Shipp filed a complaint with Medicare suggesting that doctors had misdiagnosed his wife's colon cancer. The complaint landed with Health Care Excel, a private group under contract with Medicare to ensure that patients receive quality treatment.

Instead of helping the Louisville man, the nonprofit stonewalled him. Even if it confirmed his complaint, the group told Shipp, under Medicare's rules it could not reveal the results of its review.

A stunned Shipp headed to federal court, where in August 2003 he won the right to an answer. But even then Medicare and its contractor remained stingy with details. In a brief form letter, they acknowledged that Doris Ann Shipp had received substandard care, but they would not say what actions, if any, had been taken against the doctors.