Who Should Control Your Health Care?

Who should have control over your medical care: your family doctor or a bureaucrat you've never met whose sole job is to look out for the government's financial bottom line?

That question is being debated in court right now, as three states are currently seeking a ruling from a federal judge that the final say in an individual's medical treatment lies with the government and not with that patient's doctor.

In March, Georgia, Florida, and Alabama joined in an appeal of a 2008 U.S. District Court ruling that a patient's physician was better positioned -- and better qualified -- to make decisions about that patient's medical treatment than state bureaucrats.

The case centers on Callie Moore, a disabled teenage girl living in Georgia. A stroke Callie suffered in utero left her suffering from multiple conditions, including cerebral palsy and mental retardation. For the last decade, she has received around-the-clock in-home nursing care for her medical conditions.

In 2007 though, the state of Georgia cut coverage of Callie's in-home care by 15%, from 94 hours a week to 84 over the objections of her attending physician, who was intimately familiar with her case and her needs. State officials (who were not medical professionals) cited disagreement with the attending physician about just how much care Callie needed as the primary reason for this reduction in care.

Callie's mother filed suit in 2007, arguing that the state had no right to contradict the orders of her personal physician and limit her treatment. However, because Callie receives her medical treatment under Medicaid (the joint federal and state health coverage program for low-income individuals and families), Georgia officials argued that Callie's care was subject to rationing, as the state bureaucrats' need to ensure Medicaid resources were allocated "fairly" superseded her doctor's care prescription or her personal medical needs.

On June 4, 2008, U.S. District Judge Thomas Thrash ruled that Callie's doctor, not state bureaucrats, had the right to prescribe just what medical treatment and care his patient required. Georgia was ordered to raise Callie's skilled home nursing care back up to 94 hours a week, as prescribed by her doctor.

Rhonda Meadows, commissioner of Georgia's Department of Community Health, immediately appealed the ruling to the 11th U.S. Circuit Court of Appeals on behalf of the Peach State. Her argument was that state officials, not doctors, should have final say in what treatments and care patients within their purview require. Florida and Alabama, which fall under the 11th Circuit's jurisdiction and will have to abide by its ruling, filed an amicus brief with the Atlanta-based court.

This case has thrust into the spotlight the debate about an issue that has long been confined to dark, smoky rooms in state capitals and Washington, D.C., and to the fine print of legislation that members of Congress aren't bothering -- or being allowed -- to read before their passage.