Once Health Regulators, Now Partners

Rollow said he could not explain the wide variations. Medicare says its follow-up interviews with patients who complain show that they mostly are content with the process but that only 42 percent are satisfied with the outcome.

Shipp, the Louisville man trying to learn about his wife's death, was dissatisfied from beginning to end.

Before his lawsuit, Medicare took the position that patients are not entitled to know the outcome of their review. Shipp and his attorney, Amanda Frost of Public Citizen, won that concession in 2003, but not before spending four years in federal court.

"They fought us all of the way," said Frost, now a professor at American University's law school. "They were willing to argue clearly-losing issues just to delay us from getting anything."

When the U.S. Court of Appeals for the District of Columbia Circuit upheld a lower-court ruling entitling Shipp to an answer, Medicare said the decision applied only to future complaints. "It was a ridiculous argument," Frost said. "The judge decided with us again."

At the time, Shipp thought he had scored a victory for patients' rights. But when he received the terse August 2003 form letter from his QIO, he wasn't so sure. There were no details. To this day, Shipp is unsure whether anything happened to his wife's doctors.

Debbie Pelkie, who oversees complaint reviews for Shipp's QIO, Health Care Excel, said that Medicare's rules prohibit her group from releasing such details unless the doctors agree. But in this case they didn't.

"If that's what Mr. Shipp is wanting," she said, "that's not possible."

Pelkie said that under the QIO's procedures, the review of the case is written by the staff and then shown to the doctors . A doctor is "not given the power to change the language to his liking," she said, but can opt to keep the details secret.

The letter warned Shipp not to disclose the doctors' names without their consent.

"I guess you can say I opened up the process a little," he said. "But we still can't find out what goes on behind the closed doors."

Shipp said he was discouraged to learn that the system favors health care providers over consumers.