Dr. Jolson said the agency's medical reviewers did not agree with the statistician, but the scientific panel found his evidence persuasive.

The agreement sets forth a wide range of factors that would have to be considered by medical reviewers.

The medical reviewer for the F.D.A. expressed concerns, but in a further analysis decided that it was less of a problem.

Patients could appeal to an independent medical reviewer if a health plan refused to pay for care on the ground that it was medically unnecessary or experimental.

A plaintiff could also recover up to $1.5 million in punitive damages if a health plan refused to provide care ordered by independent medical reviewers.

Under the agreement, patients could sue an H.M.O. even if independent medical reviewers had found no justification for their claims.

As this appeals process spreads to other states, an investigation of the medical reviewers employed by managed care companies is overdue.

An investigation of the medical reviewers is also critical, and standards should be established to insure their qualifications.

Patients could appeal to an independent medical reviewer if the health plan refused to pay for care.

Following his resignation in 1864, Stephenson held several political jobs, including medical reviewer at the Pension Office.