RHR
06-21-2004, 04:10 PM
High Court Limits Patient Right to Sue HMOs
Mon June 21, 2004 05:18 PM ET
By James Vicini
WASHINGTON (Reuters) - Patients cannot sue health maintenance
organizations under state law for refusing to pay for
doctor-recommended care, the U.S. Supreme Court ruled on Monday in a
decision that could affect millions of Americans.
The justices unanimously ruled that a 1974 federal law, the Employee
Retirement Income Security Act, completely pre-empted such lawsuits
brought in state court by patients who seek damages from their HMOs
over the denial of medical care.
The state laws have become important as Congress has failed to adopt
national legislation that would allow patients to sue their health
maintenance organization in a federal court for medical malpractice.
The Supreme Court decision involved a law, in President Bush's home
state of Texas, that allowed patients to sue HMOs over their medical
treatment.
The court's decision has election-year political overtones.
Democratic presidential candidate Sen. John Kerry said the ruling
showed a need for a national law to "hold HMOs accountable for
decisions that harm patients by denying necessary care."
Democrats criticized the U.S. Justice Department for opposing the
Texas law before the high court. They said Bush, who was Texas'
governor when the law took effect in 1997, had supported it during his
2000 presidential campaign.
The decision was a victory for insurers, which have warned that
allowing the lawsuits would drive up health-care costs. Millions of
Americans participate in employer-provided HMO health plans governed
by the 1974 federal law.
At least nine other states -- Arizona, California, Georgia, Maine, New
Jersey, North Carolina, Oklahoma, Washington, and West Virginia --
have laws similar to the Texas one.
George Parker Young, an attorney for two patients who sued, urged Bush
and Congress to renew a commitment to pass a patient's bill of rights.
Ron Pollack, executive director of the consumer group Families USA,
blasted the ruling as a blank check for HMOs to deny care.
'SAD DAY FOR PATIENTS, PHYSICIANS'
American Medical Association President John Nelson said, "This is a
sad day for America's patients and the physicians who care for them."
Insurers applauded the decision. Aetna Inc., which had been sued in
one of the cases, said, "The court has helped to assure that millions
of working Americans will continue to have access to quality health
coverage provided by their employers."
Karen Ignagni, president of the industry group America's Health
Insurance Plans, said, "This ruling puts the brakes on efforts by
trial lawyers to turn every question about the scope of an
individual's coverage into a costly lawsuit."
The two cases involved units of Aetna and Cigna Corp. . One lawsuit
had been brought by Juan Davila, who was covered through his employer
by an Aetna health maintenance organization.
In 2000, Davila's doctor prescribed the pain-killer "Vioxx" for his
arthritis. Aetna required Davila to try two less-expensive medications
before it would fill the prescriptions.
After three weeks on the cheaper pain reliever, Davila was rushed to
the emergency room, suffering from bleeding ulcers.
The other lawsuit involved Ruby Calad, who was discharged from the
hospital in 1999 after a hysterectomy. Cigna's nurse decided the
company would pay only for the standard one-day hospital stay,
although Calad's doctor had recommended a longer stay.
Several days after her release, Calad suffered complications. She then
sued.
In an opinion by Justice Clarence Thomas, the justices reversed a U.S.
appeals court ruling that the two lawsuits could proceed. (Additional
reporting by Kim Dixon in Chicago)
© Reuters 2004. All rights reserved. Users may download and print
extracts of content from this website for their own personal and
non-commercial use only. Republication or redistribution of Reuters
content, including by framing or similar means, is expressly
prohibited without the prior written consent of Reuters. Reuters and
the Reuters sphere logo are registered trademarks or trademarks of the
Reuters group of companies around the world.
Mon June 21, 2004 05:18 PM ET
By James Vicini
WASHINGTON (Reuters) - Patients cannot sue health maintenance
organizations under state law for refusing to pay for
doctor-recommended care, the U.S. Supreme Court ruled on Monday in a
decision that could affect millions of Americans.
The justices unanimously ruled that a 1974 federal law, the Employee
Retirement Income Security Act, completely pre-empted such lawsuits
brought in state court by patients who seek damages from their HMOs
over the denial of medical care.
The state laws have become important as Congress has failed to adopt
national legislation that would allow patients to sue their health
maintenance organization in a federal court for medical malpractice.
The Supreme Court decision involved a law, in President Bush's home
state of Texas, that allowed patients to sue HMOs over their medical
treatment.
The court's decision has election-year political overtones.
Democratic presidential candidate Sen. John Kerry said the ruling
showed a need for a national law to "hold HMOs accountable for
decisions that harm patients by denying necessary care."
Democrats criticized the U.S. Justice Department for opposing the
Texas law before the high court. They said Bush, who was Texas'
governor when the law took effect in 1997, had supported it during his
2000 presidential campaign.
The decision was a victory for insurers, which have warned that
allowing the lawsuits would drive up health-care costs. Millions of
Americans participate in employer-provided HMO health plans governed
by the 1974 federal law.
At least nine other states -- Arizona, California, Georgia, Maine, New
Jersey, North Carolina, Oklahoma, Washington, and West Virginia --
have laws similar to the Texas one.
George Parker Young, an attorney for two patients who sued, urged Bush
and Congress to renew a commitment to pass a patient's bill of rights.
Ron Pollack, executive director of the consumer group Families USA,
blasted the ruling as a blank check for HMOs to deny care.
'SAD DAY FOR PATIENTS, PHYSICIANS'
American Medical Association President John Nelson said, "This is a
sad day for America's patients and the physicians who care for them."
Insurers applauded the decision. Aetna Inc., which had been sued in
one of the cases, said, "The court has helped to assure that millions
of working Americans will continue to have access to quality health
coverage provided by their employers."
Karen Ignagni, president of the industry group America's Health
Insurance Plans, said, "This ruling puts the brakes on efforts by
trial lawyers to turn every question about the scope of an
individual's coverage into a costly lawsuit."
The two cases involved units of Aetna and Cigna Corp. . One lawsuit
had been brought by Juan Davila, who was covered through his employer
by an Aetna health maintenance organization.
In 2000, Davila's doctor prescribed the pain-killer "Vioxx" for his
arthritis. Aetna required Davila to try two less-expensive medications
before it would fill the prescriptions.
After three weeks on the cheaper pain reliever, Davila was rushed to
the emergency room, suffering from bleeding ulcers.
The other lawsuit involved Ruby Calad, who was discharged from the
hospital in 1999 after a hysterectomy. Cigna's nurse decided the
company would pay only for the standard one-day hospital stay,
although Calad's doctor had recommended a longer stay.
Several days after her release, Calad suffered complications. She then
sued.
In an opinion by Justice Clarence Thomas, the justices reversed a U.S.
appeals court ruling that the two lawsuits could proceed. (Additional
reporting by Kim Dixon in Chicago)
© Reuters 2004. All rights reserved. Users may download and print
extracts of content from this website for their own personal and
non-commercial use only. Republication or redistribution of Reuters
content, including by framing or similar means, is expressly
prohibited without the prior written consent of Reuters. Reuters and
the Reuters sphere logo are registered trademarks or trademarks of the
Reuters group of companies around the world.
