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View Full Version : Patients' Right to Sue HMOs Before High Court




IJ Reilly
Mar 24, 2004, 01:27 PM
None dare call it hypocrisy...

The White House wants a Texas healthcare law, signed by then-Gov. Bush, to be voided.

By David G. Savage, Times Staff Writer

WASHINGTON — The Supreme Court took up this year's major healthcare case Tuesday in a dispute that pits the compassionate conservatism of Texas Gov. George W. Bush versus the pro-business stand of the Bush administration.

At issue is whether patients who are denied needed medical care can sue insurance companies and health maintenance organizations.

In 1997, then-Gov. Bush signed into law the Texas Health Care Liability Act, the first state law that gave patients the right to sue HMOs for denying them "appropriate and medically necessary" treatment.

It was a piece of legislation he boasted about during his campaign for the presidency four years ago. "If I'm president … people will be able to take their HMO insurance company to court. That's what I've done in Texas and that's the kind of leadership style I'll bring to Washington," he said during the final debate with Vice President Al Gore.

But during Tuesday's arguments, Bush administration lawyers joined the insurance industry in urging the high court to void the right-to-sue provision in the Texas law and to block state lawsuits against HMOs for denying benefits.

[...]

Most of the justices sounded as though they would side with the insurance firms and against Texas.

Justice Antonin Scalia said the HMOs are not making medical decisions when they refuse to pay for certain treatment. "They're not managing care. They're giving out money," he said.

Justice John Paul Stevens disagreed. Insurers are not just deciding whether to pay bills, he said. "They are making medical decisions," he said, if they tell a patient they will not pay for another day in the hospital.

A White House spokesman said Tuesday that the president's position in the HMO case is "compatible" with his position as governor. "The president's principles are for allowing patients a fair process for challenging the decisions of health insurers without needlessly driving up healthcare costs," said Trent Duffy, deputy White House press secretary.

[...]

The issue of suing HMOs was featured in the third debate between Gore and Bush on Oct. 17, 2000.

When Gore said that he, unlike the governor of Texas, supported a national patient's bill of rights and allowing patients to sue HMOs, Bush objected.

"It's not true. I do support a national patient's bill of rights," he said. "As a matter of fact, I brought Republicans and Democrats together to do just that in the state of Texas to get a patient's bill of rights through. We're one of the first states that said you can sue an HMO for denying you proper coverage," he said, promising to do the same in Washington.

http://www.latimes.com/news/nationworld/nation/la-na-scotus24mar24,1,3109255.story



zimv20
Mar 24, 2004, 01:44 PM
i cannot think of a bigger example of flip-flopping. it's so hilarious i want to cry.

mactastic
Mar 24, 2004, 03:24 PM
i cannot think of a bigger example of flip-flopping. it's so hilarious i want to cry.

Well you know, everything changed after 9/11, so I'm sure that will be used to justify any change in position. :rolleyes:

Sun Baked
Mar 24, 2004, 03:39 PM
HMO Horror Story' Comes to Supreme Court (http://news.findlaw.com/ap_stories/a/w/1154/3-23-2004/20040323004502_02.html)By ANNE GEARAN Associated Press Writer

WASHINGTON (AP) - ...Juries often make large awards in cases where a big company seems to have taken advantage of a little victim.

That's the main reason why insurers want to move cases like Calad's into federal court, where judgments result in relatively little or no money, and the reason why the hysterectomy patient's story made its way to the Supreme Court.

The high court on Tuesday was considering whether Calad may sue for money in state court over what she claims was botched treatment following her operation nearly five years ago...

The prevailing federal law on the subject dates to 1974, before HMOs such as Calad's were such a dominant feature of American health care. Congress had tried and failed to pass national patient protection legislation, but numerous states have passed laws like one in Texas intended to make insurers accountable for their treatment decisions...

In both cases, an insurer tried to move the lawsuit to federal court, where under the 1974 Employee Retirement Income Security Act a patient may receive no more than the value of whatever benefit the HMO did not provide. There are no hefty jury awards for punitive damages.

The insurers said Calad and Davila should have contested denial of their claims under ERISA, but a federal appeals court in 2002 ruled that Calad and Davila could instead sue for malpractice damages in state court. The HMOs appealed to the Supreme Court.

Insurers, backed by the Chamber of Commerce and others, argued in court filings that ERISA has its own procedures for reviewing or appealing coverage decisions, and that sidestepping the federal law would lead to more lawsuits and drive up health care costs.

On the other side, trial lawyers, medical organizations and numerous states argued that states should have the right to hold HMOs accountable if treatment decisions shortchange patients...

The cases are Aetna Health Inc. v. Davila, 02-1845 and Cigna Healthcare of Texas Inc. v. Calad, 03-83.
2004-03-23 08:26:20 GMT ERISA vs Texas State Healthcare Law -- interesting. :eek:

In one case they may get millions (and the federal judge thinks they should) or they may only stand to get thousands, or in the polio dudes case (nothing, the cost of some pain pills).