Supreme Court rules for HMOs in malpractice rights cases
From Bill Mears
CNN Washington Bureau
WASHINGTON (CNN) -- The Supreme Court on Monday gave managed-care companies a victory in a long-standing fight against patients who wanted to take their malpractice claims to a state court.
At issue in the opinions announced Monday was whether federal courts were the proper forum for hearing certain malpractice and negligence claims against health maintenance organizations, also known as HMOs.
Different states have various laws that can either make it easier or more difficult to pursue such lawsuits in federal court. State courts traditionally have allowed greater damage awards by juries against businesses, industry and the government.
The cases announced Monday involved a patient whose hospital stay was cut short and a man forced to take a cheaper prescription drug. The two cases were brought against large HMOs in Texas. (Background on the cases)
Juan Davila claimed Aetna Health forced him to take a cheaper painkiller that caused dangerous side effects such as internal bleeding. He initially brought his lawsuit in state court, citing Texas patient protection legislation.
Ruby Calad sued Cigna Health after claiming the company would pay for only one day of post-operation recovery after hysterectomy surgery.
In the 9-0 decision, Justice Clarence Thomas, writing for the court, said that in theses cases, federal law carried greater legal weight. Thomas said congressional law was clear this was done "to provide a uniform regulatory regime."
The cases involved an issue that has stymied Congress, which has tried and failed to pass national patients' rights legislation, according to an Associated Press report. Some states have passed their own patient protection laws in the meantime, but the scope of protection varies, the AP reported.
Insurers have claimed that patients could only go to federal court, and then only to recover the value of whatever benefit the HMO denied. Insurers had argued that a ruling against them would drive up insurance costs.
The ruling weakens the Texas patient protection law and those of other states.
Davila and Calad expressed "disappointment" with Monday's ruling.
"My life is not the same and may have been cut short because of the HMO's decision to play doctor," said Davila in a written statement. "In our cases we did as our HMOs wanted, and followed their terrible medical decisions with disastrous results."
Calad said the Supreme Court "essentially looked the other way on the issue of HMO abuse."
According to an Associated Press report, the high court based its ruling on the language of a 30-year-old federal law, originally meant to protect employee pensions and other benefits, but now applied to the managed care industry.
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Associated Press contributed to this report.
