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Supreme Court Deals Blow to Malpractice Plaintiffs
In a disappointing decision for malpractice plaintiffs and their medical caregivers, the U.S. Supreme Court ruled on June 21 that patients do not have a state law private right of action against their Health Maintenance Organizations (HMOs) when such entities make coverage decisions that impact the patient's health care. The decision means patients have little recourse against their HMOs, which under federal law are liable to plan beneficiaries only for the cost of services they wouldn't cover.
Background
The cases came to the Supreme Court via Texas, which had in 1997 passed a law as part of its patients' bill of rights, Texas Health Care Liability Act (THCLA), Tex. Civ. Prac. & Rem. Code Ann. '' 88.001-88.003 (2004 Supp. Pamphlet), allowing Texas citizens to bring suit against their HMOs in state court. In these consolidated cases, two individuals sued their respective health HMOs for alleged failures to exercise ordinary care in the handling of coverage decisions, in violation of a duty imposed by the Texas law. The Supreme Court decided it would hear the two consolidated cases last fall — Aetna Healthcare of Texas v. Davila, 02-1845, 2003 U.S. LEXIS 8002; 72 U.S.L.W. 3307; 2003 Cal. Daily Op. Service 9538 (11/3/03) and Cigna Healthcare of Texas v. Calad, 03-83, 2003 U.S. LEXIS 8003; 72 U.S.L.W. 3307 (11/3/03).
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