[ OUR OPINION ]
Now it’s up to Congress
to protect patients’ rightsPATIENTS were dealt a blow by the U.S. Supreme Court's rejection of state laws allowing them to sue managed-care programs for damages resulting from refusal to cover treatment prescribed by a doctor. The decision should prompt Congress to fill what Justice Ruth Bader Ginsburg called the "regulatory vacuum" caused by the ruling, requiring compromise by both sides of the issue.
THE ISSUE
The U.S. Supreme Court has struck down state laws that allowed patients to sue HMOs for denial of prescribed treatment.
The court struck down the laws of Texas and nine other states -- not Hawaii -- that allowed members of employment-related health maintenance organizations to sue the insurers for medical malpractice. The justices ruled unanimously that the state laws are pre-empted by the 1974 Employee Retirement Income Security Act, or ERISA, which allows patients to sue insurers in federal court for reimbursement of denied benefits, but not for damages caused by the denial.
In one case considered by the court, a health plan manager provided a woman a one-day hospital stay after a hysterectomy; her doctor had recommended a longer stay, and the patient had to return to the emergency room because of medical complications at home. In the other case, the HMO rejected a doctor's prescription of medicine for treatment of arthritis and other problems in favor of cheaper drugs, which resulted in complications.
The remedy is to remove this unreasonable shelter for HMOs from lawsuits because of medical decisions forced upon doctors and patients. The concept of such a "patients' bill of rights" has received strong bipartisan support, but the failure to reconcile differences led to the collapse of the legislation three years ago.
The Senate passed a bill allowing patients to collect unlimited damages for pain and suffering and punitive damages up to $5 million from HMOs that overrule doctors on medical decisions. A House bill supported by the White House had a $500,000 limit for pain-and-suffering damages and no punitive damages. The Senate bill also provided that the lawsuits be filed in state courts, likely to award large judgments, while the House bill specified that they adhere to federal standards.
The issue will be hotly debated in this year's presidential race. President Bush, who allowed the Texas bill to become law without his signature when he was governor, said in a 2000 debate with then-Vice President Al Gore that he supported a federal patients' bill of rights, boasting that Texas was "one of the first states that said you can sue an HMO for denying you proper coverage." Before the Supreme Court, the Bush administration opposed the Texas law and supported the appeal of the two HMOs.
Sen. John Kerry, the presumptive Democratic presidential nominee, said in a Denver campaign stop, "A real patients' bill of rights has bipartisan support, and it could become law if the Bush administration was not standing in the way." If Kerry becomes president, he will need to bend on the issue to accommodate Republicans who are virtually certain to retain control of Congress.
