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San Bernardino Sun (San Bernardino, CA)

Supreme Court rules patients who claim their HMOs wouldn't pay for needed medical care cannot sue for big malpractice damages.

by Staff Writers
Jun 21, 2004

How will the Supreme Court's decision affect California's patients?

"Basically what this says is that in California, if a patient is denied care by an HMO and suffers some harm or becomes ill because they didn't receive that care, their only recourse is to sue their HMO in federal court, not state court," said Jerry Flanagan, a spokesman for the Foundation for Taxpayer and Consumer Rights.

The consumer rights group was instrumental in getting California's patient protection law passed in 1999.

Monday's Supreme Court decision weakens that state law, as well as similar laws passed in Texas, Georgia, Washington, Arizona, Maine, Oklahoma, West Virginia, New Jersey, North Carolina and Oregon.

Prior to Monday's Supreme Court decision, what rights did patients have across the nation and in California?

The Supreme Court's decision was the result of two HMO patients out of Texas who were pursuing malpractice or negligence cases against their insurers.

The patients claimed a Texas patient protection law allowed them to.

In 1997, Texas passed a state patient rights law that allowed patients to sue when they are harmed by an HMO. The law was backed by President George Bush, who was governor of Texas at the time.

California's law was passed in 1999.

"We believe this will have a negative effect on California's consumers," said Lynne Randolph, a spokeswoman for California Department of Managed Care, a regulatory agency.

Though the agency doesn't track malpractice lawsuits, Randolph said there were four cases filed last year.

Since California's law passed, only about a handful of cases have actually been filed, Flanagan said.

He said only about 3 percent of malpractice cases make it to federal court.

How does the Supreme Court decision benefit the HMOs?

The Supreme Court's decision shields HMOs from lawsuits and juries, which are more apt to side with victims and order up multimillion-dollar judgments from insurance companies.

What's next?

Flanagan said one of two things will occur. First, the decision can be challenged to bring about another law. Or second, the Supreme Court's decision could be clarified to show that it does not pre-empt the state laws.

"With this law now, the silver lining is to finally push Congress to provide a national bill of rights legislation," Flanagan said.

"This is a hot issue and very political."