Patients' Rights Cases March to Supreme Court

March 19, 2004 ( - The US Supreme Court has agreed to hear arguments in two cases involving participants' rights in pursuing malpractice claims against a health maintenance organization (HMO).

>In the hearing, the nation’s high court will weigh in on a battle over patients’ rights when their HMOs refuse to pay for recommended medical treatment, agreeing to hear two appeals.   More specifically, the Supreme Court will focus on the issue of where suits can be brought against an HMO, in the state court system or the federal, according to an Associated Press report.

>For HMOs the two different courtroom venues bring a world of difference.   One the one hand, a jury in a state court can award high amounts of punitive damages as opposed to federal court, where a participant is limited to the value of the benefit denied by an HMO.

>Both cases coming before the Supreme Court came out of the Lone Star state.   One involves a Texas man whose insurer – Aetna Health – required him to try a cheaper alternative to the painkiller Vioxx, which his doctor had prescribed for arthritis.   He claims the cheaper drug caused bleeding ulcers and almost caused a heart attack. 

The other, a case appealed by Cigna Healthcare involves a Texas hysterectomy patient who claimed she was kicked out of the hospital after one day.   This despite her doctors’ recommendations that she stay long to recover from the surgery.

Both cases were filed in state court in 2000 under a 1997 Texas law allowing patients to sue HMOs. But the cases were transferred to federal court after the insurers said the two plaintiffs should have contested the refusal of their claims under the Employee Retirement Income Security Act (ERISA).   However, under ERISA, patients are now allowed to file lawsuit for monetary damages.   In 2002, a federal appeals court ruled HMOs could be sued in state court for malpractice and the two HMOs appealed to the Supreme Court.

The cases are Aetna Health Inc. v. Davila , 02-1845, and Cigna Healthcare of Texas Inc. v. Calad , 03-83.