GOVERNMENT & MEDICINE

U.S. Supreme Court to decide if patients can sue health plans

This session will mark the fourth time in as many years that justices have weighed in on states' rights to regulate health plans.

By Tanya Albert, AMNews staff. Nov. 24, 2003.

After more than a decade of debate, the question of whether patients can sue their health plans in state court for denials of physician-recommended treatment is set to be settled by the U.S. Supreme Court.

Doctors and patients argue that health plans that get involved with medical decision-making should, as a measure of last resort, have to answer for harmful decisions in state court. But health plans say the federal Employee Retirement Income Security Act of 1974 shields them from state lawsuits, which they believe would drive up already rising health care costs.

The high court is expected to end the debate -- which was at the center of controversy over patients' bill of rights legislation in Congress -- when it hears two cases involving patients who sued their health plans under a 1997 Texas law. That statute was the first in the nation to give citizens the right to sue health plans in state court.

The Supreme Court's decision to hear the cases "is very significant because it's taking up a matter that has been in very hot contention for the past 15 years," said Mark Rust, managing partner of Barnes & Thornburg's Chicago office and chair of its health care department. "There is concern that a person who makes a medical decision be held equally responsible whether it was made by a treating physician or whether it was made by a medical director of an HMO."

The Supreme Court's decision, expected next summer, will affect 11 state laws.

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