Free Case Evaluation
Doctors who provide sub-standard care can be sued for medical malpractice. However, HMOs (health maintenance organizations) who
tell the doctors what they can and cannot do are shielded from medical malpractice lawsuits. Many believe that this practice, which has been a source of controversy for years, is unfair to patients.
Attempts for change
In the past, doctors were primarily in control of what a patient needed. Unfortunately, as most of us are painfully aware, HMOs have taken over much of the decision making process when it comes to approving or denying doctor-recommended procedures. However, according to the U.S. Supreme Court’s 2004 ruling in a case called Aetna Health Inc. v. Davila (542 U.S. 200 (2004), individuals are prohibited from suing their HMOs in state court (where better remedies are available) when they refuse to provide a recommended treatment.
Although Congress has sought to change this, it has had little success. Several bills have been introduced, but Republicans and Democrats have very different ideas about what should be allowed – and so far, haven’t come to a meeting of the minds.
Is it fair?
Many don’t think so. They say that if the ultimate decision to deny coverage rests with the HMO – and that decision turns out to be wrong and causes injury or death – then why wouldn’t they ultimately be liable for damages? The recent case of the 17 year old California girl has refueled the debate. In November 2007, a California teenager with leukemia received a bone marrow transplant from her brother. However, something went wrong and the girl went into a coma.
Doctors recommended an immediate liver transplant. However, Cigna Healthcare, her insurance company, initially refused to cover it because it was an “experimental” treatment. Her doctors and nurses pled with Cigna to reconsider and many people rallied outside of one of Cigna’s California offices. While the insurer finally agreed, it did so too late. The girl died a few days before Christmas. Her family says that Cigna is ultimately responsible for her death and plans to sue. Many believe that this case takes the issue a bit farther as Cigna’s decision had dire consequences.
When in doubt…
The laws that apply to HMOs, doctors and hospitals are very complex and often overlap. When in doubt, contact an attorney whose practice focuses in this area of the law. He or she will be able to explain whether medical malpractice, bad faith insurance practices or other causes of action might apply to your situation and discuss your options for recovering damages. To contact a qualified attorney near you, please click here.
