Yet Another Lawsuit Takes Aim at Issue of Who Can Sue HMOs

Article excerpt

Less than a week after an Illinois Supreme Court ruling allowing customers to sue HMOs for negligent care from doctors, another managed care issue is being thrust into the legal spotlight.

Attorneys filed written arguments to Illinois' high court Wednesday in the Neade vs. Portes case, in which a Lake County woman argues her husband might still be alive if his doctor didn't have a financial incentive not to order an angiogram that could have detected heart problems.

The plaintiff's central argument is that doctors should be required to disclose they may benefit financially from not ordering specific tests or treatment for patients.

Attorneys say the Illinois Supreme Court could rule this fall.

"This is an issue of putting a patient's care in direct conflict with a doctor's profitability," said John L. Nisivaco, an attorney for Terrence J. Lavin & Associates, who wrote an argument on behalf of the Illinois Trial Lawyers Association in support of the plaintiff.

Chris Hamrick, director of communications for the Chicago-based Illinois Association of HMOs, said that to infer that a doctor would neglect a patient's need to fatten his or her wallet is ludicrous.

"Physicians don't practice medicine that way," he said. Ninety- seven percent of things get covered without a hitch ... what we're saying is 'Look twice at what you're doing.' Everyone who comes in with a sore knee doesn't need an MRI."

This case brings to the forefront the issue of medical incentive funds offered by HMOs to doctors and again raises the question of whether the managed care system needs reform to increase accountability for quality medical care.

"Just as physicians are liable to patients, so too, should be HMOs," said Dr. M. LeRoy Sprang, president of the Illinois State Medical Society. "HMOs are all too often a third party intruder in the physician-patient relationship, and when they are, they must be accountable. …