Patients' Rights Lawsuits Few So Far
Ramstack, Tom, The Washington Times (Washington, DC)
Byline: Tom Ramstack
State laws that were models for the patients' bill of rights pending in Congress show that so far the crippling wave of litigation feared by business has not occurred, officials in several states say.
The patients' bill of rights is intended to give patients enrolled in health maintenance organizations (HMOs) greater choice in health care decisions. It would make it easier for them to challenge insurers' health care decisions in court, eliminate limits on damages in lawsuits against the HMOs, give patients greater access to specialists and allow doctors more discretion in treatment.
Insurers warn that expanding patients' control over HMOs will force increases in health insurance rates. President Bush has threatened to veto any legislation unless changes are made to reduce the risk of higher health care costs.
But in most of the 38 states that guarantee patients the right to challenge health care decisions, independent review boards resolve disputes without lawsuits, which state officials say keeps insurance costs from rising.
Maryland since 1999 has allowed patients to appeal HMO decisions to an independent review system overseen by the state insurance commissioner. A state official in Maryland said about three-fourths of the 255 complaints investigated last year were resolved quickly for patients without litigation.
Most of the remaining fourth of all cases in Maryland have been resolved in favor of health insurers without litigation.
"We have seen no evidence that either the Maryland patients' bill of rights or the external grievance process has increased the cost of health care or health insurance in Maryland," said Debbie Rosen-McKerrow, spokeswoman for the Maryland Insurance Administration.
Congress is also considering provisions requiring independent reviews of complaints before allowing patients to sue as part of compromise patients' bill of rights legislation.
Most of the state laws have taken effect only in the last four years. Some analysts say that makes it difficult to determine whether the independent reviews have prevented lawsuits or whether the legal action is still coming as more patients learn their rights.
"You really haven't had any time to get any really good data," said Rachel Morgan, a policy analyst with the National Conference of State Legislatures. "I do, however, feel that the independent review organizations will negate the need for most lawsuits. Most of the cases that do go to court will be catastrophic situations, where there was a death or loss of function of some sort."
Seven states, led by Mr. Bush's home state of Texas, let patients sue HMOs. Another 26 states are considering allowing lawsuits. The 1998 Texas law has resulted in 17 lawsuits against HMOs.
One Texas insurance company, Scott & White Health Plan, said it had to raise its insurance premiums 15 percent a year after the law took effect.
Jim Rohack, medical director for Scott & White, said the Texas law forced HMOs to practice "defensive medicine. …