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U.S. Courts Rule Patients Have Right to Sue HMOs

Two appeals verdicts go against interpretation of a 1973 law that has shielded health-care groups from damages.

November 02, 2003|David G. Savage | Times Staff Writer

The industry groups hope the Supreme Court will agree to hear one of the pending appeals and then rule that the federal benefits law erects a barrier to all lawsuits in state courts.

But the justices have struggled over the issue. While federal law governs employee benefits, matters of insurance and medical care are typically governed by state law.

In the New York case, the U.S. 2nd Circuit Court of Appeals in Manhattan said the health-care plan's decision to deny Carmine Cicio a transfusion may have "violated a state law duty of professional care." If so, the appeals court said, his widow had the right to sue for damages for this negligent medical care.

In its appeal in Vytra Healthcare vs. Cicio, the managed care network urged the high court to reverse this ruling and to make clear that state court juries are not empowered to second-guess the decisions made by a health-care network.

In the two Texas cases, the U.S. 5th Circuit Court of Appeals in New Orleans also ruled HMOs can be sued for providing "substandard care" to patients. Lawyers for Aetna Health Inc. and Cigna Health Care have urged the court to reverse those decisions.

For The Record
Los Angeles Times Tuesday November 04, 2003 Home Edition Main News Part A Page 2 National Desk 0 inches; 27 words Type of Material: Correction
Patients' lawsuits -- An article in Sunday's Section A about lawsuits against health plans had a headline that incorrectly referred to two appeals court rulings as verdicts.

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