SUPREME COURT Justices deny malpractice damages against HMOs

Congress has tried and failed to pass patients' rights legislation.
WASHINGTON (AP) -- The Supreme Court said today that patients who contend their HMOs wouldn't pay for recommended medical care cannot sue for big malpractice damages, removing a weapon that trial lawyers and patient rights advocates said was crucial to keep the insurers honest.
The court was unanimous in saying that two HMO patients in Texas cannot pursue big malpractice or negligence cases against their insurers in state court, as they contended a Texas patient protection law allowed them to do.
The case involves an issue that has stymied Congress, which has tried and failed to pass national patients' rights legislation. Some states have passed their own patient protection laws in the meantime, but the scope of protection varies.
Biggest question
The biggest question unresolved until today was whether patients could seek hefty damage awards in state courts, or whether they are limited only to federal courts, as insurers claimed.
The choice is significant, because state court juries can often be generous to sympathetic victims. Insurers have claimed that patients could only go to federal court, and then only to recover the value of whatever benefit the HMO denied.
The ruling weakens the Texas patient protection law and those of other states.
The court based its ruling on the language of a 30-year-old federal law, originally meant to protect employee pensions and other benefits, but now applied to the managed-care industry.
The law, the Employee Retirement Income Security Act or ERISA, forces the HMO patients at issue in the case to sue only in federal courts, Justice Clarence Thomas wrote for the court.
The insurance industry had argued that ERISA trumps state patient protection laws or other state laws that allow medical negligence suits in local courts, and lower courts were divided on the issue.
Gray area
The case concerns a gray area of medicine and insurance, in which decisions about what treatment to pursue and what coverage to offer are mingled. The situation arises frequently in managed care, where doctors belong to a closed network of providers overseen by administrators who may not be doctors but who nonetheless decide what the company will pay for.
The court ruled against a hysterectomy patient, Ruby Calad, who had claimed that Cigna Healthcare of Texas essentially evicted her from a Houston hospital after only one day of recovery.
The HMO would not pay for a longer stay, even though her doctor recommended it.
In other decisions today, the Supreme Court:
* Ruled that people do not have a constitutional right to refuse to tell police their names. The 5-4 decision frees the government to arrest and punish people who won't cooperate by revealing their identity.
The decision, reached by a divided court, was a defeat for privacy rights advocates who argued that the government could use this power to force people who have done nothing wrong to submit to fingerprinting or divulge more personal information.
U Rejected an appeal from the family of a guest murdered days after he admitted a secret crush on another man during the taping of the "Jenny Jones Show." The family of Scott Amedure won a $29.3 million award against Warner Brothers and the talk show, but the decision was later thrown out. A Michigan appeals court ruled against the family last year.
U Allowed a lawsuit to proceed that accuses the Archdiocese of Milwaukee of transferring a child molester from Wisconsin to work as a Roman Catholic priest in California. The justices declined without comment to block a lawsuit involving allegations that the priest, Sigfried Widera, molested an 8-year-old California boy after his move.
URefused to consider an appeal from South Carolina death row inmate Jamie Wilson, convicted of killing two third-graders during a shooting spree at an elementary school in 1988. Mental health groups had urged the Supreme Court to use Wilson's case to decide if it is unconstitutional for states to execute people who were seriously mentally ill when they committed their crimes.