HMO LAWSUIT: Appeals Court Gives Green Light for Texas Suit

      A federal appeals court Friday denied a Texas HMO's motion to invoke the Employee Retirement Income Security Act and redirect a lawsuit from state court to federal court, the AP/Akron Beacon Journal reports. The ruling from the 5th U.S. Circuit Court of Appeals in New Orleans came in a suit filed by Bridgett Giles, a Houston woman whose 9-year-old son died in 1996 after his doctor failed to diagnose his enlarged heart. The decision marks the first time the court, which has jurisdiction over Louisiana, Mississippi and Texas, has ruled that "a patient's lawsuit against an HMO [can] be tried in state court." Texas is the only state that allows HMO members to sue their plans for malpractice (4/11). The Dallas Morning News reports that the "surprise" ruling "could have broad implications in the raging national debate over whether consumers can sue HMOs for damages."

Fault Lines
      NYLCare Health Plans, the defendant in the suit, denies any wrongdoing in the case, arguing that the doctor was an independent contractor who met state certification requirements. NYLCare spokesperson Jill Griffiths said, "This is a tragic story, but it's not about managed care. We don't provide care, and we don't believe this is about us." For her part, Giles contends that the HMO "failed to properly screen or supervise the physicians in its network" and assigned her son to a doctor "who was not competent to diagnose the boy's heart condition." Giles initially sued NYLCare in state court, but NYLCare had the case moved to federal court, claiming ERISA jurisdiction. Giles "said her suit isn't about money or vengeance," but about "knowing that NYLCare will make changes to protect the next Alex" (Ornstein, 4/11). Jamie Court, director of Consumers for Quality Care, said, "This is a big win for patients who have little leverage against their HMOs and now have a new threat under their belt to sue if an HMO compromises quality" (AP/Akron Beacon Journal, 4/11).