HMO LIABILITY: Judge Allows Suit In Connecticut
A federal judge ruled Monday that a plaintiff could pursue a case against an HMO in Connecticut "based on the quality of care they dictate to a patient." The AP/Hartford Courant reports that the ruling stems from the case of Nitai Moscovitch, a teenager who committed suicide in 1995 after Physicians Health Services denied him further treatment. "PHS deemed that hospitalization was not necessary and that Nitai's behavior was manipulative rather than life threatening" and chose to place him in drug treatment instead. Attorneys for PHS claimed that the 1974 federal ERISA law pre-empted "claims based on denial of insurance benefits." U.S. District Court Judge Christopher Droney wrote in his decision that the case "focused on quality of care dictated by the HMO," rather than denial of care. Plaintiffs' attorney Karen Koskoff said, "(HMOs) evaluate medical records and spend a lot of time and money to provide medical care that is usually substandard and was in this case. This decision sends a message that in Connecticut the insurance capital of the world this action will not be tolerated." PHS said as "it does not treat or diagnose patients," the individual health care providers should shoulder the blame in this case. In a statement Tuesday night, PHS said "[i]t was determined that [Moscovitch] should be moved to a drug treatment center, and he was. The tragic outcome of this case saddens us all and we again express our sympathies to the Moscovitch family." Company officials added they were "confident that once all the facts are presented in court, they will prove that PHS fulfilled its obligation to ensure that our members have access to the health care services they need" (10/28).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.