RIGHT-TO-SUE: Illinois High Court Clears Path for Malpractice Suits
In a decision with national implications, the Illinois Supreme Court ruled unanimously yesterday that a Chicago woman's estate may sue her HMO for malpractice, holding that insurers aren't entitled to special protection from liability. The decision appears to bypass the need for state Legislative action regarding HMO liability. The court ruled that the estate of Inga Petrovich may proceed with its case against Share Health Plan of Illinois, a suit that alleges that the HMO negligently refused to authorize an MRI recommended by Petrovich's doctor after Petrovich complained of mouth pain. Nearly a year after the HMO's refusal, tests revealed that Petrovich had mouth cancer. HMO trade group officials are predicting the decision would inflate health care costs and erode quality of care, a sentiment echoed by two state hospital associations that filed court documents arguing that the ruling would have an "adverse effect" on Illinois providers, the Chicago Tribune reports. Nevertheless, the court found that HMOs, as for-profit organizations that influence physicians' decisions and strive to control costs, are "accountable for their ... actions and those of their agents." The Tribune reports that the ruling is part of a nationwide trend: Gov. Gray Davis earlier this week signed legislation giving patients the right to sue HMOs for punitive damages, and Congress is considering right-to-sue regulations that would govern all managed care plans (to date, plans have for the most part been immune from such suits by the 1974 Employee Retirement Income Security Act -- ERISA). Texas was the first state to pass right-to-sue legislation, in the spring of 1998. Meanwhile, the U.S. Supreme Court earlier this week announced it will hear another Illinois case that lawyers said could either uphold or "render moot" the state court's decision (Holt, 9/1).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.