TEXAS: First Suit Filed Under Patient Protection Law
The family members of a "68-year-old Ft. Worth man who committed suicide in July" have become the first plaintiffs to sue a health plan under Texas' year old HMO liability law. The case, filed yesterday in Tarrant County District Court, concerns Joseph Plocica, who was admitted to All Saints Hospital for depression. On July 8, however, Gary Neller, a physician employed by NYLCare of Texas and Merit Behavioral Care of Texas, said Plocica "had 'used up his days' of care under the HMO's protocols and that he should be discharged." The patient immediately drank antifreeze upon returning home, leading to his death. In a statement released yesterday, the HMO said it had not been served with the suit, but that "based on what we know, we intend to defend this case vigorously, and do not believe that (state statute) 386 applied to claims in the case or that anyone from NYLCare was involved in the decision at issue." The suit states that Plocica's psychiatrist, Dr. Harold Eudaly, "made it clear to Dr. Neller, who acted for Merit and NYLCare, that Joe Plocica was not ready for discharge, needed to be kept in the hospital for many more days while his medications were adjusted and until he stabilized and no longer expressed suicidal tendencies." Both Merit and NYLCare said Neller was not a staff member there.
The Big Picture
Senate Bill 386, enacted in May 1997, "holds health insurers liable for controlling, influencing or withholding medically necessary care. It is being watched closely in Congress and by many states, which are considering similar legislation." Aetna challenged the law in U.S. District Court, but a judge ruled Sept. 18 that the portion of the law allowing patients to sue their health plans could stand. The Ft. Worth Star-Telegram reports that the case is drawing attention, not only from HMOs, but from other states considering similar right-to-sue legislation. Geoff Wurzel, executive director of the Texas Association of Health Plans, said more lawsuits will likely follow the Plocica suit. "The Texas Legislature put a big piece of candy out there for the trial bar and you know it was silly for anyone to assume or assert that they, in fact, would not take advantage and grab the candy and run," he said (Lunday, 10/20).