TEXAS: NYLCare Moves To Try Landmark Case In Fed. Ct.
NYLCare Health Plans filed a brief Thursday in Fort Worth, TX, district court arguing that plaintiffs suing the HMO must do so in federal court, a move that would dramatically narrow the scope of the Texas law allowing patients to sue their HMOs for denied care. Patient advocates and industry officials are watching the case closely. George Young, an attorney for the plaintiffs, charged that "NYLCare is simply trying to chip away at the scope of the state law." Jamie Court of Consumers for Quality Care said if the health plans "succeed, the law wouldn't apply to anyone." The Dallas Morning News reports that experts say that health plans "generally view federal courts as less sympathetic to personal-injury claims than state courts." Jeff Kloster, general counsel for the Texas Association of Health Plans, defended NYLCare's brief and said, "We're in a system of law that goes upon prior precedent, and that's what we're all looking for. We're all trying to figure out what this means."
The suit, filed by the family of Joseph Plocica, charges that NYLCare denied "adequate hospitalization for his severe depression and suicidal impulses," before he committed suicide shortly after his discharge from the hospital. The NYLCare brief also argues that the case must undergo a Medicare appeals process before going to court, since the patient in question was a Medicare recipient. But Young, the plaintiffs' attorney, cited a 1996 federal appeals ruling which allows Medicare beneficiaries to "sue in state court if damage has already been done" (Ornstein, 11/21).