GOVERNMENT

Supreme Court strikes down landmark patient protection law

The ruling sparks talk again of federal patients' bill of rights legislation.

By Tanya Albert, AMNews staff. July 12, 2004.

The U.S. Supreme Court in June struck down a Texas law that gave patients the right to sue their health plans for damages in state court. Now physicians hope they won't see a return of the toxic 1990s atmosphere in which they say it was more difficult to get insurers to pay for necessary care.

The high court ruled unanimously that the federal Employee Retirement Income Security Act of 1974 preempted the first-of-its-kind Texas law, which gave patients the right to recover money for injuries resulting from plans' denial of doctor-recommended treatments.

Some physicians say they've run into fewer hassles in getting insurance companies to reimburse for treatments after the Texas law passed in 1997 and then 10 states followed suit.

Opinions about the new ruling's potential effect on health plan attitudes is mixed.

"I don't think it is going to have a big impact unless it emboldens the HMOs to go back to their old ways," said Bruce Malone, MD, an Austin, Texas, orthopedic surgeon and Texas Medical Assn. trustee. "But I don't think the public will tolerate that."

Others are not as confident.

"It is going to have a devastating effect on patient care," said George Parker Young, the Texas attorney who represented the two patients involved in the case before the Supreme Court. "We're going to see a very quick return to the horror stories we heard in the late 1990s."

American Medical Association President John C. Nelson, MD, MPH, said the court's decision allows managed care plans to practice medicine without a license and without the accountability that physicians face.

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