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Connecticut patients can sue HMOs for negligence.

Another state is allowing patients to sue their health maintenance organizations (HMOs).

Connecticut patients may sue HMOs for negligence in quality of care, U.S. District Court Judge Christopher Droney ruled in October. In September, a Texas law allowing patients hurt by treatment denials or delays to sue their health plans for damages was upheld. (See Patients' right to sue HMOs upheld in Texas, TRIAL, Dec. 1998, at 98.)

In the Connecticut case, 16-year-old Nitai Moscovitch committed suicide in July 1995 after his health maintenance organization, Physicians Health Services (PHS), refused to pay for the boy's continued hospitalization. (Moscovitch v. Danbury Hosp., No. 3:97CV1654(CFD), 1998 WL 770485 (D. Conn. Oct. 26, 1998).)

Moscovitch had been hospitalized after two suicide attempts. After eight days, PHS declared Moscovitch was exhibiting manipulative, not life-threatening, behavior and insisted that he be transferred from the hospital to a drug treatment program. The day of the transfer, Moscovitch killed himself.

His parents sued PHS for failing to provide a proper standard of care. The HMO argued that federal law under the Employee Retirement Income Security Act (ERISA) barred claims based on denial of insurance benefits. However, Droney ruled the case was not about benefits but the quality of care provided.

"It is clear that the plaintiff is challenging the appropriateness of the medical and psychiatric decisions of PHS concerning the care given to the decedent," the judge wrote. "Count Five [of the complaint] does not assert that PHS was making wrong decisions about whether certain care would be covered by its plan, but instead challenges the decisions made by PHS with respect to the quality and appropriate level of care and treatment for the decedent.... Such claims do not fall within the scope of ERISA."
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Author:Porter, Rebecca
Article Type:Brief Article
Geographic Code:1U1CT
Date:Jan 1, 1999
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