[Congressional Record Volume 145, Number 129 (Wednesday, September 29, 1999)]
[Extensions of Remarks]
[Page E1985]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

[[Page E1985]]



             CRITICAL STEP FORWARD FOR HMO PATIENTS' RIGHTS

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                       HON. JANICE D. SCHAKOWSKY

                              of illinois

                    in the house of representatives

                     Wednesday, September 29, 1999

  Ms. SCHAKOWSKY. Mr. Speaker, the United States Supreme Court will 
soon hear a case that will have far reaching consequences for millions 
of health maintenance organization patients. The justices will review 
an Illinois case about whether patients can sue HMO plans that give 
doctors bonuses to keep treatment costs down. The issue that the 
Supreme Court will examine is whether patients can sue HMOs, under 
federal law, for making medical decisions based on the bottom line.
  Millions of Americans already believe that HMOs that limit medical 
treatment to cut costs and increase profits should be held accountable 
in a court of law. That is why the Supreme Court decision to review 
this case is so critical.
  That is why it is also vital for Congress to pass meaningful and 
necessary patient protections that will help give millions of Americans 
the tools they need to end HMO abuses and hold HMOs accountable.
  I wish to attach an article from today's Chicago Sun-Times about the 
upcoming Supreme Court case.

              [From the Chicago Sun Times, Sept. 29, 1999]

                     Court To Hear HMO Bonuses Case

                          (By Lyle Denniston)

       Washington.--The Supreme Court agreed Tuesday to decide 
     whether it is legal for doctors to cut back on treatment to 
     save money for a health maintenance organization.
       The outcome of a case from Illinois may go far to determine 
     how much protection federal law will offer Americans in the 
     face of cost-cutting efforts by managed care plans.
       In the case, a federal appeals court ruled that it is 
     illegal under federal law for doctors who make treatment 
     decisions for patients of a medical benefits plan to get 
     bonuses for saving the plan money by providing less expensive 
     care.
       The 7th U.S. Circuit Court of Appeals, based in Chicago, 
     decided last year that those who make the key decisions for a 
     benefits plan must do so only to further the interests of the 
     patients.
       Anyone in the plan management, including doctors who 
     determine the nature and duration of treatment, is obliged to 
     protect the fund's assets for the patients' benefit, the 
     appeals court said.
       The appeals court said it feared that managing care has 
     been replaced by managing costs.
       A Downstate Bloomington doctor and her HMO employer took 
     the dispute to the Supreme Court, calling the appeals court 
     ruling ``dangerous and disruptive to health care providers 
     and the nation's overall system of health care delivery.''
       This controversy, the doctor and the HMO contended, ``is of 
     profound national importance. Most contemporary welfare 
     benefit plans provide for managed care, through HMOs or other 
     devices.'' The appeals court ruling, they argued, makes the 
     main type of organization now used for medical care unlawful.
       The case arose after a patient, Cynthia Herdrich, went to 
     see the Bloomington doctor for an abdominal pain. In her 1992 
     lawsuit against Carle Clinic Association, Herdrich contended 
     that the doctor found a small inflamed mass in the abdomen 
     and directed treatment to be done eight days later at an HMO-
     owned facility 50 miles away rather than at a Bloomington 
     hospital.
       During the eight-day wait, the patient claimed, her 
     appendix ruptured. She said this added further to the HMO's 
     costs, so she sued the doctor to recover for the plan the 
     expenses of her added care. Her claim was dismissed in 
     federal court but was reinstated during appeal.

     

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