Court allows HMO suits in malpractice claims
Illinois ruling first of its kind
A landmark ruling by the Illinois Supreme Court has found health maintenance organizations can be held liable for negligence involving a patient’s medical care. The decision, a major blow to the managed care industry, is expected to influence the current battle in Congress and state legislatures over whether HMOs can be liable for medical malpractice.
Institutional negligence’
Illinois is the first state supreme court to address the issue of "institutional negligence," or HMO responsibility for care provided by doctors in their networks.
"This ruling means patients can now proceed directly against the HMO for the HMO’s carelessness or negligence for causing an injury," notes A. Denison Weaver, the Chicago attorney who brought the action against Chicago HMO, a Medicaid managed care plan operated by United HealthCare of Illinois Inc. "HMOs can’t hide behind the skirts of the doctor," Weaver says.
In overturning an appellate court ruling, the state Supreme Court found the particular issue of whether the HMO was negligent in assigning so many members to a doctor in its network that it resulted in harm "falls within the purview of institutional negligence" and, therefore, should go to trial.
"We hold that Chicago HMO had a duty to its enrollees to refrain from assigning an excessive number of patients, " the court said. "HMOs contract with primary care physicians in order to provide and arrange for medical care for their enrollees. It is thus reasonably foreseeable that assigning an excessive number of patients to a primary care physician could result in injury, as that care may not be provided."
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