Glendening backs right to sue HMOs Assembly, Congress have struggled with regulating insurers

Announcement set today

Only two states allow litigation on subpar care

October 13, 1998|By Thomas W. Waldron and William F. Zorzi Jr. | Thomas W. Waldron and William F. Zorzi Jr.,SUN STAFF Sun staff writer Michael Dresser contributed to this article.

Hoping to capitalize on the public's discontent with managed care, Gov. Parris N. Glendening was to announce today that he supports giving patients the right to sue their health maintenance organizations for subpar care, according to legislators familiar with the proposal.

With the announcement, Glendening steps into a fierce debate that has raged in Annapolis and Washington, pitting doctors and patients against cost-conscious managed care organizations.

Patients' advocates say the measure is necessary to force HMOs to provide appropriate, if sometimes expensive, care, while insurers say such lawsuits will significantly boost the price of health care.

"It's a great idea," said Del. Leon G. Billings, a Montgomery County Democrat who has sponsored similar bills in recent years. "The public wants to make sure that these insurers understand if they make mistakes, they have to pay for it."

Sen. Paula C. Hollinger, the Pikesville Democrat who has sponsored legislation in years past to allow suits against HMOs and their medical directors, said that the laws are necessary to lTC make HMOs accountable for their decisions.

"Right now, HMOs are making all the health care decision and all the health care profits and who's suffering? The people who have to live with their decisions are suffering," Hollinger said.

Regulating HMOs has become an increasingly popular cause in the General Assembly and Congress in recent years because of complaints about stingy and insensitive care. But only two states, Texas and Missouri, have approved giving consumers the right to take their HMO to court.

Support for giving patients the right to sue is new for Glendening, who laid out in July a patients' bill of rights that did not include the provision.

Peter S. Hamm, a spokesman for Glendening, declined to comment on today's expected announcement.

Senate President Thomas V. Mike Miller predicted right-to-sue legislation backed by the governor would spark an emphatic debate in the State House.

"It's an issue that's volatile and it has merits on both sides," said Miller, a Prince George's County Democrat. "I would hope we could fashion some kind of compromise."

Ellen R. Sauerbrey, Glendening's Republican opponent in the Nov. 3 election, opposes changing the law to allow lawsuits against managed care organizations.

"As soon as you get such a system, you're going to have a lot of wealthy attorneys and a lot of uninsured people," Sauerbrey said. "It'll drive up the cost of health care tremendously."

D. Robert Enten, a lobbyist for the Maryland Association of Health Maintenance Organizations, said giving consumers the right to sue their insurer would lead to increased costs and higher premiums for consumers and businesses.

"I don't think anyone would take the position that increased liability will increase the quality of care," Enten said.

Sources said Glendening will also throw his support behind a proposal to require that a managed care organization's medical director be subject to the same disciplinary power as practicing physicians. Sauerbrey also supports such a measure.

Such a proposal was considered in the General Assembly this year. In a sign of the unpredictable nature of the issue, the Maryland Senate tentatively approved the legislation, only to kill it two days later under intense pressure from lobbyists for the managed care industry.

The legislature did enact a bill to allow patients to appeal medical decisions by their managed care organizations to the state insurance commissioner.

Enten, the HMO lobbyist, said that appeals process should be given time to work.

By a narrow margin Friday, the U.S. Senate rejected a move by Democrats on Capitol Hill to take up a heavily lobbied bill to define patients' rights and regulate health maintenance organizations.

The legislation would have made it easier for patients to sue HMOs and recover damages for the improper denial of care.

Pub Date: 10/13/98

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