Marta Russell
> A crack in ERISA. View the original article at:
>
> http://www.msnbc.com/local/WVIT/122278.asp
>
> Here's the text:
>
> Federal judge rules HMOs can be sued for negligence
>
>
> HARTFORD, Conn., Oct. 27 - Health maintenance organizations can be sued
> for
> negligence based on the quality of care they dictate to a patient, a federal
> judge has ruled. What many observers see as a landmark ruling came Monday in
> the
> case of Nitai Moscovitch, a 16-year-old from Brookfield, who committed
> suicide
> in July, 1995 after an HMO refused to pay for his continued hospitalization.
>
>
>
> Nitai Moscovitch
> The Moscovitch family claimed their son would still be alive if their
> HMO hadn’t refused to pay for treatment. So, they sued the HMO, the
> Trumbull-based Physicians Health Services, in Superior Court in Danbury for
> failing to provide a proper standard of care and a judge decided the case can
> go
> forward. “He wasn’t protected. He wasn’t protected. I put him in the hospital
> to
> be protected. That’s why you put people in hopsitals,” Nitai’s father Stewart
> Moscovitch told NBC 30.
>
>
> It was at this facility where Nitai Moscovitch committed suicide.
> In July of 1995 a depressed Nitai Moscovitch tried unsuccessfully to
> commit suicide. Because of that he began receiving psychiatric care at
> Danbury
> Hospital. But, soon after he was transferred to Norwalk’s Vitam Youth
> Treatment
> Center, a drug treatment facility. The transfer was made at the insistence of
> the family’s HMO. It was there where Nitai killed himself. His father says
> Nitai
> should never have been moved from Danbury Hospital and that the HMO was
> negligent. “All he needed was some help and PHS wouldn’t give it to him,”
> Moscovitch said.
> It may take a couple of years, but this could very well be that the
> first
> Connecticut case involving a lawsuit against an HMO could be heard at Danbury
> Superior Court. Lawyers for PHS had argued that a 1974 federal law barring
> claims based on denial of insurance benefits required that the Moscovitch
> lawsuit be dismissed. But, U.S. District Court Judge Christopher Droney ruled
> that the Moscovitch case wasn’t about denial of benefits or what the family’s
> medical plan covered, rather, that it focused on the quality of care dictated
> by
> the HMO. He sent the case back to state court for trial.
> Lawyer Karen Koskoff, who represents Moscovitch’s estate, said that
> Droney’
> s decision “is extremely significant, because the judge determined that when
> an
> HMO makes medical decisions in the state of Connecticut, that HMO will be
> held
> accountable for its actions like any other health care provider.”
>
>
>
> “(HMOs) evaluate medical records and spend a lot of time and money to
> provide medical care that is usually substandard and was in this case,”
> Koskoff
> added. “This decision sends a message that in Connecticut, the insurance
> capital
> of the world, this action will not be tolerated.”
> Tuesday, PHS released the following statement regarding the case. “PHS
> is
> confident that once all the facts are presented in court, they will prove
> that
> PHS fulfilled its obligation to ensure that our members have access to the
> health care services they need.”
>
> >>