The Supreme Court took up the long-running national dispute over managed health care Monday, saying it would decide whether workers and their families should be allowed to sue their medical plans for providing substandard care.
The high court agreed to hear a pair of cases from Texas. In the first, Juan Davila, a diabetes patient from the Fort Worth area, says he nearly died from internal bleeding after his health care plan refused to pay for Vioxx, a pain medication ordered by his doctor, and insisted on a less expensive generic version of the drug. In the second, Ruby Calad, from the Houston area, suffered complications after her health plan insisted she be sent home from the hospital a day after having a hysterectomy.
The Supreme Court will not decide the merits of their claims. Instead, the justices will rule whether they are free to sue their health plans for medical negligence.
When the 5th U.S. Circuit Court of Appeals in New Orleans cleared Davila and Calad to bring lawsuits in a Texas state court, Aetna Health Inc. and Cigna Healthcare of Texas appealed, arguing that they were shielded from such lawsuits under a federal law regulating employee benefits.
The Supreme Court's ruling, due by next summer, will determine the legal rights of more than 130-million Americans who receive subsidized medical care through employer- or union-sponsored benefits plans.
Since the early 1990s, these managed care networks have been charged with holding down medical costs. As they have done so, patients have complained of being denied crucial medical treatments, tests or specialty care. In the most serious cases, patients have tried to sue their health care plans, only to learn that they were barred from taking such action under a quirk in a 1974 federal law on pension reform.
That measure, the Employee Retirement Income Security Act, was designed to assure workers that they would receive the pensions and benefits they had been promised and established federal rules for these benefits. In return, employers won the assurance that the federal law would take precedence over all state laws or claims that "relate to" employee benefits.
In the mid 1980s, the Supreme Court ruled that this federal law prevented injured workers from suing to win damages in a state court. But in more recent rulings, the court has hedged and suggested that victims of medical negligence may sue for damages.
"This is about whether we get our day in court," said George Parker Young, the lawyer for the two Texas patients.
On the other side, the health insurance industry, the U.S. Chamber of Commerce, the National Association of Manufacturers and other business groups urged the court to block lawsuits against managed care plans.
Allowing patients to sue their health plans "threatens the foundation" of current benefits plans, they told the high court. Employers will reconsider sponsoring these plans if they can be sued, they said.
"Consumers and plan participants will pay the ultimate price _ facing higher copayments, deductibles and premiums," they argued.
The court will hear oral arguments in the cases of Aetna vs. Davila and Cigna vs. Calad in February or March.
Court ends Alabama
Ten Commandments case
WASHINGTON _ The highly visible crusade of Alabama's chief justice to put the Ten Commandments on public display in a courthouse rotunda ended in failure Monday in the Supreme Court.
Without elaboration, the high court issued two simple orders to turn aside a pair of appeals by Roy S. Moore, who won election as his state's chief justice three years ago by campaigning as "the Ten Commandments judge."
That action left intact a series of lower court orders that had resulted in removal Aug. 27 of a 2-ton monument from the state courts building in Montgomery.
Moore faces removal as chief justice because he refused to obey court orders to remove it.
_ Information from the Boston Globe was used in this report.