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Need for National Patients Rights Law Urgent

State Protections At Risk In Supreme Court Decision

(Washington, DC) Today's Supreme Court review of an Illinois law that gives patients' the right to independent, external review by qualified physicians is just the latest effort by managed care companies to strike down any laws holding them accountable for the medical decision they make, according to the American College of Physicians - American Society of Internal Medicine (ACP-ASIM).

"The issue in this case is not about creating new rights to sue, it's about whether consumers have any recourse -at all -when managed care companies act like doctors and make medical decisions," stated William J. Hall, MD, president of the ACP-ASIM. "A favorable finding in this case could invalidate all states' consumer protection laws, leaving managed care plans with free reign to deny and delay care to increase their profitability."

During the first session of the 107th Congress, both the House of Representatives and the Senate passed patient protection legislation, but differences between the bills were never reconciled by a conference committee. While access to external medical review was a key component of both bills, differences contained in the liability provisions were substantial.

"External medical review is the best way to avoid costly lawsuits, by giving both the insurer and the patient the right to an independent medical review when they disagree" said Dr. Hall. "Resolving issues quickly while treatment can still prevent permanent injury will benefit both parties."

Immediate passage of a national patients' bill of rights is the only way to assure that this essential patient protection is not eliminated, according to a letter ACP-ASIM sent to President George W. Bush and Congress. According to the organization, patients will remain at risk as long as Congress fails to act and state laws continue to fall under legal assault by the insurance industry. The issue at stake in the Illinois case is whether or not federal law prohibits the states from enacting measures to hold HMOs accountable, so it is up to Congress to resolve this issue by passing a federal patient bill of rights that establishes accountability as the law of the land.

The competing versions of the patient bill of rights that passed the House and Senate last year each included similar provisions on the right of patients to appeal HMO denials to independent medical reviewers. The College suggested that the remaining disagreements over health plan liability, which has blocked final action on the bills, could be resolved if all sides were willing to compromise.

"At a minimum, federal law should "do no harm" by striking down state laws to hold managed care plans accountable", said Dr. Hall. "We urge Congress to act to stop the managed care industry from trying to take us back to the days when HMOs could deny services without having to answer to anyone."

ACP-ASIM is the nation's largest medical specialty organization and the second largest physician group. Membership encompasses more than 115,000 internal medicine physicians and medical students. Internists are the major providers of medical care to adults in America.

Jennifer Whalen, (202) 261-4575
Jack Pope, (202) 261-4556

Page updated: 11-04-03

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