HMOs Can Be Sued For Negligence, Court Rules
The Hartford Courant
October 27, 1998
In a landmark decision that may affect HMOs across the country, a Connecticut federal court judge ruled that HMOs could be sued for medical malpractice if they fail to provide access to health care services.
The ruling came in the case of a Brookfield boy who committed suicide in July 1995 after Physicians Health Services (PHS) refused to pay for his hospitalization.
Distraught over his sister’s death from a brain tumor, 16-year-old Nitai Moscovitch attempted suicide twice and confessed suicidal thoughts to his mother. He was admitted to Danbury Hospital, but PHS dismissed the diagnosis of depression and suicidal tendencies as ‘manipulation’ and had him moved to a drug treatment center. The same day he was transferred, Nitai hanged himself.
Lawyer Karen Koskoff, representing the Moscovitch family, filed suit against PHS despite a federal law barring claims based on denial of insurance benefits. The judge ruled in her favor, saying that the Moscovitch case was not about denial of benefits or about the plan’s coverage, but rather it focused on the quality of care dictated by the HMO. The case is set to go to trial