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House votes to allow consumers to sue HMOs

March 24, 1997
By: Angela Greiling
State Capital Bureau

JEFFERSON CITY - The Missouri House voted soundly to give consumers the right to sue their managed care companies.

During Monday's debate over managed care regulation, House members voted 124-17 to retain a section of the bill that would make managed care providers liable for their medical decisions. Current state law explicitly excludes HMOs from the definition of medical practice and, thus, exempt from medical malpractice suits.

"It's a terrible, terrible law," Rep. John Griesheimer, R-Washington, said of the existing statute.

"The industry is practicing (medicine) and has been practicing," said Rep. Mary Bland, D-Kansas City. "People never imagined the industry would be practicing instead of trained medical providers."

The managed care regulation bill, which was drafted by a joint interim committee that met during the summer and fall, would impose statewide regulations on HMO industry.

"We're not talking about filing lawsuits against HMOs," said bill sponsor Tim Harlan, D-Columbia. "We're talking about liability."

Harlan said HMO representatives argue their job is simply to approve or disapprove cost issues for the company. In that process, Harlan said, HMOs act as medical providers by determining whether medical treatment will take place based on their willingness to pay for it.

The concern for HMO liability arose during the interim committee's hearing process, during which they heard testimony from numerous people. Those included physicians and dentists who testified that HMOs can be the bottom line in medical decisions, and therefore should be considered medical providers for liability purposes.

"We think they (HMOs) will make better decisions if they know they are liable," Harlan said.

The House also voted down an amendment that would have allowed consumers to buy more than one month's supply of a drug at a time.

"I take two medications daily, and my health care plan says that I have to renew those every 30 days," said amendment sponsor Joan Barry, D-St. Louis.

Harlan, who voted against the amendment, said there were several reasons for his decision.

"There is sometimes a question of fraud," he said, meaning that people could potentially sell excess drugs.

He also said avoiding adding additional costs to the bill was a concern, as was limiting the number of specific mandates it includes.

While debating various aspects of the HMO package, the House has yet to get to a vote on the package itself.