Panel Split on Recourse for Patients Denied Care

An advisory commission handpicked by President Clinton failed Wednesday to agree on ways to compensate patients who suffer harm when their managed-care network or other health plan denies them treatment.

Commission members’ impassioned debate over this compensation issue, which some believe is the single most important right that patients ought to have, stands in stark contrast to their consensus on the general patients’ “bill of rights” that they presented to Clinton in November.

Clinton has endorsed the rights and last week ordered all federally administered health plans to comply with it.

Panel members said Wednesday that all they could agree on was a statement noting that compensation of victims is a problem and that they should present options to the president for dealing with it. These might include allowing patients to sue health plans under state malpractice laws or changing current federal law, which limits compensation to the cost of the benefit denied. However, some commission members were leery of going even that far.

The commission’s failure to deal with the controversial question of legal remedies leaves Clinton on his own to decide whether patients who are harmed should be able to sue their health plans under state law, whether there should be some form of federal compensation available to them or whether there should be some other approach.

“We never expected consensus on this issue but look forward to seeing viable options for the president and the Congress to consider,” said a White House official. “We want to look at what the Democrats decide to do also,” the official said.

Democrats in the House and Senate are drafting their own patients’ bill of rights, slated to be introduced in the next few weeks, and are planning to include a provision allowing patients to sue health plans under state malpractice laws.

Under current law, the majority of people covered through private employer-provided health insurance can receive little if any compensation if a health plan’s decision results in harm or death. Patients can sue physicians, but not health plans, for malpractice.

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The 34-member Advisory Commission on Consumer Protection and Quality in the Health Care Industry, which has been working for a year on a patients’ bill of rights and other ways to improve health quality, includes executives of managed care companies, employers, doctors and health lawyers.

The rights they endorsed included: access to specialists, an internal and external process for appealing health plans’ decisions and coverage of emergency room treatment if a “prudent layperson” would reasonably believe that the absence of care would result in injury or death.

The commission’s final report on how to improve the quality of health care and consumer protection is scheduled to go to the president March 30.

At the crux of Wednesday’s debate were employers’ and insurers’ concerns that, if patients had the right to sue health plans for denial of treatment, their costs would skyrocket. Consumer advocates argued, in response, that the current system leaves patients with no bargaining power.