The first patient had undergone a hysterectomy and abdominal surgery. But her insurance plan only allowed a one-day hospital stay, even though her doctor said she needed to stay longer. She was sent home - only to be rushed back to the emergency room the next day.
The second patient was prescribed an anti-inflammatory drug for his arthritis. But his insurance plan required him to use a cheaper drug, even though his doctor was worried about that drug's potential side effect of abdominal bleeding. His doctor was right. He almost bled to death.
These were the cases that came to the U.S. Supreme Court last week along with this key question: Can the states pass their own laws that allow patients to sue HMOs for denying them coverage?
Unfortunately for patients, federal law passed by Congress was pretty clear, and the Supreme Court ruled unanimously. Federal law is controlling, and the 10 states that allowed these kind of lawsuits were wrong. (Florida was not among those states - heck, you think our Legislature would ever pass a law like that?)
Justice Clarence Thomas, who wrote the Supreme Court's opinion, helpfully pointed out that patients who are denied medical care by their HMO always could choose to pay for it out of their own pockets.
The court ruling was front-page news for a day, then slipped out of sight. It did not have any lasting outrage quotient, since all sides agreed that the court's ruling was "correct."
Legally, maybe it was correct.
But morally, this leaves American patients in a situation straight out of Dickens, or if you prefer something more modern, Catch-22.
States can't allow patients to sue HMOs. That has to happen under federal law.
But - whoops! What do you know! - federal law doesn't allow it in any meaningful way.
This suits the insurance industry just fine. An industry spokeswoman called the court ruling "a victory for health-care consumers and employers."
She meant "victory," presumably, in the same sense that the events at the Little Big Horn were a "victory" for Custer.
Where does the responsibility for this situation lie?
Squarely with Congress.
Congress has been trying and failing since 1999 to pass a patients' bill of rights law that would give patients some kind of recourse.
Oh, sure, they've talked about it. Everybody claims they're for it, from President Bush on down. Bush even campaigned on it.
Versions of a patients' bill of rights were passed in 1999, and again in 2001. But the same version of the bill was never passed by the Senate and House.
One sticking point was the Republican majority in the House wanted strict caps on lawsuit damages. It's sort of a fetish with those guys, who consider lawsuits against big corporations to be a worse threat to our society than patients wrongly denied medical care.
In 2001, the bill appeared to be all set to pass, but then the very night before the vote, the House leadership and the White House cooked up an amendment that would have gutted the whole bill.
So I politely suggest to you that you judge your member of Congress not by what he or she says they support, not by all the slogans and double-talk, but by the results so far.
As my grandmother used to say, the proof of the pudding is in the eating. In this case, there ain't no pudding on the table at all.
* * *
Florida, like many states, does have an appeals process for patients denied coverage by their HMOs, once they have exhausted their insurer's internal grievance process.
The office in charge has a long, bureaucratic name. Its web site is filled with gobbledygook. Nonetheless, if you are persistent, you have a chance.
You can contact the office by writing SPSAP, 2727 Mahan Drive, Fort Knox No. 1, Suite 339, Tallahassee, FL 32308. You can call 1-888-419-3456 or 1-850-921-5458. You can fax 1-850-413-0900. You can e-mail http://www.fdhc.state.fl.us/MCHQ/ Consumer/SPSAP/.
