Justices to weigh patients' rights; Case is among nine court has added for review in new term; Cost-cutting issue


WASHINGTON -- Taking on a significant case on patients' rights, the Supreme Court agreed yesterday to decide whether it's legal for doctors to cut back on treatment to save money for a medical benefits group such as a health maintenance organization.

The outcome of an Illinois case may go far toward determining how much protection federal law will offer Americans in the face of cost-cutting efforts by "managed-care" plans.

The court, showing a fresh willingness to become involved in sensitive social issues, also agreed for the first time to sort out the rights of grandparents to visit their grandchildren when the parents object. It also agreed, for the fourth time in six years, to rule on the rights of anti-abortion demonstrators outside clinics.

In addition, the court took on a dispute over Congress' power to create new rights for women who are sexually assaulted, and the court added to its docket an unusual case over the right of an individual to sue local government officials for actions that show they are out to "get" that individual purely for spite.

The court agreed yesterday to hear nine new cases, beyond the 35 it had already promised to review in its term starting Monday. Justice Ruth Bader Ginsburg, though unable to be at the court after cancer surgery, took part in all of yesterday's actions.

In the patients' rights case, a federal appeals court ruled that it is illegal under federal law for doctors who make treatment decisions for patients in a medical benefits plan to be awarded financial incentives to save the plan money by providing less costly care.

The 7th U.S. Circuit Court of Appeals, based in Chicago, decided last year that those who make the key decisions for a benefits plan must do so only to further the interests of the patients, not the doctors' financial interests.

Anyone in the plan management, including doctors who determine the nature and duration of patient treatment, is obliged to protect the fund's assets for the patients' benefit, the appeals court said.

Broadly criticizing the trends in America's medical care, the appeals court said it feared that managing care has been replaced by managing costs.

A Bloomington, Ill., doctor and her HMO employer took the dispute to the Supreme Court, calling the appeals court ruling "dangerous and disruptive to health care providers and the nation's overall system of health care delivery."

This controversy, the doctor and the HMO contended, "is of profound national importance. Most contemporary welfare benefit plans provide for managed care, through HMOs or other devices." The appeals court ruling, they argued, makes the main type of organization used for medical care unlawful.

The case arose after a patient went to see the Bloomington doctor for an abdominal pain.

In her later lawsuit, the patient contended that the doctor found a small inflamed mass in the abdomen and directed treatment to be done eight days later at an HMO-owned facility 50 miles away rather than at a Bloomington hospital.

During the eight-day wait, the patient claimed, her appendix ruptured, resulting in peritonitis. She said this added further to the HMO's costs, so she sued the doctor to recover the expenses of her added care.

Her claim was dismissed in federal court, but it was reinstated during her appeal.

The other new cases the court took on yesterday involved these issues:

In the grandparents' visitation rights case, the court will be ruling on the constitutionality of a Washington state law that permits such visits over parents' objections.

The state Supreme Court, however, struck down that law, saying it amounted to government interference with the parents' constitutional right to raise their children as they preferred.

In the abortion protest case, the court will be deciding the constitutionality of a Colorado law that creates a 100-foot protected zone around all abortion clinics and bars protesters from approaching a patient by less than eight feet to try to dissuade her from getting an abortion. The Colorado Supreme Court upheld the law.

In the case involving citizens' lawsuits against local governments, the court will review the right of an Illinois woman to sue the village of Willowbrook for waiting three months to connect her to the city water system after her well broke down.

She claims that the city took out its spite on her for having won an earlier lawsuit against it for flood damage to her property.

The issue in the case is whether a single individual, not a member of a minority or vulnerable group, can claim to be a victim of discrimination under the Constitution.

Pub Date: 9/29/99

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