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Wednesday, October 21, 1998

Lawyer files malpractice lawsuit against Texas HMO

By DAVID KOENIG Associated Press Writer

DALLAS (AP) - NYLCare is facing what appears to be the HMO industry's first malpractice lawsuit in Texas, filed by the family of a Fort Worth man claiming he was wrongly released from a psychiatric ward hours just before killing himself.

Joseph W. Plocica, 68, drank a half-gallon of antifreeze the night after he was released from All Saints Hospital in Fort Worth, according to a suit filed Monday in Tarrant County. He died nine days later, on July 17, 1998.

The suit alleges that a doctor working for NYLCare, Plocica's health maintenance organization, persuaded the hospital to discharge him "even though he was not yet medically stable, was still severely depressed and could not make a decision to go on living."

Fort Worth attorney George Parker Young said Plocica's psychiatrist wanted him to stay at the hospital up to two more weeks, but that a doctor for NYLCare's contractor, Merit Behavioral Care Corp., indicated the HMO would not pay for additional hospitalization.

Young said Plocica's doctor indicated the man wasn't ready to be released, but that NYLCare and Merit "controlled or influenced" the hospital's decision to discharge him.

Bill Blunt, an attorney for NYLCare, declined to discuss the Plocica case but said HMOs do not decide whether a patient is discharged, only whether to continue paying for hospitalization.

"The only decisions that we make have to do with insurance coverage. We don't make decisions that people get discharged or treated or not treated," Blunt said. "We have a procedure that involves doctors and nurses that review coverage decisions."

Texas in 1997 became the only state to allow patients and their families to sue health plans for medical malpractice. Plaintiff's lawyers say several more suits like the Plocicas' will be filed in coming weeks.

Employers and insurers say even the threat of lawsuits, not to mention big adverse judgments, could push premiums higher.

"When the first (malpractice) lawsuit goes against them, the industry will react negatively, and we'll start to see higher premiums. Those will be passed on to employees," said Bill Jones, owner of Materials Transportation Co. in Temple.

The Texas Association of Business and Chambers of Commerce plans to lobby next year's Legislature to cap the amount a patient can win in a malpractice lawsuit, said Richard Stone, a consultant for the group. He said there is no chance the Legislature would vote for outright repeal of the malpractice law.

NYLCare's parent company, Aetna U.S. Healthcare of Hartford, Conn., sued to block the Texas law, but a federal judge in Houston last month upheld the right of patients to sue health plans for malpractice.

Young, the Plocicas' lawyer, said he doesn't expect a flood of litigation.

"I tell other lawyers HMOs are big. They go hire very expensive lawyers and fight you tooth and nail on every scrap of paper," Young said. "If it's a screwup by a doctor or nurse or hospital, sue them; don't go suing the HMO."