Two medical patients ask the Supreme Court to declare that HMOs can be sued for medical malpractice over their coverage decisions. In separate cases, Juan Davila and Ruby Calad claim that refusals by their HMOs to pay for care recommended by their doctors caused them injuries. The HMOs say the decisions were financial, involving what care they would pay for, not medical decisions about what treatment was appropriate for the patients.
- A ruling for the HMOs would settle an issue working its way through the nation's courts about whether health maintenance organizations can be sued for malpractice over their coverage decisions. If they win, Congress would face the decision of whether to pass a law creating the right to sue.
- A ruling in favor of the patients would expose the nation's HMOs to medical malpractice suits over their coverage decisions with potentially high damages. HMOs claim such an outcome would force them to increase the cost of their coverage.
