New Jersey Assembly Set to Pass Patients’ Rights Bill

While Congress "grabs the headlines" in a fight over a federal patients' rights bill, New Jersey lawmakers this week will likely pass "one of the strongest laws in the nation" that allows patients to sue HMOs, the Bergen Record reports. The bill (A 3136), sponsored by Assembly members Guy Talarico (R), John Kelly (R), Steven Corodemus (R) and Reed Gusciora (D), would allow patients to sue HMOs and health plans for delays or denials of care that lead to death or "serious harm." According to the legislation, "Since the carriers are, in many instances, making medical decisions when they deny, delay or diminish health care treatments, they should be held to the same level of legal responsibility as physicians and other health care providers." The legislation would establish a "two-tiered system," allowing patients with the "most urgent risk of harm" to bypass a state appeals panel and sue in court, while patients with "less imminent" risk must undergo a three-step appeals process before filing a lawsuit. Under the bill, patients may only bypass the appeals process when delays or denials of care "cause an immediate risk of death, loss of an organ or limb, worsening of a life-threatening disease or condition, chronic and significant pain, or a problem that results in substantial need for additional medical treatment." Other patients must first appeal the decision to an HMO medical director, a panel convened by the HMO and an external review panel convened by the state before suing health plans in court. The legislation shields employers and trade unions from lawsuits in health care disputes. The Record reports that the bill "appears nearly certain to pass" in the state Assembly on June 28 and will likely "win a quick concurrence" from the state Senate, which passed a similar version (S 1333) last October. Acting Gov. Donald DiFrancesco (R) has promised to sign the bill (Washburn, Bergen Record, 6/26).