Our readers and commenters knew more than we did about that case referenced week before last in which the New Mexico courts are deciding whether a Texas doctor can be sued under New Mexico’s relatively pro-plaintiff law over care delivered in the Lone Star State, following a patient’s referral by a New Mexico health insurance plan. Alarmed at the ruling, some Texas docs are threatening to not accept New Mexico patients. You can find more coverage of Montano v. Frezza by Josie Ortegon at El Paso’s KVIA, and the Texas Alliance For Patient Access has a website about the case, which has drawn amicus briefs from organizations that include the University of Texas System and Texas Medical Liability Trust. Samuel Walker of McGinn, Carpenter, Montoya, and Love provides a plaintiff’s-side view of the issues in the several related Frezza suits.
7 Comments
I think it is more complex than you put it.
Apparently, the Plaintiff’s health care plan would only authorize her to go to Texas for treatment. She did not have much choice. This is more a testament to the lack of health care in the rural southwest (as well as the massive distances involved) than anything else.
I am concerned about the decision finding New Mexico has jurisdiction over this doctor. If it is because the doctor’a practice contracted with a New Mexico insurance company specifically to treat New Mexico residents, I guess that is something.
The net result of this may well be that New Mexico residents using New Mexico insurance may not be able to get care in Texas. That is the choice of the people of New Mexico.
IMHO, this is a complex public policy issue. I am not sure who is right. I am sure that the losers are residents in rural southwest New Mexico. I am also sure that I don’t really think it matters who wins. What matters is that there is certainty. If the doctors knew that they might be liable under New Mexico law, they would have made their practice choices accordingly.
Allan said, Apparently, the Plaintiff’s health care plan would only authorize her to go to Texas for treatment. She did not have much choice. This is more a testament to the lack of health care in the rural southwest (as well as the massive distances involved) than anything else.
Accepting this is true, I’ll note in passing that you aren’t required to use the Dr selected by your insurer, and that you can reviewer your insurer’s network of physicians when you select your health plan (and afterwards). On the surface, this appears to be little more than an attempt to extract financial compensation in response to a bad outcome in a high risk surgery. I have yet to see any surgeon, Dr., etc, guarantee an outcome. Here, Dr. Frezza apparently didn’t contract direction with the patient’s insurer Presbyterian Health Plans – the group practice he is part of (Texas Tech Physicians Associates) did. Dr. Frezza claims he had no authority to reject Presbyterian health Plans as a payer and didn’t seeks to gain them as a payer for the practice – no one seems to have opposed those claims – yet the NM Supremes are kicking it back down to the lower courts to explore the issues further.
Frankly, looks like a fishing expedition to find someone to hold responsible for NM’s lack of bariatric surgeons in the area…
Finally, I agree w/ Allen that the likely losers of this public policy debate – which is not being debated in the public, but rather being imposed by New Mexico judges – will be the residents of rural New Mexico. No one is weighing the costs of their potential loss of medical treatment against the injuries of a single patient (whether as result of malpractice or otherwise). Finally, where is the NM Insurance Commissioner in all this, who apparently approved an insurance plan that allegedly included no NM authorized Dr.s for this specialty/surgery?
Someone in Texas shoots a burglar who is visiting from NYC, which is perfectly justified under Texas law. Can said burglar [or his survivors] sue for damages under NY law, where self-defense with a gun is (almost) a capital crime?
Only if you also name the gun manufacturer and the shop where the firearm was sold, Great Unknown…
[…] to this report at Walter Olson’s Overlawyered blog, some Texas physicians are considering not accepting New […]
Ok constitutional guys. If I recall reaching across state lines and imposing any sort of burden has been found to be a violation of the commerce clause.
So far only the state courts have weighed in. Interstate commerce is not a state issue. Wait until the feds rule before you think of this as settled.