Establishing Right to Sue HMO in PA - HMO Malpractice
The parent’s were expecting the birth of their first baby. The parents, both professionals, were members of an HMO. In order to be seen by a doctor, they were required by the terms of their HMO to call a “triage” telephone number to obtain permission. At one point during her pregnancy, the mother began experiencing severe abdominal pains and nausea. Despite many calls to the HMO triage number, she was not authorized to go to a hospital for these complaints. Ultimately, the mother went to a more distant regional medical center despite the initial denial from the HMO. At the hospital, she was immediately determined to be in pre-term labor; however, by that time, her baby could not be saved and the baby died shortly after an emergency C-section.
Suit was filed in Allegheny County Pennsylvania and, after a week-long trial, a judge dismissed the case before it was sent to the jury on the grounds that an HMO could not be sued in Pennsylvania for medical malpractice.
Harry S. Cohen & Associates successfully convinced the Superior Court of Pennsylvania to issue a landmark decision holding that, from then on, HMOs could be sued in Pennsylvania when their control over their member’s healthcare amounts to practicing medicine. The Shannon case was sent back for another trial. During the second trial, a substantial settlement was reached.