WASHINGTON - (KRT) - The ordeal of two Texas HMO patients was the subject of a lively Supreme Court argument Tuesday, but the justices seemed to have little sympathy for their legal case, which hinged on the ability to sue insurers in state court.

Fort Worth, Texas, lawyer George Parker Young, representing Juan Davila of Denton and Ruby Calad of Sugar Land, argued that his clients had been wrongfully denied proper care and should be able to sue their HMOs under Texas state law instead of federal law.

Davila's insurer, Aetna, denied payment for Vioxx, a brand name prescription drug, and he developed bleeding ulcers after using a cheaper drug that his doctor prescribed. Calad developed complications after a hysterectomy because she was discharged from a hospital after only a day, a limit set by Cigna policy.

But Young, who was allotted 20 minutes to argue his case Tuesday, found strong resistance among the justices to his argument that state law should prevail over the federal Employee Retirement Income Security Act, the 1974 law that sets standards for private employers' pension and health plans.

ERISA has a pre-emption clause that would force insurance lawsuits into federal court and limit claimants to no more than the value of the benefit the health maintenance organization did not provide. In state court, Young's clients could look forward to large jury awards.

"States should have the power to regulate HMO medical decisions," Young said.

"That seems to be what that (federal) statute forbids, and I don't see how you get around it," Justice Stephen Breyer said.

Justice Antonin Scalia sharply disputed Young's statement that Texas, in its patients' bill of rights law, had laid out a professional medical standard of care and that without it, an HMO could even rely on "the medical necessity of a witch doctor."

"They would be subject to an appeal," Scalia said. "They would be liable for damages."

Scalia appeared to dismiss the argument that Davila was effectively denied proper care by the HMO. "All you're talking about here is money," said Scalia, who noted that the patient could have purchased the drug himself.

The HMOs contend that the decisions are not about treatment, but about reimbursement. And several justices said the patients could use the appeal process - not pursued by Davila or Calad.

The session was high profile inside and outside the court. Miguel Estrada, former U.S. Court of Appeals nominee, represented Aetna and Cigna.

Outside the court, Sen. Edward Kennedy, D-Mass., and Rep. John Dingell, R-Mich., held a press conference on the steps in support of a patient's right to sue in state court.

"Whom do you trust to make health care decisions for you - your doctor or an HMO bureaucrat?" Kennedy asked. "That's what this case is all about."

Kennedy, who was in Congress when the ERISA law was passed, said, "Congress never intended that law to be used to interfere with a patient's right to quality health care."

Kennedy and Dingell said that the case would galvanize supporters of the federal patients' bill of rights bill to revisit the legislation. The bill passed the Senate but collapsed in 2001 over the issue of the right to sue in state court.

Ron Pollack, executive director of Families USA, an organization that lobbies on medical care, said he still hopes the court would find in favor of Young's clients despite the seeming opposition of a majority of the nine justices.

"What you see in court isn't necessarily what you get when a decision comes out," Pollack said.

Young also said that oral arguments do not necessarily predict the outcome and many times he thought he had lost a case only to win it decisively. This was Young's first appearance before the Supreme Court and he was accompanied by Rep. Pete Sessions, R-Dallas, a fraternity brother from Southwestern University.

A ruling is expected in June or July and the decision will impact Texas and nine other states - Arizona, California, Georgia, Louisiana, Maine, New Jersey, Oklahoma, Washington and West Virginia - that regulate HMO treatment.

Supporting Young's position was Texas Assistant Attorney General David Mattax, who argued on behalf of the Texas law. James Feldman, assistant to the Solicitor General, argued on behalf of the Justice Department and the HMO position.