A big shift in Senator John Ashcroft’s stance on managed health care. He’s telling reporters he thinks new HMO legislation should allow patients to sue their managed care organizations. Until this week, Ashcroft had backed a republican-backed HMO plan that didn’t allow patients to sue. In the system he describes, a patient would have access to a fast-track appeal process headed by a doctor at the time a dispute arises. If the patient loses the appeal, the HMO chooses the course of action for care. Only after the care–or lack of it–if a patient shows damage from the decision, can the HMO be sued. Ashcroft refused comment on specifics of what he would require of the bill to vote for it.