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Read Making a Killing

home / healthcare / patient stories

PATIENT STORY

Baby Blind Because of HMO Denials

Madison Scott - Orange County, CA
Madison Scott was born premature, but otherwise healthy. Today she is permanently and completely blind. Her parents, Curt and Helen Scott, claim the HMO they counted on to care for her was more worried about saving dollars than it was about saving her sight. Yet, because the Scott's receive their health care through their employer, they have no remedy against their HMO.

According to personal accounts:

Madison was born three months premature. She was at extreme risk for a condition known as Retinopathy of Prematurity or ROP. Extra care is required to protect the vision of premature newborns, because the extra oxygen they receive after birth can cause blindness if not properly monitored. ROP is very treatable if monitored closely, and treatment stops the disease if started early enough.

Madison was examined by a pediatric Opthamologist, six weeks after her birth, for signs of ROP. However, he -- like her other HMO doctors who received financial incentives to delay treatment -- didn't discuss the seriousness of Madison's condition with her parents or perform the exam needed to determine her treatment. Nor did the doctor tell Madison's parents that Madison could go blind if proper care and monitoring wasn't done.

Later, the HMO delayed approval of the referral for the test, and consequently, Madison wasn't seen by the eye specialist for weeks. When the opthamologist finally saw her, the examination revealed that the ROP disease had progressed significantly. It was only then that Madison's parents were told that their daughter had a disease that causes blindness. Her condition was so serious that the doctor set an appointment for the same day with another eye specialist. That specialist told Madison's parents that the disease had progressed to the last stage and immediate surgery was required to try to save their baby daughter's sight.

Madison's parents decided to take her to a specialist outside of the HMO network for a second opinion, at the Jules Stein Eye Institute at UCLA. The doctor from the Institute told them that he wanted to do surgery on Madison the next day in order to try to save her sight. Her parents called their HMO for approval of the emergency surgery. The HMO refused to give approval for the last opportunity to save Madison's vision.

After five failed surgeries, over the course of 3 weeks, doctors told Madison's parents that 3 month old Madison was completely and permanently blind.

Her parents cannot seek damages against their HMO for Madison's future medical bills, because the ERISA law preempts state law causes of action for damages. Pending federal legislation would restore the Scott's state court remedies.





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