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Read Making a Killing

home / healthcare / patient stories

PATIENT STORY

HMO Fails Bone Cancer Patient

Shirley Moore - Union City, CA
As told by her daughter, Norma Lowe:

In January 1997, my mother went to her HMO with pain in her right ribs and a heavy cold. After a chest X-ray was taken, the doctor diagnosed lung cancer. What the HMO's doctor failed to diagnose was that my mother also had bone cancer. Mom asked the doctor why she was having so much pain on her right side, since the lung cancer is on the left. The HMO doctor looked at her X-ray and said she had a cracked rib, yet the written report says "evidence of an old fracture."

The HMO's doctor did not make any further investigations despite my mother's complaints of rib pain. A course of treatment was decided upon, consisting of chemotherapy and radiation therapy. Mother had to be hospitalized on more than one occasion during her chemotherapy treatment. For example, during one chemotherapy treatment she was given too much intravenous fluid, causing her to go into congestive heart failure. We were also very disappointed to note that the doctor treating her cancer never visited her while she was in the hospital to check on her.

After the chemotherapy, mom was referred to a non-HMO hospital to receive radiation therapy. The doctor at this hospital requested a bone scan be performed, because he was concerned about my mother's complaints of rib pain. This bone scan was performed at the original HMO on April 24. No one called us from the HMO to tell us the results!

My mother returned to the other hospital a week later where the non-HMO doctor presumed we had been informed of the results of the bone scan. He was shocked to learn we had not, especially since the scan showed that my mother had bone cancer. We found this lack of communication to be totally and completely unacceptable.

We then made an appointment to see our HMO doctor on May 5. We were told that my mother did not have the HMO's coverage. We tried to explain there was a clerical error and that my mother was covered. Even after we gave the name and number of a person who could verify this, they insisted we pay for the visit. We were embarrassed and humiliated in full view of other patients.

Our HMO doctor then scheduled a CAT scan for my mother. The results of the scan showed that the cancer had spread and was going to continue to. However, the HMO doctor failed to diagnose a cancerous cyst on my mother's spinal cord. She was crippled as a result of this cyst.

My mother succumbed to the cancer on October 28, 1997.

We are very dissatisfied with the continuity of care provided to our mother by her HMO. We are especially upset about the lack of pain management she received. Cancer that affects the bones is extremely painful, yet they failed to give her proper pain medication on numerous occasions. We wanted to be assured by the HMO that necessary medical care be given to our mother, and that she would be treated in a caring, courteous and professional manner. We feel the care was substandard and our mother was misdiagnosed and improperly treated.

Unfortunately, my mother received her health care through her employer, so the HMO is protected by a loophole in the federal ERISA law. Therefore, we are unable to recover damages. If the HMO feared such damages, maybe they would have been more concerned about my mother's care.



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