HMO’s Fatal Mistake

Kelley | Uustal was involved in an HMO negligence case involving the death of a 6-year-old girl. She was taken to her pediatrician for treatment of persistent vomiting. Her doctor correctly recognized that this could be a sign of a brain tumor. As a result, he ordered a CT scan. The request was rejected by the HMO for the reason that it was “not medically indicated.”

Months later, the little girl started screaming and holding her head. The tumor had expanded to the point that it eventually resulted in her death. It turned out to be a fast-growing benign tumor that would have been treatable back when the HMO rejected the doctor’s request for a CT scan. With our help, the family was able to recover $7 million in damages. HMOs do not have absolute immunity in Florida.

John Uustal, who represented the family, moved the Court for an order allowing a claim for “punitive damages,” which are intended to punish intentional misconduct. The Court granted the motion and allowed the family to assert their claim.

Prior to trial, the girl’s family settled with the HMO and other defendants. Because of this case, the HMO no longer requires pre-approval for CT scans.

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