08/14/03 - Humana denies care for critically injured child

Humana denies care for critically injured child

WEST PALM BEACH, FL - When special education teacher, Frederick Haddad opted to purchase family health/medical insurance coverage through his employer the Pinellas County School System, he did his homework, so to speak. Mr. Haddad read the policy, understood the coverage, and paid the premium as outlined by his employer and Humana. Little did the lauded teacher ever think that he would ever be in a battle with an insurance company over his young daughter's life.

On February 26, 2001, a car struck young, Julia Haddad. The accident caused an immediate subdural bleed, traumatic brain injury and multiple fractures. Julia was rushed to All Children's Hospital in St. Petersburg, Florida, where she spent six weeks in the intensive care unit, two of those weeks sedated because of her head injuries. She remained on assisted breathing until the day she was transferred to Bayfront Hospital to begin brain rehabilitation.

Upset and frightened for his daughter's life, Haddad spent much of his time by her side. Little did he know at the time that her condition would become even more threatening because of his insurance carrier, Humana. In late March of 2001, Julia's physicians prescribed various therapies and treatments as part of brain rehabilitation, which included admission to Bayfront. However, without Haddad's knowledge or that of many of his daughter's physicians, Humana had her assessed by Palms of Pasadena, which has a convalescent section for children, but could not provide the treatment medically prescribed for Julia. The young girl remained in intensive care, without therapy or treatment because Humana refused to find her the prescribed services. It took Haddad pressing Julia's physician and the intervention of a U.S. Congressman that he contacted to have Julia transferred to Bayfront. All while Haddad's policy stated that Humana was responsible for payment of his daughter's physician prescribed treatment.

More than five weeks after Julia was admitted to Bayfront, Frederick Haddad received a call from his daughter's caseworker at the facility, stating that his daughter had to be dismissed because her Humana coverage had run out. Again, Haddad knew this was inaccurate and that Humana was simply denying coverage. However, Haddad did not have the money to pay Bayfront, thus Julia was discharged. Humana refused a home health aide for Julia - again prescribed by a physician and covered in the policy. Instead the company authorized, nothing more than a domestic aide to change Julia's bed and help with her bath.

Julia Haddad needed physician prescribed speech/cognitive, occupational and physical therapy, which would have been received at Bayfront. Human however decided she would be sent a therapist one time and made no attempt to find or send another for the girl. Humana continued to deny and delay different forms of therapy for weeks. Haddad called, and finally Humana responded when the State Department of Insurance called. "It took all of this to get an authorization, and all the while Julia Haddad was lying in a bed, basically going backwards in progress and loosing out on her window of opportunity," said Theodore Leopold of the law firm Ricci ~ Leopold who represents the Haddad family.

"Julia had been assessed for therapies from numerous physicians and treatment centers, and all confirm that she was critically deprived of it because of Humana. This young girl could not stand straight, hold her hands up in the air, and when she closed her eyes she fell. Yet, even though she had coverage, Humana continued to say no, we won't pay for what is prescribed and covered," added Leopold.

This nightmare for the Haddad's caused by Humana did not end here. Shortly after her discharge from Bayfront, Julia started running a high temperature and experiencing great pain, yet could not explain where it hurt. Her father noticed a small red patch on the lower left leg, which was still healing from a compound fracture caused in the accident. The next morning, Haddad made an emergency appointment with Julia's primary care physician. However, before the appointment could be kept, it was determined she needed immediate - emergency blood work, and her physician sent her to All Children's for the tests. Upon arrival at the hospital, Haddad learned Humana had denied authorization for the emergency tests. The doctor attempted to intervene on behalf of the family, but Humana persisted, making the family drive across St. Petersburg to another laboratory facility. Since Julia was in such severe pain her father chose not to make the drive across town, and All Children's agreed to admit her immediately - without the Humana approval.

Hours later Julia Haddad underwent emergency surgery to remove the pins in her legs and was diagnosed with a life threatening blood borne fungal infection. She remained at All Children's for the next month on IV therapy for the infection. A hole had been created in her left leg to let the infection drain. In order to allow her to leave the hospital after one month, Julia's doctors determined that she need a Broviak line installed for administering IV treatments, along with attendant home health care. Julia Haddad was discharged with a 24-hour doctor ordered medical supervision prescription. "Amazingly, Humana denied this order and told Mr. Haddad that he 'could and should train' to provide his daughter with the care she needed," said Leopold. "Humana made this decision even though the company knew that a licensed nurse must be specially certified to use a Broviak line, and that this young girl had a hole in her leg that needed the care of a trained medical professional," he added.

Finally, Humana relented and authorized a nurse to administer the drugs through the line, however, quickly withdrew this care and provided someone to change the dressing on her wound and the bed sheets.

Frederick Haddad quite his teaching job to care for his daughter. He was not trained as a nurse, however Humana withheld his contracted coverage, and he had and has no option. Today, Julia Haddad still suffers. Had her care been authorized as the policy outlines, Julia's rehabilitation would be months if not years ahead.

"This family has been through hell and back, both physically, emotionally and financially," said Leopold. "Humana has proceeded in this matter by violating the terms of the coverage contract, they have dealt in bad faith and have showed absolutely no fairness in dealing with this family. Not only that, Humana has proven beyond doubt that Julia Haddad's life, well-being and future are worthless to them. She is a liability, as it would seem any person who costs Humana money is. Humana has taken the stance, wear this family down, deny coverage even though a policy states it is there and they will go away. This is not the first case we have seen Humana treat children as if they don't exist. Several years ago we represented a Cerebral Palsy child and the jury punished Humana by awarding the largest punitive damage judgment in Florida history. What they continue to do every day to good people who pay their premiums is a crime," he concluded.

Theodore J. Leopold is a partner in the law firm of Ricci ~ Leopold, P.A. The firm founded in 1982, headquartered in West Palm Beach, Florida, with offices located at 1645 Palm Beach Lakes Boulevard. Mr. Leopold can be contacted at 561-684-6500. Additional information about Ricci ~ Leopold and this case may be obtained from the firm's website at www.riccilaw.com.