Alexander Giles, 9 – Houston, TX
Alex Giles’ managed care plan doctor failed to give him crucial cardiac tests and to refer him to a cardiologist, resulting in the needless death of the athletic nine-year-old, according to a lawsuit filed by his family. Bridget Giles, Alex’s mother, claims the health plan’s doctor ignored obvious symptoms that require routine tests which could have saved Alex’s life. The company maintains that all claims against it are preeempted under ERISA and should be removed to federal court where no damages are available. The company is trying to appeal the case.
According to court documents:
The health plan doctor saw Alex twice, less than two months before his death. At the first appointment in 1995, the company’s physician noted that Alex had fainted on three occasions while playing basketball, including one episode resulting in an emergency room visit. Fainting during exertion is a serious medical indication that should have been evaluated immediately because it suggests a cardiac-related problem. Not only did the health plan doctor fail to order any tests, but he also failed to obtain an appropriate history of Alex’s condition. The doctor did not even take Alex’s blood pressure, pulse, or respiratory rate.
The managed care doctor should have recognized the potential seriousness of Alex’s condition and referred him to a pediatric cardiologist. Instead, Bridget Giles was simply told to give Alex Gatorade.
Two weeks after the first visit, Alex fainted again. A day later, he saw the same plan doctor. On this subsequent visit, the company’s doctor again failed to gather an adequate history of the condition and took only Alex’s blood pressure. The doctor did order a blood test and planned to do an EKG, but he never followed through with the test.
Two weeks later, at the frantic demand of Ms. Giles, the plan doctor relented and referred Alex to a pediatric ear, nose and throat doctor. The specialist referred Alex to a pediatric neurologist. Unfortunately, the original plan physician failed to follow Alex’s condition and never obtained the critical cardiology consult which would have saved Alex’s life. Alex’s cardiac condition went untreated and he tragically died shortly afterward undiagnosed.
If the managed care company has its way in court and removes the case under ERISA, Ms. Giles will be unable to recover any damages for her son’s delayed care and wrongful death from the plan. Since Alex died before getting his treatment, the managed care company, under ERISA, can be held liable for nothing in the case of Alex Giles.
