Paige Lancaster – Virginia

Eleven year-old Paige Lancaster’s HMO delayed giving her important medical tests for her frequent headaches, letting a tumor grow unchecked for four years. According to the Lancasters, the HMO had an incentive program in place to pay bonuses to physicians who avoided "excessive" care.

According to court records:

In l99l, Mrs. Lancaster took Paige to their HMO, because of her daughter’s frequent headaches and nausea. For the next four years, Paige repeatedly visited the HMO’s pediatricians for the headaches, but she was never once referred to a neurologist or given any other diagnostic test to understand the causes of the headaches.

Finally, in May 1996, after Paige’s school psychologist wrote a letter to the HMO urging the company to perform diagnostic tests to understand the debilitating headaches, her HMO doctors ordered tests. They discovered a right frontal tumor and cystic mass over 40% of Paige’s brain. A week later, she underwent surgery.

However, because of the tumor’s size and maturity, the surgery was unsuccessful, requiring Paige to undergo several more surgeries and radiation therapy.

Unfortunately, when the Lancasters tried to hold their HMO responsible for the delayed care, and to recover their costs, they found their case fell under the ERISA loophole. The District Court of Eastern Virginia had no choice but to dismiss the Lancasters’ claims for negligence and fraud against the HMO.