(December 19, 2013) GALVESTON, Texas (CN) - A little girl died when a Dominican hospital botched her appendicitis surgery because Blue Cross would not cover a flight to the United States, her parents claim in court.
Marissett and Francisco Tolentino sued Health Care Service Corp. dba Blue Cross Blue Shield of Texas, for their late, 6-year-old daughter Isabella, in Galveston County Court.
The Tolentinos were vacationing at a Dominican Republic resort when Isabella "experienced sharp pains in her stomach, in addition to occasional chills and fever," they say in the lawsuit.
One reason they picked the resort, they say, is that its doctor was a member of the Blue Cross network.
He recommended that the couple take Isabella to the nearby Hospiten Bavaro, a Blue Cross in-network hospital.
"The staff at Hospiten Bavaro performed various tests and diagnosed Isabella with appendicitis, which would require surgery," the complaint states.
"Plaintiffs were not comfortable with the idea of subjecting their daughter to a procedure in a foreign hospital that may not meet the standards of professionalism and care of an American hospital, and they expressed their desire to have Isabella transferred to the United States."
Hospiten Bavaro's doctors agreed that a commercial flight would be too risky for the girl, and recommended she be flown to the States on a medical jet, the Tolentinos say.
"Plaintiffs spoke to BCBS about this possibility and were told by them that this service was unavailable because, in their opinion, the medical condition was not severe enough. BCBS also dismissed plaintiffs' concerns about Hospiten Bavaro by saying that they had dealt with them on a regular basis and trusted their expertise," the complaint states.
But the Tolentinos say they had good reason to worry as Isabella vomited while knocked out for the surgery and blood clogged her intubation.
Isabella also showed signs of low oxygen, but Hospiten Bavaro's staff told the Tolentinos not to worry, the couple says.
"The next morning, around 7 a.m., Isabella was still in critical condition," her parents say.
Blue Cross "was fully aware of the severity of Isabella's condition but still had not authorized the medical jet," the Tolentinos say.
Blue Cross insisted on delaying the flight until Hospiten's doctors sent a report to doctors in Miami, where Isabella would be transferred, wasting "precious time that could have saved Isabella's life," the complaint states.
Blue Cross "displayed no sense of urgency in getting Isabella to the United States" and would not send a jet until the Tolentinos paid for the flight, the couple claims.
Finally, the Tolentinos say, Blue Cross told them the flight would arrive at 10 a.m. the next day. It showed up at 2 p.m.
Frantic to save Isabella's life, the Miami hospital staff checked her intubation and found it was clogged with mucus, and "the tube itself was entirely too small for someone of her age and size" just the sort of error by Hospiten Bravo that the Tolentinos were worried about, they say.
By the time the Miami doctors ran tests on Isabella it was too late: the oxygen deprivation had damaged her brain and she began having seizures, her parents say.
"Isabella was pronounced dead at the hospital in Miami," the couple says.
The Tolentinos seek damages and treble damages for Isabella's pain and suffering, their own mental anguish, and for deceptive trade, negligence under the Health Care Liability Act, and Texas Insurance Code violations.
They are represented by Jacob De Leon of Houston.
A Blue Cross spokesman declined comment.