From Catastrophe to Court
Teenager Survived a Coma; Now Her Parents Are Battling Insurer

By David S. Hilzenrath
Washington Post Staff Writer
Sunday, February 28, 1999 8:54 PM

She was asleep in the passenger seat when the car carrying her back to a New Hampshire prep school in the fall of 1992 veered off the highway, plunged down an embankment and slammed into a tree. For a moment, the tiny teenager with the outsized intellect appeared to be untouched. The hired driver thought she had slept through the crash. Then a drop of blood dripped from her nose, hinting at the true devastation.

Alistaire Moore was in a coma, a victim of severe brain damage. In the awful days that followed, doctors at a New York hospital advised her parents William and Judith Moore to disconnect life support and donate Alistaire's organs.

But the Moores refused to let go.

After 45 days, Alistaire emerged from her vegetative state--unable to talk, or walk or sit up in a chair, let alone dress and feed herself.

Today, at age 21, Alistaire is a student at Towson University, struggling with impairments but living a normal life.

That she has come this far is remarkable. But there was more to the battle. Bill and Judy Moore are suing their health insurer for hundreds of thousands of dollars, trying to recoup what they spent to bring Alistaire back.

The Silver Spring couple contends that Blue Cross and Blue Shield of the National Capital Area abandoned them during Alistaire's long and difficult rehabilitation and should pay for an extensive array of treatment they funded on their own--$433,684.88.

The tally includes tutoring in physics, math and French, along with fitness training and karate lessons. It includes two years at Phillips Exeter Academy, the elite New Hampshire prep school, plus travel and lodging there for Alistaire's mother. It includes a laptop computer, with accessories. And it includes thousands of hours that the Moores devoted to their daughter's care, time they value at $291,003.

The Moores' dedication to Alistaire's recovery is beyond dispute. The question for the judge is: Who should pay the bill?

The case of William Moore, et al. v. CapitalCare Inc. is about a family going to extraordinary lengths to overcome a medical catastrophe, but that's just the beginning.

As Blue Cross's CapitalCare HMO tells it, the case is about parents who took charge of their daughter's treatment, ignored the terms of their insurance coverage, and demanded their health plan pay the bills regardless.

As the Moores tell it, the case is about an HMO that would sooner sacrifice their daughter's recovery than spend money, a corporate bureaucracy that used a strategy of delay, deny and dodge to avoid its obligations.

As the voluminous record shows, it's a case that probes the depths of a health plan's responsibility--or irresponsibility.

Blue Cross initially argued the Moores forfeited their right to full HMO coverage because they failed to contact the company within 24 hours of Alistaire's emergency hospitalization.

The two sides have fought nearly every step of the way. When Alistaire turned 19, the insurer tried to drop her from her parents' policy, asserting that she was not a disabled dependent. An internal Blue Cross appeals board eventually ruled otherwise.

Now, Blue Cross officials dismiss the Moores' complaints with something close to mockery. "There is no provision in the contract that says, 'We'll pay for everything that possibly helps,' " attorney Lloyd Fantroy said. "What if you had a doctor that said, 'In a case this like this, I think a trip around the world will make you feel better'?"

Far from abandoning Alistaire, Blue Cross says, it paid $202,910.61 for her care through June 15. It even paid for Alistaire's hippotherapy, a form of physical therapy that involves horseback riding.

The Moores maintain they saved CapitalCare money, because the treatment they arranged was less expensive than the treatment the HMO was contractually obligated to provide. Besides, having "broken their contract and failed to treat Alistaire," Bill Moore said in an interview, CapitalCare is in no position to complain. "They forfeited that right."

Closing arguments in the non-jury case are scheduled for Friday in Washington's U.S. District Court. Judge Thomas Penfield Jackson heard testimony in August but put the matter on hold to preside over the antitrust trial of Microsoft Corp. Jackson has already ruled against the Moores' request to be compensated for so-called lost profits previously estimated at almost $1.8 million--money they say they would have earned if they didn't have to take so much time away from their audio-visual services business, Techniarts Engineering, to coordinate their daughter's care. The Moores' lawyer has asked Jackson to reconsider.

Having spent more than $200,000, CapitalCare wants a piece of the $1.3 million that Alistaire secured in settlements with other insurance companies over liability for the accident. Though the hired driver was blamed for falling asleep behind the wheel, Alistaire obtained the maximum $1 million from a Techniarts insurance policy.

To get the $1 million, a lawsuit was filed in Alistaire's name against her parents and their business, asserting that they were liable because the driver was serving on their behalf. Bill Moore had planned to drive Alistaire back to school, the Moores testified, but work intervened.

Bill Moore's Ordeal

For the father, the ordeal began at 10 a.m. on a Thursday morning, Sept. 10, 1992, when he picked up the phone in his Silver Spring office.

"The state trooper told me that he was at the accident scene," Bill Moore recounted on the witness stand. Rescue workers had cut the top off the car, and Alistaire was en route to a nearby shock-trauma unit in the Bronx. "He told me that they did not expect her to live."

Moore told his wife to go to the airport while he phoned the emergency room. Later, with about two hours to spare before he had to pick up Alistaire's younger brother from school, the methodical engineer focused on the challenge ahead.

He went to the library and began reading about comas.

The following morning, Alistaire was transferred to another New York hospital for treatment to control the swelling of her brain. It was about four days into a bedside vigil there, Bill Moore testified, that he found a hospital pay phone not in use and placed his first call to CapitalCare.

The voice on the other end told him, "Mr. Moore, the only thing I can say is that you have not called within 24 hours and, therefore, your medical benefits are restricted to 50 percent of the hospital bill," he recalled. Moore said he asked for a supervisor--and hung up after about 10 minutes on hold.

The company eventually paid the hospital bills, but Blue Cross would later invoke the delay to support its overall handling of the case.

The insurer said it has no record of hearing from Moore until 27 days after the accident.

Having studied treatment options, Moore was then preparing to move Alistaire to Kennedy Krieger Institute at Johns Hopkins University, which had special expertise working with adolescent coma patients. Though the institute wasn't part of the health plan's network, it approved the transfer, and on Oct. 13, 1992, Alistaire was flown to Baltimore by air ambulance.

There was no sudden "awakening." As she emerged from the coma, a groggy gaze gave way to the ability to blink on command; muscle movements progressed from the merely reflexive to the purposeful. In the early stages of rehabilitation, a speech therapist moved Alistaire's lips, attempting to form a smile. The parents shouldered much of the responsibility, from dressing Alistaire in the morning to helping her with exercises--for example, showing her pictures of familiar objects such as a house and pronouncing the words.

At times, the parents acted against recommendations of the medical staff, according to a Kennedy Krieger report. Though warned of risks, they "continually refused" to have Alistaire fed by tube and "were very persistent that Alistaire take majority of the food by mouth," the medical record said.

Judy Moore "acknowledged that relinquishing control of Alistaire's care to others was impossible," a social worker at the institute wrote in a case report.

Bill Moore said his wife rejected the pessimism of medical professionals and was determined to prevent Alistaire from stagnating--even if that meant sitting in a hospital cafeteria for two hours at a stretch to hold Alistaire's hand around a spoon.

By early December, the Moores decided that Alistaire had stayed long enough. Based on their research, they believed she would fare better at home, amid familiar surroundings. They also worried about the cost of continued hospitalization, Bill Moore said. Their health plan let them go outside the HMO for care, subject to a $1 million lifetime limit. At a rate of about $2,000 a day, Kennedy Krieger could quickly deplete Alistaire's benefits.

Bill Moore investigated head injury rehabilitation programs in Washington but found them wanting. Among other things, they were "not geared to people of high I.Q.," Moore later explained.

Doctors at Kennedy Krieger expressed reservations about "a premature discharge," as they noted in the medical record. They prescribed a home therapy program that was to include six hours a day of physical, occupational and speech therapy, plus a round-the-clock nursing assistant.

CapitalCare initially embraced the concept, as Bill Moore tells the story. It was a simple matter of economics, he said: Keeping Alistaire at Kennedy Krieger would have cost much more than the prescribed home care--almost twice as much per day.

"I can approve this on the basis of cost alone," Moore quoted CapitalCare case manager Barbara Mullin as declaring when he first broached the idea.

Moore said Mullin told him to line up the therapists himself because she was preparing for an office move and was too overwhelmed to handle the task. "She said, 'Just contact them and get them started.' "

It was a pivotal moment. Moore claimed he had a promise that CapitalCare would pay the bills. But Mullin would later disavow his version of their conversations.

On Dec. 4, 1992, almost three months after the accident, still an invalid, Alistaire went home.

Points of Contention

Burdened with the task of attending to their daughter's every need, the Moores had an agency send nursing attendants to help with activities such as bathing Alistaire and serving her meals. They thought coverage had been assured. But the aides stopped showing up, because Blue Cross wasn't paying.

Judy Moore phoned the case manager on Dec. 17 to plead for relief--and was infuriated when Mullin denied having made any promises.

Mullin said, 'I didn't say anything was going to be covered . . . and really what you should do is take out your policy and read it,' " Judy Moore testified.

As Judy Moore put it, she told Mullin off, saying, "I am basically working around the clock with a very sick child, and you, at least, have the responsibility for paying whatever bills that we send to you."

Mullin's notes of the conversation describe "30 min[utes] of her screaming irrationally into my ear."

Bill Moore echoed his wife's expectations, Mullin testified. "He told me that he wanted everything that they put into place paid at a hundred percent, and no involvement from the insurance company," Mullin said.

The Moores' policy excluded custodial care. Bill Moore said the aides sent by the A.A.A. Warman Agency did not fit that description. However, in an interview, director Hope Burns of the Warman Agency said, "Everything they did, whether it's cleaning the bathroom or doing laundry, it's all custodial."

Blue Cross argued that it should have been clear after the Dec. 17 exchange that the health plan had given no blanket assurances about Alistaire's rehabilitation. But where things were left that day is another point of contention. Mullin said she asked Moore to give her the names of the providers he wanted to use so she could see if there was anything she could do. Moore said Mullin reassured him she would have the providers paid.

Therapy and Tutoring

Alistaire's days were soon tightly scheduled with activities that her parents hoped would hasten her recovery.

Karate instructor Ann Roberts remembers Bill Moore carrying Alistaire up the stairs to her second-floor studio for their first session. They dressed Alistaire in a traditional white tunic and tied her in a chair to keep her from falling. Then Roberts began by teaching Alistaire how to make a fist.

In his exhaustive research, Bill Moore read a report from a Tokyo hospital, which led him to martial arts therapy as a means of restoring balance and coordination. A doctor at Kennedy Krieger gave his blessing.

Strength and conditioning coach Steve Eschholz, a former Marine Corps fitness trainer, remembers being interviewed by the Moores for more than an hour before they enlisted him to augment Alistaire's physical therapy. His methods were sometimes unconventional: When Alistaire progressed to climbing stairs, he equipped her with a flak jacket to weight her down. But, in 163 hours of training over 3 1/2 years, he helped her get up off the floor and ride a bike again.

The rotation at the Moore residence included tutoring visits by Chantal Courieut, who had been Alistaire's French teacher at the National Cathedral School; Karen Casale, a former math teacher, and Sarah Lesko, a science teacher at another private school.

"They knew that I didn't have any experience and they weren't expecting me to be a specialist in brain rehabilitation," Lesko said in an interview. "They were willing to do anything to help her recover and to achieve any potential she had."

Once, Alistaire's potential had seemed boundless. She had been an academic standout, on track to graduate from Exeter two years early. As part of a youth talent search, she took the Scholastic Aptitude Test in 1990 and got the highest verbal score of any seventh grader in the Washington area.

Using Alistaire's old physics textbook, Lesko worked to redevelop reasoning abilities--to "reawaken the brain," she said. To study principles of gravity, she and Alistaire dropped objects of different sizes over a bannister.

The teachers and trainers supplemented the work of licensed therapists, who were hard to find and couldn't devote as much time to Alistaire as she needed, Bill Moore said. The unlicensed help also worked for a fraction of the price.

The Moores said the tutoring wasn't teaching--it was "cognitive therapy." "[I]t made absolute sense to me to go back to the people that she knew in the past that could maybe draw on her memory," Judy Moore told the court.

Bills, Bills, Bills

The bills were piling up--$480 for Eschholz, $800 for a reading tutor, $1,060 for handrails installed in the Moores' home. The list went on.

On Feb. 11, 1993, Moore wrote to CapitalCare Medical Director Dennis B. McIntyre demanding payment in full.

"[Y]our representatives have been elusive and evasive when I have attempted to elicit either information or commitments," Moore wrote. "I do not expect to have to act as collection agent and I do not expect to have to write any more letters such as this one."

It was the first of many.

In a Feb. 23 letter, Moore expanded his list of complaints to include the lack of a response to his earlier complaints.

By that time, Kennedy Krieger was asking for $76,052--and CapitalCare was saying it wouldn't pay in full because Alistaire's admission had not been pre-certified, Moore wrote.

The CapitalCare medical director replied three days later, rebuking Moore. Many of the services Alistaire was receiving were arranged without CapitalCare's knowledge or consent and did not qualify for reimbursement, McIntyre said. McIntyre, a physician, said the discussion of Alistaire's case was best shifted from doctors to lawyers.

In light of "the particularly hostile comments you have made in your previous verbal and written correspondence, as well as your apparent refusal to accept the terms of your health insurance policy," McIntyre wrote, "any further discussions . . . should be conducted between your attorney and [ours]."

An attorney for the Moores wrote to the CapitalCare legal department on March 5 requesting an appeal, a hearing and a written explanation of any decision to deny coverage. But the letter went unanswered, attorney Paul Bekman testified.

Who Pays What?

To some extent, the acrimony reflected confusion--and the mysterious nature of health benefits.

Kennedy Krieger was able to document that CapitalCare approved Alistaire's admission in advance, and the company cut a check.

The health plan rejected the bill for hand rails, saying they weren't covered. The handbook that came with the Moores' insurance policy explaining what was and was not covered didn't say anything about hand rails, but it did say that benefits included "durable medical equipment" such as wheelchairs and hospital beds.

Blue Cross paid the reading tutor $2,840 the following September, but would later claim that it did so by mistake. She was not a licensed therapist, and the company said its contract excluded coverage of nonlicensed personnel. On that basis, it rejected bills from the fitness trainer, the karate instructor and the tutors, while paying the medically licensed hippotherapist.

The distinction struck the Moores as arbitrary, especially after teachers and other aides worked with Alistaire at Kennedy Krieger.

The Moores' so-called point-of-service policy--an increasingly popular form of insurance--compounded the complexity. It offered one level of coverage if the Moores used HMO doctors and followed HMO rules--and a much lower level of reimbursement if they charted their own course outside the HMO.

Outside the HMO, the health plan would pay only 80 percent of the "usual, customary and reasonable" charges--an amount the plan determined. Thus, when the HMO received $4,900 of physical therapy claims, the Moores were held responsible for $1,568--almost a third of the total. The out-of-pocket expenses mounted rapidly.

The Moores' lawyer said CapitalCare had ulterior motives for declaring many of the bills out-of-network: That way, the Moores would be responsible for co-payments, and the expenses would count toward the $1 million lifetime limit.

CapitalCare argued that the Moores went outside the network deliberately, to use health care professionals whom they preferred. It quoted Judy Moore's account in a deposition: "We interviewed and came up with the best speech therapist we could, and we hired them. . . . We interviewed and chose the best occupational therapist we could and we hired her. That is the way it was done."

Bill Moore said he thought he was staying within the HMO every step of the way.

Sorting out who should pay what could be a slow process. Some of the bills were paid more than half a year after the dates of service.

Support From a Doctor

Bill Moore thought he had found an ally in Alistaire's primary care doctor, Deborah B. Goldberg.

In late March, Moore sent Goldberg a letter declaring that several therapists were threatening to cut Alistaire off because the HMO had "yet to pay a single dollar of a single therapist's bill."

Goldberg scrawled a plaintive message to the CapitalCare medical director. "Dennis, Help," she wrote. Alistaire "has gotten better. She needs continued therapy. Is it really true that CapCare has not paid any therapy . . . ? Clearly the parents have devised a program that is effective."

Moore and a family lawyer talked with the HMO's corporate counsel, Joseph Petralia, but that did nothing to repair the breach.

Though the HMO medical director had passed the hot potato to the HMO lawyer, the HMO lawyer said it wasn't his responsibility to arrange Alistaire's care. "[I] very clearly and adamantly told him [Moore] that it was not my role, nor the role of CapitalCare to do that coordination on their behalf." As far as the HMO was concerned, that was the job of the primary care physician, Petralia testified.

Moore wrote another letter to Alistaire's doctor that cried out for help. The HMO isn't paying for the care we've arranged, Moore said, so arrange something the HMO will pay for.

"I request that the plan be in writing and be specific as to providers, treatments, milestones, and goals for each of her conditions," Moore wrote in the April 3, 1993, letter.

Two weeks later, still waiting for a reply, Moore reiterated his request. "According to the HMO agreement, Alistaire's primary care physician is to provide and coordinate these services in a manner that commits the HMO to be financially responsible," Moore noted.

Goldberg's answer, dated nine days later, pushed Moore over the edge.

"[I] feel that you might benefit from the opinion and help of a psychiatrist," Goldberg wrote. "There are several within CapitalCare."

The letter convinced Moore that there was no way he could rely on Goldberg or the HMO.

"If Alistaire was going to be treated, we had to do it," Moore said in an interview.

'A Typo'

Much later, in a federal courtroom, Goldberg would explain that her suggestion was a mistake, "a typo."

She didn't really think Bill Moore needed a psychiatrist. She meant "physiatrist," a doctor of rehabilitation, someone professionally qualified to coordinate care. Indeed, she talked about referring Alistaire to a "physiatrist" in the very next sentence.

But the damage was done. When Goldberg called Moore to recommend a particular physiatrist, Moore hung up, the doctor testified.

Moore vehemently denied that Goldberg ever gave him the physiatrist's name. If she did, it would have been the closest she or CapitalCare came to fulfilling Moore's request for an HMO-sanctioned rehabilitation plan.

On cross examination, Goldberg grudgingly conceded that she never provided a written referral for Alistaire to see any other health care professional for her brain injury. Under the HMO's rules, a referral was a prerequisite for coverage.

Of course, that point cut both ways, because the Moores had already sought a variety of services without written referrals.

The Moores' law firm wrote to CapitalCare in late April 1993 asking it to spell out its position on Alistaire's "cognitive therapy" and other claims. As with the firm's earlier letter, Moore said, there was no reply.

Back to School

The circle of therapists expanded.

There was therapeutic horseback riding to improve Alistaire's abdominal strength, and voice and diction training with a consultant to politicians and television correspondents. "We knew Lillian professionally, so Lillian came in and began working with Alistaire very much in the same way she would work for someone who was running for Congress," Bill Moore said.

There were sessions in New York with a specialist who helped actors hone their vocal skills--the man to go to, Moore said, if your Broadway role calls for a German accent.

Through the spring and summer of 1993, Alistaire's rehabilitation continued under the supervision of Marc Cantillon, a neuropsychiatrist the Moores had found outside the CapitalCare network.

Alistaire's handwriting became more legible, and she progressed from a walker to a three-point cane to carrying a book bag around the block. She even attended a St. Albans summer school course in chemistry, which had been her passion.

But as the anniversary of the accident approached, she began to regress. As Cantillon saw it, isolation was part of the problem. Warning that the patient could end up institutionalized, Cantillon recommended a dramatic solution. In September 1993, a year after the crash, Alistaire returned to Exeter.

It wasn't for education, Bill Moore testified, because Alistaire was incapable of that. The idea was to "reawaken her memories . . . and get the healing process moving forward again."

"I know that [Blue Cross] makes this claim that this is some elitist opportunity," Moore said, but "that's where her memories were."

The Moores assembled a support system of tutors and therapists to replace the one left behind in Washington. Judy Moore, who took up residence in New Hampshire, helped Alistaire with basic functions such as dressing for class.

Initially, Alistaire could do little more than sit through class with a tape recorder to backstop her fleeting memory. Once back in her dorm room, she and a tutor would replay the tape in snippets.

For an average of six hours a day, at an annual salary of $15,000, special education teacher Paula Banda assisted with English, French and history. She also worked on Alistaire's behavior, trying to moderate inappropriate reactions to, for example, a teacher Alistaire considered "incompetent" or "a student who had made a remark that Alistaire disagreed with," Banda testified.

Alistaire persevered--and graduated from Exeter two years later with a 3.0 grade point average.

The Moores paid Exeter $40,656.30. They did not seek CapitalCare's approval in advance, and CapitalCare never said it would reimburse them.

On cross examination, CapitalCare attorney Charles J. Steele challenged Bill Moore: "Can you point to a provision in the contract which says that room, board and tuition at private prep schools are a covered benefit?"

The answer, Moore said, was "certainly not." But there was more to it, he explained. "As part of a comprehensive pediatric neuro-rehabilitation brain injury program, as part of community reintegration, and as an alternative to hospitalization, yes, I believe that CapitalCare should have paid for those elements."

The Moores' attorney, Martin H. Freeman, said Exeter was a bargain compared with the alternative of prolonged in-patient treatment. Yet it is unclear whether CapitalCare would have paid for that. According to the Moores' HMO policy, for example, coverage of certain "rehabilitative" admissions was limited to 30 days.

Warring on New Fronts

As Alistaire's medical treatments took her as far away as New York, Denver and Hanover, N.H., the battle with Blue Cross advanced to new fronts, and Bill Moore's angry missives became as routine as mortar rounds in a border war.

In June 1996, shortly after Alistaire turned 19, Blue Cross notified Moore that it did not consider Alistaire a disabled dependent and would drop her from her parent's insurance unless she became a full-time student.

The Moores appealed, arguing that Alistaire was "clearly incapable of self-support." Soon, a pharmacist informed Bill Moore that Blue Cross was denying claims because Alistaire was overage. It took several months, but the Moores won the argument.

In March 1997, Bill Moore noticed that the HMO was paying only 52 percent of the charges for Alistaire's psychologist, Mary K. Jacobs. The HMO explained that "nervous and mental conditions" were not covered at the same level as "medical conditions."

Outraged, Moore fired back that traumatic brain injury is neither a nervous nor a mental disorder. Blue Cross's position, he wrote, was "taken in bad faith in order to avoid paying for treatment my daughter needs if she is to maximize her recovery."

Using a phrase from the Moores' insurance contract, the HMO said mental and nervous conditions were defined "irrespective of cause."

Once again, Moore complained to the Grievance and Appeals Committee. The outcome last July offered vindication--and exasperation. The committee determined that Alistaire's brain injury was "not considered to be a nervous or mental disorder."

However, the psychologist "billed for her services using a DSM-IV diagnosis code, 294.1, dementia due to head injury, which is a nervous or mental diagnosis." Therefore, the committee ruled, "benefits were processed correctly."

More Costs Ahead

In the years ahead, there could be a lot more to fight about.

An analysis commissioned by the Moores predicts hundreds of thousands of dollars of additional expenses, things such as $53,161.42 for a lifetime of mood-elevating drugs and $4,000 apiece for two Caesarean sections, given Alistaire's risk of labor complications.

The Moores worry about what will happen when they aren't able to carry on the fight. They want the court to order payment of Alistaire's future medical bills as they are incurred, up to $9,103.96 a year.

On a basic level, brain injury experts say they can relate to the Moores' frustration. They say coverage of brain injury rehabilitation can be pitifully inadequate and that health plans can make it difficult to obtain reimbursement. They also warn that the wording of many policies allows insurers to stop paying for therapy if the patient is making only gradual progress. Indeed, the "exclusions" listed in the CapitalCare benefits handbook included "Long-term rehabilitation or physical therapy."

On a key point, doctors who once disagreed with the Moores have come around to their way of thinking. At Kennedy Krieger Institute, where the medical staff fretted about Alistaire's "premature discharge," sending brain injury patients home as soon as possible is now preferred. "[I]t makes a lot more sense than trying to learn how to function in a hospital," said James R. Christensen, the Kennedy Krieger doctor who oversaw Alistaire's care.

Yet some members of the medical establishment express skepticism about claiming reimbursement for tutors, trainers and private school tuition.

"My personal belief is that medical insurance should pay for medically based therapies . . . that are provided by medically based personnel," said neuropsychiatrist Gregory J. O'Shanick, national medical director of the Brain Injury Association, a research, education and advocacy group. "What needs to be guarded against is just opening up floodgates."

A claim for private school tuition is "tremendously creative," but "I don't see it," said attorney Nathaniel Fick, who has represented brain injury victims in suits against insurers and serves as president of the Brain Injury Association of Maryland.

Experts say the education of students with special needs, including traumatic brain injury, is a legal responsibility of public school systems, which sometimes pay private institutions to handle difficult cases.

Overcome With Emotion

One observer sensed that the Moores' battle with Blue Cross had a searing emotional subtext. Looking back on her interactions with the family, physician Deborah Goldberg said the parents appeared devastated by the tragedy. Alistaire's mother seemed intensely angry, and her father seemed unable to "come to terms with the fact that his wonder child was not going to be what he wanted her to be," Goldberg said in an interview.

On the witness stand, Bill Moore was overcome with emotion when describing Alistaire's former intellectual prowess.

"His style was, 'If there's a problem, we can fix it.' And this was a problem he couldn't fix," Goldberg said.

Mary K. Glidden gives the Moores more credit. A nurse and rehabilitation coordinator who has spent years working with brain-injured patients, Glidden evaluated Alistaire in support of the Moores' lawsuit. "I firmly believe that if they had not done what they did, their daughter would be in a bed having to be totally cared for in all aspects of life," Glidden said.

Instead, Alistaire has recovered enough to travel on her own to the Florida Keys for an Outward Bound sailing expedition.

In a recent telephone conversation, Alistaire was articulate and self-possessed as she canceled an interview for this story. "I'm not supposed to talk to you," she said, adding that she would defer to her parents "because I really don't want to harm their case at all."

With polite impatience, the Towson undergrad said she was busy with a lab assignment and that her boyfriend was waiting.

For all the progress she has made, the Moores still believe she can go further. They have asked the court to order CapitalCare to pay for a two-year rehabilitation program at a specialized center.

Judy Moore declined to talk about her daughter's recovery, saying, "Come back in four years, five years. Give her a chance to have actually done something that we can talk about--that she can talk about as her accomplishment in life."

Meanwhile, Alistaire faces the pain of a cruel paradox. "The more she improves, the more she realizes her deficits," Glidden said. "She sees her younger brother doing things she used to do, should be doing, is no longer able to do," such as driving a car, or playing sports, or achieving high academic goals, Glidden wrote in a report submitted to the court. Learning was once a joy; now reading is a struggle.

Walking down the street, she sees her reflection in store windows and notices her unsteady gait.

"She is determined to be as she once was was," Glidden wrote. "Her focus is to regain and continue life as she knew it and had planned for it to be."

Long Road to Recovery

Alistaire Moore's therapy has included special tutoring, fitness training, karate lessons and two years at prep school.

Alistaire Moore hovered near death at the shock-trauma unit at Jacobi Medical Center in the Bronx, N.Y., after a car wreck on Sept. 10, 1992.

Still in a coma, the 15-year-old high school student was transferred to Kennedy Krieger Institute in Baltimore a month later and experienced a gradual awakening. She emerged from her vegetative state unable to talk, walk or sit up in a chair.

On Dec. 4, 1992 still an invalid, Alistaire returned to her family's Northwest Washington home to continue her rehabilitation. Soon, she was spending several hours a day with a rotation of tutors, trainers and therapists.

In the fall of 1993, Alistaire returned to school at Phillips Exeter Academy, with a lot of special help. To reawaken memories and advance her recovery, her parents said, it was essential to return her to her former environment.

Alistaire's Medical Expenses

What Blue Cross paid:

Total claims submitted by Alistaire Moore's parents and their health care providers $252,373.76

Insurance (Blue Cross) paid $202,910.61

Balance $49,463.15

Amount Moores were held responsible for

(includes rejected claims, copayments and out of network charges

exceeding the "usual, customary and reasonable" rates) $37,658.53

NOTE: Figures are as of June 15, 1998

SOURCE: Blue Cross trial exhibit

What the Moores are now seeking:

Past rehabilitation expenses, including

home care and Exeter tuition $142,881.88

Reimbursement for services performed by Bill and Judy Moore, beyond "normal parental responsibility" $291,003.00

Future enrollment in a two-year rehabilitaiton program, as much as $229,922.90

Anticipated medical needs, up to $9,103.96 annually, or a lifetime total of $548,058.16

Lost profits of the family business; 1996 estimate (final to be determined) $1,778,002.00

Total as much as $2,989,867.94

SOURCE: Plaintiff's court filings

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