Health Plan Sued Over Rejecting Twins’ Care : Courts: A mother of two boys is taking action against Blue Shield for refusing to cover home nursing at night, when her sons are at risk.

A Covina mother of 7-year-old twin boys who risk the failure of their lungs and hearts every time they fall asleep has sued a health insurance company for refusing to pay for home nursing ordered by the twins’ doctor.

Saying that the boys’ lives are in jeopardy, Linda Sarver filed a negligence and breach of contract lawsuit Wednesday in Los Angeles Superior Court against Blue Shield, the health insurer; the Public Employees Retirement System (PERS), which funds the insurance, and Healthmarc, which advises PERS on which claims it should pay.

None of the health organizations would comment on the lawsuit, which had not yet been served Wednesday morning. But a PERS official said the Sarvers’ request for home-care payment to be resumed is still under appeal. The Sarvers’ previous health insurance company had paid for home nursing nearly all the twins’ lives.

The former health insurance was provided by the city of Beverly Hills through the boys’ father, a Beverly Hills police lieutenant who lives in Santa Ana.

Under that insurance, the nurses were paid through Oct. 31. The new insurance, which took effect when the Beverly Hills Police Officers Assn. switched medical plans as part of a new contract with the city, refused to pay for the nurses, but they continued working at reduced pay from the Sarvers until early December.

According to court documents, Healthmarc told the Sarvers in early November that the boys needed only simple custodial care, which is designed to help patients meet basic living needs and is not covered by the PERS health insurance policy.

The boys’ doctor, C. Michael Bowman of Childrens Hospital in Los Angeles, urged Healthmarc in a Nov. 4 letter to immediately restore the funding because the lives of Bradley and Steven Sarver depend on skilled nursing care.

“By refusing to cover their needed home care equipment and personnel, . . . you are markedly increasing the risk that an event will occur which makes either or both boys a vegetable or corpse,” Bowman wrote.

Sarver, who was recently elected to the Covina City Council, said that since she took over the boys’ nighttime care, “I have not been getting sleep, and I feel like a walking zombie.” She added that she is “not qualified to do what those nurses did,” and that she has little time to pursue her career as a self-employed marketing specialist but is trying to keep up with council matters.

Since they were 6 weeks old, the twins have been hooked up to elaborate monitoring equipment that sounds an alarm when their heart rate or breathing slows. The nurses monitored the equipment and roused the boys dozens of times a night. Sometimes they had to perform cardiopulmonary resuscitation, according to the lawsuit.

The boys have central nervous system disorders that sometimes cause their hearts and lungs to fail while they sleep.

The nurses’ job had been to anticipate and respond to the boys’ apnea, or cessation of breathing, and bradycardia, the slowing of the heart rate. Sometimes all they needed to do to revive the boys during one of their episodes was shake them. At other times, doctors say, the nurses had to administer oxygen or CPR.

“There have been nights where I have sat between both Steven and Bradley and employed almost constant stimulation to both in response to the almost continuous apnea and bradycardia episodes,” one of their nurses, Faye Rogers, said in court documents.

The boys lead near-normal lives when they are awake, attending Badillo Elementary School in Covina and playing baseball after school. But they can’t stay over at slumber parties and are not allowed to play without a guardian. Doctors say the twins may outgrow the disorders.

Sarver’s attorney, Theresa Barta of the Claremont law firm of Shernoff, Bydart & Darras, said a hearing for a preliminary injunction that would force PERS to start paying for the nursing is set for Jan. 27.