Jalal Afshar was receiving cancer-related treatment at Kaiser Permanente's Los Angeles Medical Center. Doctors there gave him a mix of chemotherapy drugs similar to what some outside specialists had used. But Kaiser's treatment didn't improve his condition. ( LA Times )
Eventually, Afshar's condition deteriorated, and Kaiser's doctors said there was nothing more they could do. Afshar said they sent a chaplain to his hospital room to discuss his plans for dying at home. "The doctor came in and said, 'It's time for you to go home and have hospice care.'"
Afshar did not accept this. He sought treatment from an out-of-network specialist. And his disease is largely in check now, though he suffers fatigue and some numbness in his legs.
Cases like this foster significant prognostic mistrust and financial mistrust among patients and families, leading to conflict. On the other hand, Kaiser and other plans must have the ability to deny coverage for expensive treatments that are very unlikely to be effective.
I have posted a copy of Afshar's Los Angeles Superior Court complaint here . It appears this was not employer-provided coverage, so the claim will not be preempted by ERISA like some other famous Los Angeles coverage cases (e.g. Sarkisyan ).