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"BrewerCare" in Arizona a Death Sentence for Transplant Candidates?

Posted Dec 03 2010 3:25am

A heartrending story today in the NY Times, reporting that a new fatal condition for transplant hopefules in Arizona: Death by budget cut.

The story reveals the personal cost of a political decision, detailing how Shelly Gerhart consoled Janette Williams at the funeral of her husband, Mark Price, in Arizona on Thursday. Mr. Price, who needed a bone marrow transplant, lost financing for the operation.
Essentially the decision, which went into effect October 1st, stops Medicaid financing for certain transplant operations. This amounts to a death sentence for lower income patients, who lack the hundreds of thousands of dollars needed to pay for necessary transplants. 


Translant speicalist Dr. Rainer Gruessner is quoted as saying “The frustration is tremendous. It’s more than frustration.”


Organ transplants are already the subject of a web of confusing and often very questionable regulations that in no way guarantee that everyone in need of a life-saving organ will receive one. But in Arizona, even patients who have been on lists for a long time were ruled ineligible for an organ from one day to the next...unless they can raise the money themselves. 


This is one of hte more important but less talked about frontiers of medical travel: patients who need vital operations but are unable to afford the exorbitant US cost structure that drives the cost of such complext operations out of reach for the uninsured. 


There are many first class hospitals around the world: Bumrungrad in Thailand, St. Luke's in the Phillippines, Hospital Angeles system in Mexico, CIMA in Costa Rica - that make enormous investments in the latest medeical technology attract top surgeons.  They work with rigorous protocols and partner with major US hospitals and surgeons in their groundbreaking programs. The cost to patients is just pennies on the dollar - a kidney transplant with the award-winning transplant team at Hospital Angeles Tijuana is $47,000, an all-inclusive package covering all expenses for the donor and the recipient, including all pre-transplant protocols, more than  weeks worth of hospital stay, an additional week of hotel  stay, and an international patient conceirge that arranges everything: consults, lab work, the transition of medical records, dialsyis sessions, a personal nurse - and even air travel planning. 


The story of Francisco Felix aged 32, a father of four who has hepatitis C and is in need of a liver, is paticularly outrageous.  Felix tereceived news a few weeks ago that a family friend was dying; she wanted to donate her liver to him. But the budget cuts meant he no longer qualified for a state-financed transplant. His relatives scrambled to raise the  necessary $200,000 - about 4x the amount he would have needed to have the surgery abroad, at a hospital globally recognized for excellence.  But $200K was too much to have to raise, and the liver went to someone else on the transplant list.


Decisions to cut budgets in this instance, cut lives short.  As Dr. Andrew M. Yeager, a University of Arizona professor quoted in the article says: "Cuts like this are shortsighted and sad.”


Among the discontinued procedures are lung transplants, liver transplants for hepatitis C patients and some bone marrow and pancreas transplants, which altogether would save the state about $4.5 million a year.The issue is of couse a major political battle, with Democrats condemning the reductions as “Brewercare,” after Ariozna Governor  Jan Brewer


“We made it very clear at the time of the vote that this was a death sentence,” said one Democratic State Senator. In turn, the Republican governor blames  “Obamacare,” though the Arizona vote came in March, well before the health care law sponsored by President Obama President Obama was signed  into law.


Arizona is not unique in its drastic cuts in budgets and transplant patients' hopes and lives.  A number of  states have restricted benefits to their Medicaid programs - detailed in a 50-state survey published in September by the Kaiser Commission on Medicaid and the Uninsured. But Arizona stands alone in  eliminating some transplants, which are considered optional services under federal law.


The article details the frantic effortss of Mr. Felix and others in trying to reaise the necessary money for for new organs.  Some work through NTAF, a nonprofit organization based in Pennsylvania formerly known as the National Transplant Assistance Fund that helps transplant patients pay for their medical costs.  Some are holding yard sales. Some will inevitably learn of the alternatives available in Mexico, Thailand, South Korea and Costa Rica, and manage to have the necessary transplant without the crushing medical bills we've come to expect as usual in the US.

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