Murray gathers HMO testimony

http://news.bellinghamherald.com/stories/20010626/FrontPage/58141.shtml

Tuesday, June 26, 2001
The Associated Press

SEATTLE -- When James Ellison tried to get a bone marrow transplant to treat his multiple sclerosis -- the only therapy his doctor said could save his life -- his insurance company said no.

Though he was bedridden and suffering seizures, the father of two appealed the case, lost, then appealed again to no avail. The insurer insisted such treatment was experimental, he said.

"It was a death sentence for me, my son's father, my wife's husband," Ellison said Monday at a news conference following a roundtable discussion with U.S. Sen. Patty Murray, D-Wash.

Murray was gathering testimony for a patients' bill of rights now under consideration in Congress. The Senate opened a second week of debate on the bill Monday.

Ellison, a 39-year-old Seattle resident, eventually got the transplant when an anonymous donor who had heard media reports of the case forked over $75,000 needed to pay for the procedure.

But for the past year and a half, Ellison said he's had to gut his savings and liquidate his house- painting business to come up with $150,000 for follow-up treatment.

Murray said no one should have to endure such agony simply to get coverage for life-saving medical care. She vowed to take the testimony to Capitol Hill.

President Bush threatened last week to veto a proposed patients' bill of rights, saying it would encourage costly lawsuits and drive up the cost of health insurance.

Murray countered that people deserve a better health-care system -- one that gives them broader rights to get the medical coverage they need.

"I think this is one thing the American public overwhelmingly wants," Murray said Monday. "I think the support is tremendous and the need is obvious."

She added that she believes the votes are there to pass a bill Bush will not veto.

Christine Malone of Everett said her 2-month-old son Ian lost coverage for 'round-the-clock nursing care needed to make sure the brain-damaged boy can breathe.

"Ian is alive today in spite of our HMO," Malone said at the news conference.

Because Ian can't swallow, he is fed through a tube surgically implanted in his stomach. Christine Malone said the nursing care costs about $220,000 a year.

Like Ellison, Christine Malone and her husband lost appeal after appeal and were not allowed to participate in an external review of the case.

U.S. Sen. Maria Cantwell, D-Wash., issued a statement Monday saying that she, too, will fight for passage of a patients' bill of rights.

"While over 160 million Americans rely on managed care plans for their health insurance, HMOs can still restrict a doctor's medical decision based purely on financial costs," Cantwell said. "Doctors, nurses and patients -- not accountants -- ought to be in control of medical decisions."

A bipartisan patients' bill of rights before Congress would guarantee emergency care at the nearest facility, open up access to specialists, cover medically necessary drugs prescribed by a doctor and bar health plans from providing payment incentives for doctors and hospitals to deny care, among other provisions.

Congress has reached some agreement over the years on which treatments should be included in a patients' bill of rights. But lawmakers are still clashing over several sticking points.

The debate now focuses on how far the law should go in letting patients sue an employer that helped delay or deny a treatment.

Republicans believe employers should be protected and that lawsuits should be limited. Health plans agree. But Democrats have argued against granting employers who help make medical decisions immunity from lawsuits.