NY Newsday article
sue...@bellatlantic.net
NY Newsday article
NY'ers check your Newsday. There is an article in today's Ed
Lowe column on Lyme and BCBS.
BratDet
mean???? B
Mel Obeau2
me. Such a sad and common story.
Melody
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HMO: What's in a Name?
BY: Ed Lowe
EDITION: NASSAU AND SUFFOLK
SECTION: News
DATE: 11-12-1999
A08
Jessica Parente of Howard Beach visited the Jersey Shore in the
summer of 1995 but did not later connect that trip with the strange
symptoms she began to suffer the following March.
By that time, she was 19. She ached everywhere, vomited frequently
and suffered from mind-bending headaches. She fell asleep at the desk at
her secretarial job in Manhattan, where on some days she couldn't reach
to answer the telephone because of the pain in her neck. Her lymph nodes
were swollen. Her joints were swollen. Her physician thought she had
arthritis. An office colleague mentioned that her husband had suffered
the same symptoms and ultimately was diagnosed with and treated for Lyme
disease.
Jessica sought help from a physician familiar with Lyme disease, Dr.
Olaf Butchma of Great Neck, and she took a test that required her to
provide three urine samples over a week during which she took a daily
dosage of an antibiotic. "The test came back positive for Lyme," she
said yesterday.
In October, 1996, Butchma prescribed an antibiotic Jessica was to
take orally.
"I did that for about a month," Jessica said, "but my stomach
couldn't handle it. I was throwing the medicine back up, so it wasn't
helping. So then, he ordered intravenous antibiotics. They put a line in
your arm in the office, and then you go home and administer the
medication yourself. Also, once a week, a nurse has to come to your
house to change the line and make sure everything is clean and right.
But for all that, the doctor first had to get approval from Empire
Blue/Cross Blue Shield." Thus began a year and a half of a protracted
battle between the patient and her doctors on one side and the
health-maintenance organization on the other, with Lyme disease gaining
ground all the while. The disease won. Married and the mother of a
newborn, Jessica walks with a cane. She has undergone two operations on
her 23-year-old knees and is awaiting hip-replacement surgery.
Empire Blue Cross/Blue Shield covered the cost of the surgery,
though Jessica's doctors maintained that she would not have required
surgery had she been allowed the consistent administration of
intravenous antibiotics. Jessica says she now has pain in one or another
part of her body every second of every day.
Subsequent blood tests identified the strain of Lyme as particularly
common to ticks found in New Jersey.
So Jessica Parente is suing Empire Blue Cross/Blue Shield for $800
million for medical malpractice, gross negligence (practicing medicine
without a license), break of fiduciary duty, intentional affliction of
emotional distress and violation of New York Deceptive Business
Practices Act, among other complaints.
Through attorney David L. Trueman, who has offices in both Mineola
and Manhattan, she filed suit in State Supreme Court in Queens in
September.
Company attorneys maneuvered the suit into federal district court
last month, where they can be expected to argue that the company
basically is immune under the 1974 Employee Retirement Income Security
Act (ERISA). Developed to protect pensions, it included provisions
applicable to employer-sponsored health plans and has served in a number
of lawsuits as a loophole through which some managed-care companies
evade liability for such damage as denials and delays are alleged to
have caused. Trueman, also a practicing psychologist, has submitted
papers opposing this position, and the company has yet to file a
response. Company lawyer Gary Tannenbaum yesterday referred calls to
marketing and communications vice president Deborah Bohren, who said,
"The case has no merit. There is no medical evidence that IV antibiotic
treatment for extended periods works in cases of Lyme disease." In
December, 1996, according to court papers submitted by Trueman, Empire
Blue Cross / BlueShield approved intravenous antibiotic treatment for
Jessica, and during the next few months, Jessica improved dramatically.
In April, 1997, however, Blue Cross wrote Jessica saying its medical
staff had "determined that continued administration of the drug would
not be medically necessary." Jessica promptly deteriorated. In July,
Butchma pleaded with the company that he feared Jessica would become
permanently disabled without continuation of the treatment. In August,
the company apologized for any inconvenience Jessica might be suffering
because of delays in its decision-making process, and in October, it
approved another 28 days of treatment. Her condition improved again, and
then, against the doctor's fervent recommendation for continuation, the
company discontinued the treatment.
Jessica switched doctors in January, 1998. Her new physician, Dr.
Perry Orens of Great Neck, concurred with Butchma's prognosis, though
recommended a different IV antibiotic. Blue Cross denied the treatment
in March, this time saying it was "experimental/investigational." The
company's medical director, Dr. Steven Wolinsky, also wrote to Jessica
that he had reviewed Orens' plea and determined that intravenous
antibiotic therapy was not medically necessary, because, "studies of
Lyme disease show that a 30-day course of antibiotic therapy should be
adequate," he said.
Orens, Jessica and her family alternately pleaded on the telephone
with company officials, sometimes tearfully, until Orens wrote back in
March that the interruptions in Jessica's treatment were "particularly
sad, as the patient was making progress substantially, if not
dramatically. The severity of this situation cannot be overemphasized,"
he continued. "I fully understand the insurance carrier's desire to
minimize expenses especially in home IV therapy I feel it is nothing
short of criminal to stop such therapy until the patient has reached
maximum benefits." The company denied the treatment.