LDIR News - Summaries & Reviews
November 20th, 1999
Lyme Disease Patient suing BC/BS for $800 million
submitted by Donna Herrell
Reference Article: HMO: What's in a Name?
Newsday, 11-12-1999, pp A08
Description: 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, and other
complaints. She has had two surgeries, awaiting another, may be permanently
disabled and in chronic pain. Empire Blue Cross / Blue Shield says the case has
no merit and points to studies that a 30-day course of antibiotic therapy
should be adequate. The company approved more than 30 days treatment but did
not approve what two of the plaintiff's doctors (and others may of) recommended
to keep the patient from suffering permanent disability.
[Excerpts] and Summaries:
Jessica Parente, of New York apparently contracted Lyme disease in 1995 on a
trip to the New Jersey Shore but did not show symptoms until March 1996.
By age 19, her symptoms included nearly full-body pain, vomiting , severe
headaches, swollen lymph nodes, joint pain and falling asleep at her desk at
her secretarial job in Manhattan, where on some days neck pain prevented her
from answering the telephone.
She eventually sought consultation with Dr. Olaf Butchma of Great Neck who had
her take a Lyme disease test. The test was not mentioned by name, but involved
three urine samples with antibiotics.
Seven months after her symptom onset, she began treatment with oral
antibiotics. She couldn't tolerate the medication orally, to the point she
could not keep it down without vomiting. She was switched to intravenous (IV)
administration of antibiotics via a PICC line.
[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.]
Jessica, is married and a mother of a newborn. She uses a cane to walk and has
undergone two operations on her knees and is awaiting hip-replacement surgery.
Her surgery was covered by her insurance company Empire Blue Cross/Blue Shield,
but her doctors maintain the surgeries would not have been needed had she been
allowed consistent administration of antibiotics. Jessica currently is
described to have daily pain in various parts of her body.
Subsequent blood tests identified the strain of the bacteria, Borrelia
burgdorferi, that causes Lyme disease and is commonplace in New Jersey ticks.
David L.Trueman, her attorney, filed suit in the State Supreme Court in Queens
in September 1999. Charges include: 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, and other complaints.
[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).]
ERISA, Employee Retirement Income Security Act of 1974, developed to protect to
protect pensions, has been a major source of contention in recent years. ERISA
has served in a number of lawsuits as a "loophole through which some
managed-care companies evade liability", including damage caused by denials and
delays of claims they are alleged to have caused.
Trueman, also a practicing psychologist, has submitted papers opposing this
position. As of November 12th, no response from the defense. Gary Tannenbaum,
lawyer for the defense was said to have referred calls to Deborah Bohren,
Vice-President of Marketing and Communications. Her comments:
["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 / Blue
Shield approved intravenous antibiotic treatment for Jessica, and during the
next few months, Jessica improved dramatically."]
Chronology of events as they appear:
March 1996 - Symptoms begin and medical consultations are sough by Jessica.
She was at some point diagnosed with, or suspected to have, arthritis.
October 1996 - About this time she is diagnosed and begins treatment for Lyme
disease by Olaf Butchma MD
December 1996 - Insurance company approves IV treatment
April, 1997 - The company sends a letter to Jessica stating its medical staff
had "determined that continued administration of the drug would not be
medically necessary." Jessica is said to have promptly deteriorated.
July, 1997 - Butchma pleaded with Blue Cross and relayed his fears that Jessica
would become permanently disabled without continuation of antibiotic treatment.
August, 1997 - Blue Cross apologized for any inconvenience Jessica might be
suffering because of delays in its decision-making process
October, 1997 - Blue Cross [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.]
January, 1998 - Jessica switched doctors, her new physician Dr. Perry Orens of
Great Neck. concurred with diagnosis and recommended continual therapy.
September, 1999 - Lawsuit filed with State Supreme Court
Her new physician [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." ]
Dr. Steven Wolinsky, the companies medical director sent a letter to Jessica
about his review of Dr. Orens plea' and [had 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
Orens, Jessica and her family alternately pleaded on the telephone with company
officials to no avail.
[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.]
Not responsible for errors or omissions please contact editor for corrections.
For informational purpose only. Please refer to the original source(s) for
information if needed. Copyright © 1999 Lyme Disease Information Resource
** NOTICE: In accordance with Title 17 U.S.C. Section 107, this material
is distributed without profit to those who have expressed a prior interest
in receiving the included information for research and educational
source: Newsweek Dec. 22, 1997
"New Rx for Success"
"M.D.s go for M.B.A.s" by Michael Meyer
"John Keyser already makes big bucks. So why is he working most nights until 1
or 2, sweating over business-school case studies? Because, at 58, the New
Jersey plastic surgeon decided he needs an M.B.A. So every Friday for the last
two years he's attended classes at Columbia Universit's Graduate Scool of
Business in New York. He considers it a matter of survival. ' The whole
maketplace has changed. ,' he says. 'Now, to protect yourself and your
patients, you have to understand the business of medicine.'
".....Today as the medical industry reshapes itself through cost cutting,
mergers and managed care, more and more doctors are putting aside scalpels and
stethoscopes and going to B-school. Some want to understand the forces
reshaping their profession. Others seek the know-how to fend off HMOs and
healthcare managers who are whittling away their incomes or restricting their
patients care. 'It's a clear trend,' says Susan Sasenick at the American
College of Physician Executives, an association of doctors moving into medical
management. 'At least a third of
her 13,000 members are working toward advanced business degrees, she adds.
'We're growing by leaps and bounds.'........" I knew they weren't going to
Lyme disease school. I take that back. In a way they are. You can attend The
Academy of Leonard on Lyme and sleep through class and still get your " Lyme
expert" certificate. Once you start networking with the insurance companies
your home is free, I mean you're home free. They probably throw in a lifetime
supply of antibiotics for you and your loved ones.