|Author||Subject: Here is another example of Oregon's attitude toward the sick or injured|
|Tom|| Posted At 19:21:24 06/06/2000
Oregon denies transplants for dying teen
The state health plan won't authorize a combination
lung-liver surgery for Brandy Stroeder, who suffers from
Tuesday, June 6, 2000
By Joe Rojas-Burke of The Oregonian staff Sprawled on a
hospital bed and breathing enriched air through a tube in
her nostrils, 18-year-old Brandy Stroeder clasped a teddy
bear to her chest as if it were a life preserver in a stormy
ocean. She is hanging on for the legal battle that could decide
whether she lives or dies.
Stroeder was born with cystic fibrosis, one of the most
common deadly genetic afflictions. The advancing disease
has reached a point where doctors say the young woman
from McMinnville will die in a matter of months without a
combined transplant operation to replace her damaged
lungs and her failing liver at the same time.
Stroeder's health insurer, the state and federally funded
Oregon Health Plan, won't authorize the combined
operation -- even though the plan routinely pays for
separate lung or liver transplants for patients with cystic
"I don't think they've given a rational explanation of why.
They just say it's against the rules," said Stroeder, whose
health is too fragile to survive either operation alone. She
and her mother have spent the past six months appealing
the denial unsuccessfully. Now they are suing the state in
the Yamhill County Circuit Court.
"I just don't know how they can say who should live and who
should die," said the mother, Karen Stroeder, 39, who supports
her two children by working for a meat-packing company in
McMinnville and as a part-time tax preparer.
State officials declined to comment on their decision to
deny coverage for the potentially lifesaving operation.
"We've been advised by the attorney general's office not to
talk about this case because it is in litigation," said Hersh
Crawford, director of the Office of Medical Assistance Programs.
A spokesman for the attorney general's office said staff
lawyers won't comment until they've completed their review
of the case. A preliminary court hearing is scheduled for June 15.
Surgeons at Stanford University -- where Stroeder's doctors
want to send her -- and a handful of other centers around
the world have performed the combined lung and liver
operation for more than a decade. But it has not gained the
acceptance of lung transplantation alone or combined
heart/lung transplantation for cystic fibrosis. The Oregon
Health Plan has paid for 15 lung transplants for cystic
fibrosis patients in the past four years.
Dr. Jeffrey Edelman, a lung specialist at Oregon Health
Sciences University who has experience with the
simultaneous lung and liver procedure at another institution,
said it is probably a riskier operation than either transplant
alone. But if the patient makes it through the operation, his
opinion is that the risks become essentially the same as a single transplant operation.
In the largest series of patients reported in medical
literature that Edelman could recall, seven of the 10
patients who underwent the combined operation in France
were alive one year later. "That is roughly equivalent to what
survival is after lung transplantation alone," he said.
Edelman said the dispute raises ethical questions that
society has never been able to answer to the satisfaction of everyone.
"It's not a simple cut-and-dried issue," he said. The
Likelihood of success remains unknown because of a
shortage of scientific studies. Whether it would be wiser, in
general, to spend the money on more clearly effective care
remains unclear, he said.
The operation also requires giving organs that could
potentially save three lives to just one person. Because of
the scarcity of organ donors, doctors sometimes divide a
pair of lungs between two cystic fibrosis patients.
"But for this one patient, it's basically going to be a life or
death decision," Edelman said.
Long wait for organs Stroeder, meanwhile, wonders whether she can survive long
enough to make it through both the legal proceedings and
the long wait for suitable donor organs, typically about two
years for patients seeking lungs and a liver.
Lung and liver problems have put her in the hospital every
few weeks for the past year. In spite of that, she has
managed to complete her senior year with credits to spare
and she expects to attend the graduation ceremony June
16 with her classmates.
She still nurtures a long-term dream of attending culinary
school, ideally in France. She wants to make a name as a
chef at some notable four-star restaurant and then open her
own bed and breakfast.
"That's a little far-fetched right now," she said Monday from
her hospital bed. "With all this messing around and stuff, I
might get on the (transplant) waiting list and not make it
until my number is called."
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