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Read Making a Killing

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PATIENT STORY

Cancer Patient Denied Liver Transplant Living Out HMO Death Sentence

Judith Packevicz - Saratoga Springs, NY
A woman suffering from a rare form of metastatic cancer of the liver is being denied life-saving treatment by her HMO. The HMO will not pay for a liver transplant recommended by her oncologist with the support of all her treating physicians -- causing the woman to live out a death sentence.

According to court documents:

Judith Packevicz has struggled against the slow-growing cancer and now faces imminent death if the transplant is not performed. Her quality of life, according to a lawsuit filed May 27, 1998 in Federal Court, Northern District of New York, is "indescribably miserable both physically and mentally." Her son, Thomas Dwyer is a ready, willing and able donor. Thirteen friends of the family have also volunteered to donate a part of their livers. The recommended treatment is available at Mt. Sinai Hospital in New York City and will cost an estimated $345,000.

Ms. Packevicz is the mother of four children, stepmother of three and a grandmother of nine. A well-known figure in Saratoga Springs, she was an active and successful singer in a Sweet Adeline quartet, until her illness forced her to stop last year.

The suit was brought under the Employee Retirement Income Security Act (ERISA), which applies to employee benefit plans, because Ms. Packevicz purchased the health care through her employer. Under ERISA, she can recover no damages, only the cost of the procedure denied in the first place.

The HMO denied the recommended transplant on the grounds that it allegedly "does not meet the medical standard of care for this diagnosis." No explanation of why the recommended transplant allegedly fails to meet community standards was provided in the correspondence.

The lawsuit seeks a temporary restraining order, preliminary injunction and permanent injunction requiring the HMO to pay for Ms. Packevicz's cancer treatment. It argues that "community standards in the State of New York do not mandate slow, certain, miserable hopeless, excruciating and inhumane death in plaintiff's case where there is a medically recommended reasonably feasible alternative a few dollars away." Ms. Packevicz's physicians assert a very high probability of survival, with significantly improved quality of life, if the transplant is performed.

Under ERISA, should Packevicz die before receiving her transplant, the HMO is liable for no costs at all.





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