Marijuana use may have cost Big Island woman a life-saving liver transplant

[dkf]

Big Island resident Kimberly Reyes, who was diagnosed with Hepatitis in March 2008, had been told in July that she had less than 30 days to live. Her family claimed the Waimea resident had followed doctor's orders, but her insurance carrier, Hawaii Medical Service Association, denied her coverage for a liver transplant she needed to survive because three toxicology tests showed trace amounts of cannabis in her system.

According to Reyes' attorney, Ted Herhold, with San Francisco-based Townsend and Townsend, toxicology tests from June 14, July 3 and July 14 were the sole final basis for HMSA's final denial of coverage for the 51-year-old mother of five.

Reyes' mother, Noni Kuhns, and Kimberly's husband, Robin, acknowledged HMSA's decision was based upon a failure to comply with the insurer's policy forbidding drug use. However, both claimed after the claim denial that neither HMSA nor her doctors notified Kimberly or the family of HMSA's apparent policy on drug use.

Kimberly Reyes died July 27 at Hilo Hospital, 16 months after being diagnosed. In the months after her diagnosis, she suffered cirrhosis of the liver, chronic Hepatitis infection, end-stage kidney disease and hepatorenal syndrome, which is caused by low blood flow to the kidneys due to liver deterioration.

Kimberly Reyes was twice denied her application for transplant by HMSA for "technical reasons," such as missing required Alcoholics Anonymous meetings because she was too weak for doctor appointments, claimed Kuhns. However, on July 17, Reyes received HMSA's approval for a liver transplant.

Three days later HMSA denied the transplant approval after it received toxicology tests that showed cannabis in her system, Herhold said.

http://www.honoluluadvertiser.com/article/20090809/BREAKING01/308090006/Marijuana+use+may+have+cost+Big+Island+woman+a+life-saving+liver+transplant

[proud2BlibKansan]

1. So she was a recovering alcoholic?

Is that why they made her go to AA meetings?

[dkf]

4. They don't say in the article.

To be honest I'm torn on this because its sounds like she may have been a bad candidate for a transplant, yet I am a bit surprised by the drug use policy as I'd never heard of it before and I'm with HMSA. I don't do drugs, but I'm wondering what else is in there that I could be excluded for.

[buzzycrumbhunger]

19. Yes.

Demonstrating a dedication to sobriety is a requisite of any organ transplant. It makes to sense to give precious organs to someone who's going to destroy them with the exact behavior that got them there to begin with. AA or therapy sessions, plus regular toxicology tests are one way to document lifestyle modification; it doesn't make sense to take the word of an addict who simply says, "Of course, I'm clean."

And yes, they do push for smoking cessation, too. You can also be refused if you have a history of noncompliance with your prescribed medications. Getting a new heart, liver, kidneys, etc. is no magic cure. Once you get a transplant, the rest of your life is pretty much walking a tightrope to make sure they're not rejected and functioning properly. That means you pretty much have to walk the straight and narrow. I've seen patients who only got a little bit sloppy on their medication regimen and ended up in the ICU for a couple months.

I don't know about you, but I don't see that as the best use of my tax dollars (yes, a majority of the patients I transcribe seem to be indigent), not only paying for someone's new liver because they tried to drink themselves to death, but also the ensuing revolving door to the ICU.

[dkf]

22. Very eye opening.

Thank you.

[lame54]

2. poor headline - if it wasn't pot it would have been something else...

headline should read - insurance company condemns another person to death

[TheDebbieDee]

13. I agree. It seems to me that this woman's insurance company

was looking for a reason to exclude her from receiving benefits. And they seem to have been working to find several reasons (the unattended AA meetings) to deny paying her benefits.

[Eric J in MN]

3. This is why it's important the the Health Care Reform bill...

...stop recission in general, and not just recission for pre-existing conditions.

[Indydem]

9. So we start giving transplants to alcoholics and drug users

and deny them to healthy individuals with deblitating diseases?

While I hate the for-profit insurance companies, I hope that the government uses similar guidelines. Those who abuse their bodies shouldn't get organs that those who have had no hand in their suffering would otherwise get.

[Eric J in MN]

11. John Phillips of the Mamas and the Papas got a liver transplant.

He consumed lots of drugs and alcohol.

[Indydem]

12. Oh, well that makes it right?

And to boot, several months after receiving a transplant that should have gone to someone who didn't destroy their own body, he was photographed drinking.

What a classy guy.

[havocmom]

18. Doesn't make it all right. DOES show that insurance companies RATION healthcare

and we need to get their bean counters out of people's medical treatments.

[havocmom]

17. Mickey Mantle got liver transplant, and he was a boozer.

Seems the same yardstick does not measure all cases, doesn't it.

[proud2BlibKansan]

20. He was Mickey Mantle

[havocmom]

21. Yep. Regular people don't get much of a chance

People with media access get to write their own ticket.

[walldude]

16. What a crock of shit...

So what you are saying is anyone who abuses their bodies shouldn't get needed medical care? How about people who drink coffee? Eat Trans fats or fast food? How about people who play contact sports? Overweight people? People who ride motorcycles without a helmet? People who don't wear seatbelts? I could do this all fucking day. And just because they found traces of marijuana in her system doesn't mean she was addicted. Are you saying that someone who has a couple glasses of wine with dinner shouldn't get needed medical care? Who should judge who is just a casual drinker and who is an alcoholic? You? The insurance company? The government? Gimme a break. Your compassion is inspiring. :eyes:

[sharesunited]

5. No money for the operation is one thing. But was her eligibility for a donor liver affected?

[dkf]

7. Doesn't say.

I agree that it would be helpful to know, but patient confidentiality will prevent HMSA or the Doctor from commenting I assume.

[ck4829]

6. And conservatives are afraid of boards of people deciding who gets to live and die

Oh, it's a PRIVATE board of people getting to decide who lives and who dies.

Perfectly reasonable then.

:sarcasm:

[dkf]

8. Exactly!

Private businesses can be so much more arbitrary too. Republicans make the stupidest arguments sometimes.

[grytpype]

10. ... based on how much money it makes them.

[L0oniX]

14. So if you smoke tobacco you should be denied too???

Oh and add to that ...if you eat too much and get fat and have heart attack ...coverage denied!

[Wilms]

15. Another reason marijuana should be outlawed.

It's a leading cause of health-care denial.

:sarcasm:

[kiva]

23. From emedicinehealth:

Who may not be given a liver: A person who needs a liver transplant may not qualify for one because of the following reasons:

* Active alcohol or substance abuse: Persons with active alcohol or substance abuse problems may continue living the unhealthy lifestyle that contributed to their liver damage. Transplantation would only result in failure of the newly transplanted liver.

Despite the handful of cases where the wealthy and powerful avoid this criteria, this seems to be a general requirement.

[Liberal_in_LA]

24. Marijuana use leads to death sentence? That's what it sound like

[dorkulon]

25. DEATH PANEL!