Word: transplanter
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...bone scan, which showed her cancer had spread; her disease was now classified as Stage IV metastatic breast cancer. Given the standard therapies available, it was a death sentence, but her oncologist, Dr. Mahesh Gupta, warmly assured her there was hope. He recommended she consider a bone-marrow transplant and, in a breach of Health Net procedure, skipped the usual channels for making referrals and arranged a consultation with a physician he knew, Dr. Robert McMillan, an oncologist at the Scripps Clinic in La Jolla. Christy's sister, living in Colorado, had urged her to see a leading bone-marrow...
...Gupta, reviewing his notes on the case, says Dr. McMillan agreed Christy was a candidate for a transplant but said she would first have to undergo several cycles of chemotherapy to demonstrate that her tumor would respond to the potent drugs used in bone-marrow therapy. In the deMeurerses' eyes, however, it was a deeply troubling encounter. Dr. McMillan declined even to describe what was involved in a bone-marrow transplant or give the family a tour of the Scripps facilities, according to Alan deMeurers and Christy's mother, Joyce Nesmith. "I believe he was told to send us away...
...double bind. "Is it reasonable," he asks, "for an insurer to demand the gold standard of proof and simultaneously refuse to pay for patients to enter a trial to get that level of proof?" Dr. Jones is convinced that women who once would have come to him for a transplant aren't coming because their doctors, operating under tight managed-care cost guidelines, aren't telling them that transplants are a medical option. "You put yourself in a position where you don't discuss it, or else discuss it and, worse yet, indicate that all the data is negative...
When Dr. Jones examined Christy deMeurers, he believed a transplant could help her. "The available proof for its efficacy in breast cancer was at least equivalent to many other procedures that we do every day," he says. As early as 1990, even Health Net had found evidence that bone-marrow transplants might become a standard weapon against breast cancer. That year the company's then chief medical officer, Dr. Leonard Knapp, ordered a study by Technology Assessment Group of San Francisco to evaluate the treatment. The report, however, didn't reach the conclusion he had hoped for. It found that...
...June 8, 1993, the day the deMeurerses met with Dr. Jones in Denver, Health Net, with Dr. Ossorio's support, formally decided the company would not cover a transplant for Christy on grounds that it was excluded under the investigational clause of her contract...