Sarkisyan II: Victoria Chavez

We watched and read about the very high profile Nataline Sarkisyan case in Los Angeles several weeks ago. Now, there is a similar case in Sacramento in which an insurer is denying coverage for a transplant that is the patient's last best hope. The Sacramento Bee reports this morning on the case of Victoria Chavez.

Chavez has systemic scleroderma, an autoimmune disease in which the body produces too much collagen. It is hardening Chavez's lungs, reducing her ability to breathe.

The disease is irreversible . . .[and] incurable under current medical protocols, but Chavez has been accepted into a groundbreaking autologous stem cell transplant program at Chicago's Northwestern Memorial Hospital that shows promise in treating autoimmune diseases. . . .

Early results of their clinical trials indicate that seven of 10 initial scleroderma patients showed significant improvement. New findings are set to be published this week in the Journal of the American Medical Association. . . .

But [Chavez's] health care provider, Kaiser Permanente, has repeatedly denied her request for coverage of the transplant, which will cost $160,000 to $300,000.

Kaiser issued a statement reprinted in the Sacramento Bee:

We sympathize with Ms. Chavez and are committed to providing her the most effective medical care possible.

A panel of three physician specialists in the field of rheumatology reviewed Ms. Chavez's current medical condition to evaluate whether this clinical trial would be beneficial and medically appropriate for her. After a thorough review process, the physicians agreed that an autologous stem cell transplant is not only medically inappropriate for her at this time but may also be harmful.

Our physicians will continue to seek out and make available alternative treatment options that they believe would benefit Ms. Chavez. This could include other clinical trials that may be more appropriate for her condition.

Following the lesson from the Supreme Court's opinions in Moran and Davila, Chavez is now raising money to pay for the Northwestern treatment herself, while the insurance coverage dispute proceeds to the California Department of Managed Health Care.