Two Arizona Medicaid recipients denied potentially life-saving organ transplants have died, even as Arizona doctors, transplant survivors and some lawmakers push to restore health care benefits slashed last fall.
On Oct. 1, the Arizona Health Care Cost Containment System stopped paying for seven types of transplants that the state's GOP governor, Jan Brewer, and GOP-led legislature said they could no longer afford. The state faces a projected $1 billion program deficit by July 2011.
They eliminated heart transplants for non-ischemic cardiomyopathy, lung transplants, pancreatic transplants, some bone marrow transplants, and liver transplants for patients infected with hepatitis C. Arizona also restricted coverage of prosthetics, eliminated podiatric services, preventive dental services, and wellness and physical exams for adult Medicaid enrollees.
A former University of Arizona Medical Center patient waiting for a new liver died on Dec. 28 -- the second person to die since the cuts went into effect, according to Dr. Rainer Gruessner, chairman of surgery at the University of Arizona Medical Center in Tucson.
On Thursday, surgery department spokeswoman Jo Marie Gellerman confirmed that the patient, who died at another facility, "was our patient. He was on our list." She declined to identify the patient, citing medical confidentiality.
On Nov. 28, Mark Price, a 37-year-old leukemia patient from Goodyear, Ariz., died before he could obtain a $250,000 bone marrow transplant that an anonymous donor offered to fund after hearing media reports about Price's plight.
According to a Nov. 29 report by ABC's Phoenix affiliate KTAR, AHCCCS said Price's transplant was not covered because bone marrow donations from unrelated donors fail. Price's doctor said such procedures succeed 42 percent of the time. Price's family said his home went into foreclosure as he struggled with accumulating medical expenses.
The reductions in Arizona's safety net for the poor have drawn criticism from physicians as well as transplant recipients. Both groups have particularly attacked the practice of denying services to sick patients who had qualified for transplants before Arizona, with federal approval, changed its law. They warn that Arizona's actions may be a harbinger for the rest of the country as needs continue to outpace budgets.
Among the critics is Nina Roosevelt Gibson, an Arizona psychologist and granddaughter of President Franklin D. Roosevelt. Gibson, 68, received a heart transplant at the University of Arizona Medical Center in 2000 because of a genetic mutation that leads to heart failure.
Her daughter, who has had heart failure since surviving sudden cardiac arrest at age 28, qualifies for transplant coverage under the Medicare program for the disabled, but isn't high on the waiting list because her health is "pretty stable." Gibson worries that further cuts at the state or federal level could jeopardize her daughter's ability to get a new heart.
"I'm outraged when we have 90-something people who were promised a transplant and were told as of Oct. 1 that you can't have it because the state wants to save money," said Gibson, of Vail, Ariz., outside Tucson. "They were promised transplants and have not been given the time to raise the money that's necessary. People are going to lose their lives because they don't have the money."
Gibson, who was close to her grandmother, First Lady Eleanor Roosevelt, said her grandparents "would be horrified that our country has gotten to the point that people can't get health care in one of the wealthier countries in the free world. Something is wrong with this picture."
Gibson counsels transplant patients at Tucson's University Medical Center, helping them through scary parts of the process and many "bumps in the road." Among her patients is David Hernandez, a 48-year-old father and former heavy-equipment operator, denied a lung transplant he's been told he needs to stay alive.
Gibson also cites the case of Tiffany Tate, 27, of Chandler, Ariz., a cystic fibrosis patient awaiting a double lung transplant at UMC. Tate's family has been trying to raise the money for the operation.
Tate has said that without the transplant, " I will die." She also worries about fellow patients who will need transplants in the future.
Some Democratic lawmakers in Arizona have said they want to revive the issue of the cuts when lawmakers meet again this month. Incoming Senate Minority Leader David Schapira wants them to restore about $1.4 million of funding.
"Failure to restore this funding is a death sentence for people who have committed no crimes," he said.
In the meantime, a group of surgeons from four Arizona hospitals has formed a consortium to lobby to restore the money to pay for denied transplants. Among steps they're considering is reducing the number of pre-transplant tests that are performed, so that the funds could be used to help more patients get new organs.
The surgeons also contend that some of the data upon which Arizona officials eliminated transplant coverage was flawed. For example, they said liver transplant recipients infected with hepatitis C no longer have worse survival rates than those who are not infected.
Although the state determines which services Medicaid funds, it's actually Arizona hospitals that have taken Medicaid patients off their transplant lists, said Monica Coury, a spokeswoman for AHCCCS.
"That is a hospital issue, not a Medicaid issue," Coury said. "It is a matter of whether the hospitals are going to fund the transplants of patients without payors through their charity care dollars or whether the individual can find some other donor source."
Patients who are uninsured or underinsured because their health insurance won't cover transplants would be moved to inactive status. Coury said AHCCCS continues to cover after-care following a transplant, "so a hospital could decide to keep the patient on the active list and fund the transplant through their charity dollars and then AHCCCS would cover everything else. Arizona hospitals spend millions in charity care each year."