Judge Orders Insurer To Pay For Radical Chemotherapy

Blues Had Resisted 'Experimental' Treatment

October 14, 1990|By Jay Apperson | Jay Apperson,Staff writer

Eva Simmons went to court Friday with her life on the line. If she lost her case, she would almost surely die of breast cancer.

But she prevailed in the emergency court hearing, and walked out with a judge's order requiring an insurance company to pay for controversial treatment that may be her only chance of beating her advanced case of the disease. With that ruling, the 45-year-old Arnold woman is scheduled to check into the Johns Hopkins Hospital Oncology Center today to begin treatment.

Simmons will undergo "high-dose chemotherapy with autologous bone marrow transplant." That is, doctors will use a needle to remove her bone marrow, allowing her to receive high enough doses of chemotherapy to have a chance to kill the cancer. If they don't remove the bone marrow, the doses needed to kill the cancer that has spread from her breast would cause deadly side effects.

In this technique, the bone marrow is frozen for transfusion into the patient after high-dose chemotherapy.

At issue in the emergency hearing Friday was whether Blue Cross-Blue Shield of Maryland Inc. should have to pay the estimated $100,000 needed for the treatment. The insurance company said the treatment is experimental and thus not covered under the group health plan held by her husband, a state employee.

Lawyers for Simmons said the woman, who was found earlier this year to have cancer in an advanced stage, has only about a year to live. Time was running out to start the treatments, and she can not afford to pay for them. They asked for an expedited trial, but instead got an emergency injunction hearing.

Simmons' lawyers produced affidavits from seven doctors saying the treatment was the most appropriate for a woman with her advanced cancer.

Circuit Judge Eugene M. Lerner sided with Simmons and issued an injunction preventing the insurance company from refusing the woman's claim, clearing the way for her treatment. He also refused the insurance company's request that the woman be required to post a bond to cover the price of the treatments.

Simmons wept, hugged family members and left the courthouse with a chance to beat cancer.

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