Ruling Should Help Breast Cancer Patients With Expenses

February 28, 1991|By Elise Armacost | Elise Armacost,Staff writer

Pasadena cancer patient Judy Marsh scored a victory over Blue Cross/Blue Shield of Maryland yesterday when a federal judge ruled in favorof two women engaged in a similar fight with the insurance company.

Blue Cross/Blue Shield has refused to pay for the bone marrow transplant sought by these breast cancer patients, saying the treatment is experimental.

But in a precedent-setting decision, U.S. District Judge Marvin Garbis deemed the procedure an accepted medical practice and ordered Blue Cross/Blue Shield to pay for it. The plaintiffs were Alexandria Adams of Millersville and Kelly Whittington of Hagerstown, Washington County.

Marsh is receiving treatment at Duke University Hospital in Durham, N.C., and could not be reached for comment. She was able toget the treatment early last winter because friends and neighbors raised $115,000 toward the $170,000 cost.

Marsh has prepared a lawsuit against Blue Cross/Blue Shield, but has waited for the outcome of the Adams-Whittington case before filing it, said Richard Carter, theAlexandria attorney who represents all three women. Garbis' decisionmeans Marsh and several other Maryland women probably will not have to go to court, he said.

The ruling "can't help but help Judy," Carter said. "I hope it means all these other cases don't have to go totrial."

Carter is handling cases for six to eight Maryland women who have cancer and want a bone marrow transplant but cannot afford it unless Blue Cross/Blue Shield covers the cost. Many of those women have been waiting for Garbis' ruling in the Adams-Whittington case, he said.

In a 40-page decision, Garbis concluded that high-dose chemotherapy autologous bone marrow transplants, in which a patient's bone marrow is removed, frozen and reinjected after being submitted to high doses of chemotherapy, are not experimental under Blue Cross/Blue Shield's definition.

Blue Cross/Blue Shield defines as "experimental" any procedure that is not an accepted medical practice by specialists in Maryland.

Maryland oncologists testified during the trial that autologous bone marrow transplants were an accepted medical practice at the time the plaintiffs sought the treatment in the spring and summer of 1990, Garbis noted in his decision.

Not only that, but experts -- including Blue Cross/Blue Shield -- testified that theyreferred patients for the procedure, and many major hospitals offer the transplants, Garbis wrote.

Blue Cross/Blue Shield plans to appeal Garbis' ruling to the U.S. Court of Appeals.

Blue Cross/Blue Shield of Virginia lost an almost identical court battle last year, Carter said. The plaintiff, Pam Pirozzi of Tracey's Landing, was the first woman in the U.S. to win the right to have Blue Cross/Blue Shieldpay for the bone marrow transplant.

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