Doc­tor says in­sur­ers push sui­cide over med­i­cal care

Life-end­ing drugs cost less than treat­ment

The Washington Times Daily - - FRONT PAGE - BY BRAD­FORD RICHARDSON

A Ne­vada physi­cian says in­sur­ance com­pa­nies in states where as­sisted sui­cide is le­gal have re­fused to cover ex­pen­sive, life-sav­ing treat­ments for his pa­tients but have of­fered to help them end their lives in­stead.

Brian Cal­lis­ter, as­so­ciate pro­fes­sor of in­ter­nal medicine at the Univer­sity of Ne­vada, said he tried to trans­fer two pa­tients to Cal­i­for­nia and Ore­gon for pro­ce­dures not per­formed at his hos­pi­tal. Rep­re­sen­ta­tives from two dif­fer­ent in­sur­ance com­pa­nies de­nied those trans­fer re­quests by phone, he said.

“And in both cases, the in­sur­ance med­i­cal di­rec­tor said to me, ‘Brian, we’re not go­ing to cover that pro­ce­dure or the trans­fer, but would you con­sider as­sisted sui­cide?’” Dr. Cal­lis­ter told The Wash­ing­ton Times.

The phone calls took place last year within the span of a month, Dr. Cal­lis­ter said, adding that he did noth­ing to prompt the as­sisted sui­cide sug­ges­tion in ei­ther case.

“You would think the sec­ond time, I would have been ready for it,” the doc­tor said. “But I was so stunned, I mut­tered the same stupid line: ‘That’s not le­gal in Ne­vada yet.’ That’s all I could come up with.”

The al­le­ga­tion comes as more than a dozen states are con­sid­er­ing leg­is­la­tion to le­gal­ize physi­cianas­sisted sui­cide, in­clud­ing Ne­vada, where Dr.

Cal­lis­ter tes­ti­fied against a pro­posed bill on Mon­day.

In Fe­bru­ary, the Dis­trict be­came the sixth U.S. ju­ris­dic­tion to en­act such a law, join­ing Cal­i­for­nia, Colorado, Ore­gon, Ver­mont and Wash­ing­ton. The Mon­tana Supreme Court has ruled that help­ing ter­mi­nally ill pa­tients to end their lives does not vi­o­late state law.

As part of a cam­paign to curb the trend, the Pa­tients Rights Ac­tion Fund on Wed­nes­day re­leased a video fea­tur­ing Dr. Cal­lis­ter.

“As much as most in­sur­ance com­pa­nies try to come across as your best friend, they want to do what­ever the least-costly thing is,” Dr. Cal­lis­ter says in the video. “It’s a lot cheaper to grab a cou­ple of drugs, kill you, than it is to pro­vide life-sus­tain­ing ther­apy. Sim­ple as that.”

The anti-as­sisted sui­cide group plans to re­lease other videos, in­clud­ing one of Stephanie Packer, a ter­mi­nally ill Cal­i­for­nian who said she was de­nied cov­er­age and of­fered life-end­ing pills af­ter the state en­acted its law in 2015.

Be­fore air­ing the video, the Pa­tients Rights Ac­tion Fund said it con­sulted a lawyer who ad­vised against nam­ing the in­sur­ance com­pa­nies in­volved, cit­ing the Health In­sur­ance Porta­bil­ity and Ac­count­abil­ity Act (HIPAA), a fed­eral pri­vacy law.

Dr. Cal­lis­ter said, be­cause he makes such trans­fer re­quests in­fre­quently, the at­tor­ney said nam­ing the in­sur­ance com­pa­nies could lead to the iden­ti­fi­ca­tion of the pa­tients.

“It’s a low-enough num­ber that nam­ing the in­sur­ance com­pa­nies would po­ten­tially make the in­di­vid­ual pa­tients iden­ti­fi­able, and there­fore a vi­o­la­tion of HIPAA,” Dr. Cal­lis­ter said. “I would love to name the in­sur­ance com­pa­nies, but it is what it is.”

He also said he was un­able to ob­tain waivers from ei­ther pa­tient to au­tho­rize the dis­clo­sures.

Cathryn Don­ald­son is the di­rec­tor of com­mu­ni­ca­tions for Amer­ica’s Health In­sur­ance Plans, an ad­vo­cacy group that rep­re­sents in­sur­ance providers. She said in a state­ment that aid-in-dy­ing laws do not change the be­hav­ior of in­sur­ance com­pa­nies.

“Health plans do not with­hold or deny life­sus­tain­ing care in states that have physi­cian-as­sisted sui­cide,” Ms. Don­ald­son said, “and the abil­ity of the pa­tient to de­ter­mine that op­tion is up to the pa­tient and their physi­cian with ab­so­lutely no in­volve­ment from health in­sur­ers what­so­ever.”

What’s more, the Amer­i­can Med­i­cal As­so­ci­a­tion, the na­tion’s largest as­so­ci­a­tion of doc­tors, has long op­posed physi­cian-as­sisted sui­cide.

Kat West, na­tional di­rec­tor of pol­icy and pro­grams at Com­pas­sion & Choices, which works to en­act aid-in-dy­ing leg­is­la­tion, said she’s “skep­ti­cal” of Dr. Cal­lis­ter’s story. She said “the names of the in­sur­ance com­pa­nies he talked to are ab­so­lutely not cov­ered” un­der HIPAA.

“I’m not a HIPAA lawyer, but that sounds re­ally — it sounds like some­one who does not want to share in­for­ma­tion,” said Ms. West, who tes­ti­fied in fa­vor of the Ne­vada aid-in-dy­ing leg­is­la­tion on Mon­day. “That’s what it sounds like to me.”

She said “there’s no ev­i­dence” to sup­port Dr. Cal­lis­ter’s claim, and “he needs to come for­ward and pro­vide ev­i­dence” if he wants to make such an al­le­ga­tion.

But Dr. Cal­lis­ter said it’s no co­in­ci­dence the in­sur­ance agents stumped for as­sisted sui­cide over the phone.

“Now was this in writ­ing? Of course not,” he said. “This was on the phone. They’re too smart to put that in writ­ing.”

There have been sev­eral cases of in­sur­ance com­pa­nies of­fer­ing as­sisted sui­cide to pa­tients in writ­ing.

In 2008 Bar­bara Wag­ner re­ceived a let­ter from her state’s Med­i­caid pro­gram de­clin­ing to cover a lung can­cer drug that would have cost $4,000 per month. The Ore­gon Health Plan, how­ever, did of­fer to pay for the 64-year-old to pro­cure as­sisted sui­cide drugs, priced at $50.

Anne Som­mers, board chair of dis­abil­ity rights group Not Dead Yet, said in­sur­ance providers are mo­ti­vated by profit, and help­ing pa­tients end their lives is cheap. She said in­sur­ance com­pa­nies en­cour­ag­ing as­sisted sui­cide is an in­evitable con­se­quence of the prac­tice’s le­gal­iza­tion.

“If you asked a se­ries of economists, and didn’t tell them you were talk­ing about [as­sisted sui­cide], they would laugh you out of the room,” Ms. Som­mers said. “Of course it’s go­ing to have an ef­fect. It’s only when pol­i­tics be­comes in­volved that peo­ple find a way to tor­ture the facts to come up with the an­swer they want.”

Com­pas­sion & Choices’ Ms. West pointed to a 1998 study in The New Eng­land Jour­nal of Medicine ti­tled “What are the po­ten­tial cost sav­ings from le­gal­iz­ing physi­cian-as­sisted sui­cide?” that pre­dicted in­sur­ance com­pa­nies would hardly al­ter their be­hav­ior in re­sponse to as­sisted sui­cide laws.

She said her ad­vo­cacy group wants ter­mi­nally ill pa­tients to “get the best care pos­si­ble” and would be “ap­palled” if there were ev­i­dence to sup­port Dr. Cal­lis­ter’s claims.

Due to pri­vacy laws and the fact that in­sur­ance com­pa­nies rarely of­fer rea­sons for deny­ing cov­er­age, Ms. Som­mers said it’s dif­fi­cult to col­lect data ei­ther for or against the claim.

“This is a very con­ve­nient thing for Com­pas­sion & Choices to say, that this is all anec­do­tal, that there are lots of rea­sons peo­ple are de­nied treat­ment,” she said. “But physi­cian-as­sisted sui­cide will al­ways be the cheap­est op­tion.”

Even pro­po­nents of aid in dy­ing have ar­gued that eco­nomic pres­sure will help to nor­mal­ize the prac­tice.

In his 1998 book “Free­dom to Die,” Derek Humphry, who founded the Hem­lock So­ci­ety, which evolved into Com­pas­sion & Choices, wrote that “eco­nom­ics, not the quest for broad­ened in­di­vid­ual lib­er­ties or in­creased au­ton­omy, will drive as­sisted sui­cide to the plateau of ac­cept­able prac­tice.”

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