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W. SENECAN FINALLY GETS OK FOR LIVER TRANSPLANT TALE POINTS OUT NEED FOR INSURANCE REFORM

Sally McCarthy has had an 11th-hour reprieve from a medical bureaucracy that had doomed her to die of liver failure because of an insurance problem.

Until 1:30 p.m. Friday, Mrs. McCarthy of West Seneca was in limbo -- not enough insurance to cover the staggering costs of a liver transplant and too much money to become a welfare patient.

Then came word at last that she had been given emergency Medicaid authorization and was accepted at another transplant center.

Her tale points out one of the shortcomings of a medical care system, whose reform is now a national priority. And it has outraged plenty of people, including her doctors and her husband.

The story unfolded this way:

Mrs. McCarthy was set to go to the Pittsburgh University Medical Center May 21 for a liver transplant. But the hospital called back and told her husband, Joseph, that he had to bring $143,000 cash with him because he did not have enough health insurance coverage.

"We were all packed and ready to go when the hospital called," McCarthy said Friday.

"The doctors here in Buffalo were flabbergasted. And so am I. I can't believe I live in a country which has the funds for weather disasters and foreign aid, but doesn't take care of its own taxpayers.

"Well, whatever happens, there is going to be a crusade about this -- and I'm going to lead it."

An employee of Ferguson Electric, McCarthy and his family are covered by medical insurance carried by the International Brotherhood of Electrical Workers.

"But I only have $75,000 worth of major medical," he said. "Pittsburgh said it was not enough."

Diagnosed with acute onset liver failure, Mrs. McCarthy had been admitted two days earlier to Buffalo General Hospital. Her doctors, Nancy Nielsen and James Corasanti, immediately made plans for a transfer, because Buffalo General does not perform liver transplants.

"The irony is that if Mrs. McCarthy were on welfare, Medicaid would have paid for the entire thing," said Dr. Nielsen, Mrs. McCarthy's primary care physician.

"This is a tragedy, a failure of our system -- and this is not 'greedy doctors,' either, because the $250,000 Pittsburgh wants for a liver transplant does not even cover doctors.

"The medical staff there accepted her, but a 'transplant analyst' -- a bean counter -- looked over the insurance coverage and simply told this woman she was going to die."

It is not uncommon for hospitals to wait for massive payments -- as happened two years ago when the Amish community in Conewango was told by Buffalo Children's Hospital it could take as long as needed to pay for heart operations for three of its children.

But the Pittsburgh transplant center's spokeswoman, Susan Manko, said: "It is our policy to require a deposit of $208,000 from every liver transplant admitted."

She said the cost for a liver trans
plant starts around $250,000 and goes up from there, depending on the individual case.

"Payment plans could be arranged," she said, "but Mrs. McCarthy was never put on our list as a transplant candidate. To be put on our list, you must first be financially cleared, and that means insurance. We advised her to apply for New York's medical assistance."

When that happened, scores of people started trying to help.

Steven Pigeon, a former Erie County legislator who now serves on President Clinton's health-care advisory committee, hand-delivered the information to the Oval Office. Rep. Jack Quinn, R-Hamburg, also contacted the Pittsburgh hospital on the McCarthys' behalf, as did the state Health Department in Albany.

Erie County Social Service Commissioner Karen Schimke apparently made every effort to eventually certify Mrs. McCarthy as a Medicaid client. But Ms. Schimke said Friday she could not discuss the case nor her office's involvement due to state confidentiality laws.

"This is one time when I wish I could talk about an individual case," she said.

"Pittsburgh is not doing charity work," Dr. Nielsen said. "They are expanding, they are adding to that transplant center all the time."

The half-dozen U.S. transplant centers that can do livers all seem to operate in similar fashion. But on Friday afternoon, after a week of negotiations, it was announced that Mrs. McCarthy had been approved as a Medicaid recipient and will be accepted as a patient in Mount Sinai Hospital.

She will leave for New York City today, where she will be treated and monitored pending the availability of a suitable donor organ.

"The tragedy is that these are honest, working stiffs -- like you or me," Dr. Nielsen said. "That is what's scary.

"If someone told me my child needed an operation and that I had to come up with that kind of money in the next 24 hours, I couldn't. Almost no one could. And you know, I don't think my Blue Cross policy would cover an expense like that."

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