Medi-Cal/ObamaCare's "Death Panel Of One" and Catch-22

Full Definition of CATCH-22

1:  a problematic situation for which the only solution is denied by a circumstance inherent in the problem or by a rule <the show-business catch–22—no work unless you have an agent, no agent unless you've worked — Mary Murphy>; also :  the circumstance or rule that denies a solution

           2        a :  an illogical, unreasonable, or senseless situation

b :  a measure or policy whose effect is the opposite of what was intended  

          c :  a situation presenting two equally undesirable alternatives

3:  a hidden difficulty or means of entrapment :  catch

My roomie, Jes, is facing a real-life Catch-22 with her hospitalization for liver failure brought on by the prescribed drug, methotrexate. Unless she gets a liver transplant, she only has weeks to live. She is only 33.

She was prescribed this drug due to a skin disorder three years ago. It is a very powerful drug and, as it turns out, can damage vital organs and cause nerve damage.

Her doctor said that the methotrexate caused the damaged liver, not alcohol.

Herein lies the problem. As she had a history of alcohol abuse (she had a DUI four years ago), Medi-Cal (her medical insurer) assigned a "death panel" of one, a Dr. Knealer who said that because of this (and the fact that she had two glasses of champagne on New Year's) her placement on the transplant list has to be deferred until she completes six months of Alcoholics Anonymous classes. This is despite that she completed nine months of AA classes last July. They disregard that as they consider her to have "relapsed" from drinking two glasses of champagne. This is, according to Medi-Cal, is a rule brought on by the Affordable Health Care Act (ObamaCare) that governs Medi-Cal!

Here's the Catch-22: She does not have six months. Even if she did, she is too ill to leave the hospital. Also, the hospital will not allow AA classes in her hospital room. 

So, what the hell are we supposed to do?!

At present, her doctors are appealing Dr. Knealer's ruling. Hopefully, Dr. Knealer will see the stupidity of his ruling and allow Jes to be placed on the transplant list. Keep in mind that our dispute is with Medi-Cal, not the hospital. The hospital has been nothing less than wonderful.

We are exploring other means of getting Dr. Knealer to reverse his ruling. One possibility is to go to court and get an emergency order to force Medi-Cal to put Jes on the transplant list. Another is to force them to reverse their decision through media pressure. This blog post is only the beginning. I will be contacting media representatives shortly.

In any case, we don't have any time to waste. We have been told that another patient is under the same Catch-22 problem.

Thankfully, I have an excellent attorney friend who has given us some great advice, who summed our situation up this way:

If I understand Jes' situation properly, you guys are literally betting on her living that long to see if Medi-Cal changes their bureaucratic pea-brained minds. Why should they? They have no incentive to do so without a push. It saves them money and paperwork to deny her the benefits. They don't care whether she lives or dies - she's a number to them, not a person.  Did you ever watch "Erin Brockovich?"  That took place in my area, and that is a good example of how the big companies will bank on just waiting, since they can afford to, until the person dies or whatever happens.  Jes is not one iota closer to fulfilling what they claim she needs while she is in the hospital, yet she can't come out of the hospital. That is Catch-22.  The only way in which companies give in and pay out is by pressure and repeatedly bugging them. That is not on the hospital - it is on Medi-Cal. And the more mired we become in the Obamacare state of being, the more people who will not get the help they need from here on out.

You would be a great help to our cause if you would pass on this blog post to any media contacts you may have!

UPDATE (3/12/14):
Medi-Cal denied the Jes's doctors's appeal and won't change their position on listing Jes for a transplant and there's no more appeals. We will need to go to Superior Court to get an emergency order to force them.

UPDATE (3/15/14):
I received word yesterday that Jes is "doing better" and is to be released from the hospital next week. While it is nice to have her back home again, I am concerned that this release is the hospital's way of throwing their hands up in the air as Medi-Cal refuses to approve her to be listed for a liver transplant. I will find out more this weekend. Thankfully, we have the "machinery" necessary to pursue an emergency court order to get her listed.