Texas treatment treated on this blog on Medical Futility. Thanks, Les, for the tip.
..................................
In Texas, when a patient's surrogate asks a health care provider to provide life-sustaining treatment that the provider deems medically inappropriate, the provider may refuse so long as (1) she gets confirmation from her facility's ethics committee and (2) she gives the surrogate an opportunity to transfer the patient to another facility willing to provide the requested treatment.
To help surrogates navigate the transfer process, the Texas Advance Directives Act established a "registry" of providers willing to accept transfers of patients who want LSMT that their current facility is unwilling to provide. But the registry is comprised primarily of lawyers "willing to receive requests for legal counsel from families that are going through a transfer." And Texas Right to Life states that it is "willing to help transfer to a facility that provides treatment." Even with such help, transfers are very hard to find.
But perhaps there is a solution. Either UCLA could list itself on the Texas registry or at least TRL and the Texas law firms could focus on UCLA as a potential transferee. As recently reported in the 2008 Dartmouth Atlas of Health Care, the UCLA Medical Center was by far the most aggressive in managing chronic illness, as measured by the use of medical specialists and intensive care units, as well as the total number of physician visits.
(chart from NYT) Medicare spent an average of $52,911 for U.C.L.A. patients but only $28,763 for those who used the Mayo Clinic hospital.
Take just one tangential illustration: the Nataline Sarkisyan case. Cigna got a lot of flack for refusing to cover a liver transplant for this girl with leukemia and multiple organ failure. But it did appear that UCLA recommendation for the transplant was far more aggressive than not only the independent reviewers whom Cigna used but also more aggressive than other leading medical centers like UCSF and Baylor.
Texas Right to Life, Transfer Patients to UCLA
8mm
