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Letter from Dr. Rub to the Foundation
Health Grievance and Appeals Committee.
November 19, 2001
Foundation Health Grievance
and Appeals Committee
1340 Concord Terrace
Sunrise, FL 33323
Attn. Grievance and Appeals Department
Phone: 1-800-441-5501
Fax: 1-954-845-9224
Re: Patient Jennifer Hart
Dear Grievance and Appeals Committee
Coordinator:
On behalf of Jennifer Hart and
the parents of Jennifer Hart, I write to you this
letter of appeal for the approval of all of the
services that have been excluded regarding the medical
and hospital services of lung transplantation and
organ donation harvesting for Jennifer Hart. it
is imperative that Jennifer Hart receives
a lung transplant in order to extend her life expectancy.
At this time, as I am dictating this letter to you,
her life expectancy is severely shortened because
of her underlying disease and severity of there
lung condition. It is important to point out that
a lung transplant is a very rare procedure by itself
and the exclusion clauses are certainly not on particular
area that a layman understands clearly. Even doctors
do not know exactly what lung harvesting for living
related donor really means. I believe this exclusion
for the patient who is covered for lung transplant
should have been included.
In medical terms, her function
is FEV-1 of 19% of predicted and her FEF is 8% of
predicted. This is interpreted as severely reduced.
Normally, you have 80% of predicted or above to
function with full activity. When you lung functions
are less that 50% of predicted and are not improving,
your life expectancy is severely shortened. When
you are less than 30% of predicted, the only alternative
is a lung transplant. If a lung transplant is not
done in a timely fashion, her lung function, which
has already worsened, will deteriorate to the point
that she will die. Overall, life expectancy for
her for the next three years is less than 50%. If
she sere to have a lung infection in the next six
months to a year, her prognosis of survival would
be very poor. At times, Jennifer Hart is gasping
for air and requires additional oxygen. She already
has a tracheotomy with nighttime mechanical ventilator
and supplemental oxygen as needed. She is using
accessory muscles occasionally and she is using
greater effort to speak at times. her sputum has
grown Pseudomonas aeruginosa in the past.
At this time after discussing
her case with the Children's Hospital of Philadelphia
Transplant Tea, Dr. Tim Hoffman, and with Dr. Maite
Lamorena, transplant coordinator form St. Louis
Children's Hospital. As per the request of the Foundation
Health Corporation regarding a letter dated November
13, 2001, we proceeded with pursuing St. Louis Children's
Hospital as a designated center by the Foundation
health Network to be the center for the lung transplant.
It is my opinion that pending the decision of the
St. Louis Children's Hospital, the only alternative
for her is a living related lung donor transplant.
I would appreciate that the
Foundation Health Grievance and Appeals Committee
review her case closely and approve the option to
do a living related donor and approve the coverage
for the lung transplant as well as the organ donation
harvesting the return trip from the hospital in
St. Louis, Missouri to Miami, Florida where she
lives. There is a possibility that she may die before
she may even be considered o she may be eligible
for the lung transplant, but it is imperative, and
I repeat that Jennifer Hart be given a chance based
solely on medical need to have a lung transplant.
Any other decision this being financial or social
should not play a role in the decision of the determination
of her lung transplant.
Once again, I appeal to your
good medical sense and humanity to review this case
closely and to approve for the organ donation harvesting
since this would mean her only chance for obtaining
a living related donor because of the waiting for
a cadaveric lung will surely be a futile effort.
I appreciate your attention to the seriousness of
this matter and Jennifer Hart, as well as her parents
appreciate your kind effort in this case.
This is Dr. Mario Rub, pediatric
pulmonology, Miami, Florida at 305-792-XXX. ME0069XXX.
If you have any questions or concerns regarding
her case, please do not hesitate to call me at 305-792-XXXX
of fax me at 305-792-XXXX, or call me at 1-800-685-XXXX.
I can also be reached at DrMRub@aol.com.
Sincerely yours,
Mario Rub, MD
MR/ms
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