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Current government healthcare in action:
Mother of 8 battles failing health, Medicaid
By ANDY MILLER
The Atlanta Journal-Constitution
Published on: 06/11/08
Every evening, instead of bringing her dinner, one of her daughters attaches a long tube to a catheter that dangles from Sabrina Holloway's arm. A pump delivers nutrients into a vein for 16 hours, as Holloway lays in bed at home.Holloway cannot eat or drink. She has been fed intravenously since January, when doctors removed most of her small intestine. The mother of eight needs an intestinal transplant, according to her doctor, Ian Katz, a general surgeon in Decatur. Without that surgery, Holloway likely will not live long, Katz says. "Two to three years, I'm guessing.''
The bags of nutrients keep her alive, but they don't ease the pain and fear. "I feel so sick," Holloway says in her soft voice, barely audible over the whirl of a small electric fan beside her. In these moments, she looks older than her 38 years.Right now her hope for a transplant is stalled at an intersection of payment and insurance coverage — a labyrinth that many individuals seeking medical care, even those who are insured, struggle to navigate. Holloway is covered by Georgia Medicaid, the health insurance program for the poor and disabled that's jointly funded by the state and federal governments.When Katz asked Medicaid to approve the intestinal transplant, the state replied that it did not cover this surgery for patients 21 and older. The federal government gives state Medicaid programs leeway on which transplants to approve. Georgia Medicaid allows transplants of kidney, liver, bone marrow and cornea for adults, according to the rejection letter sent to Katz. "Lung, bowel, pancreas and heart-lung transplants are not covered," the letter states. Other states' Medicaid programs — which have their own coverage rules — approve intestinal transplants for people Holloway's age. "To my knowledge, most Medicaid programs cover it," says Dr. Douglas Farmer, head of the intestinal transplant program at UCLA. The operation costs $200,000 to $400,000, doctors say. A year of nutritional intravenous feeding, as Holloway now requires, can cost $150,000, Farmer says. "They could get out cheaper with a transplant,'' says Farmer, who says intestinal transplants can cost less than $200,000. Georgia Medicaid's ruling, he says, "is very surprising." In Holloway's case, the Medicaid spending on IV treatment doesn't include the bills for four subsequent hospitalizations for infections. The intravenous feeding makes Holloway prone to infection, Katz says. Holloway has an abnormal blood-clotting condition that has caused the destruction of most of her small intestine. "She's miserable," Katz says. "A transplant would allow her to enjoy life. "Even when approved by insurance, an intestinal transplant isn't a common medical process. About 150 procedures are performed worldwide each year, UCLA's Farmer says. The waiting list for an intestinal transplant — currently at 230 nationwide — is relatively small because not many of the procedures are done, says the United Network for Organ Sharing. The median wait time is 200 to 250 days, says Joel Newman, a UNOS spokesman, who adds that intestinal transplants are more commonly performed in children than adults. The long-term success rate has improved partly because better drugs have been developed to counteract the organ-rejection problem. Ironically, the same federal agency that oversees Medicaid approved intestinal transplants for Medicare patients in 2000. The decision by the Centers for Medicare and Medicaid Services "was huge for us in the field," Farmer says. As often occurs after a Medicare approval, coverage from many private insurance plans followed. No Georgia hospital performs intestinal transplants. A Florida hospital that does, the University of Miami/Jackson Memorial Medical Center, Katz says, has indicated that it would do the Holloway operation — with Medicaid funding. For now, Holloway remains in limbo. She returned home from DeKalb Medical in mid-May from a stay for an infection. But later in the month, another infection sent her back to the hospital. Her kids, she says, "are so stressed out because I've been in the hospital so much. "Holloway was born at Grady Memorial Hospital and has lived in the area since. With a large family, she has not worked since she was a teenager. Her bedroom in the rented Ellenwood home has stacks of bandages, medical tape and surgical gloves. A television provides distraction, as does the constant presence of her kids, ranging in ages from early 20s to 10. Her children help keep the home running and make their own meals. One of her twin daughters and her husband, Hydrick, help hook her up to the bag of IV nutrients. "I just want to be me again — that's all I want,'' Holloway says. "So I can be a mother again.''
"I don't want to think of in a year, I may not live," she says, but adds: "I have tremendous faith in God. God's going to turn this around."
Holloway is otherwise relatively healthy and a good candidate for a transplant, Katz says. They have appealed the Medicaid decision. Georgia Medicaid, through a spokeswoman, declined to discuss Holloway's case, citing privacy rules. The appeal has already taken weeks, and there's no end in sight. Katz says a Medicaid official told him that there were hundreds of cases ahead of Holloway's. It may take months for the review, Katz says. Georgia Medicaid has a "huge backlog" on appeals, says Linda Lowe, a consumer health advocate. "I know cases that have been on appeal for months that haven't even been sent to the hearing officer.'' Meanwhile, Katz has suggested that if Georgia continues to reject her appeals, Holloway should move to a state that covers the operation, such as North Carolina or South Carolina, and establish residency. Asked why he has worked so hard for her, Katz replies: "Every human life to me is precious. If something is fixable, and there's hope, we should do it. "She has a long potential life ahead of her," Katz adds. Through it all, Holloway is determined to get better. "I'm ready to go to Florida and do what I got to do."
Mother of 8 battles failing health, Medicaid
By ANDY MILLER
The Atlanta Journal-Constitution
Published on: 06/11/08
Every evening, instead of bringing her dinner, one of her daughters attaches a long tube to a catheter that dangles from Sabrina Holloway's arm. A pump delivers nutrients into a vein for 16 hours, as Holloway lays in bed at home.Holloway cannot eat or drink. She has been fed intravenously since January, when doctors removed most of her small intestine. The mother of eight needs an intestinal transplant, according to her doctor, Ian Katz, a general surgeon in Decatur. Without that surgery, Holloway likely will not live long, Katz says. "Two to three years, I'm guessing.''
The bags of nutrients keep her alive, but they don't ease the pain and fear. "I feel so sick," Holloway says in her soft voice, barely audible over the whirl of a small electric fan beside her. In these moments, she looks older than her 38 years.Right now her hope for a transplant is stalled at an intersection of payment and insurance coverage — a labyrinth that many individuals seeking medical care, even those who are insured, struggle to navigate. Holloway is covered by Georgia Medicaid, the health insurance program for the poor and disabled that's jointly funded by the state and federal governments.When Katz asked Medicaid to approve the intestinal transplant, the state replied that it did not cover this surgery for patients 21 and older. The federal government gives state Medicaid programs leeway on which transplants to approve. Georgia Medicaid allows transplants of kidney, liver, bone marrow and cornea for adults, according to the rejection letter sent to Katz. "Lung, bowel, pancreas and heart-lung transplants are not covered," the letter states. Other states' Medicaid programs — which have their own coverage rules — approve intestinal transplants for people Holloway's age. "To my knowledge, most Medicaid programs cover it," says Dr. Douglas Farmer, head of the intestinal transplant program at UCLA. The operation costs $200,000 to $400,000, doctors say. A year of nutritional intravenous feeding, as Holloway now requires, can cost $150,000, Farmer says. "They could get out cheaper with a transplant,'' says Farmer, who says intestinal transplants can cost less than $200,000. Georgia Medicaid's ruling, he says, "is very surprising." In Holloway's case, the Medicaid spending on IV treatment doesn't include the bills for four subsequent hospitalizations for infections. The intravenous feeding makes Holloway prone to infection, Katz says. Holloway has an abnormal blood-clotting condition that has caused the destruction of most of her small intestine. "She's miserable," Katz says. "A transplant would allow her to enjoy life. "Even when approved by insurance, an intestinal transplant isn't a common medical process. About 150 procedures are performed worldwide each year, UCLA's Farmer says. The waiting list for an intestinal transplant — currently at 230 nationwide — is relatively small because not many of the procedures are done, says the United Network for Organ Sharing. The median wait time is 200 to 250 days, says Joel Newman, a UNOS spokesman, who adds that intestinal transplants are more commonly performed in children than adults. The long-term success rate has improved partly because better drugs have been developed to counteract the organ-rejection problem. Ironically, the same federal agency that oversees Medicaid approved intestinal transplants for Medicare patients in 2000. The decision by the Centers for Medicare and Medicaid Services "was huge for us in the field," Farmer says. As often occurs after a Medicare approval, coverage from many private insurance plans followed. No Georgia hospital performs intestinal transplants. A Florida hospital that does, the University of Miami/Jackson Memorial Medical Center, Katz says, has indicated that it would do the Holloway operation — with Medicaid funding. For now, Holloway remains in limbo. She returned home from DeKalb Medical in mid-May from a stay for an infection. But later in the month, another infection sent her back to the hospital. Her kids, she says, "are so stressed out because I've been in the hospital so much. "Holloway was born at Grady Memorial Hospital and has lived in the area since. With a large family, she has not worked since she was a teenager. Her bedroom in the rented Ellenwood home has stacks of bandages, medical tape and surgical gloves. A television provides distraction, as does the constant presence of her kids, ranging in ages from early 20s to 10. Her children help keep the home running and make their own meals. One of her twin daughters and her husband, Hydrick, help hook her up to the bag of IV nutrients. "I just want to be me again — that's all I want,'' Holloway says. "So I can be a mother again.''
"I don't want to think of in a year, I may not live," she says, but adds: "I have tremendous faith in God. God's going to turn this around."
Holloway is otherwise relatively healthy and a good candidate for a transplant, Katz says. They have appealed the Medicaid decision. Georgia Medicaid, through a spokeswoman, declined to discuss Holloway's case, citing privacy rules. The appeal has already taken weeks, and there's no end in sight. Katz says a Medicaid official told him that there were hundreds of cases ahead of Holloway's. It may take months for the review, Katz says. Georgia Medicaid has a "huge backlog" on appeals, says Linda Lowe, a consumer health advocate. "I know cases that have been on appeal for months that haven't even been sent to the hearing officer.'' Meanwhile, Katz has suggested that if Georgia continues to reject her appeals, Holloway should move to a state that covers the operation, such as North Carolina or South Carolina, and establish residency. Asked why he has worked so hard for her, Katz replies: "Every human life to me is precious. If something is fixable, and there's hope, we should do it. "She has a long potential life ahead of her," Katz adds. Through it all, Holloway is determined to get better. "I'm ready to go to Florida and do what I got to do."
