EXPERIMENTAL TREATMENT: ‘Forgotten’ Bill Allows Legal Recourse

      In a letter to the editor in today's San Jose Mercury News, PacifiCare of California Medical Director Dr. Gordon Norman reminds people of a law that offers recourse for terminally ill patients denied coverage for experimental treatments. Three health plans, PacifiCare, Kaiser and Health Net, all lined up behind AB 1663 in 1996 to create "external, independent review processes to review coverage determinations for terminally ill patients." Earlier this month, adds Norman, state Sen. Liz Figueroa (D-Fremont) wrote an op-ed in the San Jose Mercury News calling a recent Aetna lawsuit in which an enrollee was denied experimental treatment "tragically familiar." Norman counters that AB 1663 was not in effect at the time of the Aetna lawsuit, and "the fact is that the situation is not 'tragically familiar' these days." Norman concludes, "Unfortunately, it takes considerable research time and analysis to sort out which experimental therapies are safe and effective. ... External, independent review under AB 1663 affords everyone involved, especially the family, the comfort of knowing that what is right for each individual patients is the main focus" (3/2).