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Legal Aid sues over transplant

Citizen Staff Writer



Southern Arizona Legal Aid is suing AHCCCS, the state’s Medicaid administrator, and Mercy Care Plan Inc. to get a liver transplant for a 50-year-old Tucson woman who will die within months without one, said her lawyer, Wendy H. Ascher.

Ascher said Thursday that anyone receiving public benefits has a “constitutional right to appeal the denial of those benefits.”

The Arizona Health Care Cost Containment System and Mercy Care, Lenna Kwon’s HMO, denied the transplant, in part based on their medical expert’s opinion.

The opinion said Kwon has a 50 percent chance of surviving for five years after a transplant.

Ascher said in an interview that Legal Aid’s medical expert told an administrative law judge in an appeal of two denials by AHCCCS that Kwon has a 70 percent chance of surviving one year after transplant, based on her current medical condition.

“This case has implications for any AHCCCS member who is elderly or who has an estimated life expectancy of less than five years,” Ascher said.

Kwon had a liver transplant about 18 months ago as part of her treatment for liver cancer, but the surgery was “flawed,” Ascher said, and the transplanted liver is failing.

She said that without a transplant, Kwon has months to live and that University Medical Center’s liver transplant team is willing to perform the surgery.

Kwon had metastasized tumors removed from a lung last winter and is doing well enough now to have a successful liver transplant, Ascher said.

A new liver would allow her chemotherapy treatment – aimed at preventing more tumors – to be made more aggressive, because she would have a better-functioning liver, Ascher said.

The denial by an administrative law judge was based on the state’s definition of “medically necessary” and how AHCCCS interprets the law, Ascher said.

It states that medical services must “prevent disease, disability or other adverse health conditions or their progression” or be “to prolong life.”

“The practical impact of AHCCC’s narrow definition of ‘medical necessity’ is that it denies Lenna a lifesaving treatment even when experts agree that a transplant is the only appropriate treatment,” Ascher said in statement released Thursday.

The suit was filed Jan. 30 in Pima County Superior Court.

Kwon is divorced and has a son, 12, living with her in Tucson, and two adult children.

She worked as a tailor and seamstress for more than 20 years and has lived in Tucson with her family for 20 years, Ascher said.

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