A jury recently decided to award $200 million in damages to the family of a deceased man who was denied insurance coverage for specific lung cancer treatments, but questions remain: jury error exist its decision?
Bill Eskew was battling lung cancer and eventually died after UnitedHealth decided not to include the proton beam treatment he expected. In a recent interview after the jury verdict, a lawyer representing his wife said the payer’s refusal to treat caused Eskew unnecessary suffering.
“He had difficulty swallowing food, drinking water or taking medication for up to a year until he died,” said Doug Terry.
But Zeke Emanuel, a bioethicist and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania his opinion The jury’s decision was questioned about the value of proton therapy.
“It’s almost inevitable that a person with lung cancer will suffer in some way, and there’s a lot you can do to manage the symptoms, but they’re often very difficult to control,” said Emmanuel, senior fellow at American Progress. “If we think about how much he might have suffered. Pain, he may suffer less, but is it worth $200 million in a year? Hard to believe.”
After being rejected by the jury, UnitedHealth plans to appeal the lawsuit.
“We are disappointed by the jury’s verdict,” a UnitedHealth representative said in an emailed statement. “The judgment and damages do not reflect the facts of the case or the law applicable here.”
This isn’t the first case of a jury favoring a patient denied proton therapy. In 2018, the jury sided with a patient and his family Cunningham v. Aetna, Terry also tried a case. The case resulted in a $25.5 million verdict for the Cunningham family.
“Insurers need to act in good faith, not profit,” Terry said.
you Diagnosed with stage IV metastatic lung cancer in the summer of 2015. He and his wife Sandy Eskew sought the best treatment for his lung cancer and went to University of Texas MD Anderson Cancer CenterA team of oncologists determined that the best treatment for Eskew was proton beam therapy (PBT) based on the location of the tumor.
Doctors chose this treatment because they could deliver the appropriate dose of radiation to reach tumor cells near his esophagus and windpipe, while avoiding radiation near his other organs, according to Eskew’s attorneys. Sierra Health & Life Ins. A subsidiary of UnitedHealth, Terry said Eskew’s claim was denied based on a medical policy that was not disclosed to Eskew or his wife at the time of the purchase.
Eskew purchased a specific insurance plan from Sierra after his diagnosis, based on the belief that proton therapy would be covered. According to Terry, Eskew’s wife Sandy told Sierra agents that her husband had lung cancer and wanted MD Anderson to be a participating provider and asked if PBT was covered. The agent, at Serra’s direction, handed Sandy the insurance policy and statement of benefits. Sandy saw that medically necessary radiology services were covered. PBT is not excluded from coverage. Terry said Sandy believed that if MD Anderson determined that Bill’s PBT was medically necessary, then PBT would be covered.
Instead, the policy automatically rejects claims for proton therapy for lung cancer. Eskew then went through IMRT According to Terry, he had grade 3 esophagitis, inflammation, blistering and scarring of the esophagus. He died nearly a year after receiving radiation therapy.
“We believe the jury spoke out their verdict that Sierra’s conduct was unacceptable and would not be tolerated,” Terry said.
At the time of Bill’s rejection, Dr. Sierra was handling Sierra’s claims as an independent contractor and was handling claims part-time in addition to his full-time oncology practice. The doctor who denied Eskew’s claims testified that he was processing 20-25 claims a week for Sierra at the time. According to Terry, he also testified that he spent 30-60 minutes reviewing Eskews’ claims before denying it. However, the doctor’s billing records show that in the week he denied Bill’s claims, he processed 79 claims for Sierra and that he charged Sierra for 16.5 hours for the work. That showed the jury that he spent an average of 12 minutes per claim, Terry said.
Eskew’s family gets $40 million Compensation for physical, mental and emotional harm and $160 million in punitive damages is designed to punish Sierra for denying Eskew’s claim and deter Sierra and other health insurers from engaging in similar conduct in the future.
While Emanuel admits he is not familiar with the specifics of Eskew’s case, he doesn’t think there’s enough evidence that proton therapy is worth the money.
“Unless there is evidence that proton therapy can alter lifespan or improve quality of life in a well-controlled randomized trial, it will be difficult to justify paying double, triple or quadruple the cost of radiation for hope, prayer, assertion, and when this Not evidence-based,” Emanuel said. “This is not the basis of our treatment. It should be based on randomized controlled trials comparing outcomes in similar patients.”
Photo: art4stock, Getty Images
