Lambda Legal Appeals Medicaid Decision To Deny a Liver Transplant to a Pennsylvania Man Because He Has HIV

(Pittsburgh, Tuesday, Nov. 18, 2003) - Saying that Pennsylvania’s Medicaid program may cost an Altoona man his life by refusing to cover a liver transplant because he has HIV, Lambda Legal will argue its appeal in the case at a hearing tomorrow (Wednesday, Nov. 19), asking the state program to reverse its denial in light of a range of scientific data and the man’s personal health history and experience.

“In denying our client the care he needs, Pennsylvania’s Medicaid program is ignoring published reports on organ transplants for people with HIV and not looking at the patient’s individual health status,” said Hayley Gorenberg, AIDS Project Director at Lambda Legal. “In the last seven years since the advent of better treatments for people with HIV, the medical community nationwide has learned a great deal about organ transplants. Medicaid’s decision denying this man’s transplant is not based on good medicine or sound science, and it may cost him his life.”

William Jean Gough, a 46-year-old resident of Altoona, was denied a liver transplant shortly after being accepted as a candidate in August by the transplant team at the Thomas E. Starzl Transplant Institute because Medicaid said the procedure was not “medically necessary.” The Starzl Institute is a part of the University of Pittsburgh and has performed transplant surgeries on people with HIV for years. Gough suffers from advanced liver disease and is often not well enough to care for himself because of the ailment.

In today’s appeal, Lambda Legal said Medicaid’s justification is simply untrue. “It’s flat-out wrong that liver transplants for people with HIV are experimental and have unfavorable outcomes,” Gorenberg said. “There’s a solid and growing body of scientific and medical evidence that clearly shows HIV does not significantly affect the outcome of liver transplantation.”

Last month, Lambda Legal successfully argued to overturn Kaiser Permanente’s decision to decline a kidney transplant for a Colorado man with HIV. Lambda Legal had filed a formal appeal with Kaiser Permanente, asking the HMO to reverse its denial in light of a range of scientific data and client John Carl’s personal health history and experience.

“In contrast to Mr. Carl’s situation, there is no feasible ongoing treatment like dialysis for Mr. Gough,” Gorenberg said. “The situation is dire. Medicaid has placed Mr. Gough’s life in jeopardy by ignoring the medical norms on organ transplants, because he has HIV.”

In its appeal papers, Lambda Legal cites mainstream medical journals that show “no evidence of poorer survival among otherwise healthy HIV-positive patients who are receiving anti-retroviral therapy,” which Gorenberg said is precisely Gough’s situation. The articles conclude that “transplantation in HIV-positive patients should … not be considered experimental.”

“Given the medical facts and the health of our client, there’s no question that this transplant should be granted as quickly as possible,” Gorenberg said. “By continuing to delay a transplant by denying coverage, Medicaid could cost Mr. Gough his life.” Gough tested positive for HIV and hepatitis C in 1996. While Gough’s viral load has been undetectable for years and he suffers no disabling symptoms from HIV, the hepatitis has caused an advanced form of liver disease. The effects of his liver disease are at times completely debilitating, requiring his longtime partner Bob Hoffman to care for him.

According to Lambda Legal, people with HIV are sometimes blocked from being considered for transplants, even though medical and scientific evidence makes it clear that they should be evaluated on a case-by-case basis like any other transplant candidates.

In Matter of William Jean Gough, Gorenbergh is handling the case for Lambda Legal. AIDS Law Project of Pennsylvania is co-counsel.

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Contact: Fred Shank, 212/809-8585 ext. 267