Jessica Parente Vs. Empire BC/BS- Dr. Perry Orens

LDIR News - Summaries & Reviews November 20th, 1999

Lyme Disease Patient suing BC/BS for $800 million

Submitted by Donna Herrell

Reference Article: HMO: What's in a Name? Newsday, 11-12-1999, pp A08

Description: Jessica Parente is suing Empire Blue Cross/Blue Shield for $800 million for medical malpractice, gross negligence (practicing medicine without a license), break of fiduciary duty, intentional affliction of emotional distress and violation of New York Deceptive Business Practices Act, and other complaints. She has had two surgeries, awaiting another, may be permanently disabled and in chronic pain. Empire Blue Cross / Blue Shield says the case has no merit and points to studies that a 30-day course of antibiotic therapy should be adequate. The company approved more than 30 days treatment but did not approve what two of the plaintiff's doctors (and others may of) recommended to keep the patient from suffering permanent disability.

[Excerpts] and Summaries:

Jessica Parente, of New York apparently contracted Lyme disease in 1995 on a trip to the New Jersey Shore but did not show symptoms until March 1996.

By age 19, her symptoms included nearly full-body pain, vomiting , severe headaches, swollen lymph nodes, joint pain and falling asleep at her desk at her secretarial job in Manhattan, where on some days neck pain prevented her from answering the telephone.

She eventually sought consultation with Dr. Olaf Butchma of Great Neck who had her take a Lyme disease test. The test was not mentioned by name, but involved three urine samples with antibiotics.

Seven months after her symptom onset, she began treatment with oral antibiotics. She couldn't tolerate the medication orally, to the point she could not keep it down without vomiting. She was switched to intravenous (IV) administration of antibiotics via a PICC line.

[But for all that, the doctor first had to get approval from Empire Blue/Cross Blue Shield." Thus began a year and a half of a protracted battle between the patient and her doctors on one side and the health-maintenance organization on the other, with Lyme disease gaining ground all the while.The disease won.]

Jessica, is married and a mother of a newborn. She uses a cane to walk and has undergone two operations on her knees and is awaiting hip-replacement surgery.

Her surgery was covered by her insurance company Empire Blue Cross/Blue Shield, but her doctors maintain the surgeries would not have been needed had she been allowed consistent administration of antibiotics. Jessica currently is described to have daily pain in various parts of her body.

Subsequent blood tests identified the strain of the bacteria, Borrelia burgdorferi, that causes Lyme disease and is commonplace in New Jersey ticks.

David L.Trueman, her attorney, filed suit in the State Supreme Court in Queens in September 1999. Charges include: medical malpractice, gross negligence (practicing medicine without a license), break of fiduciary duty, intentional affliction of emotional distress and violation of New York Deceptive Business Practices Act, and other complaints.

[Company attorneys maneuvered the suit into federal district court last month, where they can be expected to argue that the company basically is immune under the 1974 Employee Retirement Income Security Act (ERISA).]

ERISA, Employee Retirement Income Security Act of 1974, developed to protect to protect pensions, has been a major source of contention in recent years. ERISA has served in a number of lawsuits as a "loophole through which some managed-care companies evade liability", including damage caused by denials and delays of claims they are alleged to have caused.

Trueman, also a practicing psychologist, has submitted papers opposing this position. As of November 12th, no response from the defense. Gary Tannenbaum, lawyer for the defense was said to have referred calls to Deborah Bohren, Vice-President of Marketing and Communications. Her comments:

["The case has no merit. There is no medical evidence that IV antibiotic treatment for extended periods works in cases of Lyme disease." In December, 1996, according to court papers submitted by Trueman, Empire Blue Cross / Blue Shield approved intravenous antibiotic treatment for Jessica, and during the next few months, Jessicaimproved dramatically."]

Chronology of events as they appear:

March 1996 - Symptoms begin and medical consultations are sough by Jessica. She was at some point diagnosed with, or suspected to have, arthritis.

October 1996 - About this time she is diagnosed and begins treatment for Lyme disease by Olaf Butchma MD

December 1996 - Insurance company approves IV treatment

April, 1997 - The company sends a letter to Jessica stating its medical staff had "determined that continued administration of the drug would not be medically necessary." Jessica is said to have promptly deteriorated.

July, 1997 - Butchma pleaded with Blue Cross and relayed his fears that Jessica would become permanently disabled without continuation of antibiotic treatment.

August, 1997 - Blue Cross apologized for any inconvenience Jessica might be suffering because of delays in its decision-making process

October, 1997 - Blue Cross [approved another 28 days of treatment. Her condition improved again, and then, against the doctor's fervent recommendation for continuation, the company discontinued the treatment.]

January, 1998 - Jessica switched doctors, her new physician Dr. Perry Orens of Great Neck. concurred with diagnosis and recommended continual therapy.

September, 1999 - Lawsuit filed with State Supreme Court

Her new physician [concurred with Butchma's prognosis, though recommended a different IV antibiotic. Blue Cross denied the treatment in March, this time saying it was "experimental/investigational." ]

Dr. Steven Wolinsky, the companies medical director sent a letter to Jessica about his review of Dr. Orens plea' and [had determined that intravenous antibiotic therapy was not medically necessary, because, "studies of Lyme disease show that a 30-day course of antibiotic therapy should be adequate," he said.]

Orens, Jessica and her family alternately pleaded on the telephone with company officials to no avail.

[Orens wrote back in March that the interruptions in Jessica's treatment were "particularly sad, as the patient was making progress substantially, if not dramatically. The severity of this situation cannot be overemphasized, " he continued. "I fully understand the insurance carrier's desire to minimize expenses especially in home IV therapy I feel it is nothing short of criminal to stop such therapy until the patient has reached maximum benefits." The company denied the treatment.]

Not responsible for errors or omissions please contact editor for corrections. For informational purpose only. Please refer to the original source(s) for information if needed. Copyright © 1999 Lyme Disease Information Resource Contact.

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