Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SATURDAY, June 26, 1993 TAG: 9306260090
SECTION: VIRGINIA PAGE: C-3 EDITION: METRO
SOURCE: Associated Press
DATELINE: RICHMOND LENGTH: Medium
A three-judge panel of the 4th U.S. Circuit Court of Appeals upheld a judge's ruling that the state Medicaid program must pay for an Alexandria child's heart transplant.
"We are not unaware of the potential consequences of our decision today," Judge Michael Luttig wrote. "Our responsibility, and the limit of our authority, however, is to interpret the law as it has been enacted by the Congress."
The state had claimed it had discretion under federal law to decide whether to pay for Natalia Pereira's transplant, but Luttig wrote that "Congress indisputably required that states fund medically necessary organ transplants for children under the age of 21."
Assistant Attorney General Pamela Malone Reed, who argued the case on behalf of the state, said she had not read the opinion and could not comment.
But she noted that transplants "are expensive procedures, and all of the states will want to deal with them in the best way possible."
Virginia officials have said rising Medicaid costs are largely responsible for the state's budget problems. The state has little control over the growing Medicaid-eligible population and escalating health-care costs.
Bruce U. Kozlowski, director of the state Department of Medical Assistance Services, was out of his office and unavailable for comment. His department administers the state's Medicaid program.
The decision "is good news. I do believe it was the proper ruling," said E. Clarke Dummit of Winston-Salem, N.C., lawyer for Natalia and her parents, Carlos and Lourdes Pereira.
Without a heart transplant Natalia, now 4, would have died. U.S. District Judge Robert R. Merhige Jr. ordered the state to pay for last December's operation, which was successful.
"She's doing wonderful," Lourdes Pereira said.
She said she did not know how much the operation costs at a Virginia hospital, but a Pennsylvania hospital was asking for a $100,000 deposit for the same surgery. "I never could pay that," she said.
The appeals court said it could find no language in the federal law or its legislative history that would allow the state to withhold payment.
Judge Clyde H. Hamilton wrote a concurring opinion to emphasize that the ruling applies only to organ transplants for children.
The ruling "will invariably open the door to individuals over the ages of 21 to claim that states . . . are required to pay for their organ transplants under the Medicaid statute because the procedure is medically necessary," Hamilton said.
by CNB