- The Washington Times
Wednesday, May 31, 2017

A Nevada physician says insurance companies in states where assisted suicide is legal have refused to cover expensive, life-saving treatments for his patients but have offered to help them end their lives instead.

Brian Callister, associate professor of internal medicine at the University of Nevada, said he tried to transfer two patients to California and Oregon for procedures not performed at his hospital. Representatives from two different insurance companies denied those transfer requests by phone, he said.


“And in both cases, the insurance medical director said to me, ‘Brian, we’re not going to cover that procedure or the transfer, but would you consider assisted suicide?’ ” Dr. Callister told The Washington Times.

The phone calls took place last year within the span of a month, Dr. Callister said. He said he did nothing to prompt the suggestion in either case.

The patients were not terminal, but “would have become terminal without the procedures.”

“It was estimated that their chance for cure — cure, not just adding time — of about 50 percent in one case and 70 percent in the other case,” Dr. Callister said.

The allegation comes as more than a dozen states are actively considering legislation to legalize physician-assisted suicide, including Nevada, where Dr. Callister testified against the proposed bill on Monday.

In February, Washington became the sixth U.S. jurisdiction to enact such a law, joining California, Colorado, Oregon, Vermont and Washington state. The Montana Supreme Court has ruled that helping terminally ill patients to end their lives does not violate state law.

As part of a campaign to curb the trend, the Patients Rights Action Fund on Wednesday released a video featuring Dr. Callister.

“As much as most insurance companies try to come across as your best friend, they want to do whatever the least-costly thing is,” Dr. Callister says in the video. “It’s a lot cheaper to grab a couple of drugs, kill you, than it is to provide life-sustaining therapy. Simple as that.”

The anti-assisted suicide group plans to release other videos, including one of Stephanie Packer, a terminally ill Californian who said she was denied coverage and offered life-ending pills after the state enacted its law in 2015.

Before airing the video, the Patients Rights Action Fund said it consulted a lawyer who advised against naming the insurance companies involved, citing the Health Insurance Portability and Accountability Act (HIPAA), a federal privacy law.

Dr. Callister said, because he makes such transfer requests infrequently, the attorney said naming the insurance companies could lead to the identification of the patients.

“It’s a low-enough number that naming the insurance companies would potentially make the individual patients identifiable, and therefore a violation of HIPAA,” Dr. Callister said. “I would love to name the insurance companies, but it is what it is.”

He also said he was unable to obtain waivers from either patient to authorize the disclosures.

Cathryn Donaldson is the director of communications for America’s Health Insurance Plans, an advocacy group that represents insurance providers. She said in a statement that aid-in-dying laws do not change the behavior of insurance companies.

“Health plans do not withhold or deny life-sustaining care in states that have physician-assisted suicide,” Ms. Donaldson said, “and the ability of the patient to determine that option is up to the patient and their physician with absolutely no involvement from health insurers whatsoever.”

What’s more, the American Medical Association, the nation’s largest association of doctors, has long opposed physician-assisted suicide.

Kat West, national director of policy and programs at Compassion & Choices, which works to enact aid-in-dying legislation, said she’s “skeptical” of Dr. Callister’s story. She said “the names of the insurance companies he talked to are absolutely not covered” under HIPAA.

“I’m not a HIPAA lawyer, but that sounds really — it sounds like someone who does not want to share information,” said Ms. West, who testified in favor of the Nevada aid-in-dying legislation on Monday. “That’s what it sounds like to me.”

She said “there’s no evidence” to support Dr. Callister’s claim, and “he needs to come forward and provide evidence” if he wants to make such an allegation.

But Dr. Callister said it’s no coincidence the insurance agents stumped for assisted suicide over the phone.

“Now was this in writing? Of course not,” he said. “This was on the phone. They’re too smart to put that in writing.”

There have been several cases of insurance companies offering assisted suicide to patients in writing.

In 2008, Barbara Wagner received a letter from her state’s Medicaid program declining to cover a lung cancer drug that would have cost $4,000 per month. The Oregon Health Plan, however, did offer to pay for the 64-year-old to procure assisted suicide drugs, priced at $50.

Anne Sommers, board chair of disability rights group Not Dead Yet, said insurance providers are motivated by profit, and helping patients end their lives is cheap. She said insurance companies encouraging assisted suicide is an inevitable consequence of the practice’s legalization.

“If you asked a series of economists, and didn’t tell them you were talking about [assisted suicide], they would laugh you out of the room,” Ms. Sommers said. “Of course it’s going to have an effect. It’s only when politics becomes involved that people find a way to torture the facts to come up with the answer they want.”

Compassion & Choices’ Ms. West pointed to a 1998 study in The New England Journal of Medicine titled “What are the potential cost savings from legalizing physician-assisted suicide?” that predicted insurance companies would hardly alter their behavior in response to assisted suicide laws.

She said her advocacy group wants terminally ill patients to “get the best care possible” and would be “appalled” if there were evidence to support Dr. Callister’s claims.

Due to privacy laws and the fact that insurance companies rarely offer reasons for denying coverage, Ms. Sommers said it’s difficult to collect data either for or against the claim.

“This is a very convenient thing for Compassion & Choices to say, that this is all anecdotal, that there are lots of reasons people are denied treatment,” she said. “But physician-assisted suicide will always be the cheapest option.”

Even proponents of aid in dying have argued that economic pressure will help to normalize the practice.

In his 1998 book “Freedom to Die,” Derek Humphry, who founded the Hemlock Society, which evolved into Compassion & Choices, wrote that “economics, not the quest for broadened individual liberties or increased autonomy, will drive assisted suicide to the plateau of acceptable practice.”


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