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February 23, 2002
Medical Examiner
C/O Bill Owens, Governor
136 State Capitol, Denver, CO 80203-1792
State of Colorado
1560 Broadway
Denver, CO 80202
Medical Examiner
C/O Bob Holden, Governor
State of Missouri
P.O. Box 720
Jefferson City, MO 65101
Minnesota Board of Medical Practice
2829 University Avenue, S.E., Suite 400
Minneapolis, MN 55414-3246
William J. Kirven III, Commissioner
Colorado Dept. of Regulatory Agencies
Division of Insurance
1560 Broadway, Suite 850
Denver, Co 80202
Scott B. Lakin, Director
Missouri Department of Insurance
301 West High Street
P.O. Box 690
Jefferson City, Missouri 65102
Health Technology Advisory Committee
121 East 7th Place, Suite 400
St. Paul, Minnesota 55101
Ken Salazar, Attorney General
Department of Law
1525 Sherman St., 7th floor
Denver CO 80203
Missouri Attorney General's Office
Supreme Court Building
207 W. High St., P.O. Box 899
Jefferson City, MO 65102
Minnesota Attorney General’s Office
1400 NCL Tower
445 Minnesota Street
St. Paul, MN 55101
George W. Bush, President
United State of America
1600 PENNSYLVANIA AVE NW
WASHINGTON, DC 20502-0001
Federal Trade Commission
Anti-Trust Section, CRC-240
Washington, D.C. 20580
The Surgeon General
Office of the US Surgeon General
5600 Fishers Lane, Room 18-66
Rockville, MD 20857
Anthony S. Fauci M.D., Director
National Institutes of Allergy & Infectious Disease
Bethesda, Maryland, 20892
Ronald W. Cates, Interim Director
Missouri Dept of Health & Senior Serv.
P.O. Box 570
Jefferson City, MO 65102
Jane E. Norton, Exec. Dir.
Colorado Depart. of Public Health & Environment, State of Colorado
4300 Cherry Creek Drive South
Denver, Colorado 80246-1530
Minnesota Dept of Health
Minnesota Department of Health
P.O. Box 64975
St. Paul, MN, 55164-0975
Re: Medical Malpractice, Restraint of Trade--US Bancorp Contracts with United Health Care, Kaiser Permanente of Colorado, Express Scripts, & Merck-Medco.
Re: Denial of Appropriate Hepatitis C & HIV Treatment
Dear Examiner, Commissioner or Public Official in Oversight
I am writing to you today regarding a number of health care issues. Most of you have direct supervision of the activities of these firms in your state or jursidiction, others directly impact public policy regarding health care and insurance practices, therefore I have called upon all of you to review these concerns and to take the appropriate action in your jurisdiction.
These issues are founded on my personal evidence and experience but are issues that I believe affect a great number of patients and employees and I believe this complaint if addressed appropriately, has far-reaching impact beyond myself and this fight for my life. These concerns affect public health and many more lives and such policies therefore the public needs to be involved. The actions of these firsm are nothing short of the deliberate killing of patients, a less dramatic but more insidious “John Q.”
This complaint regards, United Health Care, Express Scripts, Kaiser Permanente, Merck-Medco and US Bancorp, all parties to insurance and health care contracts providing inadequate and inappropriate care for employees and patients as I outline below.
® Kaiser Permanente refused to provide a liver biopsy to adequately ascertain the baseline of my liver condition Hepatitis C (HVC). Even after new treatment options (Rebetron) were available where it was clear that a biopsy was important to do.
® Kaiser Permanente refused to provide information regarding the standard of care for HCV to replacing the outdated misinformation it has and is providing to patients . Kaiser rejects these appropriate standards of care.
® Express Scripts, excludes PEG-Intron in its treatment protocols and in fact, all injectable drugs with the exception of insulin are excluded in my plan. I was referred to United Health Care to see if they are covered in Major Medical but have been told Peg-Intron is excluded. This treatment is 25% more like to eradicate the HCV virus in my class of patient as the older interferon-a (68% to 43%) with reduced side effects. From less than a 50% chance to better than 2 in 3.
I find this policy a violation of the medical oaths by having medical decisions made by administrators. It is a betrayal of medical standards in the treatment of infectious disease. By the exclusion more people will remain infected, may infect others and in fact many will infect others resulting in more cases and more expense to the companies and the communities. It is not good policy nor good public policy to allow this exemption in treatment to continue in any form.
I have attached a current review from some of the best and most respected physicians in this field supporting this position. Current Review of Hepatitis C Virus in HIV/HCV Coinfection, Andrew Talai, M.D., M.P.H. Assistant Professor of Medicine, and Ira Jacobson, M.D., Vincent Astor Distinguished Professor of Clinical Medicine, Director of GI and Hepatology, both at Weill Medical College of Cornell University.
® United Health Care categorically denies coverage for all injectible drugs. United Health care was not named in the recent class action lawsuit of the five largest insurance/HMO providers, but may be yet named as they negotiate with the firm of Scrugg Law Firm.
“The lawsuit filed in federal court in Hattisburg claim the companies are violating racketeering laws and have offered bonuses to doctors who restrict patients’ access to expensive procedures, treatments and tests,” according to reports by Associated Press February 21, 2002. AP also notes, “The only major HMO not sued was United Health Care, which Scruggs has agreed to meetings next week with the lawyers.” (Report attached.)
This strategy is designed to reduce the cost to the companies at the expense of the ill and in fact discriminates against the most vulnerable population, the economically disadvantaged, that often do not have a voice in these matters. It is also a reduction in covered health care by US Bankcorp, from that provided previously with Blue Cross Blue Shield, and therefore may violate employee contracts.
® Express Scripts provides inadequate and untimely mail order prescription service, inadequate to maintain appropriate and comprehensive adherence to HIV/AIDS medications. Although they include in their network of local pharmacies for prescriptions one of the most respected HIV/AIDS specialist pharmacy available in my area, they restrain fair trade with these policies in an effort to capture the market. I believe they fill one in six prescriptions in the United States, comprising 17% of the market, 43 million members.
Along with Merck-Medco, (see below) these mail order systems may have an unfair advantage in the contracts they create. This program appears to be designed to punitively penalize patients and burden patients with exorbitant fees if care is obtained elsewhere. Initially, we fill our prescriptions locally with a pharmacist we trust. Then we are required by Express Scripts, Merck-Medco and US Bankcorp due to reverse financial incentives to cut this pharmacist out of the plan. I believe this constitutes a unfair restriction to fair trade and an effort to capture the market. The business ethics are less than palatable to me.
® Merck-Medco provides inadequate and untimely mail order prescription service inadequate to maintain appropriate and comprehensive adherence to HIV/AIDS medications or appropriate access to pharmacies that specialize in the unique needs and concerns of HIV/AIDS and HCV population.
® Merck-Medco has a conflict of interest as a major manufacturer of medications. I believe Merck-Medco once paid some of the highest penalties for fixing the price of vitamins. Given the ethics are suspect, there should be impartial parties closely monitoring actions by this company, Again, the business ethics and duplication of having my local pharmacist, which I can choose and trust, start my treatments and monitor the initial care and then is cut out of the profits, is repugnant.
® United Health Care, Express Scripts, Merck-Medco, Kaiser Permanente of Colorado in cooperation with US Bankcorp is a party to these agreements in defining and making the contracts that affect patient care. It is naïve and preposterous to believe that USBankcorp does not share responsibility in forming and developing treatment plans, if by nothing else, after the fact by establishing appeal committees, instituting rules, exceptions and prohibitions to treatment. The claim by US Bancorp, “of not being responsible” or “out of there purview of this committee” etc., I find specious. These are moral issues reflecting the integrity and ethics in medical treatment and the corresponding ethics of these corporations.
Here the most vulnerable--the sick, disabled and retired--are most at risk. They are often economically disadvantaged and more of the cost is being transferred to the ill, instead of spread among all those covered. It is not too much to suspect their integrity given the recent brouhaha with Enron and the other shenanigans of others companies that have set such poor examples of corporate integrity.
The most notable parallel of course is how the employee was left holding the bag. The intense lobbying and collusion in the recent advertising blitz of the medical industry against the “Patient Bill of Rights” is also indicative of the corruption of ethical and humanitarian standards of care in the political arena, similar to the Enron campaign contributions spectacle.
This behavior is reprehensible lacking any form of compassion and must be changed now.
Enclosed are:
® Dr. Robert Neihart’s letter requesting treatment.
® A review on Hepatitis C Virus in HIV/HCV Coinfection, by Andrew Talai, M.D., M.P.H. and Ira Jacboson, M.D. Weill Medical College of Cornell University.
® A treatment graphic on PEG-Intron + Ribavirin, demonstrating 25% greater effectiveness in my class of patient—viral load under 2 million, type I, HCV.
® Treatment information from Schering-Plough Corp. via e-mail from Hepatitis C Action & Advocacy Coalition.
® Associated Press Report, HMOs Become Latest target of Tobacco Attorneys, By Gina Holland
® The original complaint letter to US Bankcorp, Kaiser Permanente and Merck-Medco,
® E-mails between Debra Christopherson, US Bankcorp, discussing the complaint and response in excess of 30 days.
® E-mail to Debra Christopherson, US Bancorp, addressed to The Benefit Claims Subcommittee for appeal with additional concerns regarding Merck-Medco’s service.
® E-mail to Debra Christopherson, US Bancorp, for additional complaint for the appeal regarding Express Scripts drug formulary and United Health Care’s denial of treatment.
® E-mails to Customer Service Express Scripts regarding service problems with Express Scripts.
® Assorted responses and communications with Kaiser Permanente and US Bankcorp, mostly, form letters, delays and denials. Including the most recent from Kaiser, claiming I do not have access to certain reviews, as I am no longer a patient of Kaiser, as if the claim and the issues lack merit or not of immediate concern to all patients who may one day need treatment, this case is not mute.
I believe the delay in changing these policies, responding to my complaints and taking action to correct these policies provides evidence these firms are culpable in shortchanging patients and patient care until action must be taken. I believe action will be taken because this is nothing short of murder, and an abrogation of the responsibility in providing appropriate health care for patients and employees. In my class of patients, 25 out of each 100 patients will die of liver complications in the future. Many more will be infected and will also die.
Currently, I serve the community in several capacities and which should be disclosed, as my health allows, I struggle with fatigue and the side effects of the medications I take as a person infected with HIV/AIDS and hepatitis C virus. I am a member of the Adult AIDS Clinical Trials Group, Central Unit, Community Constituency Group (part of the National Institutes of Health, also a member of the Community Advisory Boards for the AIDS Clinical Trials Units at Univ. of Nebraska Health Center and Washington Univ. St. Louis. I serve as the editor of MO/KAN Plus! a community HIV/AIDS newsletter, resource guide and calendar for the Kansas City region.
Please give this complaint the serious hearing it deserves and the strongest response possible from your office. As I have felt a bit under duress (knowing that a treatment exists which could save my life but which I have been denied and my requests for consideration have been postponed) and have undertaken this process and course of action I request and expedited review.
If you need anything further or have questions or comments, please do not hesitate to contact me at any time. Thank you.
Sincerely,
Rodney Bake
4330 McGee St.
Kansas City, MO 64111
816-561-3799
cc: w/enclosure
Richard Scruggs, Esq.
Scruggs Law Firm
726 Delmas Ave.
Pascagoula, MS 39567
Benefits Claims Subcommittee,
USBancorp
4000 W. Broadway
Robinsdale MN 55422-2299
Barren Toan
Chairman, CEO
Express Scripts Inc.
P.O. Box 39073
Bloomington, MN 55439-0873
Kaiser Permanente Customer Service
Administrative Services
Waterpark I
2500 South Havana St.
Aurora, CO 80014-1618
David Bellamy, Director
Kaiser Permanente Customer Service
Administrative Services
Waterpark I
2500 South Havana St.
Aurora, CO 80014-1618
Board of Directors
Express Scripts, Inc.
13900 Riverport Drive
Maryland Heights, Missouri 63043
Raymond V. Gilmartin
Chairman, President & CEO
Merck & Co., Inc.
One Merck Drive
P.O. Box 100
Whitehouse Station, N.J. 08889-0100
NCQA
Human Resources – Web
2000 L. Street, NW
Suite 500
Washington, DC 20036