Matter of an individual who was denied eligibility for transplant procedure because of his HIV status
Morris Murray had HIV for more than a decade when he developed end-stage liver disease due to his concurrent condition of Hepatitis C infection. Murray’s physicians at the University of Pittsburgh approved him for placement on their transplant list. Upon visiting his health care administrator for the required pre-approval, Murray was denied because of his HIV status. Lambda Legal began working with Murray during the second round of appeals with his benefits program, the UFCW Local 56 Health & Welfare Fund. Lambda Legal argued that scientific evidence clearly shows that HIV does not affect the outcome of liver transplantation. The fund reversed its decision, and agreed to cover his transplant and allow him to be placed on a national waiting list. Later, however, when his health care administrator recalculated his eligibility for continued heath insurance benefits, Murray was told he had to pay an increased premium during his final six months of coverage — this additional hurdle was appealed twice by Lambda Legal before finally being resolved by settlement.
While there is no evidence to support that otherwise healthy HIV-positive patients are less likely to survive organ transplants, many continue to face obstacles accessing medical treatment. People living with HIV have a right to equal treatment under the federal Americans with Disabilities Act and denial of services on the basis of their HIV-status is a violation of these statutes.
Lambda Legal’s Impact
Lambda Legal has successfully argued with other major healthcare providers (including Kaiser Permanente and the Department of Veteran Affairs) that HIV-positive patients’ eligibility for transplant procedures should be evaluated the same way as for everyone else, on a case-by-case basis. Our work in this area has helped combat discrimination, bias and stigma and ensure access to treatment.
- August 2004 Murray seeks preapproval of coverage for medically necessary liver transplant and fund denies his predetermination request.
- September 2004 After appeal by Murray, fund affirms denial.
- December 2004 Murray appeals decision to fund’s Board of Trustees.
- February 2005 Lambda Legal begins representation of Murray and submits letter brief to fund’s Board of Trustees in support of the appeal, refuting the company’s claims that transplants in HIV patients are experimental with hard evidence.
- March 2005 The fund rules in Murray’s favor and agrees to pay for the procedure.
- April 2005 The fund informs Murray that it has recalculated his eligibility for continued medical coverage and raised the amount he must pay for the remaining period of coverage. Lambda Legal appeals that decision.
- January 2006 A settlement is reached, resolving the challenge to the fund’s efforts to re-evaluate Murray’s eligibility for insurance coverage.