PITTSBURGH - An HIV-positive man in need of a liver
transplant was wrongly denied coverage under the state's Medicaid program,
an administrative law judge ruled.
William Jean Gough's liver is deteriorating because of hepatitis C. The
46-year-old was accepted as a strong candidate for the lifesaving
operation in August by Pittsburgh's Thomas E. Starzl Transplant Institute.
The state Department of Public Welfare, which oversees the state's
Medicaid program, denied coverage for Gough, saying that infection with
the AIDS virus is a life-limiting condition that rules
out a transplant.
In a ruling made public Wednesday, Judge Bernadene Kennedy dismissed the
state's argument, saying that scientific advances allow people with HIV to
live full lives.
Gough "could live 10, 20, 30 years or more with a liver transplant,"
Kennedy wrote. "Given his ability to successfully control his HIV, the
appellant may live a prolonged life and maintain quality of life
equivalent to non-HIV transplant patients."
The judge expedited the case because Gough's condition worsens by the day
and he could be ineligible for a transplant if his liver deteriorates too
Doctors said the Altoona man could die in nine to 12 months without a
transplant. The average wait is six to 12 months.
"I've struggled with this disease for many years and you've got to have
hope," Gough said Wednesday. "I just think it's a lack of education in our
health care system. It seems to me the state's working off of old
The Department of Public Welfare will not appeal the judge's ruling,
spokeswoman Stephanie Suran said.
It is the second time in two months that Lambda Legal, a gay legal rights
group, has successfully argued that patients with HIV should not be
excluded from transplants just because they are HIV-positive.
In October, Kaiser Permanente, one of the nation's largest health
maintenance organizations, approved a kidney transplant for an
HIV-positive man in Denver, reversing an earlier decision. The HMO
initially refused John Carl's request for a new kidney, saying a
transplant on someone with the AIDS virus is too risky because drugs used
to prevent rejection of a new organ can jeopardize their already weakened
--- One the Net:
Lambda Legal: http://www.lambdalegal.org