Solving the Problem

Elinor Mire is not the first Austin ISD teacher to be denied prescribed stem-cell replacement treatment because of the limitations of Amil International's insurance coverage. In 2001, Tovia "Toby" Solomon – a teacher at Langford Elementary school in South Austin – died from Hodgkin's disease. She too had been fighting with Amil to obtain coverage for the stem-cell transplant that could have extended her life. As Solomon's case reflects, it is not only rare cancers like Mire's multiple myeloma that rely on stem-cell transplantation for treatment. According to Doug Ulman, director of survivorship at the Lance Armstrong Foundation, stem-cell transplants are routinely used for treatment of more common cancers such as leukemia and lymphomas like Hodgkin's. Ulman found it "absolutely unacceptable" that the AISD insurance plan would exclude stem-cell transplantation when it is medically appropriate.

Austin Sen. Gonzalo Barrientos has indicated that he is extremely troubled that AISD, the second largest employer in Austin, has contracted with an insurance carrier that does not comply with Texas Medicare and Medicaid guidelines authorizing peripheral stem-cell transplantation. Amil's Donald Coronado responds that Amil is "not governed by [those] guidelines."

Asked via e-mail whether AISD has any plans to address the questions raised about the adequacy of this aspect of the district's health care coverage, spokeswoman Nicole Kaufman responded, "AISD is aware that this procedure is not covered under the current policy with Amil. The District's Health Insurance Committee meets regularly during the school year, and will discuss the possibility of including this benefit in the District's next bid for an insurance provider in the spring of 2005."

Barrientos said he intends to pursue legislation in the January 2005 session and to "get some squeaky-clean guidelines" to remedy this discrepancy and make certain that the Department of Insurance has the authority to require that insurance companies doing business in Texas comply with Texas Medicare and Medicaid guidelines. "The bottom line," Barrientos continued, "is that teachers have enough to deal with – if they get sick, they don't need to be fighting anybody, especially their own insurance company. They need to fight the disease." Linda Turner, Mire's friend who assisted her with the quagmire of insurance coverage issues, adds, "teachers – who take care of our children, and are already underpaid and over-burdened – deserve better than this."