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Judge says Pa. erred in HIV patient's case

Liver transplant should be covered under Medicaid

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 life-saving operation in August by Pittsburgh's Thomas E. Starzl Transplantation 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 yesterday, 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 much.

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 yesterday. "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 criteria." 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 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 immune systems.

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