CARLTON SURGERY PROCEEDS; INSURER REACHES LAST-MINUTE DEAL

Blue Cross and Blue Shield of Missouri agreed Tuesday to pay for a costly bone marrow transplant for cancer patient Mike Carlton of Cape Girardeau. The agreement ended months of dispute over who would pay for the treatment.

Carlton's attorney, Sheldon Weinhaus of St. Louis, said an attorney for Blue Cross informed him late Tuesday afternoon that the insurer would agree to submit to a proposed court injunction and pay for the transplant.

The transplant will be performed at St. Louis University Medical Center, where Carlton was admitted around 5:30 a.m. Tuesday.

Weinhaus said he plans to prepare a lawsuit and file it today in state court in St. Louis. The lawsuit will ask the court to issue an injunction requiring Blue Cross to pay.

The injunction, which Blue Cross has agreed to, would still give the insurer the right to pursue litigation against either Carlton or the hospital at a later date in an effort to recover the costs of the medical treatment.

"It's good news," Carlton said from his hospital bed Tuesday evening. "I am elated by it. Now, I can concentrate on my health."

Carlton said he is scheduled to remain in the hospital four to six weeks for the treatment.

His identical twin brother, Ron "Ike" Carlton of Cape Girardeau will provide the donor bone marrow that will be used in the transplant procedure.

"I feel like they came around and did the right thing," Carlton said of Blue Cross. "The only thing I am sad about is they prolonged it for four unnecessary months."

Blue Cross had refused to pay, arguing that it was experimental treatment.

Weinhaus voiced happiness with Blue Cross' decision Tuesday to pay for the treatment.

"I am extremely delighted," he said, only minutes after receiving the news from Blue Cross.

"An attorney in this area (of litigation) has so many ups and downs, you never know from one day to the next," he added.

Earlier Tuesday afternoon, both Weinhaus and Blue Cross officials had indicated that last-minute negotiations had fallen through.

At that time, Weinhaus suggested litigation was likely in an effort to force Blue Cross to pay for the treatment.

Officials at St. Louis University Medical Center and Carlton's physician, Dr. Gary Spitzer of the medical center, had already agreed before Tuesday to proceed with the transplant even though payment had yet to be worked out.

Blue Cross officials declined to discuss at length their decision to pay for the treatment.

But Deborah Wiethop, a spokesperson for Blue Cross in St. Louis, said Tuesday night that the company is always concerned for persons battling life-threatening diseases.

"We feel for these people, and we don't want to stand in the way of them getting care," she said.

Earlier Tuesday afternoon, Wiethop had announced efforts to work out an agreement had fallen through.

Weinhaus said at the time that Blue Cross officials had suggested they might pay for the transplant, provided that the procedure was done at the University of Arkansas Medical Center in Little Rock, Ark.

But Weinhaus said attorneys for Blue Cross never made a final commitment to such a plan, and indicated the treatment could not take place immediately.

"They were supposed to advise me by (last) Friday noon what they were going to commit to," said Weinhaus. But he added, that didn't happen.

"They indicated on Monday that whatever agreement was concluded would not provide for Mike Carlton to be admitted immediately, nor would they give me a date," said Weinhaus.

He said Spitzer indicated Monday that the bone marrow transplant needed to proceed as quickly as possible.

Carlton suffers from multiple myeloma, a cancer of the white blood cells. Weinhaus said the Arkansas hospital has experience in handling bone marrow transplants in cases of multiple myeloma.

But he said the St. Louis hospital also had considerable expertise in this area and was perfectly capable of providing the treatment. "We have topnotch people right here in our own backyard."

Weinhaus said it was "irresponsible" for Blue Cross of St. Louis to propose Carlton travel to Arkansas for such treatment, particularly since the St. Louis hospital is much closer in terms of travel time for Carlton's Cape Girardeau relatives.

Weinhaus said it would have required six hours of travel time to reach the Little Rock hospital compared to about two hours for the St. Louis medical center.

But Wiethop said the health insurer was looking for a hospital that was experienced in such transplants, but one that also was willing to help pay the cost for what Blue Cross considers experimental treatment. It's estimated the transplant could cost $150,000 to $300,000.

"We were looking for someone to share the risk," she said. "We have considered this procedure investigational all along."

But she said Blue Cross officials felt the transplant has a better chance for success than most because it involves a transplant of bone marrow from Carlton's identical twin brother.