Case of Boy Whose Hand was Saved Exemplifies Much Bigger Health Problem

The St. Louis Post-Dispatchrecently highlighted a heartwarming story about Devin Graham, a 12-year old boy from Kansas, who underwent surgery at St. Louis Children’s Hospital after nearly having his hand torn off by a rope.

A Freak Accident

Devin and his mother, Marla Graham, were driving home from school when they stopped to help a teenager whose cargo trailer had gotten stuck deep in the mud. Devin and his mother got on one side of the trailer to try to tip the trailer on its side by pulling on a rope attached to the truck. The truck moved too quickly causing the rope that Devin had wrapped around his palm and index finger to nearly sever his hand.

Devin was first taken to a Wichita, Kansas, hospital where surgeons told his mother that their only option was to amputate. The hospital did not have the specialists or the many resources needed to perform the complex surgery. Moreover, the chances that the hand could be saved were only 50-50 at best.

Devin’s mother wasn’t about ready to give up. Devin had been through way too much over the last few years, including the recent deaths of his father, grandparents, an aunt and a neighbor, to bow to this latest adversity. She was determined to do whatever it took to save Devin’s hand. After all, a 50% chance of success carried just as much weight as a 50% chance of failure. The Wichita hospital put out a plea to bigger medical centers in Kansas City and St. Louis.

That’s when Dr. Charles Goldfarb, an orthopedic surgeon at St. Louis Children’s Hospital, stepped up. Looking at the images of Devin’s devastated hand, Dr. Goldfarb knew what he and his surgical team would be up against when Devin arrived later that night. He didn’t want to give the family false hopes, yet he felt that a 12-year old boy deserved a chance to save his hand.

And that is precisely what Dr. Goldfarb and his talented surgical team did during the grueling 5-hour surgery that night. Devin was released from Children’s Hospital only 10 days after his accident. Dr. Goldfarb remarked that with intense physical therapy, he fully anticipates Devin will regain good use of his hand.

The Bigger Problem: Inadequate Reimbursement and Lack of Access to Complex Care

While there is a happy ending to this particular story, many other patients requiring complex surgery, such as “replants”, aren’t nearly as lucky. Dr. Goldfarb commented that medical centers are increasingly not performing complex surgery because public reimbursement (e.g., Medicaid)—the kind that Devin’s family had—doesn’t pay well for the vast and highly-specialized resources that such surgery demands: skilled surgeons and nursing staff, anesthesiologists, operating room, very expensive and state-of-the technical equipment, etc.

Dr. Goldfarb’s comment was echoed by Dr. Scott Levin, Director of the Penn Medicine hand transplant program and Chairman of the Trauma Task Force for the American Society for Surgery of the Hand.

There are many people who are candidates for a limb-saving procedure that just can’t reach a center that does it…who are told, ‘All we can offer is amputation.’

Dr. Martin Boyer, one of the surgeons on Goldfarb’s team, said,

You’re speaking to a nationwide issue that has really been struggled with at the highest levels of surgical and hospital leadership. The struggle is between staying profitable while also providing the best care.When you have a child in front of you whose limb has to be amputated, reimbursement is furthest thing from your mind. There has to be an understanding that we do what is best for the patient regardless of what that entails in terms of cost, in terms of inconvenience for the providers, in terms of anything.

The Right Thing to Do

As a trial attorney second; and a human being, first, I am terribly distressed and saddened when I hear there are “many people” who can’t get the care they need simply because they happen to be impoverished and  covered by public insurance that compensates poorly for complex medical treatment like hand surgery. It goes against everything that I was raised to believe—my most cherished and deeply-held values—to think that as a society, we can’t come up with a better solution to this tragic dilemma.

In my practice, I represent many clients who are either on public assistance or have little to no health insurance. Part of my role as a compassionate advocate is to assist these clients in finding the best medical and rehabilitative care available. I can—and do—make special arrangements with top-flight doctors, surgeons, chiropractors, physical therapists—to make sure that my clients receive the care they so desperately need and that the medical professionals get full reimbursement in return for rendering their specialized services. I arrange for payment through “exercising a lien”; in other words, the cost of the medical and rehabilitative treatment is calculated as part of the settlement award and is paid back to the providers at the time of settlement.

If you find yourself in this difficult situation, you are welcome to call me personally to discuss your options. We pride ourselves on taking difficult cases other lawyers do not.

Call us at 314-409-7060 or 855-40-CRASH (toll free).

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