PacifiCare agrees to pay for treatment for young cancer patient

By Courtney Perkes
Orange County Register
March 25, 2008

The Cypress-based HMO says it will support Nick Colombo's family.

CYPRESS Ricky Colombo, 19, feels helpless when his younger brother, Nick, cries out in pain from the cancerous tumor bulging from his tailbone.

But he felt a sense of accomplishment today when the family's insurer, PacifiCare, announced to a gaggle of television news cameras that the HMO would pay for a specialized radiation treatment.

Colombo, a student at Vanguard University, organized a group of Nick's friends from Valencia High in Placentia to wake up early on their spring break and carry picket signs in front of PacifiCare's headquarters this morning. He also contacted the news media.

"I don't have the power in me to make him better but I can do something," Colombo said of his 17-year-old brother. "I can make the people at PacifiCare change their mind because I know they can help him."

More and more patients dissatisfied with decisions by their insurance companies are seeking to exert public pressure from rallies to letter writing campaigns. It's hard to know what effect they have. Some medical ethicists say allocation of health care should be determined by expected outcomes, not lobbying efforts. The matter is more complicated in cases like Nick's, where doctors disagree on the best course of treatment.

PacifiCare spokesman Tyler Mason said the company would pay for Nick's treatment anywhere in the country despite independent doctors concluding that he wasn't a good candidate.

"The evidence-based medicine is telling us one thing, but options are limited. We decided to support Nick's family," Mason said. "At the end of the day, it's important for Nick's family to have options during a trying time."

Mason said conversations with Nick's family – not publicity – led to a decision of empathy.

PacifiCare, which is owned by insurance giant UnitedHealth Group, called Nick's family with the news late Monday, as his parents were running out of options.

"I just started bawling. I said, 'Can you repeat that one more time?'" said Patti Colombo, Nick's mother.

The state Department of Managed Health Care turned down the family's appeal for Nick to receive the treatment known as Cyber Knife, which delivers an extremely powerful, precise dose of radiation through a robotic arm. While the procedure can be very effective, doctors at Stanford University concluded Nick was at risk of infection because the tumor is so close to his skin.

But Nick's doctor at Childrens Hospital Los Angeles wrote a letter this month calling Cyber Knife his "best chance of prolonged disease control." Nick's parents found a Kansas City doctor who they say would treat him. They hope to fly there within a month and expect the treatment to cost up to $100,000.

Nick, a senior who is schooled at home, was diagnosed four years ago with Ewing's sarcoma, a rare bone cancer most often found in teenage boys. His tumor is 6 inches wide and 4 inches deep with nerves shooting through it, preventing doctors from surgically removing it, his mother said. Past radiation and chemotherapy treatments shrunk the tumor, but it returned two years ago in the same spot.

"He graduated eighth grade in a wheelchair," said Patti Colombo, 47. "I told him last night, 'You're not graduating this year in a wheelchair. You're walking up there.' We have to have faith he will be healed."

Nick called PacifiCare's reversal a miracle.

"I really think it's the only thing that can cure me right now," he said. "I really need to get there to do it. I'm in so much pain just where the tumor is down to my calves, all that nerve pain."

Steven Torres, a Valencia senior, attended the protest with more than a dozen friends. Some carried signs that read "Save Nick" or "There's No Place like Kansas."

"He's a really loyal friend," Torres said. "His will has not faltered at all. He's remembered by a lot of us."

Nick is insured through his father Richard Colombo's job as a union bricklayer.

"I don't know what to say other than that we're so thankful," Richard Colombo, 47, said. "Now we don't have to hope that we're going to get it."

The rally also drew about 20 Southern California nurses from the state nurses' union. It marked the second time this month that the California Nurses Association has protested an insurer over a denial. They marched March 10 in Costa Mesa after Blue Cross refused to cover a controversial type of back surgery for a nurse. She underwent the surgery and paid for it herself.

In January, state officials announced that PacifiCare could face as much as $1.3 billion in penalties over 130,000 alleged violations of handling claims, including wrongful denials and incorrect payments, mostly since the purchase by UnitedHealth. Mason said he expects resolution soon.