September 26, 2011
Students in the Elder and Health Law Clinic won an impressive victory when an administrative law judge ruled last month that their client was entitled to an expensive medical procedure previously denied him under his coverage.
"This is the third Medicare Part C coverage that our students have handled and we are 3-for-3," said Professor Melissa Brown, the supervising attorney for the clinic. "Moreover, they have likely signaled a path to other lawyers and claimants for getting this type of procedure covered."
The client, a 70-year-old man suffering from a severe case of chronic tinnitus (an unrelenting roaring in the ears), sought an experimental procedure with an 80-percent success rate. The procedure, Deep Brain Stimulation (DBS), was Medicare-approved for Parkinson's patients but not for tinnitus.
Katie Roe, '12, Jason Truong, who will graduate in December 2011, and Ian Scharg, '12, were enrolled in the clinic during the 2010-2011 academic year and took on the complicated case. Roe's colleagues kept in touch with her as she worked at the clinic full-time in the summer, and the three students dug into the medical science and Medicare law and policy. They concluded that DBS is approved for the treatment of chronic, intractable pain and later gained the support of attending physicians at UCSF who agreed with their position. In July, the doctors testified at a hearing held at the San Francisco Veterans Hospital by an administrative law judge, who travelled from Anaheim to hear the matter at the students' request due to the severity of the client's condition.
"The judge agreed with our position and approved the $30,000 procedure for Medicare coverage," said Brown. "This is a life-changing decision for our client, and frankly, it may be life-saving. I am so proud of our three students who poured their hearts and souls into the case."
The Elder and Health Law Clinic, which is now in its fourth year of operation, has won a variety of public notice for its excellence. In addition to being one of a few clinics to receive a recent cy pres award, it has also been nominated for other awards for its public-interest commitment. The clinic also had scored a big victory last spring when Corrie Erickson, '11, convinced a Social Security Administration law judge that her client, an elderly woman with a disability, did not owe a significant overpayment that the agency had first claimed she did.