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Hiepler: Well, having battled an insurance company on behalf of my sister who had no criminal past and was a wonderful mother of three, I have an emotional reaction --
Marlow [host]: -- and was seeking a transplant? Bone marrow?
Hiepler: Yeah, seeking a transplant and it was a covered benefit. I have an emotional reaction that many people in prison are getting better healthcare than people who are in HMO's in America right now.
Is it fair? Under California law, a prisoner gets medically necessary care, doesn't have to file a lawsuit against the prison department to get it, and that's what the legislature has determined is reasonable. The sad thing is that there are so many non-convicted felons that have covered benefits that have paid all their life for their healthcare and yet they're fighting to stay alive and others are getting it for nothing. There is a fairness issue and it is a financial issue. It doesn't become an issue until it costs something.
Zavala [host]: So should we put a mechanism in place to prevent inmates --
Elders: -- Absolutely not. I feel that we in medicine have to offer every human being the very best healthcare that we have available. The problem is, we in this country, the richest country in the world, do not offer universal access to healthcare for all of our people. The only people in the country with the constitutional right to healthcare are prisoners.
Zavala: But you can't really mean that. Let's take somebody on death row and you know that he's going to be executed in six months. He doesn't get a heart transplant, right? So you don't offer everything.
Capron: There are people on death row who spend a lot of time there and who are even released when it turns out that they were innocent, or their sentence is commuted. So I don't think that we can start saying that the statutes would provide one penalty for, say, robbery and now have a new penalty which is that you will die when you're deprived of a transplant to which you are otherwise entitled. That is to say, the mechanism that decides who gets the heart is one which doesn't look at that factor, but it looks at all the other relevant factors and he came to the top of the list.
Marlow: How about the issue of those who are denied a transplant because of lifestyle? Those who have used drugs --
Zavala: -- or let's say you smoke?
Elders: I just think that we can't start having those kinds of issues getting in front of medicine. Just because someone goes out and didn't wear a helmet on a motorcycle and has a head injury does not mean that he can't get the very best healthcare that we have to offer. We have laws that say you have to wear a helmet in some states. I think we have to offer every patient --
Marlow: Would this issue be moot if there were plenty of organs available for transplant?
Capron: Well, you'd still have the financial issue. I mean, I think that both Dr. Elders and Mark have made the same point with which I agree. What makes this case so unbearable is the notion that there are forty-some million people who don't have any guaranteed access to our healthcare system. If everyone had access and if the level of care that they all had was adequate, then we would just be facing the issue of the scarcity of the organs.
But here, a lot of people can't put down the quarter of a million dollars and they don't get in the line at Stanford hospital to even compete with this fellow if they're the most suitable person to get the heart. That is a problem, but it's not a problem that you take out by criticizing the doctors for treating this man. It's a problem we do something about in our whole healthcare system.
Elders: You're absolutely right. It's our fault that we as Americans have not demanded that we have universal access to healthcare for all of our people. That's what we've got to have because we know that people do not have equal access today. You know, you look at race, you look at poverty, you look at urban inner city areas. You know that our access is not equal.
Zavala: But what you're painting is a utopian idea. Of course, we'd all love to have access and afford the best medical care for everybody, but we don't. Next week this decision may come up again. they're going to have to choose. Should it go to the inmate or should it go to the mother with three kids?
Hiepler: If the legislature got involved, there'd be a ballot initiative that would pass overwhelmingly that says, if you're a convicted felon, you don't get a transplant. I don't know why the legislature hasn't come up with a proposition to do that because of the cost and because there are limited resources. At the same time --
Marlow: -- and because it's a moral and ethical issue, is it not?
Elders: The moral issue is that we as Americans don't have health insurance for everybody, but as far as an ethical issue as to the doctors treating this patient, every patient should be treated the same once they become a patient.
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