Swiss Miss

When his wife required an emergency transplant, this professor was ready to donate his own kidney -- but CU wasn't willing to pay the price.

Victor Saouma carefully shapes his sentences, at pains to be accurate. Part Lebanese, part Colombian, he holds himself with dignity. A professor of civil engineering who earned his doctorate at Cornell University and did post-doctoral work at Princeton, Saouma once thought of his employer, the University of Colorado, as a center for learning and high intellectual aspiration, a concordance of scholars bound together by mutual ideals.

That was before his wife, Rhea, became deathly ill in Switzerland and he discovered precisely what his fifteen-year relationship with the university was worth. Late last year, the Saoumas successfully settled a lawsuit against CU.

Rhea's health problems had started years earlier in Boulder, after a driver made a sudden and illegal left turn in front of her car and she slammed into him. She was badly injured -- whiplash, soft-tissue damage, neck and back pain -- and her treatment included high doses of antibiotic and anti-inflammatory drugs. But when doctors took her blood preparatory to some needed surgery, they discovered that her creatinine serum reading was dangerously high. It seemed the drugs had damaged her kidneys.

"It was the first time we heard about creatinine," says Rhea. "We didn't even know what it was. Basically, the type of disease I ended up with was renal tubular acidosis. The kidney did not filtrate anymore."

On her doctor's advice, Rhea eventually began the procedures necessary to get on the transplant list. But while she was undergoing interviews and tests, her condition radically improved. So in July 1997, the Saoumas decided -- with the encouragement of Rhea's doctor -- to finally take Victor's long-delayed sabbatical. They left for Switzerland, where Victor would teach at the Swiss Federal Institute of Technology in Lausanne and continue his research; Rhea would concentrate on caring for their two daughters, Caroline and Sophia. (Their son was attending college in Berkeley.) But by the spring of 1998, Rhea's health was declining rapidly. "I was a vegetable," she recalls. "Throwing up, retaining fluid. You know, with kidney failure you have no pain, but you're completely drained. You feel tired all the time. You get up an hour, you sleep two. You get up an hour, you sleep two. You sleep poorly at night and poorly during the day.

"By May, I was going downhill. The fluid in my body was so high that I went to the hospital with a heartbeat at 157. They couldn't get it to stop. It was pounding. At that point the doctor said, 'You're going on dialysis immediately,' and they inserted a catheter in my neck. It took them two weeks before they were able to remove the fluid."

Still, the catheter was only a temporary solution: Such catheters carry a high likelihood of clogging or infection, and infection posed a profound risk for Rhea, whose illness had been created, at least in part, by antibiotics and who was now allergic to most antibiotic medicines. A transplant represented the only permanent fix, and Rhea's Swiss doctors determined that Victor would be a suitable kidney donor. They also decided that if they performed the transplant soon, they wouldn't need to replace Rhea's catheter with a fistula, a more permanent implant for dialysis whose surgical installation can be painful and difficult and which also poses a high risk of infection.

So far, the Saoumas' insurance with CU had covered Rhea's care. That June, Victor called the university to check on coverage of an operation that would transplant one of his own healthy kidneys into his wife's ailing body. His request was backed by a letter from Dr. J.P. Wauters of the Department of Nephrology, University Hospital, Lausanne. "We herewith certify that Ms. Rhea Saouma is now suffering from advanced renal failure which requires urgent renal replacement therapy in the following week," Dr. Wauters wrote. "Failure to act on this will have fatal consequences. Furthermore, her conditions do not allow her to safely travel to the USA."

Since 1989, CU had given most employees the option of getting their insurance through the state or signing on for the university's self-insured plan; faculty members were eligible only for the latter. Under that system, CU set its own premiums and paid claims from a self-administered pool; treatment was provided by CU's Health Sciences Center. But plan participants could maintain a certain amount of freedom by signing up for a more expensive option, the Silver plan, which allowed for some treatment outside of CU. The Saoumas had opted for the Silver plan. "We always took a plan which provided us with the most possible choices," says Victor, adding that they'd never had any problems getting reimbursed for outside care.

But by 1997, enrollment in the Silver plan was dropping and its costs were rapidly rising, since enrollees willing to pay more for insurance also tended to need it more. Premiums were now $580 a month for a single employee and $1,702 for a family. "Only football players could afford it," Saouma remembers.

When CU administrators began discussing eliminating the option, however, many faculty members were furious over the possibility of losing the Silver plan and being confined to one provider -- even if it was their own health sciences center. Although it's not uncommon for a university associated with a medical school to make its own facilities an element of its benefit plan, CU's complete reliance on the health sciences center was highly unusual. While the center offers excellent care in many areas, certain kinds of specialists are unavailable there. And since many CU faculty members and staffers live in Boulder or Colorado Springs, being forced to bypass local hospitals and travel to Denver for every medical problem could represent a real hardship. A CU staffer who suffered a massive heart attack in Boulder and was rushed to Boulder Community Hospital was sharply rebuked by administrators for not having driven to Denver -- despite the fact that extra time on the road might have cost her her life. (CU's plan eventually covered her care.)

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