February 19, 2008

GLAD Applauds Victory in Case of Girl With HIV

Court Reverses MassHealth Refusal to Cover Surgery

Gay & Lesbian Advocates & Defenders applauded today’s decision by the Massachusetts Court of Appeals in favor of 18-year-old Ashley Shaw who has sought to get MassHealth to cover her AIDS-related surgery.

“This is a great victory because it affirms that a teenaged girl living with AIDS must receive the health care that her doctors deem necessary,” said GLAD staff attorney Janson Wu. “As people with HIV live longer � and especially children born with HIV live into adulthood � access to care is the critical issue of their lives.”

Ashley Shaw has lived with HIV since her birth, and the powerful anti-AIDS drugs she takes cause multiple side-effects, including the growth of an abnormal fat pad on the nape of her neck. This “buffalo hump” caused her daily pain, severe headaches, abnormal posture, and posed the danger of permanent damage to her spine. In 2004, her doctors at Children’s Hospital concluded that surgical removal was a necessity.

Literally on the eve of the scheduled surgery, MassHealth denied coverage. In light of Ashley’s pain and the risk of long-term damage, Ashley’s mother, Liz Shaw, decided to proceed with the surgery and appeal the decision later. “Any mother would have made the same decision,” said Liz. MassHealth denied her right to appeal because the surgery was performed “without authorization.”

“This was error,” wrote Judge Elspeth Cypher on behalf of a unanimous Court. “We reject the DMA’s [Division of Medical Assistance] view that Ashley’s claim may be terminated because the procedure had been performed without authorization. There was no timely and reasonable alternative available when the request for authorization was denied.”

“When Ashley was born, the median life expectancy of children with HIV was eight years old,” said Liz Shaw. “But she is part of the first generation of children who are growing up and living into adulthood. She’ll continue to need medical care, and I’m grateful to the Court for providing that access to care.”

GLAD had filed suit in Suffolk Superior Court in 2005 on behalf of Ashley and Liz Shaw. The Court found on behalf of MassHealth and GLAD filed the appeal with the Massachusetts Court of Appeals, arguing before the court on October 4, 2007.

Gay & Lesbian Advocates & Defenders, now celebrating its 30th year, is New England’s leading legal rights organization dedicated solely to ending discrimination based on sexual orientation, HIV status, and gender identity and expression.