(Transcribed from the original)

August 19, 1998

Lucy Finger
Director of Human Resources
Metromedia Restaurant Group
6500 International Parkway
Plano, Texas

RE: Ronald James Martin

We are again attempting to resolve the issue of R.J.'s insurance's unwillingness to pay for treatment--treatment that is necessary for R.J.'s recovery. He has been under my care since January, 1996. His progressively debilitating diagnoses include:

Lyme Disease (LD), late disseminated stage;
Lyme Encephalitis;
Lyme Arthritis;
Lyme Meningitis;
Protein C clotting disorder;
Optic Neuritis;
Facial Palsy;
Central nervous system (CNS) involvement;
Immune system (IgG subclass) deficiencies;
Musculoskeletal degradation;
Tremors and spasticity;
Cognitive dysfunction, including memory lapses; and
Neuropsychiatric problems.

Testing to support the clinical diagnosis of Lyme disease include:

Positive ELISA IgG and IgM;
Lyme Western Blot, unequivocal by CDC standards;
Visual Evoked Potentials (VEP): optic neuritis;
Confirmatory second opinion by Dr. Steven Phillips, consultant to the Lyme Disease Foundation.

Treatment has included various courses of oral antibiotics. These brought some degree of improvement but increased frequency of relapses, which are known as Jarisch-Herxheimer reactions. Due to R.J.'s Jarisch-Herxheimer reactions to date, increasing the dosages of the oral antibiotics would leave him bed-ridden, in my medical opinion. Since his hospitalization in June of this year, R.J. has demonstrated increased CNS involvement, with rapid degradation of his musculoskeletal capabilities, and which warrants the necessity for intramuscular (IM) antibiotic injections or intravenous (IV) antibiotics because oral antibiotics have become mostly ineffective. I previously changed R.J.'s course of treatment to include IM Rocephin, whose reimbursement has been denied by your plan administrator, First Health. IV administration has also been denied. To date, $11,352.50 worth of treatment, including routine lab and tests since 1996, remains unpaid by First Health. This is an economic burden that neither I, as a physician, nor R.J. can absorb.

R.J. must now ambulate with the aid of a cane to provide some stability. I have prescribed Baclofen, a muscle relaxant used to treat muscle spasms associated with Multiple Sclerosis (MS) and/or spinal cord injuries. Of particular concern at this time is the emergence of optic neuritis and the spasms and tremors R.J. now experiences. The literature on this particular ailment suggest that 50%-90% of patients who suffer from optic neuritis go on to develop MS. Lyme is known to mimic MS as well as other major diseases. The treatment of optic neuritis also requires IV antibiotics to penetrate the optic nerve. Oral medication on its own cannot penetrate the CNS to a curative degree.

R.J.'s prognosis at this time is poor. Without authorization for the recommended treatment, his condition will not improve and he cannot return to a productive state of health. The treatments and tests for which immediate written authorizations are needed include:

diagnostic lumbar puncture;
MRI brain and MRI spine (to differentiate between Lyme and MS lesions);
IV Rocephin, 2 grams daily for at least 28 days.

Your assistance in obtaining immediate authorization for treatment would be greatly appreciated.

Sincerely,


Dr. Xxxxxx



cc: Linda Farina, Director, Employee Benefits / First Health


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