Topeka - An attorney for a Jehovah's Witness told the Kansas Court of Appeals on Wednesday that her client is willing to die for her faith rather than get a liver transplant paid for by the state.
Corrine Petrik told the three-judge panel that the religious freedoms of her client, Mary Stinemetz, were violated by the Kansas Health Policy Authority's decision to deny Medicaid coverage for a bloodless liver transplant.
"This case is a life-or-death case for a citizen of Kansas," Petrik said. "This is a seriously held belief by Mary that she's willing to die for."
Stinemetz, 64, of Hill City in western Kansas, says her faith prohibits her from using blood products in medical treatment. No hospital in Kansas performs bloodless liver transplants, but Stinemetz could get it done in Nebraska.
Brian Vazquez, an attorney for KHPA, told the court that the agency didn't deny the procedure because of religious issues but because of other criteria, including distance from Kansas. Had the procedure been available in Kansas, KHPA would have approved coverage, he said.
"The procedure is the same. What the state does is fund a medical service," Vazquez said. "How the doctor is going to do it is not our call. That's the doctor's call."
Stinemetz, who has primary biliary cirrhosis of the liver, says the state is infringing on her First Amendment rights to freedom of religion. She lost her first round in court in December in Graham County District Court. She did not attend Wednesday's hearing.
The court expedited the hearing because of her medical condition but gave no indication how soon a decision would be issued.
Stinemetz did not return a phone message for comment Wednesday.
Petrik said that while the regulations for denying Medicaid coverage are religion neutral, her client's religious rights were being violated because the agency has the discretion to grant coverage.
She said the state showed no compelling interest in denying the claim for coverage.
Vazquez said KHPA officials could grant a waiver and allow individual exemptions for coverage, but that he's not aware of Stinemetz making such a request based on religious grounds.
In its briefs to the court, the KHPA said Stinemetz failed to meet the requirements that would have permitted coverage at Omaha's Nebraska Medical Center, even though it was outside the 50-mile boundary limits for out-of-state coverage.
"There is no medical necessity for the beneficiary to have a bloodless transplant -- a regular liver transplant is available in Kansas and would be considered medically necessary," the state said in denying coverage in early February 2010. "The beneficiary's religious preference to have a bloodless liver transplant does not meet medical necessity."
Stinemetz first went to the University of Kansas Hospital in 2009 after learning she would need a transplant. She told physicians she wouldn't accept the transplant that involved blood transfusions.
The hospital recommended she seek another hospital that might perform a bloodless transplant. The Nebraska Medical Center performs such surgeries. They are offered on a limited basis nationwide.
At an administrative hearing in March 2010, Dr. Wayne Wallace, a clinical consultant for KHPA, testified that performing a bloodless transplant involved risks to the patient and raised ethical questions about the presiding surgeon. Without using blood transfusions during the transplant, Wallace said, the surgeon must be willing to accept that a patient could die.
Court records show that Jehovah's Witnesses follow strict directives to abstain from blood, citing biblical passages. Church doctrine leaves it to individuals to accept certain blood fractions and donor organs.
The Watchtower Bible and Tract Society of New York filed a brief with the court saying Kansas was forcing Stinemetz to choose between violating her religious belief or bypassing surgery that could save her life.
Stinemetz testified at the March 2010 hearing, saying she could "repent" for accepting a blood transfusion and remain a member of the Jehovah's Witnesses, but that she chose to honor her faith by not choosing that option.
