San Antonio defense attorney pushes for Medicare to cover treatment for ‘side effects’ of cancer care

A San Antonio-based criminal defense attorney who built her more than 30-year career defending those wrongfully convicted is now taking on the nation’s health insurance system.

In April, Cynthia Orr lobbied Congress to support the Lymphedema Treatment Act. The bill is on the US House and Senate floors — labeled HB 3630 and SB 1315 — and is gaining bipartisan support among lawmakers.

If passed, the legislation would require Medicare to pay for compression garments used to prevent and treat lymphedema – a painful condition that affects 1 in 1,000 cancer patients. People with the disease experience significant swelling and may benefit of such treatment.

Orr considers herself a “professional problem solver,” so when she heard that cancer survivors were suffering needlessly because they couldn’t afford prescription compression garments, she voluntarily took up the cause. . She understands what people with lymphedema go through and why they need this treatment, because she is one of them.

The top lawyer recently won support from the San Antonio Bar Association and says she won’t stop until compression therapy is covered by Medicare and Medicaid. Then, she reasons, it would only be a matter of time before private insurance companies would approve doctor-prescribed treatment for their beneficiaries.

Lymphedema is caused by a buildup of fluid that occurs when the lymphatic system is defective or damaged. The condition can result from injury or removal of his lymph nodes as part of certain cancer treatments, which was the case for Orr.

She was diagnosed with breast cancer in 2013, and although she has to regularly visit MD Anderson in Houston for treatment, she has largely kept her condition a secret. She tried and won a federal terrorism case while undergoing chemotherapy.

Orr recalled a nurse explaining that her life-saving surgery had made her more susceptible to developing lymphedema, describing it as a “side effect”, but over the years the cancer became a distant memory.

That was until November 2020, when Orr cut his left hand while chopping vegetables for dinner. In less than 24 hours, it swelled to more than double its normal size. She immediately understood what was happening to her.

“They should call it something more serious than a side effect,” she said during an interview at her law office on the top floor of the Tower Life building in downtown San Antonio. .

Orr is used to fighting for people who get rough treatment from the criminal justice system.

Orr was part of the legal team that advocated for the release of Michael Morton, an innocent man who was convicted in 1987 of the murder of his wife in Williamson County.

She also helped Hannah Overton of Corpus Christi get her conviction overturned and secure her release after spending seven years behind bars. She was charged with the salt poisoning death of her 4-year-old son. A poster for a 2016 documentary based on the case hangs in Orr’s office.

Orr recently demonstrated how she wraps her left arm in custom compression garments several times a day. The treatment is tedious, extending from the bottom of his fingers to his shoulder, but it is necessary to minimize painful swelling and avoid the risk of more severe disability.

Dr. Brian Fricke, director of the division of cancer rehabilitation at MD Anderson Mays Cancer Center at UT Health San Antonio and the only such specialist in South Texas, treats Orr.

She was at high risk of developing lymphedema due to the removal of almost all the lymph nodes in her armpit during her cancer treatment, Fricke said.

“Then she also underwent radiation therapy, which caused scarring and a narrowing of the caliber of the lymphatic vessels that remained in her arm,” he said. “So when she cut her hand, it was kind of like the straw that broke the camel’s back.”

Fricke said while most people can fend off a minor infection from a cut with Neosporin, in Orr’s case it activated his lymphatic system to trigger an immune response, which failed to mobilize properly.

The swelling in her left arm has since subsided with intensive decongestant therapy, but not as quickly as she had hoped.

She was referred to Dr. Anton Fries, a reconstructive microsurgeon at UT Health San Antonio, who performed a delicate operation to transplant laparoscopically removed lymph nodes from Orr’s stomach to her arm.

Orr appreciates that she has the chance to be able to pay for and receive the medical care she needs. Many lymphedema patients do not receive compression therapy or are forced to ration bandages, wraps, and clothing because health insurance companies do not cover them.

And for people with more advanced or severe lymphedema, especially those with lower extremity lymphedema, Fricke said, “something as simple as a fingernail or ingrown toenail” can become serious.

Historically, Fricke said, Medicare, Medicaid and private insurers viewed lymphedema as a cosmetic problem.

“That’s so far from the truth,” he said.

Still, pneumatic compression pumps, devices that cost Medicare between $4,000 and $6,000, are covered. Meanwhile, Medicare pays when patients with lymphedema end up in intensive care units or on intravenous antibiotics.

“It’s costing the entire healthcare system a lot of money to save, you know, pennies on compression garments,” Fricke said.

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About Antoine L. Cassell

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