It is a case worth more than a million dollars that the Paris Court of Appeal will study this Thursday. Transplanted with both hands in the United States in 2016, because she considered this type of operation then impossible in France, a young woman is indeed suing Social Security to obtain reimbursement of her bill.
At first instance in July 2021, the Paris court overturned the refusal to cover and ordered the Paris primary health insurance fund (CPAM) to pay two-thirds of the sum, but the latter appealed.
Four limb amputee after septic shock
The plaintiff, Laura Nataf, had four limbs amputated in 2007 at the age of 19 after septic shock. In 2013, she was placed on the list of patients awaiting a transplant, as part of a research program at the Georges-Pompidou hospital in Paris (AP-HP). But a year later, no compatible donor had been found. The health authorities did not renew the authorization for the program and Laura was removed from the list, her lawyer, Valérie Sellam Benisty, told AFP.
His surgeon, Laurent Lantieri, then offered him to have surgery in the United States and publicized the affair, castigating an “administrative and bureaucratic overload” and deploring the lack of funding “to make these innovations” in France. In February 2016, Social Security sends a refusal of coverage. But the young woman nevertheless had surgery in August at Penn Medicine Hospital in Philadelphia, which sent her the following year a bill of 1.13 million dollars.
Cnam defends itself
In its letter refusing coverage in the United States, the National Health Insurance Fund explains that it directed Laura Nataf “towards an experimental program open to the Hospices Civils de Lyon relating to bilateral allografts of hands and forelegs. arms, which would have allowed him to obtain the necessary care in France and the assurance of care, “said the Cnam to AFP. “Ms. Nataf did not choose to use this option. We consider, as such, that the refusal of support opposed is validly motivated, ”added the public establishment.
“It is completely false” to say that “Laura could have been operated on under the same conditions in France”, believes on the contrary Me Sellam Benisty, recalling his removal from the waiting list. In 2016, “transplants were suspended in France for lack of funding for research projects, due to the lack of donors and economic constraints”, assures the lawyer. “The medical world is unanimous on the infeasibility of such a transplant in France during the period that occupies this case”.
Me Sellam Benisty also argues that the refusal of coverage must be sent by registered mail, be signed and be accompanied by a “detailed medical opinion”, which was not the case with the “laconic” letter received by his client.
The first hand transplant performed in France in 1998
France was the pioneer of this type of operation, with the first hand transplant performed in 1998 at the Hospices Civils de Lyon (HCL) by Jean-Michel Dubernard on a New Zealand patient who suffered a cutting accident. . In 2000, a new world first, with the first transplant of both hands and part of the forearms, on a 33-year-old house painter who was amputated after being seriously injured in the explosion of a home-made rocket.
But until 2016, only six other patients then benefited from this double transplant, authorized on a case-by-case basis within the framework of the Hospices Civils de Lyon (HCL) program. In 2017, following in particular the case of Laura Nataf, France undertook to better define the legal and financial framework for this type of transplant.