The Story of Dr. Dan Hurley

Dan Hurley, M.D. was a member of our Patient / Family Advisory Board and wrote the publication on Insurance Authorization and Getting Your Care Approved (see attached). Dan lost his battle with Chondrosarcoma this past Thursday, August 3.

One of his colleagues: Ron Howrigon wrote the commentary below.

The Story of Dr. Dan Hurley

I have worked in health care for over 36 years and over those years I have had the good fortune of meeting some incredible doctors, people who went into medicine to help others when they need it most. These dedicated individuals devote their lives to alleviating suffering and to fighting disease and illness. Some of those doctors have made a lasting impact on me.

Dr. Dan Hurley is one of those physicians and this is his story.

I met Dr. Hurley just a few short months ago. He reached out to me after reading a story from ProPublica about insurance company denials in which I was quoted. After reading the story, Dr. Hurley sent me an email and asked if we could talk. We set up a Zoom call a few days later. I must admit, I didn’t know what to expect from the meeting and I certainly wasn’t prepared for the impact it would have on me.

I was surprised when Dr. Hurley joined the call from a hospital bed. He quickly informed me that he was in the middle of receiving a treatment for a very difficult cancer diagnosis. Dr. Hurley told me the story about both his diagnosis and treatment regimen. The story included difficulties he had experienced in getting the care he needs approved and authorized by his insurance company. Dr. Hurley told me how lucky he was that, as a physician, he was able to quickly navigate the health care system and find a specialist who would easily be considered one of the preeminent experts in the rare cancer he was dealing with. The oncologist treating Dr. Hurley started him on a treatment path to deal with his disease and tumor right away. Along that journey, Dr. Hurley and his physician ran into a roadblock that is all to frequent in our system today. Dr. Hurley’s insurance company denied a PET scan ordered by his oncologist. The requested PET scan was denied by a Medical Director because that physician deemed it to be not “medically necessary”.

Let’s stop there and really understand what that means. A physician who, with no transparency or consequences for his or her actions, decided (with probably very little if any review of Dr. Hurley’s medical records and very likely no formal training in oncology) that a test ordered by a national expert from the Mayo Clinic – after careful review of Dr. Hurley and his condition – was not needed. That’s right, an uninformed physician likely practicing outside of his or her specialty decided they knew better than a well-informed expert in the field.

Ok, back to our story. After hearing all of this, I quickly asked Dr. Hurley what I could do to help. That was when Dr. Hurley really made an impression on me. He informed me that he wanted to tell his story so others wouldn’t have the same experience. He told me he wanted to dedicate his life to exposing this problem in the hopes of changing the insane system of insurance company denials. I remember thinking how incredible this was. Here I was talking to a doctor while he was getting chemotherapy for his cancer, and instead of being angry or wanting vengeance, was concerned only about future patients. Patients that he would never know or treat. Patients who wouldn’t even know of his efforts to help them and patients that he would never receive any payment from for his activities. This is the kind of selfless behavior that I see in many physicians.

I was immediately all-in. I was quickly drafted and readily joined Team Hurley. I started sharing Dr. Hurley’s name and information with as many people as I could to hopefully help him tell his story. As part of that effort, we interviewed Dr. Hurley on our own podcast.

Over the next few weeks, I spoke with Dr. Hurley a few times. Each time I was impressed with his approach to his situation and his continued desire to help future patients that he would never meet. At one point he shared with me an honest conversation about his disease. He told me that while he was an optimist, he was also a doctor and knew that it was unlikely he and I would be having this conversation again in a year. He told me his goal was to live long enough to see his child graduate and to hopefully take his wife on a trip to France one more time. This was so typical of the Dr. Hurley I was fortunate enough to get to know. His goals were not about him, but rather his loved ones.

That was in May of this year. Now, fast forward to today. Last week I was approached by a reporter from the Washington Post. She was developing information about the practice of payer denials and wanted to talk with me to get some background information. During this conversation I told her about Dr. Hurley and suggested that she interview him. I immediately sent an email to Dr. Hurley introducing him to this reporter. That was last Friday. That evening we received a call from one of Dr. Hurley’s partners informing us that he had passed away the night before.

I have never met Dr. Hurley face to face. I have only talked with him via zoom or over the phone. I can’t say that we were good friends or that I had known him for years. Despite that, the news of Dr. Hurley’s passing hit me very hard. I think it was because of what an amazing person he was and because it made things very real for me. I talk about the health care problems we face in macro terms or on the level of public policy. Upon hearing the news about Dr. Hurley’s passing the problems in our system suddenly had a face and a name. It was in that moment I decided Dr. Hurley’s story, and his desire to help solve this problem for future patients, would not end with his passing. I vowed to tell his story every chance I get and to do what I can to carry the flag he had picked up.

With that in mind, I am going to jump up on the soap box built by Dr. Hurley. I will warn you that I am not going to do this with the grace and sensitivity that Dr. Hurley would have. I’m not going to do that because in the words of Peter Finch from the movie Network; “I’m mad as hell and I’m not going to take this anymore.”

As I write this, I struggle to control the anger I am feeling right now. I think about the Medical Director that denied Dr. Hurley’s PET scan and all the other Medical Directors that spend their days signing off on “medical necessity” denials for hundreds of thousands of patients all dealing with their own medical issues. I think about those physicians, and I wonder how they reconcile what they are doing with the Hippocratic Oath they took when they became doctors. I would ask them to remember their oath and the statement “first do no harm.”

As I write this, I can hear the response from insurance executives. A response I issued several times when I worked for insurance companies. “We are not denying care we are only making coverage decisions.” Put bluntly, this is B.S. It was B.S. when I said it all those years ago and it’s still B.S. now. People have insurance because they can’t afford to pay for care without it. Withholding payment for care is the same thing as withholding the very care they need. Trying to explain it any other way is simply wrong. I can also hear the insurance company spin doctors explaining this behavior by trying to paint it as being good for society. “Our mission is to make health care more affordable in this country.” If that were the case, then why did the major insurance companies reap record profits during the Covid crisis? Why did insurance companies see dramatic increases in their stock prices during the worst health care crisis in this country this century? Spare me the hypocrisy and don’t insult my intelligence with that kind of drivel.

The process insurance companies use to deny care is not focused on the patient but rather on their own profits. That’s the reality of the situation. It’s about companies putting profits before people. It’s as simple as that and it must change.

So, how do we fix this? How do we protect patients from corporate greed? Well, it’s not complicated. It just takes a change in the way we think about patients’ rights and the practice of medicine by insurance company Medical Directors.

First, we need to give patients the same kind of protections we give people in our justice system. Our justice system is built on the idea of presumed innocence. It doesn’t matter if you are caught on video doing the crime you are presumed to be innocent, and the prosecution has the burden to prove your guilt beyond a reasonable doubt. Further, you are allowed to be judged by an impartial jury of your peers. We do this because we have decided that its worse to jail an innocent person than it is to let someone who is guilty go free. Shouldn’t the same thing apply to health care? Isn’t it worse to deny care to someone who needs it than to approve care that isn’t totally necessary?

Imagine if your physician was presumed to be correct in what he or she prescribed for you and the insurance company couldn’t deny that order unless they could prove beyond a reasonable doubt that your physician is wrong. Imagine if rather than a single medical director, compensated by the insurance company, practicing outside of his or her specialty, with no transparency when determining your doctors’ order was not “medically necessary”, that instead it was reviewed by an independent group of his or her peers that started with giving the treating physician the assumption of being right. That’s right, independent physician’s, not on the insurance company payroll, who are peers. You know, practicing physicians in the same specialty? Imagine what that would look like. I’m guessing it would cut down on these kinds of automated or inappropriate denials.

Another simple solution would be to pass a law expanded the definition of “practicing medicine” to include the act of denying a service as “not medically necessary.” This would mean that the doctors signing the denial would need to have a license in good standing. They would have to be practicing in their field or specialty and they could be held responsible for malpractice if the denial was not clinically reasonable and resulted in a bad outcome. Imagine what that would look like. It would end the scenario where a single doctor could sign off on 60,000 denials in one month, where Medical Directors sign off on denials after spending less than 2 seconds reviewing the case. Imagine the field day a plaintiff’s attorney would have in a malpractice case involving the denial of the PET scan for Dr. Hurley. Again, I’m guessing this simple change would fix that problem.

The problem here isn’t what happened to Dr. Hurley. The problem is the thousands, tens of thousands, maybe hundreds of thousands of people out there that have had care denied by an insurance company. The problem is that Dr. Hurley’s story isn’t an anomaly but rather an example of something that happens every day in this country. That’s the problem.

I can’t say approving the PET scan for Dr. Hurley would have saved his life. No one can say that. I can’t say that approving that PET scan would have helped him live one day longer. What I can say is that the denial was wrong. I can also say that when a person is going through cancer or any other difficult disease, the last thing they should have to spend energy on is fighting with an insurance company. They shouldn’t have to worry about paying for things like a PET Scan. They should be able to spend 100% of their focus on fighting the disease they have or enjoying their remaining time with their family. That’s the way things should be, and I am going to continue to tell Dr. Hurley’s story until things change.