While at work one day last April, Byran Hunt felt the dull pain of a heart attack settle on his chest like a lead weight.
Two days later, doctors performed quadruple bypass surgery on the 56-year-old Troy resident. Yet, because Hunt received a drug known as TPA in the early stages of his seizure, he was home in less than a week.Hunt was the first heart attack victim in the region, which is known as `the Palouse,' to receive TPA as part of his emergency room treatment. The drug, tissue plasminogen activator, dissolves blood clots that block circulation to heart tissue.
A single dose of TPA costs $2,300, and because it is not covered by Medicare and most major health care insurers, the drug has raised ethical questions at hospitals.
The American Hospital Association has lobbied the Health Care Financing Administration, which monitors the Medicare system, to reimburse hospitals for TPA. So far, HCFA has shown little interest in funding the drug.
So in the excitement of an emergency, a physician must make a split-second decision about using the drug viewed as a lifesaver, knowing that the hospital may have to pick up the tab.
Responding to an April 26 call, Moscow emergency technicians whisked the woodworker from his workshop on the Troy Highway to Gritman Memorial Hospital in Moscow. As he lay on a hospital bed in the emergency room, Hunt's wife, Ruth, whispered he was going to be part of an experiment.
"I was a guinea pig," said the owner of Hunt Wood Products. "I was wondering if it was all worth it and I guess it was. I thought, `Well, if I'm going to die, I might as well die trying."'
Moscow physician Dwain Leonhardt had emergency room duty when Hunt was rolled in. He examined Hunt's electrocardiogram reading and prescribed use of TPA within an hour of his being admitted to Gritman. By the next morning, Leonhardt said, Hunt's EKG was back to normal.
"TPA will probably be used more in future because of its effectiveness," said Leonhardt, who's practiced on the Palouse for nearly 10 years. The physician added that TPA has fewer allergy-related side effects than the drug more commonly used to dissolve clots, streptokinase.
Hunt's TPA injection stemmed damage to his heart from clots in four of the major blood passageways. And while Hunt still needed to have those vessels bypassed with replacement arteries from his left leg, the situation would have been worse without the new drug, the patient said.
The next morning, Hunt was flown to Spokane and received his bypass surgery at Deaconess Medical Center. He was home a week later.
Robert Colvin, administrator at Gritman, said Blue Cross picked up most of the TPA costs in Hunt's case. But, Colvin said, heart attack patients on Medicare would not be covered for the treatment.
That puts the burden on hospitals.
"Basically, if the physician feels the treatment is needed then we will provide TPA," Colvin said. "If that patient is on Medicare, we're giving that treatment away."
To Hunt, worries about medical costs don't matter as much as a new chance at life.
"The doctors said there was good news and bad news before the operation," said Hunt, back in his woodshop. "Now, if I hadn't got TPA, I don't know where I would've been. Maybe there wouldn't have been any good news."
The jovial Hunt says he feels stronger every day, adding that he also trots up and down the hill behind his woodshop, a task he couldn't handle before his operation without completely losing his breath.
"I never thought your breathing would have anything to do with your heart," said Hunt, who has been placed on a low-fat, low-sodium diet. "It feels like they opened up my pipes full bore. They told me I was going to be better than 100 percent."
The Food and Drug Administration approved the drug TPA for use late last year, but many hospitals have been reluctant to stock it because of the cost. Gritman received TPA in February.
The drug is manufactured by a California-based firm called Genentech Inc. and is marketed under the brand name Activase.