Paul Coppola, 2000
Paul Coppola is a 63-year-old retired inspector and supervisor in the aviation
industry and a former Lance Corporal in the U.S. Marines Corps. Paul never
expected his life to be a "rose garden." With the courage and
pride found in the innermost being of every Marine, he has faced and beaten
previous health problems having conquered both prostate cancer and heart disease.
In the early Spring of 2004, Paul noticed an unusual swelling of his abdomen.
The uncomfortable swelling and weight gain continued throughout the summer.
Initially, Paul took an aggressive stance strictly limiting his food intake
determined to lose the excess pounds. But, in August 2004 his "starvation"
diet produced a near toxic hypoglycemic event requiring him to seek medical
attention at the emergency room of a nearby hospital. Tests revealed fluid
in the abdomen. Paul was scheduled for a paracentesis which was performed
at the Hoag Memorial Hospital in Newport Beach, California. During that
procedure 10.8 liters of fluid were removed. That's nearly the equivalent
of five 2-liter bottles of soda and a cup of coffee. Can you imagine how
uncomfortable you would feel with that much fluid trapped inside your
belly? Paul immediately dropped 30 pounds from his burly six foot frame.
The fluid removed during the paracentesis was sent to the hospital laboratory
for evaluation. The cytological testing of the fluid revealed the presence
of mesothelial cells but the pathologist was unable to provide a definite
diagnosis. Doctors at Hoag Memorial informed Paul that the laboratory's
findings were inconclusive but highly suspicious for a malignancy. It
was recommended that he meet with a Hoag Memorial staff oncologist during
his hospital stay. After the oncologist's physical examination of
Mr. Coppola and perusal of his medical records, he urged Paul to consider
a tissue biopsy.
After spending three frustrating days in the hospital, Paul was sent home
with no confirmed diagnosis and no conception of what loomed ahead. After
a number of sleepless nights and lengthy conversations with his wife Terrie,
Paul conceded and agreed to have a tissue biopsy.
On August 20, 2004, Paul returned to Hoag Memorial where the surgeon performed
an omental biopsy. A laparoscope was utilized to diligently explore the
abdominal and peritoneal cavities. After the procedure, the surgeon advised
Paul that his entire abdominal cavity as well as the top layer of his
intestine were coated with small "bumps." One pearl-sized nodule
was noted. The good news was that there did not appear to be any major
organ or lymph node involvement. The bad news; the diagnosis was peritoneal
Paul returned to the oncologist seeking a treatment plan. The oncologist
honestly and regretfully admitted that his staff was not qualified to
treat peritoneal mesotheliomas. Mr. Coppola returned to his primary care
physician who suggested he try to obtain a referral to see Dr. Robert
Cameron at UCLA Medical Center in Los Angeles, California. Paul's
medical records were immediately forwarded to Dr. Cameron's office.
Unfortunately, Dr. Cameron's expertise is in treating pleural mesotheliomas
and the scheduled consultation was canceled. Dr. Cameron's office
directed Paul and his wife Terrie to the Mesothelioma Applied Research
Through MARF, Terrie was given the contact information for
Dr. Brian Loggie, at Creighton University Medical Center in Nebraska and Dr. Robert Taub
at Columbia University Medical School in New York. But before any appointment
could be made with either physician, Paul would have to file the prior
authorization provision required by his insurer. Paul would need a referral
from the oncologist who had been unable to treat him.
The oncologist graciously requested the referral for Paul to see Dr. Loggie.
Since there are but a handful of surgeons in the United States qualified
to provide surgical treatment of peritoneal mesothelioma, the Coppola's
assumed the referral to Dr. Loggie would be approved. The Coppola's
contacted his office to schedule a consultation. Medical records were
forwarded for his review. On September 17, 2004, the insurance company
denied the request for the medical consultation with Dr. Loggie. The determination
was made based upon their review of his health condition in relation to
his health plan's medical necessity criteria or guidelines and in
accordance with the terms and conditions of Paul's insurance plan.
Specifically, Paul had requested permission to see another specialist
outside of the network of providers contracted by his insurance carrier.
The denial was also based on part because Paul had failed to see Dr. Cameron
for his diagnosis of abdominal mesothelioma, a provider that they had
It was obvious that the paper pushing decision makers at the insurance
company did not understand the complexity of Mr. Coppola's disease.
Paul had two options. He could accept the insurance carrier's decision
or file a grievance. Mr. and Mrs. Coppola decided to file an expedited
grievance whereby their appeal would be resolved within 72 hours if they
could prove that the standard decision process of 30 days would pose an
imminent and serious threat to Paul's health.
Terrie, frustrated but determined to help her husband, contacted our office
for assistance in obtaining the medical information needed to reverse
the insurance carrier's decision. Daniel Dollison, Dr. Loggie's
physician assistant and new patient coordinator quickly responded to our
request and provided our office with a wealth of information. This research
along with Dr. Loggie's curriculum vitae and description and plan
of treatment, "
Intraperitoneal Hyperthermic Chemotherapy for Peritoneal Carcinomatosis
and Malignant Ascites" was forwarded to the insurance provider's appeals and grievance
During the appeal process, the insurance company requested that Mr. Coppola
see another oncologist within the provider network. Mr. Coppola was scheduled
to see that oncologist at Hoag Hospital on October 7. On October 1, 2004,
Mr. and Mrs. Coppola were notified that the medical director of the insurance
company had overturned the board's previous ruling. However, the approved
authorization was for one initial consultation only and was to be done
prior to October 29. All travel and lodging expenses were excluded. Any
further medical treatment required preauthorization and review by the
medical director and board. Paul and Terrie were elated. They had challenged
the insurance company and won.
As directed, Mr. Coppola kept his scheduled appointment with the oncologist
on October 7. During the consultation, Paul asked numerous questions,
one troubling question since learning of his diagnosis. Would surgical treatment
prolong his life or give him a better quality of life? The oncologist
advised that surgery would probably give him a better quality of life
but it may not prolong his life.
Prior to the October 7 consultation, Paul had consumed the surgical information
provided by Dr. Loggie's office. Paul felt that precious time had
already been wasted between the time of his diagnosis and his battle with
the insurance carrier. Although he had won the first battle reversing
the insurance carrier's denial, there was no guarantee that further
medical treatment outside his provider network would be approved.
Paul had already survived two major surgeries. He questioned his body's
strength. The fluid had returned causing a weight gain of 21 pounds. A
second paracentesis performed in mid October, yielded 5.5 liters of fluid.
After much contemplation and discussion with Terrie, Paul decided against
surgical intervention as a treatment option. Paul chose to seek treatment
with the oncologist approved by his insurance carrier.
Since making this decision Paul's emotional health has remained positive.
He pulled the juicer out the cupboard and made significant changes in
his diet, adding a variety of vegetables. He takes close to 20 pills a
day. To keep on top of his medication, he has prepared a chart which lists
each drug, the dosage and when to take it. His days are busy, filled with
daily errands, visits to the Senior Center and his grandchildren's
Saturday soccer games.
On November 1, 2004, Paul had his first chemotherapy treatment. He did
not experience any side effects. The plan was for Paul to receive treatment
at three week intervals, with continuous monitoring by his oncologist.
Since November Paul has completed five treatments but as Paul explains,
"it has been rough, very rough." His battle with nausea after
each treatment has wrecked havoc with his blood sugar levels. When he
does manage to eat, there is no taste or flavor to savor, describing each
bite as if he was eating ice cubes. He complains of dizziness which limits
his activity level. And, just when Paul feels he is getting his strength
back it's time for another treatment.
On February 7, Paul met with his oncologist to discuss his recent CT scan
and treatment plan. Paul, exhausted from the constant chaos his body endured
after each chemotherapy treatment, decided to discontinue chemotherapy.
Paul didn't want to know the results of his latest CT scan, and did
not inquire. He told his oncologist that he needed a break, both emotionally
and physically, from his treatments. His oncologist agreed that a little
time away might be a good idea. Paul was taken off all his medications
except what was needed to control his diabetes.
During the first part of March, Paul had another paracentesis. Paul felt
that the buildup of the fluid in his abdomen, which had been kept at bay
by the chemotherapy, was keeping him from being active. Since the procedure,
Paul's appetite has increased along with his strength and energy.
With his new "can do" attitude, Paul is making plans to finish
the patio and tend to some much needed home and yard maintenance.
Terrie is afraid that Paul may try to do too much. She wishes he'd
slow down and ease into his projects gradually. But she understands his
determination and stubbornness. Terrie portrays Paul as "your typical
macho Italian man." With that Tony Soprano constitution and attitude,
we're confident Paul will continue to fight and win his battle with
*** POSTED APRIL 4, 2005 ***
Mr. Paul Coppola passed away on May 13, 2006