Overcoming Setbacks to Obtain Second Opinion And Surgery

Los Angeles was booming, and in1955 Barbara Harris began her career in real estate. By 1961 she had acquired several high-rise commercial buildings as part of her property management portfolio. She energetically guided the Building Owners and Managers Association for the Greater Los Angeles Area from 2002-2006 ( www.bomagla.org). Her service as president was the culmination of more than forty years' experience in real estate. Barbara recalls: "It all began when I answered an ad for a job at a public housing project in the San Fernando Valley in the 1950s. Soon I was leasing and managing apartments, then medical facilities, and finally high-rise office buildings."

Barbara spent hours amidst the tradesmen as they hustled to complete drywall, painting, and final changes so that tenants could move in on time and according to spec. She remembers how eager she was to learn her trade as property manager. Barbara took pride in the workmanship she supervised and it shows. "My buildings are my pride and joy," she says, and Barbara's reputation for excellence in property management has grown. Even today, many years after her career has extended beyond hands-on management, she proudly thinks of herself as a property manager.

But her work ethic and desire to know the entire process came at a hidden, terrible cost: as drywallers mixed the joint compound and sanded it down, and as workers serviced and repaired insulated equipment in mechanical rooms, they created clouds of deadly asbestos, breathed in by workmen and bystanders like Barbara.

Barbara and her husband Dale had always led active lifestyles, but her life was about to change drastically. Some forty years after beginning her career in real estate, Barbara woke up with a pain in her chest. Her doctors were baffled, as they counseled her to "wait and see." In June, 2006 a biopsy confirmed that she had malignant pleural mesothelioma.

Barbara was astounded by this diagnosis after more than a year of inconclusive testing by physicians, specialists, and surgeons. She called the diagnosis a "painful interruption of my career and my family life."

UNANSWERED QUESTIONS

Neither Barbara nor her doctors had any idea what was wrong when she first told them of mild chest pressure on October 30, 2004. Her primary physician at Kaiser Permanente's Thousand Oaks Medical Offices ordered chest X-rays that revealed fluid around the lung. She remarked that "the usual tests were done, but there seemed no explanation, and I wasn't sick."

In November, Barbara saw a pulmonary specialist. He ordered several tests: a CT scan, x-ray, ultrasound, blood tests, echocardiogram, and a thoracentesis to remove the fluid around her lungs. While he found that Barbara had a right lung pleural effusion, the tests were indeterminate, and neither he nor his colleagues could explain the accumulation of fluid behind her lungs. Her doctors decided to "monitor" the situation, and she dutifully went in quarterly for chest x-rays and examinations.

On December 16, Barbara saw a thoracic surgeon who gave a similar prognosis. The surgeon could not identify the cause of the fluid, and did not perform a thoracoscopy to explore her chest cavity because she was not "sick," and because he believed it would put her through unnecessary pain.

Barbara's pulmonary specialist monitored her condition steadily over the next year. She consulted doctors about obtaining a second opinion outside of her medical insurance plan, but her doctors discouraged her, believing she would not find any conclusive information even though they had never ordered diagnostic tests such as cytology on the extracted fluid or a PET scan. Barbara was growing increasingly concerned, but her primary physician assured her that she did not have cancer.

On May 2, 2006, Barbara returned to her pulmonary specialist's office complaining of shortness of breath. Another x-ray showed that her pleural effusion had increased. Once again, the cause was undetermined. Exasperated, Barbara demanded action. She was referred to a new thoracic surgeon who would perform minimally invasive surgery. The surgeon ordered an additional x-ray, CT scan, and a pulmonary function test, but the tests returned the same inconclusive results.

Opting for one more strategy, the thoracic surgeon performed a video-assisted pleural biopsy to remove affected tissue for further examination. He removed two and one-half liters during the biopsy and performed a talc pleurodesis, which attempts to prevent further fluid accumulation in the lungs.

One month later, Barbara received the results of her biopsy and was stunned to hear that she had right-sided pleural mesothelioma, a malignant and aggressive cancer. After all, she had been told for over a year that cancer had been "ruled out."

TAKING MATTERS INTO HER OWN HANDS

Tired of waiting on her doctors' advice, Barbara took charge. She and her son Michael, a public relations professional in Costa Mesa, began to seriously research mesothelioma and available treatment options. After contacting the Mesothelioma Applied Research Foundation ( www.marf.org ), Barbara was referred to Dr. Robert Cameron. "It soon became clear that there were only a few mesothelioma specialists, and that fortunately one of the best was in my city of Los Angeles," she says.

Barbara arranged a consultation with Dr. Cameron, a nationally renowned physician, surgeon, and Chief of Thoracic Surgery at UCLA Medical Center in Los Angeles. Dr. Cameron concluded that Barbara was a good candidate for a pleurectomy with decortication (P/D), where the tumor surrounding the lung is removed, leaving the lung itself intact. Depending on the patient's recovery, the surgery is followed with further treatment, such as radiation, chemotherapy, or immunotherapy, which helps the body fight off remaining tumor cells.

MORE DELAYS

For nineteen months, Barbara's HMO doctors had made little progress diagnosing and treating her symptoms, and when she finally received answers, Barbara expected that real action would finally happen. However, because Dr. Cameron was outside her insurance plan, she could not gain a proper referral. While her HMO's thoracic surgeon offered to perform a pleurectomy with decortication surgery, he admitted that he had never performed the procedure before. Dr. Cameron, on the other hand, developed the pleurectomy with decortication procedure and has performed it on hundreds of mesothelioma patients. In addition, the HMO surgeon would not provide the additional non-invasive therapies which have successfully increased the life expectancy of many of Dr. Cameron's patients.

Barbara would not allow herself to be a "guinea pig" for the HMO surgeon and would not settle for half of the treatment necessary to effectively treat her mesothelioma.

In July, 2006 Barbara made efforts to see Dr. Cameron, but her insurer denied the consultation. Despite this, she took matters into her own hands and made an appointment for July 24, 2006. After seeing Barbara and evaluating her case, Dr. Cameron advised her that she was a candidate for the tri-modal approach to treating her mesothelioma and suggested beginning "as soon as possible."

Before proceeding with Dr. Cameron's treatment plan, and with assistance from the Law Offices of Roger G. Worthington, Barbara made another request for her HMO to approve and pay for the "out of plan" services. In support of the request, Barbara asserted that, based on the HMO surgeon's lack of any experience performing the procedure and the HMO's inability to provide the same post-surgical therapies, the HMO could not realistically assert that it could provide the same services "in plan." Nevertheless, the HMO adhered to its simply ludicrous position that the requested services were available "in plan" and refused to pay for Barbara's treatment with Dr. Cameron.

Determined to get the best treatment available, Barbara persisted without the aid of insurance. Dr. Cameron performed the surgery on August 10, 2006. The surgery went well. The affected area in and around her seventh rib was successfully removed and a portion of her diaphragm was repaired using a sheet of bovine pericardium, the tissue surrounding a cow's heart. The tumor was removed successfully from the area between the lungs. Some air leakage required that three large chest tubes be inserted, and Dr. Cameron removed approximately one liter of fluid. He could see no evidence of a pleurodesis even though Barbara had previously undergone a talc pleurodesis procedure just a few months before.

THE "DOWN TIME" AFTER SURGERY

Even though the surgery and its aftermath were more painful than Barbara would ever let on, she tolerated her stay in the hospital with courage unstinting goodwill. Her husband Dale and her son Mike supported her throughout the ordeal. Less than two months after surgery, Barbara continues to fight the battle of how much pain medication to take. She says that "Tylenol and Motrin don't quite keep my back free of pain, but stronger pain killers seem to dull my mind. That's discouraging, as I normally pride myself on clear thinking. But then, I've really never been ill before. I can't wait to be free of all medications." To help get her through the "down time of surgery," Barbara looks forward to projects she wants to accomplish as soon as she returns to her executive responsibilities.

Dr. Cameron has recommended further treatment. Hopefully, with the aid of these follow-up treatments, she will return to work soon. She's readying for Dr. Cameron's therapy regimen with interferon, and feels fortunate to have met him. "Things are looking good," she says. "And like the old saying goes-no sense in borrowing trouble!"

MORE THAN A REAL ESTATE EXECUTIVE

Over the years, Barbara has received numerous honors for her work educating and training property managers. She is a member of the Mayor of Los Angeles' advisory council for Homeland Security, helping to determine how best to protect the safety of L.A. office building tenants and visitors.

Before that, Barbara attended the Goodman School of Theatre in Chicago, where she met and married Dale Harris, a young man just out of the Army and WWII service in Okinawa, who aspired to an acting and singing career. From Chicago they came to Los Angeles-Dale to pursue his career, which included recordings and singing in large Las Vegas productions-Barbara to give birth to her son Michael and begin her real estate career. Barbara and Dale celebrated their 57th wedding anniversary in February 2006.

Barbara is an avid reader of fiction and non-fiction, and is presently reading presidential biographies. She has also written a novel called, Who is Julia?, which was published to excellent reviews and made into a T.V. movie. She is a member and past president of PEN Center USA, a literary organization.

She is a founder, past president, and advisory board member of the Ross Minority Program in real estate at USC, an executive education program that has certified over 400 students since 1993. She cannot wait to return to the work she loves.

*** POSTED FEBRUARY 16, 2007 ***