Claim denied: SPD vet's insurance fight for lifesaving transplant

In his 26 year career as a Seattle police officer and volunteer, Dave Clement has been decorated for his abilities as a crime-solver and a leader. His reputation among his co-workers is that of a humble people-helper. He was once named Precinct Officer of the Year. He also spent months of vacation time building homes in the poorest areas of Honduras.

But now, the 56-year-old detective and recent grandfather lives with hand tremors and constant pain, and he's in the middle of the fight of his life. While he's battling a rare but debilitating disease, which is slowly robbing him of muscular control, he says the city of Seattle has denied his chance at a potentially life-saving cure.

Doctors diagnosed Clement with Chronic Inflammatory Demyelinating Polyneuropathy, or CIPD, which only affects 1 or 2 in every 100,000 people. It causes his immune system to attack and destroy his own nerve cells, and doctors say it will almost certainly leave him paralyzed.

"I have a certain faith," said Clement. "I believe that God is good, and this is all going to work out."

Clement and his wife, Pam, say they felt things working out when a world-renowned specialist at Northwestern University Medicine in Chicago tabbed Dave as a perfect candidate for stem cell transplantation which, according to Northwestern, has cured nearly 80 percent of the CIDP patients who've been treated.

"You're talking well over 300 people who've done it, and the success rate is just amazing," Clement said. "The doctor said this would be a perfect time for me to have this done, and he wanted to start the process last June."

The stem cell transplantation involves removing and growing Clement's own stem cells. Doctors would shut down his body with chemotherapy and then re-introduce his stem cells to "reboot" his immune system. The price tag for the promising procedure, which would take about 60 days, is $125,000.

So far, Clement's insurance provider has refused to cover the procedure.

"They rejected it, denied," said Clement. "So we appealed it, and they denied that too," he said.

Four times, Clement and medical specialists, calling the treatment "rescue therapy," have written detailed appeals to Aetna-- Seattle's insurance administrator -- and they've had their claim denied every time, citing that the therapy is still in clinical trials.

In one case, Aetna explained "The City of Seattle does not cover experimental treatments, including those experimental treatments provided in clinical trials."

Northwestern Medicine has documented that Aetna paid claims for eight other CIDP patients to receive stem cell transplantation.

The Clements had other doctors help them appeal once again, saying his current standard IV treatments have already cost the city close to half a million dollars, and it's not improving his condition. Dr. Richard Burt, the specialist who would perform the procedure wrote in the appeal: "He would benefit from our therapy more than any other therapy available to him. This would be of great benefit for your patient to stop his current treatment and it also would be cost effective for the city."

Since the City of Seattle is self-insured and Aetna manages its employee health policy, the Clements are convinced the city, not Aetna, is ultimately rejecting their claim.

"The city says it's Aetna, Aetna says the city, it goes back and forth like this and we're in the middle," said Pam.

The Clements made their final appeal to the City of Seattle in January, and so far, they have yet to hear any news. KIRO 7 asked to speak to Mayor Ed Murray about the issue, but calls were not returned.

"I could get a phone call from the city right now that says OK, yes, we've decided to do this," said Clement. "We're waiting."

Clement recently provided Aetna with written authorization to discuss his case with KIRO 7. An Aetna representative said she was waiting for clearance from the company's executive response team, which is researching this case before they could answer questions.

Seattle Police Guild President Ron Smith told KIRO 7 he brought Clement's story to every city worker and councilmember who would listen. "The City of Seattle needs to do the right thing here," he said. "We're talking $125,000, not millions. I would think we have money to help save a veteran police detective's life."

Seattle Police Chief Kathleen O'Toole agreed, speaking to KIRO-7 following  Murray's state of the city address.

"That detective is a very, very dedicated member of the SPD family," she said. "He's made a lot of contributions to this community, so it's my hope that both on a professional front and a personal front I can weigh in and do whatever I can to assist him."

Clement’s community and fellow SPD officers set up a GoFundMe account to defray the out of pocket cost of traveling to Chicago for therapy.

Meanwhile, Dave and Pam Clement are still amazed by the former CIPD patient they met on their last trip to Northwestern, who's now in complete remission.

"She had been an aerobics instructor, and the disease left her bedridden," Pam Clement said. "She got the stem cell therapy and she's now an aerobics instructor again. She walked by us like nothing happened. It's incredible.

"Would you rather not give a chance for Dave to have success, or pay for him to be bedridden? I mean, it's a no-brainer, right?"

Cox Media Group