Back in late June of 2017 I wrote about a Vietnam-era Veteran (and my friend) David Brayton, who is in desperate need of a double lung transplant and had just won an 18-month battle with the VA for permission to have the transplant performed near his home in Los Angeles instead of being forced to move to Seattle for up to two years to wait for new lungs.
As promised, we are chronicling the big developments in David’s case, and the latest development is sad and infuriating.
A bit of catch-up: David received approval May 4 to have the transplant done at either UCLA or Cedars-Sinai Medical Center. He had already been approved to be placed on the transplant registry at the VA, having been through their full screening and diagnostic procedures.
David and his wife, Courtney, chose UCLA. His first appointment there was June 22, with Dr. Lynch, head of the lung transplant program. The Braytons reported on the visit that day on his transplant Facebook page:
UCLA update. David Brayton and Courtney Brayton had the first official appointment with Dr. Lynch. It went well! He is…
(Note the hat David is wearing in the photo.)
The Braytons wrote, in part:
“He [Dr. Lynch] is an expert in pulmonary fibrosis so we are in great hands! Dr. Lynch said David is an excellent candidate for a double lung transplant. So, next step is we will be getting a call from UCLA on what tests remain and then we need to meet with the surgeon, social worker and psych.”
Since David had been unable to exercise for a few years (two years with an oxygen tank will do that to ya) he needed pulmonary therapy in preparation for the transplant. In August, he started that, on campus at UCLA.
David has started pulmonary rehab at UCLA! He needs to get stronger! He's doing a great job at sticking with it 😊
Though his first appointment was June 22, by Thanksgiving the Braytons still hadn’t heard whether David had been officially accepted by UCLA. It would seem that only a change in medical circumstances would change the VA’s recommendation.
Over six months after his first visit (and more than 18 months since he was told that a transplant was needed as soon as possible), David received this letter from UCLA, authored by Dr. Lynch, the same physician who said David was a great candidate for a double lung transplant.
The Lung Transplant Selection Committee at UCLA met on December 7, 2017 regarding David Brayton, who has been evaluated for lung transplantation (LT).
Significant concerns were raised by multiple individuals. David had apparently raised the possibility that he may “shut down the transplant program” from the VA system if he was not accepted as a candidate. He also discussed to another individual circumstance where he may consider litigation if his case was not accepted. He has a history of being in prison for a weapon’s offense. He had been smoking but had told individuals within our lung transplant program that he was not smoking. Our transplant psychiatrist indicated that there were significant concerns regarding compliance and behavioral issues.
In light of these concerns, we will not consider him as a candidate for lung transplantation at UCLA.
The letter’s filled with grammar and punctuation errors, hearsay, untruths, and only two possible legitimate reasons for concern.
Brayton has never been in prison, and never convicted of a “weapons charge.” (Or a “weapon’s charge.”) Brayton was arrested on a politically-motivated and false charge of carrying a concealed weapon, which was dismissed by the LA Sheriff’s Department. He was illegally jailed for five days immediately post-arrest and denied his heart medication, and sued the LASD in federal court for violating his civil rights. (You can read about that saga here.)
As part of the interviews with both the VA and UCLA, when asked if he had ever been in jail Brayton mentioned this incident – which is a far cry from having a “history of being in prison for a weapon’s offense.”
Even if he had been in prison for any type of offense, that is not a reason to deny a person a transplant. According to the United Network for Organ Sharing (UNOS) there is some subjectivity in the process, but even incarcerated felons can be approved for transplant. The UNOS guidelines exist to ensure uniformity in selecting transplant recipients – ensuring that one cannot “doctor shop” for a more favorable recommendation.
In an exclusive interview with RedState, David Brayton said he never said anything even hinting at any kind of lawsuits or “shutting down the VA transplant program” and has never even had those thoughts. Though he will passionately debate politics online, David said his mindset throughout the process with UCLA has been one of honoring the extreme sacrifices his wife made in battling the VA bureaucracy to get them to this point.
“I would never do anything to dishonor what Courtney has done for me, or what she’s done for all veterans by advocating for passage of the VICTOR bill.”
If David didn’t make these statements to anyone at the VA or UCLA, where did the team get them? Since there are no direct quotes and no sources listed, it seems the burden is on David – a man with only a very short life expectancy in the absence of a transplant – to fight again to get this information, then fight for a transplant he should have had two years ago?
The letter states that “he was smoking,” but David denies that also. He said he stopped smoking six years ago, but that around the time his request to have the transplant done in LA was approved he smoked one cigar – a Cuban Cohiba cigar he’d had for years – as a “last hurrah.” There was still some nicotine in his blood at his first appointment, but none in the months since. He said if he had still been smoking, he would fully agree with a denial.
The last “reason” UCLA cites is the transplant psychiatrist’s “significant concerns regarding compliance and behavioral issues.” Obviously a psychiatrist’s opinion about a potential transplant recipient’s ability to comply with a rigorous medication, therapy, and appointment schedule is crucial. But, the VA had already approved the Braytons, and David is already following a rigorous medication, therapy, and appointment schedule – or he would be dead.
Of course, David and his friends think this reasoning stinks. Some who are familiar with the transplant world think it does, too. One woman, Laura P., whose husband received a kidney transplant from a living donor, said she’d seen many rejection letters directed either at a recipient or a potential donor. While all were somewhat vague, they all referenced specific medical or psychological criteria the decision was based on, and none referenced hearsay statements from unknown third parties.
Ann A., a dialysis nurse who works with transplant patients, says:
“All the rejections I’ve seen are based on verifiable, quantifiable comorbid medical conditions that would adversely affect the transplanted Kidney, or would make surgery more risky than beneficial. There’s blood work, cardiac scans, stress tests, ultrasounds etc. Real diagnoses, real numbers that back up the decision for rejection. David’s rejection letter is mostly based on 3rd hand information by anonymous sources.”
Interestingly, the next week the Braytons received an entirely different letter.
The relevant portion reads:
“The decision of the committee is, at this time, single lung transplantation would not be an appropriate option for you based on the following reason(s): significant concerns regarding compliance and behavioral issues.”
Single lung transplantation? David says single lung transplantation was never discussed as an option – double lung transplantation was always the recommendation of the plan. And this letter contains no mention of the alleged smoking or the third-party anonymous statements. Is it possible that David received an “internal only” memo that accidentally states their real bias?
The second letter still begs the question of why is there a difference between the VA’s recommendation and UCLA’s? How could they find there were no concerns regarding compliance, and UCLA does? How does UCLA explain the fact that David’s only survived the past two years by being compliant and having an appropriate support system in place?
No one wants to think that members of a transplant team are petty enough to recommend denying a lifesaving operation to someone based on political beliefs, but David said he received a chilly reception each time he was at UCLA with his Trump hat on. He didn’t wear it to offend the medical staff; he is simply a proud supporter of the President. (He was okay with it upsetting the college students, however.) And, let’s not forget just how upset many progressives were about Trump’s victory, especially those who work in the social sciences (like psychiatry).
David would like to find out what really drove their decision, but he doesn’t have the luxury of spending time on it. He’s sent a copy of the letters to his Congressman, who was instrumental in getting his LA-based transplant approved through the VA to see if there’s anything his office can do about the situation.
He’s gone back to the VA to see about getting the transplant done at Cedars-Sinai instead, but they’ve basically said no, you chose UCLA. Now your only choice is to go to Seattle like we originally wanted you to. Brayton says that’s logistically impossible for his family, which is supported by their family-run business.
“If we did that, the business we’ve built up over more than a decade would tank. Then if I don’t survive – either die waiting for a transplant or not make it through the surgery and recovery – Courtney and our kids are screwed.”
One other way David could get the transplant in LA, at Cedars-Sinai, is if the VICTOR Act is passed in the Senate (it’s already been passed in the House) and signed into law. That law would allow all VA transplant patients who live far from VA transplant centers to have their life-saving surgery performed close to home.
David’s ability to get the transplant that we, as Americans, owe him for his service is the first priority. But as a society we need to find out the true reasons for UCLA’s denial of David’s transplant, before we have more “death panels” randomly deciding the fate of our veterans and elderly citizens.