State Puts Hold on Transplant for Baby Girl : Medicine: Medi-Cal will not pay for an out-of-state bone marrow procedure. Parents are left to wonder whether little Stephanie will get a shot at her best chance at survival.

Farhat Rudat had planned to be in Seattle on Wednesday to see doctors about the bone marrow transplant scheduled for her 16-month-old baby, Stephanie, next month.

Instead, Rudat sat by the baby’s side at Children’s Hospital of Orange County, wondering whether the transplant--Stephanie’s best chance at survival--will ever take place.

The Anaheim family has used up its $1-million limit in health insurance coverage in treating Stephanie’s leukemia and was counting on state money to pay for the transplant. But the family was notified Tuesday that California Children Services and Medi-Cal will not subsidize the out-of-state procedure, and now they are worried that time will run out before in-state arrangements can be made.

“The most important thing is the time,” Rudat said Wednesday over Stephanie’s cries. “My kid doesn’t have time to wait for everybody.”

Stephanie was diagnosed with acute non-lymphocetic leukemia when she was 6 weeks old. Chemotherapy sent her quickly into remission, and last summer the baby had an autologous transplant, in which her own bone marrow was removed, chemically treated and reinserted into her body with the hope that all cancer cells had been killed.

In October, she suffered a relapse.

Since then, Dr. Felicity Hodder, an oncologist, has been searching for bone marrow donors for Stephanie, who is still on chemotherapy. After finding that Children’s Hospital of Los Angeles could not perform the transplant, Hodder started a donor search at Seattle’s Fred Hutchinson Research Center in Seattle.

Although all hospitals use a national donor database, patients may be registered with just one transplant center at a time, Hodder said.

Meanwhile, Stephanie’s hospital bills surpassed the Rudats’ $1-million insurance cap, and Medi-Cal took over. But when the Hutchinson Center found a donor that matched the baby’s marrow, state officials told the Rudats that they will not pay for the transplant--which costs $220,000--unless it takes place in California.

“If there’s some fancy-shmancy care that’s only available on Planet X, they’ll send you to Planet X, but if it’s available in state, they prefer you keep it in state,” said Hodder, Stephanie’s primary doctor.

So, Stephanie’s search was transferred to UCLA Medical Center. But at the same time, Hodder appealed to California Children Services, saying that the time saved by sticking with the Hutchinson Center--where a match had already been found and testing was underway--might save the baby’s life. UCLA doctors said it would take at least six weeks before a donor could be found, Hodder said.

“She’s beaten the odds today, (but) she could relapse any day,” Hodder said.

Hodder and Rudat said local Children Services staff told them earlier this month that the time factor would enable them to pay for the out-of-state transplant. The Seattle hospital took Stephanie’s case back, set the transplant for July 15 and scheduled a first examination for Wednesday.

The Rudats were all set to go when Medi-Cal called early this week and said no way.

“If the procedure can be performed in California, then it must be done so,” said Ken August, spokesman for the state Department of Health Services.

He noted that Medi-Cal does pay for out-of-state care in emergencies or when treatment is available only at a certain facility. “The regulation is clear,” August said.

There is a good chance that Stephanie can get a transplant in California. Hodder said a new transplant center at UC San Francisco may be able to perform the operation by summer’s end. However, this week’s news crushed Stephanie’s mother.

“It’s like you go way up high and then you go way down on the floor,” said Rudat, who emigrated from Pakistan with her husband, Kelly, in 1979 and has been living in Anaheim for six years. “I woke up (Wednesday) morning and felt like somebody had beat me up all night.”

Rudat took disability leave from her job as an account manager when Stephanie became sick. She spends 12 hours a day by the baby’s bedside in the intensive-care unit at Children’s, while Kelly Rudat works as a sales representative for a beer distributor, and then stops by day care to pick up Stephanie’s older sister Christina, who is 2.

“We don’t want anybody’s charity,” Farhat Rudat said. “All we are doing is trying to make the best out of the situation and try to make it out of this with our kid alive.”