No snow softened the bare outlines of trees and ground in Ronkonkoma, Long Island in the winter of 1997. Janet Franquet, 32, a new mother and nurse at a rehabilitation center and nursing home, looked forward to celebrating Christmas with her husband, Robert, and their baby, Michael. But in the midst of that festive season, Janet was diagnosed with inflammatory breast cancer (IBC) - rare and very aggressive, diagnosed more often in younger women. After undergoing chemotherapy in an attempt to shrink the cancer, Janet’s next course of treatment was a mastectomy. Since IBC infiltrates the lymphatic vessels of the breast skin, Janet’s surgeon planned an immediate abdominal flap breast reconstruction, which would use her own abdominal skin and fat to restore her breast and close the wound.
But the day before surgery, her insurance provider denied her coverage, saying the procedure was cosmetic. They suggested her surgeon use a pig skin graft instead. “I was numb,” Janet said later. She and her surgeon, Dr. Todd Wider, began a lengthy appeals process with the insurance company.
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| Janet Franquet - Christmas 1995 Photo lovingly provided by her twin sister, Joyce Gagliardi |
Some states, including Janet’s home state of New York, had already passed laws barring insurance companies from denying coverage for breast reconstruction after mastectomy. But they didn’t cover self-insured employer plans, which are under federal jurisdiction. Robert provided the health insurance for the family through his job as a truck driver, via his trade union. Unfortunately that fell outside the new state law.
Watching this young mother endure the assaults dealt her by both cancer and her insurance provider, Dr. Wider called upon Carol M. Baldwin, a breast cancer survivor and well-known breast cancer advocate (and mother of several famous actors). Two years prior, she and her family and friends had founded the Carol M. Baldwin Breast Cancer Research Fund. She was able to use her influence to enlist help for Janet from then U.S. Senator Alfonse D’Amato.
Thankfully, Dr. Wider went ahead with the reconstructive surgery, generously providing his services free of charge. Eventually the insurance company reversed its decision.
Janet was determined to fight for the medical coverage to which she believed every woman in her circumstance had a right. Her bravery filled D’Amato with similar resolve. “What happened to Janet Franquet was tragic,” he said. “It should never happen again.” On the floor of Congress, D’Amato championed for passage of a law that would require all insurance companies to cover breast reconstruction. D’Amato said, “I ask you, Mr. President, how many other Janet Franquets are out there? Will they be lucky enough to have a Dr. Wider to take care of them?” On October 21, 1998, the Women’s Health and Cancer Rights Act (WHCRA) was signed into federal law and officially named “Janet’s Law.”
Today, too many women remain unaware of this legislation. They mistakenly believe breast reconstruction after cancer is considered cosmetic and thus beyond their financial means. But Janet’s Law states that if a woman has health insurance covering mastectomy, breast reconstruction and surgery to attain symmetry are covered as well.
Janet lost her battle with cancer in May of 1999. In her obituary, D’Amato was quoted, “She demonstrated great courage during her short time on this earth. She said to me, ‘Maybe God put me here so that I could do this.’” He added, “She was the inspiration for a national law which now says every woman is entitled to reconstructive surgery. If not for Janet Franquet, I don’t think this would have happened.”Janet’s Law states:
(a) IN GENERAL -- A group health plan, and a health insurance issuer providing health insurance in connection with a group health plan, that provides medical and surgical benefits with respect to a mastectomy shall provide, in a case of a participant or beneficiary who is receiving benefits in connection with a mastectomy and who elects breast reconstruction in connection with such mastectomy, coverage for--
(1) All stages of reconstruction of the breast on which the mastectomy has been performed;
(2) surgery and reconstruction of the other breast to produce a symmetrical appearance; and
(3) prostheses and physical complications of mastectomy, including lymphedemas;
in a manner determined in consultation with the attending physician and the patient.
Thank you, Janet.
