It was a bold rescue effort, offering tiny conjoined twin sisters, only 10 months old, hope for a normal life. Eighty doctors and nurses worked in a 22-hour surgery to separate Regina and Renata Salinas Fierros, fused from the lower chest to the pelvis, locked in an awkward embrace.
The successful surgery at Childrens Hospital Los Angeles last month made national headlines, and reporters kept a virtually round-the-clock presence.
For The Record
Los Angeles Times Tuesday July 04, 2006 Home Edition Main News Part A Page 2 National Desk 1 inches; 35 words Type of Material: Correction
Twins' operation: The photo captions that accompanied an article in Sunday's California section about who will pay the costs for the operation to separate conjoined twins incorrectly identified Dr. Jae Townsend as Dr. Cathy Shin.
But for all of the publicity the case has received, hospital and state officials have remained tight-lipped about one key aspect of the twins' care: the cost, at least a portion of which will be paid by taxpayers.
Cost, however, is a growing concern in American medicine, and as prices rise, a debate is raging over where dollars should flow.
Experts say cases like the twins' highlight the lengths to which the system sometimes goes to rescue individuals in dramatic and emotionally compelling situations, even as those with chronic or more mundane conditions often struggle to afford care.
In that context, many ethicists and economists say, it is worth asking some uncomfortable questions about single, expensive cases.
Dr. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania School of Medicine, put the matter bluntly: "Is that the best use of scarce dollars?" he asked after hearing the twins' case described.
He acknowledged, as did several colleagues, that most Americans would consider the very question "morally untouchable."
To parents and caregivers, such procedures often are perceived as priceless -- worth doing at any cost. But they do come at a price, even if it is not made public.
Judging from other separations of conjoined twins, the Salinas Fierros' surgery alone could approach $1 million or more. Months, perhaps years, of aftercare could push the bill much higher.
None of the ethicists and economists consulted by The Times argued that the girls, specifically, should not have been separated. But several said this case and others underscored some of the system's unspoken priorities.
"Our medical culture is not to take into account the common good, but the needs of this particular patient who needs to be saved," said Stephen G. Post, a bioethics professor at Case Western Reserve University School of Medicine in Cleveland.
