San Francisco Firefighter Dies After Insurance Dispute Delayed Cancer Treatment
Ken Jones, a retired San Francisco firefighter who spent months fighting with his health insurer over access to cancer treatment, died Saturday at age 71.
Jones had been living with Stage 4 metastatic cancer and became the focus of a series of NBC Bay Area investigations examining his struggle with Blue Shield of California. The insurer twice denied treatment requested by Jones’ oncologist, a decision that sparked criticism from medical professionals, city officials, and fellow firefighters.
Blue Shield said in a statement that it was “deeply saddened” by Jones’ death and offered condolences to his wife, family, friends, and former colleagues at the San Francisco Fire Department.
Jones devoted 17 years to the department, serving not only as a firefighter but also as its lead counselor. In that role, he helped first responders navigate trauma, serious illness, and other personal crises.
Among those closest to him was former San Francisco Fire Chief Jeanine Nicholson, who had known Jones and his wife, Helen Horvath, for nearly three decades.
When Nicholson was diagnosed with breast cancer more than 10 years ago, Jones drove her to medical appointments for six months while she underwent treatment.
“Chemotherapy really is tough – it’s tough on your body because it’s killing all the good cells as well as the bad,” Nicholson said. “[Ken] had to suffer a lot through that, and then being denied further treatment— it’s just so cruel. It is so cruel.”
Nicholson believes the delays in Jones’ care had devastating consequences.
“I believe, wholeheartedly, that they expedited his death. They should be ashamed.”
At the center of the dispute was a disagreement over whether Jones should receive a specific combination of chemotherapy and immunotherapy. Blue Shield has repeatedly maintained that its denials were not based on cost considerations but on medical guidelines that, according to the company, did not support the treatment regimen requested for Jones’ stage of cancer.
Jones’ oncologist, Dr. Matthew Gubens, strongly disagreed with that assessment.
Gubens, who heads the UC San Francisco Thoracic Medical Oncology Clinic and has helped develop some of the nation’s most widely used cancer treatment guidelines through the National Comprehensive Cancer Network, argued that Blue Shield misapplied those standards.
“There’s gray area in medicine,” Gubens previously told NBC Bay Area.
“The time spent trying to get approval of a regimen that I requested, [Ken] lost ground – tumors are growing, pain is increasing, his appetite is going down.”
After Blue Shield initially denied the treatment request, Gubens said he attempted to appeal the decision but struggled to reach the appropriate department within the company. He said repeated calls to the phone number listed in the denial letter led him in circles.
“I reached people who apologized, but they weren’t the right place to send the appeal to and often referred me back to the first person I talked to. That day, I spent about three hours calling different phone numbers for this insurance company.”
Blue Shield did not respond to earlier requests for comment regarding why Gubens was unable to connect with the proper contact to file an appeal.
Gubens eventually submitted a written appeal, but that request was also denied, creating what he described as a weeks-long delay in care.
“Any of our cancer treatments are harder to give and less effective the weaker a patient is when we’re seeing them,” he said.
The controversy surrounding Jones’ case drew the attention of San Francisco officials. Following NBC Bay Area’s reporting, members of the Board of Supervisors called on Blue Shield executives to appear at a City Hall hearing to explain the company’s claims review process and discuss reforms intended to ensure firefighters and other first responders can obtain timely medical care.
Blue Shield is one of three insurers contracted by the city to provide health coverage to more than 40,000 employees and retirees. According to data obtained from the San Francisco Health Service System, those contracts are worth more than $1 billion.
Jones’ death has also renewed attention on the health risks firefighters face. Research from the Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health found firefighters are diagnosed with cancer at rates roughly 9 percent higher than the general population and face a 14 percent greater risk of dying from the disease.
Exposure to smoke, soot, ash, and other hazardous materials has led the World Health Organization to classify occupational exposure in firefighting as a carcinogenic risk.
Despite Jones’ passing, discussions about potential reforms are expected to continue. Blue Shield is scheduled to meet next week with leaders of the local firefighters’ union and other advocates to discuss possible changes to the claims process.
City supervisors have also indicated they plan to bring Blue Shield executives back to City Hall to provide a public update on those efforts.
“We need to hold insurance companies accountable for their actions,” Nicholson said. “They are in the business of making money. They are not always in the business of giving people the best care or the care that they deserve.”
Moumita Basuroychowdhury is a Contributing Reporter at The National Digest. After earning an economics degree at Cornell University, she moved to NYC to pursue her MFA in creative writing. She enjoys reporting on science, business and culture news. You can reach her at moumita.b@thenationaldigest.com.
