by Charles Platt, Vice-President, Suspended Animation Inc.

Staff of Suspended Animation also serve as stanbdby-transport team.
Charles Platt, Kelly Kingston, Matthew Sullivan, Aschwin de Wolf

The agreement that Suspended Animation and the Cryonics Institute negotiated during 2005 was a bold adventure for both organizations. Now that it has been "test marketed" we are learning more about what members want and how to satisfy their needs. Below I will describe some features of a new version of the agreement which supercedes the old version as of January 1st, 2006. Also I will explain how Suspended Animation has decided to accept life insurance as an alternate way to pay for standby procedures, even though we still believe that a pay-per-day approach is preferable.

First, here's a quick summary of our new fee schedule. "Local" standbys are those that occur within 200 miles of our facility at Boynton Beach. "Remote" standbys are outside that area.

Deployment Fee: Local $4,500, Remote $7,500 (covers one deployment up to 72 hours requested by a member experiencing Small or Serious risk.)

Continuation Fee: Local $2,000 per day, Remote $2,500 per day (while a Small or Serious Risk prevails a member may request additional days of Standby but must pay a Continuation Fee for each 24-hour period.)

Flat-Rate Fee: Local $20,000, Remote $25,000 (covers up to two deployments, plus unlimited standby days, while a Serious Risk prevails.)

Continuation Fee: Local $2,000 per day, Remote $2,500 per day (this additional fee is required only if the assessed risk diminishes from Serious to Small but the member requests a continuation of standby.)

Insured Standby Plan

Insurance coverage: Local $25,000, Remote $30,000 (Covers up to two deployments, plus unlimited Standby days, only while a Serious Risk prevails.)

Continuation Fee: Local $2,000 per day, Remote $2,500 per day (this additional fee is required only if the assessed risk diminishes from Serious to Small but the member requests a continuation of standby. The fee can be covered by additional insurance or cash payment, at the option of the member.)

Under any of these plans, separate transport fees are required for procedures that begin after legal death is pronounced: $25,000 for a Local patient, and $30,000 for a Remote patient. Cryopreservation by the Cryonics Institute is paid for separately.

One feature of the new agreement between SA and CI is that we have sharpened the distinction between our procedures before and after legal death. Before a patient experiences cardiac arrest, we hope to deploy all our equipment, establish a good relationship with any health providers and family members who are involved, assess the patient's condition, and make ourselves immediately available. We now limit the word "Standby" to describe only this preliminary waiting period. After pronouncement, our active work begins, including these primary obligations:

a) Administer medication and apply rapid cooling in an ice bath.

b) Use cardiopulmonary support to circulate the meds, ventilate the lungs, and enhance the effect of surface cooling.

c) Perform blood washout with an organ preservation solution, followed by air transport of the patient to the Cryonics Institute. (For a precise description of our protocol, please see our web site at www.suspendedinc.com.)

We now use the word "Transport" to describe these active measures and everything else that we do, beginning after legal death and continuing until we transfer custody of the patient to CI.

We have clarified this distinction largely for financial reasons. I feel uncomfortable discussing matters of life and death in these terms, because I am very emotionally committed to the purpose of cryonics. In the everyday world, however, my responsibility to the investors in Suspended Animation requires me to run the company in a manner that is prudent, and I have to consider financial issues as unemotionally as possible.

The most fundamental financial reality is that the value of a life insurance policy is paid only after a death certificate has been signed. For this reason, life insurance clearly is a good way to pay for procedures that begin after legal death, but is not a reliable way to pay for standby work that occurs before legal death, when the outcome of the vigil is not yet known.

I have participated in several standbys where the patients recovered and the team members packed up all their equipment and went home. Since our whole objective is to protect and sustain human life, naturally we are happy when our help turns out to be unnecessary; but when legal death does not occur, life insurance cannot provide immediate compensation for the standby that has been abandoned. This situation presents us with only two alternatives: Request payment in cash, or wait for an indefinite period, perhaps for another standby that does lead to cryopreservation of the patient, at which point the value of the life insurance policy will be released.

The first alternative is problematic, since many people may be unable to pay the high cash cost of a standby. The second alternative involves some uncertainty, since we may imagine a scenario where someone recovers after a standby and then allows the insurance to lapse, so that Suspended Animation's beneficiary status becomes worthless. (Other scenarios are possible, but since they are more complex and even less likely to occur, I will omit them here.)

Since the Cryonics Institute prefers to minimize the financial risk associated with standby-transport work, we agreed from the beginning that if CI would reimburse Suspended Animation for our expenses during the transport phase, we would take the responsibility of deciding how to compensate ourselves for the standby phase, and we would contract with each member individually for this purpose. Because there are no significant problems associated with transport funding, the rest of this text will deal solely with standbys.

When you go on vacation, you pay for the number of nights you spend at a hotel. You also pay for the number of days that you rent a car. Ideally, everyone would finance standby procedures in a similar way, since you get exactly what you pay for.

Unfortunately a standby tends to be far more expensive than a vacation. Typically four team members are deployed, with large quantities of equipment. Supplies are consumed. Restocking after a case requires additional time and supplies. Suspended Animation charges fees that barely cover the actual costs of a standby, but still, at $2,500 per day (for cases more than 200 miles from our facility in Boynton Beach) a three-week standby can cost as much as an average American earns in a year.

Also, standbys inevitably occur when people are facing the end of their natural lives and are in no state to deal with the prospect of paying for each additional day that our team is on-site. Many patients may be unconscious or otherwise incapable of mmaking payments at this time. Consequently some CI members have asked us for alternatives to the pay-per-day option, which we now refer to as the "Prepaid Incremental Standby Plan." To make it more attractive, we include a provision for the member to name someone as a surrogate who can call for the standby and disburse funds during it, and we encourage each CI member to make an advance payment for multiple days in addition to the basic mandatory deployment fee, which is sufficient for just the first three days. Any advance payment that we receive will earn interest and will be returnable at any time. We can set up a joint bank account to assure the member that the funds will be immediately accessible.

For someone who has prepaid for a number of standby days, we will do our best to respond as flexibly as possible, even in a situation where the risk of mortality is "Small." We define this as meaning that legal death may be likely within the next 30 days, as determined by at least two qualified medical advisors. I say we will "do our best" because of course some situations may impede us--for example, if airline problems, weather conditions, or other factors make it physically impossible for us to respond. Still, we have an obvious immediate obligation to assist anyone who requests our help on a pay-per-day basis.

3. A Flat-Rate Plan For people who wish to avoid the possibility of pay-per-day standby costs escalating on an open-ended basis, we have offered an alternative plan in which a larger one-time flat-rate prepayment replaces the deployment fee and is sufficient to cover

an unlimited number of standby days. This is our "Prepaid Flat-Rate Standby Plan," which gives the CI member a greater feeling of security, although for us it is entails greater risk. We may find ourselves spending many days in a remote location, waiting to see how a case will be resolved, while our expenses mount until they exceed the flat-rate prepayment that we have received. If this occurs, we will simply use our own funds to cover the extra days, knowing that other cases may be concluded more rapidly, and overall, everything should average out.

To limit our risk we have to impose a restriction: Under the flat-rate plan, a single advance payment only covers up to two standbys, and we will respond to a member, and continue a standby, only so long as the risk of mortality is "Serious." We define this as being a situation in which legal death may be likely within the next seven days (again, we require at least two medically qualified people to make this determination). If the risk diminishes from Serious to Small, normally we will abandon a flat-rate-funded standby, but the member may prolong it by paying an additional daily continuation fee, which will be the same as in a pay-per-day case.In this way, the flat-rate fee eliminates the need for a per-day fees during situations where the risk is Serious, but per-day fees are still required if a member wants us to initiate or continue a standby when the risk is assessed as Low.

4. The Insurance Substitute

Since we have agreed to accept a one-time flat-rate fee, can't we find a way to overcome our reluctance to accept life insurance as a substitute? Really, this means trying to assess the probability of someone following the sequence of events that I mentioned earlier, in which a member recovers from a standby and then allows life insurance to lapse.

After reviewing some cryonics history, we concluded that this is sufficiently unlikely, we can accept life insurance as a payment for standby procedures if its face value is $5,000 greater than an advance payment in the flat-rate plan. We believe that this will be sufficient to cover the additional risk involved. Aside from using insurance instead of a prepaid fee, the Insured Standby Plan offers the same terms as the Prepaid Flat-Rate Standby Plan. Already we have three CI members who are interested in retaining Suspended Animation on this basis.

The pay-per-day option seems foolproof, yet we may find ourselves in a stressful situation if a member pays for the first few days of a standby and then cannot or will not pay for additional days, even while the prospect of legal death becomes more imminent. What should we do in such a situation? Can we really be so cold-hearted, we will turn our backs and take our equipment away?

In everyday medicine, patients who are unable to pay will still receive medical treatment in most hospital emergency rooms. In cryonics, a comparable situation does not exist, mainly because the field is too small to subsidize those who have insufficient funds. Obviously we would find it extremely painful to say "no" to a person who is threatened with oblivion, but if a small organization over-extends itself by doing "pro bono" work for compassionate reasons, it is liable to erode its ability to respond to other patients who do have adequate funding arrangements. Clearly, they should be our first obligation.

Consequently we will feel compelled withhold our care if we believe that our organization may be weakened by providing assistance without receiving compensation. Cryonics is not rich enough to be a charitable institution.

If someone uses our flat-rate or insured standby plans, the standby is covered for an unlimited period of Serious risk, and we will avoid the nightmarish possibility of withdrawing assistance from someone who needs it. Still, a different potential problem may occur. Suspended Animation will rely on recommendations from at least two medical advisors when we determine the need for a standby. What if their advice turns out to be wrong? Predicting the outcome of a terminal case can be hazardous, as my own experience has shown.

When I arranged a standby for Timothy Leary (who was a member of CryoCare Foundation at that time) I was told that his condition was so grave, he had no more than two weeks to live. I traveled to California and remained there for six weeks, at the end of which Leary was still defying all predictions, enjoying himself in all-night parties with a house full of guests. He then decided to cancel his cryonics arrangements altogether, so that the entire standby turned out to be futile.

At the other extreme, during 2004, Suspended Animation was following the condition of a member of the American Cryonics Society who was suffering terminal cancer but was still alert, conversational, and able to do simple things to care for himself. When several authorities assured us that he had at least another month of life, we postponed the deployment of our principal equipment. Just three days later, the patient died of a totally unexpected apparent heart attack. Fortunately we had taken the precaution of placing some medications at the site. Nurses administered the meds, provided some cooling, and did CPR while we scrambled to respond.

Neither of these cases is typical. The outcome often can be predicted with some accuracy. Still, if people have prepaid for "unlimited" standby, either with cash or with life insurance, how can we guarantee that they will "get they paid for"? Conversely, how can we be sure that someone won't change his mind and leave us with a mountain of unpaid bills? The answer is, there are no guarantees in cryonics. We will simply apply our experience and the experience of our advisors to make the best judgment calls possible.

At the same time, there is a way around the problem of bad judgment calls by medical advisors. If someone has made pay-per-day arrangements, medical advisors are no longer in the position of calling for a standby, or denying a standby.

The member (or the member's surrogate) is the one who makes this decision. The situation becomes elegantly simple: If we are not summoned, we will remain at our facility. If we are summoned, we will respond.

Please consider these factors if you evaluate the possibility of a standby provided by Suspended Animation. Also bear in mind that insurance itself costs money. Using insurance to prepay a standby on a flat-rate basis may seem attractive, but the payments you make for additional insurance may actually be greater than the interest income you may lose by placing prepayment funds in a relatively low-interest-bearing bank account--assuming you have sufficient money to use this option.

For information on funding arrangements and the contractual steps that you need to take, to acquire standby coverage from Suspended Animation, please contact the Cryonics Institute. If you want more information about procedures, or technical details, please contact Suspended Animation at (561)296-4251 or email info@suspendedinc.com.

Obligatory Disclaimer

The commentary above is intended only to help people understand the reasoning that led us to establish three different plans. The commentary shall not be interpreted as an extension or modification of our legal documents which define the precise terms and conditions of those plans. The documents are available for inspection at www.suspendedinc.com.