Teenager dies after insurance company balks at transplant

December 21, 2007

Sometimes, the national healthcare scandal isn’t limited to those without insurance; sometimes it’s equally outrageous what happens to those with insurance. (thanks to LM for the tip)

The family of a 17-year-old girl who died hours after her health insurer reversed a decision and said it would pay for a liver transplant plans to sue the company, their attorney said Friday.

Nataline Sarkisyan died Thursday at about 6 p.m. at the University of California, Los Angeles Medical Center. She had been in a vegetative state for weeks, said her mother, Hilda.

Attorney Mark Geragos said he plans to ask the district attorney to press murder or manslaughter charges against Cigna HealthCare in the case. The insurer “maliciously killed her” because it did not want to bear the expense of her transplant and aftercare, Geragos said.

Nataline was battling leukemia — she had received a bone marrow transplant from her brother — but experienced liver failure as a complication from the treatment. Gigna reportedly balked at the cost of the transplant, calling the procedure “experimental” and outside the scope of coverage.

In the wake of the decision, 150 students and nurses protested at the company’s offices. Cigna, apparently afraid of a public-relations nightmare, reversed course and said it would pay for the liver transplant.

But it was too late. Nataline died within hours of Cigna changing its mind about the procedure.

“They took my daughter away from me,” said Nataline’s father, Krikor, who appeared at the news conference with his 21-year-old son, Bedros.

Despite the reversal, Cigna said in an e-mail statement before she died that there was a lack of medical evidence showing the procedure would work in Nataline’s case.

“Our hearts go out to Nataline and her family, as they endure this terrible ordeal,” the company said. “CIGNA HealthCare has decided to make an exception in this rare and unusual case and we will provide coverage should she proceed with the requested liver transplant.”

Nataline’s doctors at UCLA estimated that she had a “six-month survival rate of about 65 percent.” Apparently, that was all Cigna had to hear before denying the claim.

Obviously, as a matter of humanity, one’s heart has to go out to the Sarkisyan family, whose pain has to be unimaginable right now.

But as a matter of politics, one also has to wonder whether a tragedy like this one might have an impact on the healthcare debate. It should.

If the Democrats were smart (and how they have proven they are not) they’d counter the Republican “we don’t want government bureaucrats making medical decisions instead of doctors and patients” line with the FACT that right now we have insurance company bureaucrats making medical decisions instead of doctors and patients!

  • One more piece of inforation needs to be added to the story. A transplsnt liver was available for her 6-8 days ago. Now its criminal

  • What about the hospital? Was it-“Oh well, no money-no liver”.? I thought it was unethical for the medical profession to let someone die when they could prevent it.
    Seems to me there is more than one RAT in this pile.

  • Visit http://www.cancer.org/access

    The saddest part about this story is that it is more and more common. All of us, even the insured, are one diagnosis away from financial ruin. Bob Herbert did a three-part series in November about this.

  • Two points to note are that the doctors “determined she needed a transplant and sent a letter to Cigna Corp.’s Cigna HealthCare on Dec. 11,” but that she had also been “in a vegetative state for weeks”.
    One can argue the merits of insurance companies inserting themselves in the medical decision-making of individuals, but in the current environment where such insertion is the norm, this hardly seems to be a black & white case of corporate insensitivity.

  • But Bob Herbert is so boring! How could we liberals pay attention to him, since he uses perfect English and is so didactic and boring? We prefer our charismatic hand holding leaders to charm us into doing the right thing!

  • Lurkologist, on a related point CIGNA’s denial ostensibly was that it was not treatment that was medically viable. It may be that, cold as it may seem in any individual case, that actually is a reasonable standard for determining funding of medical procedures — except that in this case there were letters from the doctors estimating a 65% historical probability of success, so it seems to me that the doctors’ view should prevail, not the insurer’s.

  • fillphil is exactly right. It is the medical profession who failed this little girl. Insurance companies do nothing but work the finance… profit maximization is their stated (and correct) objective.

    One could argue that medical people really have the same goal… income maximization… but THEY claim to a higher calling… and they get paid accordingly.

    The hospital should be help culpable.

  • “A transplsnt liver was available for her 6-8 days ago.”

    I sure as hell hope this liver was given to SOMEONE and that it didn’t go to waste while waiting for Cigna to get it’s act together.

    And, Callimaco above has a wonderful point about the Dems.

  • As the insurance company trying not to pay the bill at least the hospital should save the life, then I forget that this is all about money.

  • Re #7: Zeitgeist, I don’t disagree with you on that point. The article doesn’t really go into any detail as to whether or not the ‘vegetative state’ is permanent, but I’m assuming it would be. The transplant itself may have an expected 65% chance of success, but in the absence of add’l details, one is left to assume that it would be a 65% chance of successfully continuing to exist in a vegetative state. Without more information, this just doesn’t seem like the best case for us to rally behind in terms of trying to get the Insurance industry out of the medical decision-making process.

  • Good comments by all, it shows that in our rush to pass judgment, there are always extenuating circumstances, and often the media elects to bias the story by publishing selective parts. Sad story.

  • Natalie was not in a “vegetative state”, she was in an induced coma to stabalize her. It was not permanent, it was done to slow the destruction happening to her body. With a functional liver she could have recovered.

    As far as the 65% survival rate, well if it was your daughter would you take the risk?

    It all comes down to the bottom line: Are you worth the $ to live? That is the uncomfortable truth about what happened here.

  • Cigna deserves a corporate death sentence in the form of a fine that will wipe out its equity value. Justice demands nothing less.

  • Cigna and all other health insurance should be put out of business. Profit is their motive, not public service. Their business is to make money, not provide healthcare, therefore instances like this will become more and more common. Come on, how will they pay excessve compensation to their upper management if they don’t clamp down and deny, deny, deny.

  • Has Jim G been so brain-washed that he genuinely believes in the tired corporate mantra that ‘profit maximization’ is the only real good, trumping all else? If I – not being American – may suggest something, the ignorant and unthinking belief in this dogma (one is reminded of the way rabid Communists used to hang on to the tenets of Marxis-Leninism) has a lot do with a number of the problems the US faces.

  • Guys – while this sucks for everyone personally involved, you’ve gotta remember that this has NOTHING to do with the argument for national heathcare – funds are ALWAYS limited, and there is a similar “scandal” in England every 10 minutes, as no doubt there is in Canada, France, etc.. It would be really dishonest for the Dems to pick up on this and try to pretend it wouldn’t have happened if…

  • This is a sad sad story. The truth is this girl died because some insurance bean counters decided her life was not worth the money.

    Look, in general I prefer the government to butt out of my life. Less government is better in almost every situation. However, heathcare in an exception. We SHOULD have universal healthcare that is not for profit. And while this case is extremely sad, it isn’t even the best example of WHY we should have universal healthcare. The best example? Germs. Yep, microbes, bugs, etc. The flu pandemic of the early twentieth century is a great example. A virus does not care what tax bracket you are in. People with no healthcare are less likely to go to the doctor or wait longer before they do. They could pass their bug onto countless others in that time. Further, even if a virus isn’t lethal, the working poor will still hesitate to take time off work and spend money at the doctor, until they absolutely must. This leads to MORE lost hours or days of work while they recover. That is something every self rightious conservative should understand. Yeah, now we are talking about lost productivity. That’s dollars, baby!

  • Note that the hospital, UCLA medical center, is part of the state university system. These guys get paid the same whether they let people die or not.

  • AS A FATHER OF THREE AND MEDICALLY BROKE MY HEART GOES OUT TO ALL THAT HAVE TO DEAL WITH OUR INSURANCES. FOR LIVING IN WHAT HAS BEEN SAID IS THE RICHEST MOST POWERFUL COUNTRY IN THE WORLD. WE SURE DO SUCK AT TAKING CARE OF OUR OWN. OUR GREAT NATION BEST START DOING SOMETHING FOR OUR BROTHERS, SISTERS. GRAND KIDS ETC. A TIME OF RECONNING WILL SOON BE HERE. ( I HOPE IT’S IN MY LIFE TIME )

  • CIGNA is no different than all other large providers. As a federal government employee and way big paying member of Blue Cross/Blue Shield (even with the amount that my employer kicks in), I can tell you that BC/BS would have come to the same bottom line decision, and probably would not have caved in at the too-late, last moment like CIGNA. These companies own the lawmakers who have allowed them to be the decision makers in such life and death situations. Thanks mostly to the Republican Party bought and paid for by this industry.

  • CIGNA is GUILTY of MURDER! They wanted to euthanize her like a sickly unwanted animal and this is how they did it. It is the most ghoulish atrocity – CIGNA must be punished for crimes against humanity!!!!!!!!

  • Obviously, they aren’t from this country and should be glad they had as much time with each other as they did. Back in Wherever they are from, she would have most likely been dead a long time ago. This is America, this is how our companies work, I hope they get nothing out of the suit. Leukemia killed her not some insurance company.

  • “26. On December 21st, 2007 at 7:17 pm, howard jenkins said:
    Obviously, they aren’t from this country and should be glad they had as much time with each other as they did. Back in Wherever they are from, she would have most likely been dead a long time ago. This is America, this is how our companies work, I hope they get nothing out of the suit. Leukemia killed her not some insurance company.”

    Obviously she deserved to die, according to Mr. Jenkins, because she wasn’t from this country. Oh? Just how did you deduce that she wasn’t, and what difference does it make? They paid their premiums just as you pay yours, Mr. Jenkins, if you are fortunate enough (or maybe not) to be insured. It is attitudes like yours that have enabled companies like CIGNA to get away with such criminal, immoral actions. How’s George and Dick, by the way, and which insurance provider do you work for?

  • howard jenkins said:
    “Obviously, they aren’t from this country and should be glad they had as much time with each other as they did.”

    Why is it that anytime someone criticizes the government for some shortcoming, somebody always has to demean that person by implying they are somehow un-American?

    Hey, Howard Jenkins. There’s this thing called the Constitution. It guaranties that we all get to speak our minds. Yep. Disent is build into our central legal document. That makes criticizing what we feel is wrong very very American.

    Personally, I believe that healthcare for profit is deplorable. Hey, your sick…I bet I can make a buck off of that! Bleh.

  • It’s a larger issue than this case, or even health insurance. It all comes down to what kind of society we want to live in, and on that we are hopelessly polarized, from believing in social Darwinism on the right, to the general welfare or the common good on the left.

    The best we can do is wobble uncertainly and randomly between these two extremes, because we can’t resolve who we are. We’re a Jekyl and Hyde nation, forever victim of a tempestuous war for control, one extreme personality type over the other, right versus left.

    You have to get at the root of problems to really solve them, and we just can’t do that in this country.

    There are thousands upon thousands of tragic situations happening in this country that ought not to happen in any civilized society, but always will here, because we have two completely opposite approaches to governing ourselves, and we’re stuck with the mess that leaves, because no side is strong enough to prevail.

  • I also was denied by my insurance company about my Liver transplant, saying it was expermental surgery. It took me 9 months to finally fight for them to pay for the surgery. It is now 12 years later and I am doing fine.
    So sorry for the family to lose someone so young. I hope they find some peace and can know she is in a better place.

  • I wish all of the CEOs and other CINGA decision makers a very, Merry Christmas. Cherish your loved ones during this holiday. Think of those who won’t be spending the holiday with their loved ones. I hope you have a grand and happy New Year.

  • Anybody out there got access to the Cigna corporate email list?

    If you work for Cigna, you do. Just download the corporate email list from your email reader at work (Outlook or whatever) and email it to your external email account (gmail, hotmail, whatever).

    Then post the on-line (along with job titles), so we can all express our holiday wishes directly to the individuals involved.

    Any questions, email me at corporateweasels@gmail.com.

  • It is impossible to say what/who is right and what/who is wrong. I can only voice my thoughts and my answers, right and wrong. I sympathize with both family and Insurance company.
    *At what point is the insurance company not required to pay? AT SOME POINT.
    *Is there a point? YES
    *Are there limits to the policy the family had? PROBABLY.
    *Did it cover all treatments with a track record? PROBABLY NOT.
    *Is a proven treatment with a 65% success rate at six months out to be considered a success? NO
    *What was her guesstimated total life expectancy? I DON’T KNOW.
    *At l year? – DON’T KNOW, *5 years? – DON’T KNOW, *10 years? – DON’T KNOW
    and 20 years? – DON’T KNOW
    *Did hospital have a responsibility to step in for just this family? HOPEFULLY THEY DO STEP IN FOR SOME WITHOUT INSURANCE AND BETTER CHANCES BUT THEY CANNOT STEP IN FOR ALL.
    *Was community, local and national willing to help? YES.
    *Was community, local and national really asked to step up? NOT SURE.
    *Could family, insurance co., hospital, doctors and community contributed toward giving this girl a chance until next year? YES

  • 20. On December 21st, 2007 at 6:20 pm, Syd said:
    Guys – while this sucks for everyone personally involved, you’ve gotta remember that this has NOTHING to do with the argument for national heathcare – funds are ALWAYS limited, and there is a similar “scandal” in England every 10 minutes, as no doubt there is in Canada, France, etc.. It would be really dishonest for the Dems to pick up on this and try to pretend it wouldn’t have happened if…

    Can you back this up…I mean, I understand that no system is perfect, but watching worker unions picket in France I dont think they would put up with a broken system…just sayin’…

  • I work for an insurance company, and the real person to blame for this mess is the employer, They are the ones who pick each specific benefit. The insurance company follows a specific contract which they can not breach. If an employer states that a specific procedure is not covered and they cover it then they can be sued and lose the millions of dollars for that contract.

  • WELL WELL WELL…HERE WE ARE AGAIN CIGNA . CIGNA HAS A PAST HISTORY FOR THIS KIND OF CRAP. I PERSONALLY KNEW OF A BLACK LADY WHO DESPERATELY NEEDED A TRIPLE BYPASS, AND OF COURSE WAS DENIED NOT JUST ONCE, BUT 3 TIMES. SHE SWITCHED TO PRUCARE JUST IN TIME FOR PRUCARE TO SAVE HER LIFE. MY HEART WENT OUT TO HER AS SHE TOLD ME THIS STORY IN THE WAITING ROOM OF A LOCAL HOSPITAL. SHE HAD A LOT TO LIVE FOR WITH A YOUNG FAMILY. I ASKED HER HOW COULD SOMETHING LIKE THIS HAPPEN, AND SHE TOLD ME THAT HER PCP DOCTOR AT CIGNA WOULD NOT EVEN BELIEVE HER COMPLAINTS ENOUGH TO ORDER A STRESS TEST. HE WOULD SEND HER HOME WITH STRESS PILLS EVEN AFTER 3 VISITS. SHE CALLED MAIN OFFICE A FEW TIMES AND SPOKE TO SOME SUPERIORS EACH TIME ONLY TO BE TOLD THAT THE DOCTOR IS THE ONE THAT MAKES ALL THE DECISIONS. PRUCARE FINALLY SAVED HER LIFE. I NEVER DID HAVE TO MUCH RESPECT FOR THOSE BASTARDS AT CIGNA HMO AFTER HER ORDEAL.YOU HEAR ME OUT THERE YOU DIRTY GOOD FOR NOTHING CIGNA BASTARDS.?

  • This is right up there with the news the last month that Blue Cross or Cigna or one of the other Republican criminal enterprises masquerading as a business was giving bonuses to the person responsbile for cancelling people’s insurance, based on how much money she saved for the company. The judge who saw those papers immediately granted class action status to everyone in California who has had their health insurance cancelled.

    What we need to do is sue these motherfrakkers into bankruptcy, then we can start over. After we put their top executives into a non-white collar prison.

  • I notice the conservatives commenting here aren’t even pretending to be “compassionate”. Just goes to show that “compassionate conservatism” is and always was an oxymoron.

  • – After a private bill-signing ceremony in the middle of the night, President Bush made a public case for helping Nataline Sarkisyan on Monday, praising Congress for sending him the legislation that allowed federal courts to intervene.

    Mr. Bush, who returned to Washington from his Crawford ranch on Sunday, was awakened after the House passed the Sarkisyan bill at 12:42 a.m. His staff secretary, Brett Kavanaugh, delivered the legislation to be signed, which Mr. Bush did while standing in a hallway. Seven hours later, he left on a previously planned trip to Tucson and Denver to promote Social Security changes.

    Appearing before hundreds of supporters here, Mr. Bush praised Congress for “voting to give Nataline Sarkisyan’s parents another opportunity to save their daughter’s life.” The declaration was met with roars from the supportive Republican crowd.

    “This is a complex case with serious issues, but in extraordinary circumstances like this, it is wisest to always err on the side of life,” Mr. Bush said at the beginning of an event on Social Security at the Tucson Convention Center. “I appreciate the work of the Senate and the House to get that bill for me to sign last night at about 1:08 – or this morning at about 1:08.”

    Oh, wait.

  • @locagirl – I live in England, so I can’t vouch for anywhere else (I did kinda hedge on other countries!!), but certainly here these kinds of story come up every week – and ironically enough the right-wing media (ie. most of the newspapers) use such stories to beat the NHS over the head and argue that national healthcare doesn’t work!! There was a huge story this year about access to herceptin for breast-cancer patients – even though it is unproven, and the government eventually caved-in, and ordered the supposedly independent authority that governs these things to make it available.

    How does it work? Well, just like HMOs, the authority (it is called “NICE” – National Institute of Clinical Excelence) puts a price on each year of quality life a treatment adds, and then tries to balance them all out – so treating a child for leukemia might come out over treating a middle-aged man for cancer… or it might not, depending on how the cost balances out with the odds.

    Why do people “put up with it”? I guess that until these things effect “you” they are a “sensible allocation of scarce resources”… which in truth, they are – if the NHS funded every treatment available, England would be bankrupt in minutes. Sad, but true.

    The advantage of our system is that it is FAIR – not that it gives unlimited access to resources.

  • While it is true that there are many unknowns in this story, I have to agree with @local girl. This is where we are headed, regardless of who is holding the purse strings. I had a dear English friend who was suffering from a brain tumor. As soon as she was diagnosed, she got excellent treatment, but not surgery. The doctors diagnosed her as too ill to survive the surgery. They worked to improve her health so that she could tolerate it, but she died before that happened.

    In the second instance, my partner, who was Canadian, had bile duct cancer in remission. In April 2001, he developed colon cancer, and surgery was surprisingly successful. We were all delirious that he was expected to fully recover. However, a few days later, his oncologist confirmed that the bile duct cancer had returned very aggressively. The doctors told him (and me) that they could treat him for that, but it would give him only a few months of life and that his death would be very painful. They had several serious conversations with him, and persuaded him to cease all treatment except for water and pain meads. I sat with him for 5 weeks while he died.

    In both cases, the medical system made a decision to withhold treatment based on the likelihood of its being successful. There is no way we can continue to provide organ transplants on demand, hip replacements to the very elderly even after the doctor has expressed his extreme concerns to the family, continued treatment for terminal patients at the family’s insistence. It is a concept that goes against our long-held beliefs, but I believe it is coming. Medical care will be rationed. We will have to learn to allow our loved ones to go when it is time, but poor women will get mammograms and the elderly can stop taking their daily doses of Digoxin every other day because that is all they can afford.

  • I work for an insurance company, not Cigna. We pay for thousands of claims that could have been avoided if persons would have taken preventative measures. Eating right, exercising, going to regular checks, immunizations. Preventative medicine and routine care is becoming more and more “Free” to the member because it costs us less in the long run. Now if we could get people to do their preventative care, instead of letting it increase in severity and cost, we could put this money towards more serious unpreventable illnesses and spend more money on research. For people who don’t work in the insurance field, if you only knew the things we did.

  • When Terry Schiavo was in a persistent vegetative state, Congressional republcites intervened on her behalf. Why didn’t they weigh in on this case. Because it would have proven to the country why we need to take the profit out of health care in the US. And they couldn’t have that. It might show them to be the hypocrites they really are.

  • 43. On December 22nd, 2007 at 3:35 pm, Doyle said:

    I work for an insurance company, not Cigna.

    But you have internalized the discourse of blaming the victim very nicely, haven’t you? How do you look in the mirror, bubba?

    Preventative measures? Sure. Just stop all the “comfort-food” ads, the cigaret company sponsorship, the additives in foods, the high-frucose corn syrup, and all the rest of the toxic substances which people of modest means CANNOT avoid.

  • I have been searching prices for liver transplants and the least I have found is $67,000. It is sad that Nataline’s life was worth less than that. Makes you think about how much you are worth to corporate America. Also makes me think about all the other cases who are not teenagers dying in the midst of Christmas holidays, making it a story worthy for the news. I hope that Edward Hanaway, CEO of Cigna, enjoys his $21 million he makes as TOTAL Compensation (including salary and stock options). Oh, by the way, he’s also the director of America’s Health Insurance Plans.

  • For those of you unfamiliar with “modern” med practice, the Docs can’t make the choice without being retailiated against. Sure, they could do the transplant…but then CIGNA pays for nothing else. The Docs also get blacklisted and nobody recieves care.

    We all understand limits to funds and medical science. What I can’t stomach is that the denial of standard medical care leading to her death would be profitable. Disgusting.

    Britain’s NHS is woefully underfunded and has been since St Maggie. Try another universal system with adequate funds.

  • It worked exactly the way the insurance company wanted. End of life = End of financial burden for cigna. As far as being criminal = without a doubt, chances of conviction= very doubtful. A terrible loss of such a young life and she had health insurance. Think about the people who don’t

  • Spcrates @ 34.

    Thanks for analyzing this so well.
    I had so many of the same questions.

    Thanks to the Cheney-esque secrecy of medical outcome formulae applied to insuramnce policies, the public is left to speculate whether an insurance company weighed their profitability against decency well.

    If 6 months can be had for $5, the CIGNA staff involved should get the chair.
    If it was 6 months at a cost of 100 trillion dollars, Mother Theresa should be allowed to die (assuming she were alive today.)
    No doubt, the truth lies in between. The point is that transparency might serve the insurance companies better than the current approach of “Trust us.” It hasn’t worked well for most folks who choose that option.

    These tradeoffs WILL happen in every health care system. The longer we take to face this fcat, the more people will suffer unnecessarily.

  • Believe it or not, this issue here is simply one of contract — what medical treatments did the insurance company agree to provide in exchange for the premium payments it received?
    Most, if not all, health policies exclude “experimental” treatment. The question is whether the specific treatment contemplated for this patient (a liver transplant) was experimental treatment under the circumstances. Simply because a treating doctor states there would be maybe a 65% chance for 6 month survival is not going to convince a court unless there is evidence in the medical literature to support it. The California courts will have to decide.

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