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When Insurers Play Doctor (Part One)

Posted by Jane Akre
Wednesday, December 26, 2007 9:55 PM EST
Category: Major Medical, Protecting Your Family
Tags: Medical Malpractice and Negligent Care, Wrongful Death

Cigna HealthCare denied a liver transplant or a 17-year-old patient who died. Now her attorney is suing  saying Cigna maliciously killed her.

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It’s difficult enough when a young person dies.  But when a medical procedure that might have saved her life is denied by the insurance company –  some are calling that criminal.

Attorney Mark Geragos has been hired by the family of 17-year-old Nataline Sarkisyan to sue CIGNA Corporation. Geragos is asking the district attorney to file criminal charges as well.

The lawsuit stems from the death of the young woman last Thursday. 

Nataline was denied coverage by Cigna for a liver transplant she needed following complications from a bone-marrow transplant one month earlier.

UCLA Medical Center had a healthy liver available for transplant December 14th, but needed Cigna’s okay and a $75,000 down payment before beginning the procedure, an amount the family could not afford.  Nataline was covered under her mother’s insurance coverage offered through her work as a real estate agent.

Geragos, on his web site, says the insurer “maliciously killed” Nataline because it did not want to spend money on the transplant.

Cigna had previously indicated the procedure would not have been effective after consulting with two unnamed experts in the field. Drugs to fight organ rejection might have worsened Nataline’s leukemia according to Cigna which also called the procedure unproven and experimental.

But four doctors from UCLA Medical Center, including the director of the Pediatric Liver Transplant Program, wrote a letter to Cigna on December 11, urging the insurer to reconsider. 

They classified Nataline as Status 1A for a transplant and said that patients usually have a six-month survival rate of about 65 percent. The doctors said that Nataline’s treatment was not experimental or unproven.

About 150 doctors and nurses rallied outside of Cigna’s Glendale California offices in a protest headed by the California Nurses Association. The family hired Geragos, a Los Angeles lawyer famous for representing high profile cases such as Congressman Gary Condit and actress Winona Ryder. The Armenian community got involved in the protest as well.   

Then on the 20th Cigna sent an approval letter to Geragos & Geragos and the Sarkisyan family reversing itself due to the “unique circumstances of this situation.” 

But the reversal came too late Sarkisyan who was put on life support. She died shortly after the family decided she should be taken off.  

Cigna’s HealthCare's slogan is “A Business of Caring.”

In a statement, CIGNA HealthCare President David Cordani and Chief Medical Officer Jeffrey Kang, expressed condolences saying “our hearts go out to the family and friends of Nataline Sarkisyan during this difficult time.”

Geragos believes the memo was written by lawyers and media crisis experts looking to avoid bad PR.

But the insurer says it “filled its responsibly correctly and with the utmost integrity.”   Insisting 90 percent of liver transplant requests are fulfilled, Cigna says it does not pay for experimental treatments or treatments outside of a patient’s plan. However the statement goes on to say that in this case, it made an exception.

“Based on the unique circumstances of this situation, and although it was outside the scope of the plan’s coverage and despite the lack of medical evidence regarding the effectiveness of such treatment, CIGNA decided to make an exception.  CIGNA did not reverse the clinical determination that the member’s plan did not cover the transplant. In fact, CIGNA went above and beyond the plan and offered to provide payment in the event the procedure should be completed.”

The California Nurses Association, Executive Director Rose Ann DeMoro said the case illustrates what’s wrong with our health care delivery system.  “Insurance companies have a stranglehold on our health. Their first priority is to make profits for their shareholders – and the way they do that is by denying care.” 

Nataline was a sick girl. The young woman’s leukemia had been in remission until last summer. The bone marrow transplant she received the day before Thanksgiving was given to fight her leukemia but complications destroyed her liver.  The teenager was in a vegetative state, according to her mother. No one knows whether the transplant would have saved her young life. Her family says now they'll never know.

On the Geragos web site is an article which questions whether transplantation is a viable option for a leukemia patient. Immune-suppressing medication required to fight organ rejection could make the cancer worse. Other experts say immunosuppressant drugs tend to help tumors grow.

Investor’s Business Daily admits her case was a  Tough Call.  While the dailykos blog calls Nataline’s case Murder by spreadsheet.  

Meanwhile, Weiss Ratings which ranks finance and insurance products, finds double-digit profits for health maintenance organizations annually.

Cigna HealhCare President Cordani's salary in 2006 is more than $3 million in cash compensation. H. Edward Hanway, CEO of parent Cigna Corporation raked in more than $21 million in 2006 alone.

Cigna’s profits posted in the third quarter SEC filings show on page 11 a discussion about the reduction in medical claims payable over 2006.

The Sarkisyan case is not an isolated one. The insurance industry reports it get 1.3 million complaint calls from consumers each year about claim denials, delays or low settlement offers.

The California Nurses Association has taken a leadership role in promoting a single payer guaranteed healthcare stance as a solution to our nation’s healthcare crisis providing one standard of care for everyone. 

As a nurse says in this video, she doesn’t want to have to choose between a patient who is insured and one who is not. 

The group has posted a number of YouTube videos showing real people with real health care issues who have been

at a time they need it the most.  #

READ PART TWO OF THIS STORY 


1 Comment

Posted by Brent Adams
Wednesday, January 16, 2008 7:24 AM EST

The federal judges are to blame for this tragedy.

They have interpreted the ERISA lay to allow insurance companies to decide for themselves if they should pay health insurance claims.

They have denied claimants such as Nataline Sarkisyan the right to a jury trial or even a trial of any kind.

They have allowed the insurance companies to be in total control.

Thes judges are oblivious to the reality that there is a direct conflict of interest.

See our blog on Fayetteville Injury Board for more detail.

Comments for this article are closed.

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