[HM2Viking]

The point is that given her age there is no real doubt that she should have been given the "benefit of the doubt" for transplantation. Liver transplants aren't really experimental anymore. As I recall from my peds course last summer the prognosis for leukemia patients in adolescence is actually quite good.

I think this is one of those cases that can be used to talk about how to rationally allocate medical procedures. A 17 year old with a reasonable chance of survival should automatically be given a liver transplant. But should a 75 yo be given the same services? Probably not. In that case it should probably be after all other candidates were ruled out. Hypothetically a transplant priority system could look like this: (I have no transplant experience so this is a thought experiment.)

0-21 excellent chance of survival-AAA
0-21 moderate chance-AA
0-21-good- A
0-21 fair B
0-21 poor C

22-50 excellent chance (with dependent children)- AAA
22-50 excellent chance (without dependents) -AA
22-50 Moderate Chance (with dependents)- AA
22-50 moderate without dependents- A
22-50 good chance with dependents- A
22-50 good chance without dependents- B
22-50 fair chance with dependents- BB
22-50 fair chance without dependents- B
22-50 poor chance with dependents- B
22-50 poor chance without dependents- C

This is one possible way to allocate precious transplant resources for maximum benefit of individuals and society. The priority goes to children first (because they are the future) and then next to parents of dependent children (because they raise the future). Other adults would be eligible but at a lower priority. Rationing on ability to pay seems wrong to me. The impact of not treating a parent is much higher to society as a whole than not treating a non-parent Cigna was wrong to deny coverage for this procedure.

I don't know the answer but I think an honest ethical discussion about how to use precious resources for the maximum benefit of individuals and society needs to be held.

I sincerely hope that this girl survives and recovers from her liver failure.

[Angie O'Plasty, RN]

Originally Posted by jeolsz

We all like to blame the insurance company, probably because it is face less and represents what we see as money oriented and less than human. The truth is, if this proceedure was needed in the doctor's eyes as life saving, why wasn't the procedure done? And did they have a liver that matched? What other disease processes and complications were going on that might have made this procedure more risky? I work for an "evil" insurance company and have seen members wait in the surgery suite for needed surgery, while doctor's offices call and await approvals. Next time take a close look at the doctor who is complaining about the insurance company.. What kind of car does he drive? Where does he live? How many vacations did he go on last year? And how much money did he waste last year in your hospital on needless tests, delays in service( especially on weekends) and unnecessay hospital days, especiallly with his Medicare patients? There are 2 sides to every story, unfortunately the doctors, who we often give Godlike attributes to come out smelling like a rose instead of a rat. And often the patients and family are in the middle.

I disagree. Healthcare has been changing ever since the advent of DRGs and has slowly been taken over in the US by insurance companies.

The insurance companies only seem to want to insure healthy people and cover a minimum of procedures and medications. My family deductible last year was $3000. That didn't even cover the ambulance.

What kind of insurance do we have that doesn't even cover the ambulance in an emergency?

Do you know how many patients I have seen that are stroke or heart attack victims who are coming to the hospital by neighbors and friends because they literally do not have the $600 for the ambulance ride?

Do you know that it practically took an act of God for my friend to get breast reconstruction after a radical mastectomy back in the 80s because the insurance company actually called it "cosmetic" surgery?

The docs are not the villains here. The patients are not the villains here. The insurance companies, who reward medical professionals for denying procedures, are.

[jeolsz]

I feel I have to respond back to Angie.. Take a good look around you where you work.. Want to know why your premiums are so high?.. Do you realize the waste and lack of continuing education towards the lastest medical trends that goes on in most acute care facilities? Why should a patient wait from Friday until Monday for a test that could have been done on Saturday? Why should a patient stay in an acute care facility such as a hospital when maybe a subacute facility may be a better fit? I myself felt the pinch of the rising cost of insurance and felt cheated, however when I opened my eyes and saw both sides of the argument things became much clearer. I have to say I have never worked with better educated and healthcare motivated people as I have with the health insurance Co I now work with.. And I've been working as an RN for more than 25 years.. The Dr's and nurses who work with these companies have many years of bedside experience and believe it or not truely care about the welfare of the members they are responsible for. Insurance co's get a really bad rap for being uncaring and money grubbing.. but look around you.. can't the same be said for the Dr's and nurses working at the bedside?

[pickledpepperRN]

Her Mother knows her daughter is in heaven. My heart is broken for this family.
On local TV this morning they said that on December 11th the doctors gave her a 65% chance for a full recovery with the transplant.

…A Northridge teenager awaiting a liver transplant died Thursday after she was pulled off of life support….

http://abclocal.go.com/kabc/story?se...cal&id=5848163

I was in one of many buildings owned by insurance companies yesterday. No one working in any of them provides any healthcare at all.
If they have doctors and nurses working there those professionals are not caring for patients.

I do not believe direct care nurses are the problem in healthcare.

[jlsRN]

Very sad. I watched the video. I have mixed emotions. On the one hand, I'm uncomfortable with the profit motive aspect of insurance companies, on the other hand, it seems as if the public wants it all and is unrealistic about the fact the it doesn't come free. It's not as if a liver transplant is a routine procedure especially in the case of a girl whose liver malfunction is not her only medical problem.

Now the family wants to perhaps sue the insurance company, which will only make further demands on the system. I don't know what the answer is. In the case of socialized medicine, they also have rationed care.

I'm sorry for the family and their pain.

[ingelein]

Oh, my gosh, the delay they caused in approving the liver transplant CAUSED her death.They should have to pay and pay BIG, but still a life is GONE. I wonder how many more cases like this are out there that we havent heard about?

[jeolsz]

Excuse me, space nurse, but do you have any idea how many of the members I review have preventable bedsores?...lets not pretend bedside nurses are all Mother Teresa.. that being said, I was a bedside nurse for 20 years and I know how difficult and demanding a job it is and I have nothing but the utmost admiration and respect for those who choose to work at the bedside...
Health insurance is not made up of buildings and invisible people.. There are health care professionals from all fields who work and interact with the general public everyday, myself included.. And trust me.. we are not there to screw the members..We are very much patient advocates..
And one more thing, while I'm on a rant...Don't believe everything you read in the paper.. both sides have very different spins on any story..You needs to ask yourself..1. If, as the paper's claim she was in a vegetative state, what other comorbidities did she have? 2. Did they have an acceptable donor?..3. How many others in a similar situation have survived the transplant? If any?.. Livers are not something you can buy in a department store.. they are in short supply and there is a lot of criteria that needs to be met to be an acceptable candidate.. how much of this did she meet?..
There are so many questions that are not addressed and misinformation as well in any news article.. Trust me, health insurance companies do not employ people without empathy and feelings.. We do bleed the same color as you.

[Jolie]

Originally Posted by ingelein

Oh, my gosh, the delay they caused in approving the liver transplant CAUSED her death.

That's a pretty bold accusation! Do you have proof to back it up? If the medical center and surgeon were certain of the benefit of a liver transplant, why did they not initiate the process while awaiting approval from the insurance company or arranging for alternate funding?

Was there a viable liver availabe to this patient in the time the case was being appealed? Again, if so, why didn't the transplant team accept it and deal with funding at a later time?

[ingelein]

Originally Posted by Jolie

That's a pretty bold accusation! Do you have proof to back it up? If the medical center and surgeon were certain of the benefit of a liver transplant, why did they not initiate the process while awaiting approval from the insurance company or arranging for alternate funding?

Was there a viable liver availabe to this patient in the time the case was being appealed? Again, if so, why didn't the transplant team accept it and deal with funding at a later time?

This is the most comprhensive article I have been able to find regarding this."On December 14, Hilda Sarkisyan was told by the hospital that a healthy liver was available, but because CIGNA had refused authorization, the family would have had to make an immediate down payment of $75,000.to proceed, an amount the family could not afford." MONEY was why the doctors and the hospital did not initiate the transplant.
http://www.emaxhealth.com/124/19349.html

[Angie O'Plasty, RN]

Originally Posted by spacenurse

I do not believe direct care nurses are the problem in healthcare.

I've been enlightened. I've read Nursing Against the Odds and the other day, I watched Sicko.

I know that Sicko is true because I've seen it happen to my patients and even in my family.

Nurses don't have the power to D/C patients or get tests ordered over the weekend. I strongly suspect that some of these folks who have to wait the weekend for a test really need to be in the hospital. LOS has shortened to the point that a hospital "stay" is a mockery and many of the patients that I deal with should be in the hospital at least two days longer.

What's the cost of adhering to the DRG guidelines and then seeing the same patient come back with the same Dx? The hospital eats the cost, not the insurance company. The insurance companies have denied so many claims that the hospitals all employ personnel to wrest every possible dx out of every admission so that they will be fairly compensated.

All this when having more nurses could save both hospital, insurance company, and patient a lot more money. We nurses are worth our weight in gold and we are the best bargain the healthcare system has.

And you know, jeolsz, "preventable" is in the eye of the beholder. Remember, insurance won't cover treatment to prevent a bedsore, only to treat it. I've seen patients whose bedsores could've been greatly minimized if we'd been given the choice to put them on a special mattress/bed. But nobody asks us, because our recommendations might cost money.

IMO, the only group truly advocating for the patient is the nurses and doctors who care for them. That young girl's surgical team should never have been expected to pay for the surgical suite, the radiology and labs, and the nursing care to transplant a liver to her. That was the insurance company's job.

Is it not ironic that we're paying the salaries of the people who hold our very lives in their hands? And believe me, I'm not talking about doctors. I'm talking about insurance processors who approve or disapprove claims. Have you never heard of Linda Peeno, the M.D. who blew the whistle on managed care, or seen the movie, Damaged Care, that resulted?

Here's a link to her website for more information:

http://drlindapeeno.tripod.com/id3.html

With all due respect to you and the company you work for, Nathile's story is not an isolated one.

Whether or not her case merited it, problems getting claims paid to healthcare providers are rampant, even today, which is why this story is receiving the attention that it is getting.

Normally, I wouldn't be going off on a rant about things like this, but you went and told us that you, too, were a nurse. Because of that, I know in my heart that you are hearing us.