17- year-old girl needs liver transplant, CIGNA denies

FireStarterRN, BSN, RN · Dec 21, 2007

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.

Simplepleasures · Dec 21, 2007

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 · Dec 21, 2007

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, BSN · Dec 21, 2007

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?

Simplepleasures · Dec 21, 2007

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

UM Review RN, ASN, RN · Dec 21, 2007

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.

FireStarterRN, BSN, RN · Dec 21, 2007

Sadly, without money the hospital would go bankrupt. I can't pass judgement on this particular case, but honestly the hospital would go under if they did not get reimbursed. I can relate because I wouldn't work as a bedside nurse if I weren't paid. Financial renumeration is my #1 reason I go to work.

It's a sad case, but I don't see it as a black and white one.

Jolie, BSN · Dec 21, 2007

This article indicates that Cigna initially approved the liver transplant surgery, but rescinded the approval when she began to experience complications that made it less likely that they surgery would be successful.

The Sarkisyan family claims that CIGN first agreed to the liver transplant surgery and had secured a match weeks ago. After the teen, who was battling leukemia, received a bone marrow transplant from her brother, however, she suffered a lung infection, and the insurer backed away from what it felt had become too risky a procedure.

http://abcnews.go.com/GMA/CancerPreventionAndTreatment/story?id=4038257&page=1

HM2VikingRN, RN · Dec 21, 2007

Ultimately the decision should have been her, her families and the doctors to make NOT the benefit denial specialists at Cigna. The insurers make money through denial of appropriate care.

There actually was a Law and Order episode on TNT yesterday that discussed this very issue of insurers denial of care.

In this case our flawed reimbursement system in all probability contributed to this girls death.

Rationing by ability to pay kills patients:

The U.S. Supreme Court recently established that rationing is fundamental to the way managed care conducts business. Rationing in U.S. health care is based on income: if you can afford care you get it, if you can’t, you don’t. A recent study by the prestigious Institute of Medicine found that 18,000 Americans die every year because they don’t have health insurance. That’s rationing. No other industrialized nation rations health care to the degree that the U.S. does.

http://www.pnhp.org/facts/singlepayer_faq.php#canada_ration

In this case she died as a result of underinsurance.

pickledpepperRN · Dec 22, 2007

ABC got some important facts wrong.On December 11, 2007 UCLA had a matching liver and on that day Cigna denied to transplant as "experimental". She developed pneumonia and had to be sedated AFTER the denial.

Yesterday on December 20th I was there when Cigna approved the transplant.

I don't think anyone will ever know whether she would have survived if she had received the transplant. The denial guaranteed her death.

Also ABC stated she lived in Glendale but did NOT. She lived in Northridge. The rally was at the Cigna office in Glendale.

Cigna refused to pay for a 17-year-old leukemia patient's liver transplant until the family staged a protest Thursday, but Nataline Sarkisyan died shortly after the reversal.
A grieving family is blaming an insurance company for the death Thursday of a 17-year-old leukemia patient, who died hours after the company reversed course and agreed to pay for her to receive a liver transplant....
... "She had a 65% chance of survival if she had gotten the liver," Hilda Sarkisyan said from her home this morning.
The Sarkisyans' insurer, Philadelphia-based Cigna HealthCare, denied the transplant earlier this month.
Doctors at UCLA sent a letter Dec. 11 to Cigna emphasizing that Nataline was eligible for a transplant, Hilda Sarkisyan said. But Cigna refused to pay, citing a lack of medical evidence the procedure would help....
... On Thursday, the family rallied supporters online and staged a protest at Cigna's Glendale office with about 150 people, including many members of the local Armenian community and the California Nurses Assn., which had released statements supporting the family's cause.
Later in the day, Cigna released a statement approving the transplant payment.
"Although it is outside the scope of the plan's coverage, and despite the lack of medical evidence regarding the effectiveness of such treatment," spokesman Wendell Potter wrote, "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. Our thoughts and payers are with Nataline and her family at this time."
Nataline died about 6 p.m....
http://www.latimes.com/news/local/la-me-transplant22dec22,1,500306.story?coll=la-headlines-california

I know there are good people and some patient advocates working for insurance companies.

But they do not provide healthcare.

And the corporations have a fiduciary duty to the shareholders to make a profit. That is a conflict of interest.

pickledpepperRN · Dec 22, 2007

I suggest that if you want to post an opinion that you read the posts and links first.

I am sad that one news source got facts wrong.

…On Dec. 11, four leading physicians, including the surgical director of the Pediatric Liver Transplant Program at UCLA, wrote to CIGNA urging the company to reverse its denial.
The physicians said that Nataline “currently meets criteria to be listed as Status 1A” for a transplant. They also challenged CIGNA’s denial which the company said occurred because their benefit plan “does not cover experimental, investigational and unproven services,” to which the doctors replied, “Nataline’s case is in fact none of the above.”
“So what happened between December 11, when CIGNA denied the transplant, and December 20 when they approved?
A huge outpouring of protest and CIGNA’s public humiliation.
Why didn’t they just listen to the medical professionals at the bedside in the first place?” asked Geri Jenkins, RN, a member of the CNA/NNOC Council of Presidents who works in a transplant unit at the University of California San Diego Medical Center….
…"It is simply not possible to organize major protests every time a multi-billion corporation like CIGNA denies care that has been recommended by a physician," DeMoro said. “Having insurance is not the same as receiving needed care. We need a fundamental change in our healthcare system that takes control away from the insurance giants and places it where it belongs – in the hands of the medical professionals, the patients, and their families."…
http://www.calnurses.org/media-center/press-releases/2007/december/rn-s-statement-on-death-of-nataline-sarkisyan-cigna-should-have-listened-to-her-doctors-and-approved-the-transplant-a-week-ago.html?print=t

Letter from Cigna - http://www.calnurses.org/assets/pdf/signa_approval_ltr_122007.pdf

Noryn · Dec 22, 2007

We pay so much in taxes that everyone should get free care. This is ridiculous to even be debating. Hopefully they will file murder charges against the insurance company like they plan (yes it will contribute to higher costs but will also lead to accountability).

If a doctor prescribes a treatment then the doctor,nurse, or claims rep at the insurance company should be held accountable for their decision to override the doctor.