Thursday, December 9, 2010

CIGNA and the tragic death of Nataline Sarkisyan

Nataline Sarkisyan died at the age of  17 on December 20, 2007, awaiting approval by CIGNA of a liver transplant. She had been fighting leukemia since she was 14 years old and had thought she had won but it resurfaced. She had a bone marrow transplant but due to the chemotherapy and/or other complications, her liver  had been damaged and she needed a liver transplant to survive.

She and her family was informed that they had found a perfect donor and she was admitted for transplant surgery. Just before the surgery, her family was told that CIGNA would not approve the surgery. Wendell Potter outlines the inner workings of CIGNA in rejecting coverage as part of their company policy of maximizing profits at the expense of patient care in his book Deadly Spin.

He discusses it at length in an interview with Bill Moyers

*The Sarkisyan tale began on December 14, 2007 when a Los Angeles TV reporter called Cigna to say a young woman was being denied a transplant. Potter investigated the situation. In the meantime he sent out a general statement to the press that the company couldn’t comment on any specific member for privacy reasons. But generally speaking, members can appeal denials. The investigation determined that the girl had been denied payment for the transplant because she was considered too sick. Her doctors disagreed, giving her a 65% chance of surviving for five more years. The family’s first appeal to Cigna had already been denied. Potter convened an emergency meeting with then-CEO Edward Hanway, current CEO David Cordani who was then running the health insurance division, and medical director Jeffrey Kang.
*The story snowballed because a media-savvy union, the California Nurses Association, organized protests and sought coverage. Protester picketed the company’s LA office. Cigna decided to take the unusual step of paying out of its own pocket for the transplant, even though Sarkisyan was covered by a Mercedes Benz company plan that Cigna managed but didn’t fund. But the same day that the reversal was relayed to the family, the girl died in the hospital. Presidential candidate John Edwards got involved and Sarkisyan’s mother joined him on the campaign trail. A lawsuit was threatened by celebrity lawyer Mark Geragos. Geragos called for Cigna executives to be criminally prosecuted. It all spun out of control very quickly. “The one bit of good news for CIGNA was that the company was not mentioned by name in most of the headlines,” Potter writes.
*After Sarkisyan’s death Cigna began a PR. campaign to try to deflect the negative attention. Potter had misgivings about this. He had a daughter about the same age as Nataline. And he had stopped drinking a year or so earlier, which depressed his ability to repress emotional responses to his job.
*Cigna’s law firm hired a spy to attend Nataline Sarkisyan’s funeral at the Armenian cathedral and report back on what was said about the company. It turned out nothing was said about Cigna.
*Cigna worked with the national HMO lobby AHIP on the fall-out. They hoped to encourage coverage that would emphasize that the girl would not have been offered transplant in other countries. An American Enterprise Institute scholar (and physician) Scott Gottlieb wrote an attack on John Edwards in the Wall Street Journal, though Potter never explains the direct link between Cigna and Gottlieb.
*This is where I make a brief appearance. Potter writes: “I scored several coups when favorable or at least balanced articles appeared in Forbes and the Wall Street Journal…I couldn’t have been happier to see the headline on the January 8 Forbes story: ‘Does Cigna Deserve All the Blame?‘” Potter says I didn’t press the company hard enough about what kinds of financial incentives it had to deny the transplant, and makes it sound like I got snowed. Readers can decide for themselves.
*Potter also takes credit for a story that ran in the news pages of the Wall Street Journal that included the line: “John Edwards has been bashing big health insurers in recent days with the story of a girl who died waiting for a liver transplant. But the details of the case suggest the Democratic presidential candidate may be over-simplifying the tale.”
*After the Sarkisyan episode, “I was dismayed with what I read and disgusted by myself,” Potter writes. His boss criticized his attitude at work. He began to entertain the notion of leaving the company. He reached out to a former Cigna executive who was now working at a nonprofit health clinic. ”In previous years I would have been consuming enough alcohol to stay sufficiently anesthetized,” he writes.
*Two years later Potter met up with the Sarkisyan family on an NBC Dateline special, and says it was a tense meeting. He also describes how the family’s lawsuit against the company went nowhere, since you can’t really sue your health plan in this country if you get it through your employer.

According to Potter's book, Nataline's story stands out only because of the media attention that survived the typical PR news suppression which CIGNA and the health insurance industry makes a part of their standard operating procedure to maximize profits. Her story is typical. Profit maximizing, according to Potter kills thousands of Americans each year!

In spite of this, American voters and legislators were persuaded/bribed by an influx of millions of industry dollars to oppose the  public option, the one thing in health care reform that could end Nataline Sarkisyan stories.

1 comment:

  1. My name is Alex, I am from Ukraine, I am 32 years old man. I don't smoke cigarettes and don't drink alcohol. My blood is O+ and I have a good health. If you need liver transplant I am ready to give part of my liver, but I want to receive a big compensation for that.

    P.S. This is not a joke and I am not a scammer or cheater.