Saturday, December 22, 2007

Too Late for Nataline

Nataline Sarkisyan was only 17. She had leukemia and recently received a bone marrow transplant from her brother. Complications from that transplant caused her liver to fail. She died December 21, 2007 at 6: PM. Our hearts break for the Sarkisyan family’s loss of their lovely daughter and sister.

CIGNA Insurance Company initially denied Nataline Sarkisyan’s liver transplant surgery. Their justification: “it was too experimental.”

The company finally agreed to pay for the surgery; eight days later after news of their initial decision became public; and just before Nataline died at the University of California, Los Angeles Medical Center.

Clearly, it was a public relations decision, not a health care decision; way too little, way too late and for all the wrong reasons.

Nataline’s death is another illustration of our morally corrupt for-profit health care system; and the lengths insurance companies will go to insure profitability.

What is Experimental?

According to Wikipedia, “Liver transplantation nowadays is a well accepted treatment option for end-stage liver disease and acute liver failure.”

It was 1967 when Dr. Thomas Starzl performed the first successful liver transplant in Denver. Liver transplantation remained experimental and patient’s survived at a rate of about 25% through the 1970s. Sir Roy Calne invented the first anti-rejection drug and patient survival rates dramatically improved. Specialists now perform liver transplantation surgeries at over one hundred centers in the US, as well as numerous other centers worldwide.

1989 saw the first transplant of a partial liver from a live donor. It is possible to donate a portion of a liver, because to some degree, it can regrow tissue.

In 2005, about 6,500 patients received liver transplants in the United States. More than 35,000 people on the planet have had successful liver transplant surgery. About 17,000 Americans are currently on a waiting list for a liver transplant

One-year patient survival is 85-90%, and outcomes continue to improve. Next to the kidney, the liver is the most commonly transplanted major organ.

This is not an experimental surgery.

What was Unusual?

In a letter reversing their initial decision, Deborah Garnsey, a registered nurse who reviews cases for CIGNA, said she had reviewed the family's appeal on Thursday and decided that day "to make an exception in this rare and unusual case."

On Thursday December 20th, friends, family and members of a nurses association held a protest outside CIGNA headquarters in Glendale, urging the insurance company to reconsider.

That is what is unusual about this case. It was the lengths the family and the California Nurse’s Association were willing to go, to bring this story to the public. Unfortunately, CIGNA still won. They delayed their decision long enough to ensure that Nataline would not survive. CIGNA will not have to pay for the surgery or for her after care now.

What would it cost?

According to the United Network for Organ Sharing, estimated charges for liver transplantation are around $314,600; annual follow-up charges run about $21,900 for the rest of the person's life.

In 2000, the Southern Medical Journal published a study titled, Liver Transplantation in the Era of Cost Constraints. Here is what the researchers found:

These tremendous expenditures have brought pressure on the health care industry to minimize cost of services and/or eliminate services. Managed care has been touted as a potential means of limiting the explosion of health care costs. Managed care corporations and third-party payers in turn are putting pressure on providers to limit costs. This has resulted in a shift of the financial risk from the payer to the provider and has put pressure on transplant programs… Studies have shown that transplantation in the sickest patients is not cost-effective… Thus, for transplant centers to become more economically efficient, they must… streamline costs and become more prudent in patient selection. [emphasis added]

Clearly, the decision about who gets a transplant no longer belongs to scientists, but to actuaries. Each year more than 27,000 Americans die of liver diseases.

People with disabilities face a difficult battle with physicians about the value of our lives. However, in this case, we had doctors and nurses fighting to keep Nataline alive, and bean counters signing her death certificate.

What Will Happen Now?

Attorney Mark Geragos told reporters at a Friday news conference that the girl's family will file a civil lawsuit against CIGNA. He is also asking a California district attorney to look into filing manslaughter or murder charges against the company. "CIGNA Health Corporation literally, maliciously killed her...they consciously disregarded her life," Geragos said of CIGNA. "And they did that for one specific reason: they did not want to pay for her after-care."

The California Nurses Association (CNA) publicized Nataline's case, calling it an illustration of the need to abandon private insurance coverage in favor of a single-payer plan.

"If CIGNA could approve the transplant yesterday in response to hundreds of phone calls and people pounding on their door in Glendale, why couldn't they have done it eight days earlier?" said a CNA spokesperson. "The transplant was recommended by the medical professionals at the bedside, they should have been listened to."

Did leukemia and liver disease kill young Nataline Sarkisyan? Or, did she die because CIGNA, a profitable company, was not profitable enough for its shareholders; so they made a callous decision to save some money.

That answer is obvious.

It will take Americans refusing to let an avaricious insurance industry make our health care choices. Fighting for single-payer/universal coverage is the first step.


Anonymous said...

It took a lot of public outrage to change CIGNAs mind; then it was too late.

This must be horrible for the family.

Anonymous said...

I found your blog rather interesting. Cigna Insurance is one of the few insurance companies which does not have too many negative reports. It seems to pay out the reimbursement in time, in full amount. The customer service is also impressively good. though displays people’s dissatisfaction with the company. Obviously, there are some gaps in the way the company provides its services.

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