Editorial: A Christmas Story Without a Happy Ending
During the holiday season many of us go out searching for the perfect gifts for loved ones or cross our fingers in hopes that we’d get what we really want. But in December in Los Angeles a 17-year-old girl and her family had Christmas wishes of a different kind.
Nataline Sarkisyan got the bad news when she was just 14 years old – leukemia. Two years of treatment brought the cancer into submission, but leukemia is a nasty business and this summer it came back.
Her doctors and her family formulated a plan of attack. Her brother donated his bone marrow for a transplant, which went down the day before Thanksgiving. And then things started to move very quickly.
Complications from the transplant led to liver failure, which within a week put her in a vegetative state. Her doctors at UCLA Medical Center ordered a liver transplant Dec. 6 and a donor was found on Dec. 10. And then things started to move very slowly.
Nataline’s insurer, CIGNA HealthCare, refused to pay for the procedure, calling it “experimental” because her doctors gave her a 65 percent chance of surviving another six months. Her doctors rallied around the girl, who by this time was on life support, and her family raged against a decision they felt was unfair. They implored the health care company. They talked to lawyers. They went to the press.
On Dec. 21 CIGNA reversed their decision. It was the same day Nataline died.
And now the spin comes fast and furious. CIGNA President David Cordani and Chief Medical Officer Jeffrey Kang, in an internal memo that was leaked to the press, said, “CIGNA went above and beyond the plan and offered to provide payment in the event the procedure should be completed.”
The Sarkisyan family, through their lawyer Mark Geragos, tell a different tale, one that alleges malfeasance on the insurer’s part for, they claim, taking the girls name twice off the donor list and delaying approval for payment long enough to reduce the chances they would ever have to cut the check. Gregaros said he is seeking criminal charges against CIGNA, whose slogan is “A business of caring.” There will certainly be a civil suit.
It will not be the first time the health-care giant has had to defend its actions in court – a 2002 class-action lawsuit filed by nearly 700,000 physicians who accused the company of “bundling, down coding and arbitrarily denying claims.” CIGNA settled the suit for more than $1 billion.
And yet, according to the family of Nataline Sarkisyan and her doctors, the problem still persists.
But when proper health care is treated as a privilege and not a right, when human beings are reduced to dollar signs and percentages, when life-and-death decisions are made by bean counters and the only vital signs that matter are the ones reported on the stock ticker, it always will.
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