Teen dies hours after liver transplant approved

m1ldslide1

Platinum Member
Feb 20, 2006
2,321
0
0
http://www.cnn.com/2007/HEALTH...ansplant.ap/index.html

GLENDALE, California (AP) -- A 17-year-old died just hours after her health insurance company reversed its decision not to pay for a liver transplant that doctors said the girl needed.

Nataline Sarkisyan died Thursday night at about 6 p.m. at University of California, Los Angeles, Medical Center. She had been in a vegetative state for weeks, said her mother, Hilda.

"She passed away, and the insurance (company) is responsible for this," she said.

"They took my daughter away from me," said Nataline's father, Krikor, who appeared at a news conference Friday with his 21-year-old son, Bedros.

Mark Geragos, attorney for the girl's family, said he plans to ask the district attorney to press murder or manslaughter charges against Cigna HealthCare in the case. The insurer "maliciously killed her" because it did not want to bear the expense of her transplant and aftercare, Geragos said.

Nataline had been battling leukemia and received a bone marrow transplant from her brother. She developed a complication, however, that caused her liver to fail.

Doctors at UCLA determined she needed a transplant and sent a letter to CIGNA Healthcare on December 11. The Philadelphia-based health insurance company denied payment for the transplant.

On Thursday, about 150 teenagers and nurses protested outside CIGNA's office in Glendale. As the protesters rallied, the company reversed its decision and said it would approve the transplant.

Despite the reversal, CIGNA said in an e-mail statement before she died that there was a lack of medical evidence showing the procedure would work in Nataline's case.

"Our hearts go out to Nataline and her family, as they endure this terrible ordeal," the company said. " ... 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."

In their letter, the UCLA doctors said patients in situations similar to Nataline's who undergo transplants have a six-month survival rate of about 65 percent.

District attorney spokeswoman Sandi Gibbons declined to comment on Geragos' planned request for murder or manslaughter charges, saying it would be inappropriate to do so until Geragos submits evidence supporting the request.

Officials with CIGNA could not immediately be reached for comment Thursday night.



---------------------------------

I'm rooting for the family. I hope the insurance company gets nailed to the wall for this, and as a result we have a chance at some healthcare reform in this country. Shame on them.

There has to be a way to keep providing the quality of care that American hospitals are capable of without denying it to those who really need it.
 

GenHoth

Platinum Member
Jul 5, 2007
2,106
0
0
Originally posted by: m1ldslide1

In their letter, the UCLA doctors said patients in situations similar to Nataline's who undergo transplants have a six-month survival rate of about 65 percent.

That is pretty bad. I'm wondering if they had a better recipient for the liver. 65% @ 6 months isn't a great survival rate. Without better access to medical records and the transplant list, who knows? I guess we can wait and see what info comes out. That said, I hate HMOs
 

Slew Foot

Lifer
Sep 22, 2005
12,379
96
86
65% for 6 months? That's absolutely shitty. Im sure there was a better place to put a liver, Ive seen patients live for 20+ years.
If you were about to fork over $2 million (estimated lifetime cost of a liver transplant) along with an ultra scare resource (human liver), where would you rather put it?

 

quikah

Diamond Member
Apr 7, 2003
4,141
703
126
The story quotes the mother saying she had been in a vegetative state for weeks. I wonder if that is the real reason the insurance company denied coverage?
 

umbrella39

Lifer
Jun 11, 2004
13,816
1,126
126
A 6 month survival rate of 65%... Are they saying she had a 35% chance of dying even with a transplant?
 

1EZduzit

Lifer
Feb 4, 2002
11,833
1
0
Originally posted by: Slew Foot
65% for 6 months? That's absolutely shitty. Im sure there was a better place to put a liver, Ive seen patients live for 20+ years.
If you were about to fork over $2 million (estimated lifetime cost of a liver transplant) along with an ultra scare resource (human liver), where would you rather put it?

It would be interesting to know where the liver ended up.
 
Oct 27, 2007
17,009
1
0
The survival rate is irrelevant, it's not up to the insurance company to decide who is most worthy of a donor liver. The issue is that the company delayed payment and the implication is that the delay caused the death of the girl. There are transplant committees that can decide who is worthy of a liver donation and they are completely separate from the insurance companies. Discuss the issue, don't get side tracked with irrelevant details.

We need more details about the reason for the denial of payment before anyone can make a reasoned argument one way or another. These details will like emerge during the case, and until then (and I know this is like trying to control the weather) I think we need to reserve judgment.

In an off-topic note, I have noticed the mods have relaxed the requirement for the OP to contain commentary, not just the article. What's up?
 

ProfJohn

Lifer
Jul 28, 2006
18,161
7
0
Originally posted by: umbrella39
A 6 month survival rate of 65%... Are they saying she had a 35% chance of dying even with a transplant?
Yea that seems to be the story.

Plus her leukemia could have came back and killed a year or two down the road.
 

umbrella39

Lifer
Jun 11, 2004
13,816
1,126
126
Originally posted by: ProfJohn
Originally posted by: umbrella39
A 6 month survival rate of 65%... Are they saying she had a 35% chance of dying even with a transplant?
Yea that seems to be the story.

Plus her leukemia could have came back and killed a year or two down the road.

I wonder what the 1 year, 2 year prognosis was? I would not want to a an insurance company rep trying to explain to a family that 65% chance of living for at least 6 months is not something they want to take a chance on. You couldn't pay me enough for that job.
 

ProfJohn

Lifer
Jul 28, 2006
18,161
7
0
The five year survival rate for leukemia is about 50%.

That is up from only 14% in the early 60%.

There are four types of leukemia and we don't know which one she suffered from.
 

Kntx

Platinum Member
Dec 11, 2000
2,270
0
71
Originally posted by: Slew Foot
65% for 6 months? That's absolutely shitty. Im sure there was a better place to put a liver, Ive seen patients live for 20+ years.
If you were about to fork over $2 million (estimated lifetime cost of a liver transplant) along with an ultra scare resource (human liver), where would you rather put it?

That's not the insurance company's call. It's the doctor's / family's call.
 

ProfJohn

Lifer
Jul 28, 2006
18,161
7
0
Originally posted by: Kntx
Originally posted by: Slew Foot
65% for 6 months? That's absolutely shitty. Im sure there was a better place to put a liver, Ive seen patients live for 20+ years.
If you were about to fork over $2 million (estimated lifetime cost of a liver transplant) along with an ultra scare resource (human liver), where would you rather put it?
That's not the insurance company's call. It's the doctor's / family's call.
Like it or not it is the insurance companies money.

If the family wanted to pay for it with their own money we wouldn't be having this discussion.

I am 100% sure that the treatment for this young lady ran up into the six figures easily FAR FAR more than her mom or dad will ever pay in premiums over their life time.

Insurance companies exist to make money, not run around paying for every risky and experimental treatment procedure people can think of. The system may suck, but it is still far better than it was 40 years ago.
 

Pabster

Lifer
Apr 15, 2001
16,986
1
0
Originally posted by: Kntx
That's not the insurance company's call. It's the doctor's / family's call.

It is always the insurance company's call. Unless you're paying for your services out of pocket, then you can call as you choose.
 

Slew Foot

Lifer
Sep 22, 2005
12,379
96
86
Originally posted by: Kntx
Originally posted by: Slew Foot
65% for 6 months? That's absolutely shitty. Im sure there was a better place to put a liver, Ive seen patients live for 20+ years.
If you were about to fork over $2 million (estimated lifetime cost of a liver transplant) along with an ultra scare resource (human liver), where would you rather put it?

That's not the insurance company's call. It's the doctor's / family's call.

You cant get on the list unless you have funding.

Once on the list, a team of doctors and other medical professionals determine where the organs go.

Now that I read she has leukemia, Im surprised she even made the list, cancer usually is an automatic exclusion.
 

Balt

Lifer
Mar 12, 2000
12,673
482
126
Originally posted by: ProfJohn
Originally posted by: Kntx
Originally posted by: Slew Foot
65% for 6 months? That's absolutely shitty. Im sure there was a better place to put a liver, Ive seen patients live for 20+ years.
If you were about to fork over $2 million (estimated lifetime cost of a liver transplant) along with an ultra scare resource (human liver), where would you rather put it?
That's not the insurance company's call. It's the doctor's / family's call.
Like it or not it is the insurance companies money.

If the family wanted to pay for it with their own money we wouldn't be having this discussion.

I am 100% sure that the treatment for this young lady ran up into the six figures easily FAR FAR more than her mom or dad will ever pay in premiums over their life time.

Insurance companies exist to make money, not run around paying for every risky and experimental treatment procedure people can think of. The system may suck, but it is still far better than it was 40 years ago.

Give me an f'ing break. :roll:

Some people are going to cost the insurance money more than they will ever pay in premiums. Many people will cost the insurance company far less than they will ever pay in premiums. That's why insurance companies have many, many clients to spread out the risk.

"If the family wanted to pay for it with their own money we wouldn't be having this discussion." - You pointed out yourself that it probably could have cost six figures. One of the reasons people have insurance is "just in case" of worst-case scenario situations like that, because they will never be able to afford it themselves.


Maybe her odds of survival with the transplant weren't very good, but her odds of survival without the transplant turned out to be 0%. It's strange that some people on these forums rant about the sanctity of life issues with regards to an embryo but are willing to throw living, breathing children and adults under the bus when they become too expensive to keep alive. :roll:
 

ProfJohn

Lifer
Jul 28, 2006
18,161
7
0
Originally posted by: Balt
Originally posted by: ProfJohn
Originally posted by: Kntx
Originally posted by: Slew Foot
65% for 6 months? That's absolutely shitty. Im sure there was a better place to put a liver, Ive seen patients live for 20+ years.
If you were about to fork over $2 million (estimated lifetime cost of a liver transplant) along with an ultra scare resource (human liver), where would you rather put it?
That's not the insurance company's call. It's the doctor's / family's call.
Like it or not it is the insurance companies money.

If the family wanted to pay for it with their own money we wouldn't be having this discussion.

I am 100% sure that the treatment for this young lady ran up into the six figures easily FAR FAR more than her mom or dad will ever pay in premiums over their life time.

Insurance companies exist to make money, not run around paying for every risky and experimental treatment procedure people can think of. The system may suck, but it is still far better than it was 40 years ago.
Give me an f'ing break. :roll:

Some people are going to cost the insurance money more than they will ever pay in premiums. Many people will cost the insurance company far less than they will ever pay in premiums. That's why insurance companies have many, many clients to spread out the risk.

"If the family wanted to pay for it with their own money we wouldn't be having this discussion." - You pointed out yourself that it probably could have cost six figures. One of the reasons people have insurance is "just in case" of worst-case scenario situations like that, because they will never be able to afford it themselves.


Maybe her odds of survival with the transplant weren't very good, but her odds of survival without the transplant turned out to be 0%. It's strange that some people on these forums rant about the sanctity of life issues with regards to an embryo but are willing to throw living, breathing children and adults under the bus when they become too expensive to keep alive. :roll:
And when Cigna takes the $100,000 to $400,000 it costs to provide her transplant and divides it up among its other members and has to raise rates to stay in business people like you will be the first to complain about how insurance cost to much money.
 

Rainsford

Lifer
Apr 25, 2001
17,515
0
0
Originally posted by: ProfJohn
Originally posted by: Balt
Originally posted by: ProfJohn
Originally posted by: Kntx
Originally posted by: Slew Foot
65% for 6 months? That's absolutely shitty. Im sure there was a better place to put a liver, Ive seen patients live for 20+ years.
If you were about to fork over $2 million (estimated lifetime cost of a liver transplant) along with an ultra scare resource (human liver), where would you rather put it?
That's not the insurance company's call. It's the doctor's / family's call.
Like it or not it is the insurance companies money.

If the family wanted to pay for it with their own money we wouldn't be having this discussion.

I am 100% sure that the treatment for this young lady ran up into the six figures easily FAR FAR more than her mom or dad will ever pay in premiums over their life time.

Insurance companies exist to make money, not run around paying for every risky and experimental treatment procedure people can think of. The system may suck, but it is still far better than it was 40 years ago.
Give me an f'ing break. :roll:

Some people are going to cost the insurance money more than they will ever pay in premiums. Many people will cost the insurance company far less than they will ever pay in premiums. That's why insurance companies have many, many clients to spread out the risk.

"If the family wanted to pay for it with their own money we wouldn't be having this discussion." - You pointed out yourself that it probably could have cost six figures. One of the reasons people have insurance is "just in case" of worst-case scenario situations like that, because they will never be able to afford it themselves.


Maybe her odds of survival with the transplant weren't very good, but her odds of survival without the transplant turned out to be 0%. It's strange that some people on these forums rant about the sanctity of life issues with regards to an embryo but are willing to throw living, breathing children and adults under the bus when they become too expensive to keep alive. :roll:
And when Cigna takes the $100,000 to $400,000 it costs to provide her transplant and divides it up among its other members and has to raise rates to stay in business people like you will be the first to complain about how insurance cost to much money.

That would seem to underline the real problem, it's not that insurance is expensive, it's that HEALTH CARE is ridiculously expensive.
 

ProfJohn

Lifer
Jul 28, 2006
18,161
7
0
Originally posted by: Rainsford
That would seem to underline the real problem, it's not that insurance is expensive, it's that HEALTH CARE is ridiculously expensive.
Did you miss my post where I pointed out that the survival rate for leukemia has gone from 14% to 50% since 1960?

It may cost a lot, but we are getting our moneys worth.
 

m1ldslide1

Platinum Member
Feb 20, 2006
2,321
0
0
Originally posted by: ProfJohn
Originally posted by: Rainsford
That would seem to underline the real problem, it's not that insurance is expensive, it's that HEALTH CARE is ridiculously expensive.
Did you miss my post where I pointed out that the survival rate for leukemia has gone from 14% to 50% since 1960?

It may cost a lot, but we are getting our moneys worth.

I don't think I would argue with that, at least for those who can get treatment. I just find it very sad and frustrating when step #1 to getting on the list (like someone else pointed out) is whether or not you have funding. That, to me, shouldn't even be a consideration. I don't find wealthy people or public employees (great insurance) to have a greater right to life than anyone else. Obviously that's how it's been through history, and I think it's time to evolve a little. Just a little.
 

alchemize

Lifer
Mar 24, 2000
11,486
0
0
I'd like to hear a bit more on this, so far it just sounds like quite a bit of sensationalization, both from the attorney (yah, right murder charges? How about we charge every lawyer out there with perjury, libel, and treason :roll:) as well as the mother. Sorry mom, Leukemia killed your daughter, not an HMO. You don't like the HMO's decision? Go out of network/out of pocket.

I'll have to ask some doc friends of mine. At first glance, it makes better sense to give somebody a liver that has a much better prognosis. They don't grow on trees, yah know.
 

SirStev0

Lifer
Nov 13, 2003
10,449
6
81
by reversing there decision ... they are admitting they were wrong to deny the transplant.

with that being said... the HMO is going to try to settle the hell out of this one so it doesn't make any news... if this thing went to court it would be HUGE.

and I will finish with ... it is still sad that Corporations make our health care decisions, not doctors or family.
 

alchemize

Lifer
Mar 24, 2000
11,486
0
0
Originally posted by: SirStev0
by reversing there decision ... they are admitting they were wrong to deny the transplant.

with that being said... the HMO is going to try to settle the hell out of this one so it doesn't make any news... if this thing went to court it would be HUGE.

and I will finish with ... it is still sad that Corporations make our health care decisions, not doctors or family.
HMO's reverse decisions every day. HMO's set policy, that policy is subject to review by the employers that provide the insurance and the state insurance boards. They may or may not be wrong, really it's going to come down to their standing policy and their medical management review board. When a transplant is denied - a doctor that works for the HMO is doing the denial, not some pencil-pusher. There will be other cases of this, this won't be the first.

Of course these folks are suing...why do you think their lawyer is trumpeting this up, and the parents are so "grief stricken" that less than 24 hours later they are providing interviews about how the HMO killed their daughter? It's the american way - the lawsuit lottery!

 

Vic

Elite Member
Jun 12, 2001
50,422
14,337
136
Originally posted by: Rainsford
That would seem to underline the real problem, it's not that insurance is expensive, it's that HEALTH CARE is ridiculously expensive.

That's what I keep saying...
 

Slew Foot

Lifer
Sep 22, 2005
12,379
96
86
Originally posted by: m1ldslide1
Originally posted by: ProfJohn
Originally posted by: Rainsford
That would seem to underline the real problem, it's not that insurance is expensive, it's that HEALTH CARE is ridiculously expensive.
Did you miss my post where I pointed out that the survival rate for leukemia has gone from 14% to 50% since 1960?

It may cost a lot, but we are getting our moneys worth.

I don't think I would argue with that, at least for those who can get treatment. I just find it very sad and frustrating when step #1 to getting on the list (like someone else pointed out) is whether or not you have funding. That, to me, shouldn't even be a consideration. I don't find wealthy people or public employees (great insurance) to have a greater right to life than anyone else. Obviously that's how it's been through history, and I think it's time to evolve a little. Just a little.

Step 1 to the list isnt funding, there's a bunch of factors invovled such as estimated life span (how long will the person life with vs without the liver), estimated survival(how likely is the person to survive the procedure), psychological factors (will the patient be able to take care of the new organ- no alcohol, take meds on time), family factors (does person have adequate family support), and of course money (whos going to fork over the nearly 2 mill over the course of the persons lifetime). There not like a farm growing organs where you can slap a new one into every Tom, Dick, and Harry that happens to walk on by. You have to allocate them by need very carefully. Many people wait for years to get livers.