Death of Nataline Sarkisyan

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Nataline Sarkisyan
Natalinesarkisyan.jpg
Born Nataline Mary Sarkisyan
(1990-07-10)July 10, 1990
Los Angeles, California, U.S.
Died December 20, 2007(2007-12-20) (aged 17)
Los Angeles, California, U.S.
Occupation Student
Parents Krikor (also spelled Grigor) and Hilda Sarkisyan

Nataline Mary Sarkisyan (Armenian: Նատալին Սարգիսյան; July 10, 1990 – December 20, 2007) was an American teenager with recurrent leukemia. Her case became part of the health care reform debate in the United States in 2007 when Cigna HealthCare denied coverage for a liver transplant operation. The company later reversed its decision after a great deal of media attention to her story, but Sarkisyan died hours later.[1][2]

Background[edit]

Diagnosed with leukemia at age 14, Sarkisyan had health insurance coverage under the employer coverage of her parents. Physicians informed the family and insurance company[when?], Cigna HealthCare, that patients in similar circumstances have a six-month survival rate of 65% after a liver transplant.[citation needed] The likelihood of success of the recommended procedure was questioned. Dr. John Roberts, chief of the transplant service at UC San Francisco (not the transplant center treating Sarkisyan), stated[when?] that his center generally does not accept a patient without a 50% or greater five year survival rate. The chief of the Baylor Regional Transplant Institute in Dallas, Dr. Goran Klintmalm, said[when?] this particular operation was a "very high-risk transplant." Dr. Klintmalm did state that he would consider the same operation on a similar patient.[3] On December 11, 2007, Cigna rejected the request for coverage for the liver transplant. Sarkisyan's doctors at the UCLA Medical Center, including the head of its transplant unit, wrote a letter to protest that the treatment proposed was neither experimental nor unproven and called on Cigna to urgently review its decision.

Cigna HealthCare refused to pay for treatment by citing policy provisions which do not cover services considered experimental, investigational and/or unproven to be safe and/or effective for the patient.[4] Cigna noted that it had no financial stake in the decision because it only administered the insurance plan and would not bear the cost of any operation. The cost of a liver transplant and one year of follow-up care was $450,000 in 2005. UCLA declined two livers while waiting for insurance approval from Cigna. Ms. Sarkisyan's family was also informed that they could proceed with the transplant if they could make a down-payment of $75,000.

Among the groups who publicly spoke out against Cigna's decision was the California Nurses Association/National Nurses Organizing Committee.[5]

After public media attention grew, Cigna reversed its decision, but offered to pay for the transplant itself when it made the exception to the policy.[6] Cigna's reversal of its policy, offering to pay for the transplant, came several hours before Sarkisyan's death.[7]

Aftermath[edit]

Sarkisyan's family spoke out at a New Hampshire rally in support of Senator John Edwards' presidential campaign on January 6, 2008 based on his advocacy of reforming and overhauling the US health care system.[8][9][10]

Lawsuit[edit]

Sarkisyan's family retained attorney Mark Geragos to sue Cigna, and requested that Los Angeles County District Attorney Steve Cooley file murder charges against the insurer.[11][12][13][14] The case was thrown out due to a Pilot Life Ins. Co. v. Dedeaux, 1987 U.S. Supreme Court ruling shielding employer-paid healthcare plans from damages over their coverage decisions.[15]

See also[edit]

References[edit]

  1. ^ Flower, Joe. Healthcare Beyond Reform: Doing It Right for Half the Cost, p. 193
  2. ^ Chen, Pauline W. (6 January 2011). When Insurers Put Profits Between Doctor and Patient, The New York Times
  3. ^ "Tough calls in transplant case - Los Angeles Times". Latimes.com. 2007-12-22. Retrieved 2012-10-08. 
  4. ^ "CIGNA document". Cigna.com. Retrieved 2012-10-08. 
  5. ^ Prosono, Marvin. 'Bystander Sociology' and the Sonderbehandlung of the Social in The Shape of Sociology for the 21st Century: Tradition and Renewal, at p. 273 (2010)
  6. ^ Vanessa Fuhrmans & Laura Meckler; "A Medical Case Becomes Political"; The Wall Street Journal 2008-01-07, p. A1
  7. ^ Pilkington, Ed (21 December 2007). Insurer's U-turn too late to save life of transplant teenager, The Guardian
  8. ^ TomP (2008-01-06). "Update IV (Video of Sarkisyans at Rally): Family of Nataline Sarkisyan To Join Edwards Today". Daily Kos. Retrieved 2012-10-08. 
  9. ^ Wendell Potter Deadly Spin: An insurance company insider speaks out how corporate PR is killing health care and deceiving Americans, Bloomsbury Press, November, 2010, chapters 8-9
  10. ^ Burling, Stracey (13 January 2008). When a health insurer says it won't pay Ethicists and economists say a 17-year-old girl's case points up complex questions on rationing resources, Philadelphia Inquirer
  11. ^ (22 December 2007). Attorney Wants Criminal Charges Against Insurer , ABC News
  12. ^ Hernandez, Miriam (21 December 2007). Teen's family plans to sue health insurer, KABC-TV
  13. ^ Abram, Susan (07/10/2012). "Annual fashion show keeps Nataline Sarkisyan's story alive". Daily News Los Angeles. Retrieved 23 January 2013. 
  14. ^ (21 December 2007). Lawsuit promised in transplant case, USA Today
  15. ^ Lisa Girion (2009-10-18). "Insurer's agreement to cover surgery comes too late - Los Angeles Times". Articles.latimes.com. Retrieved 2012-10-08. 

External links[edit]