Negligent Insurance Companies Claim Another Victim

A 17-year old girl suffering from leukemia died yesterday in the UCLA hospital a few hours after her insurance company, CIGNA, approved a liver transplant that had been denied before due to the lack of evidence that the transplant would help her condition. Her parents removed her from life support, because they deemed her condition as “hopeless.”

CIGNA initially declined to pay for the transplant for Nataline because her plan did not cover “experimental, investigational and unproven services,” her doctors said.

The denial prompted a nationwide series of protests, including a rally outside CIGNA’s Glendale offices attended by a crowd estimated by organizers at 150. Hundreds of telephone callers also clogged lines at CIGNA offices around the nation today on Nataline’s behalf, organizers said. About 15 minutes into the rally, it was announced that CIGNA would make an exception to its rules and approve the transplant.

Sadly, the case of this girl, Nataline Sarkisyan, is far from being unique. Even if we cannot agree on the ways in which we can bring about health care to all without exception, I am going to assume that we can agree on how inherently wrong it is that the fate of many lives are decided by a few people in closed-door meetings . It is simply not right and not just.  Enough of the bureaucracy in the health care system of this country.

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  • http://www.patheos.com/blogs/voxnova/ Morning’s Minion

    THis is simply inevitable when the profit motive underpins health care. The extra adninistrative cost of the US health care industry, compared with government insurance programs in other countries, is $84 billion a year. That means money spent to screen patients and deny claims.

  • PJ

    An incredibly sad state of affairs. I wonder how health care has gone from a basic human right to a profit-motivated industry. Below is a link to an article by Glenmary Father John Rausch of the Catholic Committee of Appalachia. A good read.

    http://www.ccky.org/Resources/Rausch/2007/11%2016%2007%20Doctoring%20the%20Health%20Care%20System.pdf

    The link is also accessible through the Catholic Conference of Kentucky’s website,
    http://www.ccky.org

    Peace

  • http://populisthope.blogspot.com Matt Talbot

    I’ve heard this sort of thing described as “murder by spreadsheet”.

  • arewak

    Watch out for the “Dems are pro-abort” responses…never fails.

  • Jonathan

    Odd – her parents removed her from life support because they said that her condition was hopeless? And CIGNA approved the transplant?

    Why don’t we point the finger at UCLA, which has the resources (with a 1 billion dollar plus endowment, much of it earmarked for the medical school) to have funded this surgery? Why didn’t the patient advocates, nurses, and so on, ask the school, which has so much money and was certainly aware of the gravity of the situation, to fund this operation?

    Or is it simply that the insurance company is too easy a target?

  • http://civilizationoflove.wordpress.com Katerina Ivanovna

    Jonathan,

    Let’s not miss the big picture here and let’s not play the blame game. Even if UCLA decided to pay for the transplant, this is only ONE case that we’re talking about. What about the hundreds (or thousands?) of people who cannot receive the treatment they need to survive? Is UCLA going to pay for that as well? Or the respective hospitals? Sustainable healthcare is simply not going to be achieved by relying on charity or donations from hospitals. It is simply not sustainable. The questions you are raising are not directed to provide a sustainable health care system that covers everyone. Honestly, this is what I don’t understand about the health care argument of many. Let us not focus on the specific circumstances of a single case, because it just doesn’t apply to every case. As I said, this case is not unique. Let’s look at the big picture and ask the right questions.

  • Jonathan

    If we’re not going to play the blame game, why did you, in your initial post, point the finger at the insurance company?

    These are some questions, then:

    1) How can health care for all (which is a charitable endeavor, as it will care for individuals who almost always not be able to pay for it) not be based on charity (in your opinion)?
    2) What would the system you envision look like?
    3) How can it be enacted without making a massive bureaucracy to replace the insurance bureaucracy, in the process?
    4) How do you avoid any potential problems of violation of subsidiarity discussed in Quadragesimo Anno, which violations are considered therein to be a “grave evil?”
    5) If the greatest mission of the Catholic, and the mission of the Church is salvation of souls, how would the health care plan which you envision further that mission?

  • Blackadder

    This is clearly a tragic situation. I would note a couple of things, however.

    There are tens of thousands of patients in the U.S. on liver transplant waiting lists, and more than a thousand die each year while waiting for a liver (the percentage of those who die waiting for a liver, by the way, is significantly higher in Canada than it is here). Because of the limited supply, giving a liver to Nataline Sarkisyan would have meant that someone else, quite likely someone with an equally tragic personal story, would not have gotten a liver, and quite possibly would have died because of it. The same is true of other sorts of transplants as well – the demand for organs is much greater than the supply, and many people die because of it.

    Now, there are some organs that cannot be transplanted from a live donor, and in such cases the supply of organs is largely beyond anyone’s control. But there are some organs, such as the kidney and the liver, where live donor transplants are possible, and if we wanted to increase the supply of such organs (and thus save lives, each of which is as precious as Nataline Sarkisyan) one way to do so would be to allow donors to be paid for donating their organs. More information on this idea can be found here:

    http://www.liberty-page.com/issues/healthcare/organs/main.html#socialism

  • http://www.patheos.com/blogs/voxnova/ Morning’s Minion

    It is quite right to point one’s finger at the insurance company. As I said, they are in business to make money. Paying out insurance claims is deemed a “medical loss” in their parlance.

    Now, as I’ve mentioned before, the subsidiarity angle is barking up the wrong tree. Moving from a large bureaucratic profit-making insurance company to a large bureaucratic non-profit making government insurance plan has no implications for subsidiarity, but major implications for solidarity (because the universal insurance system does not make a living by denying claims). If subsidiarity is a problem, then you have to question every large insurance scheme that pools risks.

    Subsidiarity could be a problem if the government actually ran the health care system in its entirety (which is one reason why I’m not fond of the British system). But most single payer systems are not like that– doctors work for themselves, hospitals are independent, and the only effect is that instead of a plethora of private insurers they deal with one. Ideally, for subsidiarity, we need more emphasis on primary care and a personal relationship between the doctor and patient. We are far more likely to see that in a place like France than here (try getting an after hour’s appointment). More generally, the US system is actually biased against primary care, and instead people rely on the ER which is hardly optimal.

  • Jonathan

    It seems even more strange than an institution nominally “not” in it for the money, UCLA, would not have stepped forward, then, does it not?

    That does not answer my last question though – on the question between such a system and salvation?

  • Joe

    Minion:
    1) Not sure what subidiarity as a general and complex moral principle has to do with the claim you make about primary care vs. the ER. Or, for that matter, why the ER, since it is indeed open to everyone, apparently doesn’t constitute acceptable medical care.

    2) Not sure why as a general rule government bureacracies–wide-mouthed siphons of human resources–are deemed to be free of greed, concupiscence, saving money, and sin, while private industry is usually automatically driven merely by profit margins.

    3) Not sure why universal medical care is a “right”; not to say that it isn’t a moral good, but if indeed we define it as a right, where are its limits and obligations, and what are the responsibilities and obligations of those seeking it?

    4) Everyone dies.

  • http://civilizationoflove.wordpress.com Katerina Ivanovna

    If we’re not going to play the blame game, why did you, in your initial post, point the finger at the insurance company?

    Perhaps because this family paid CIGNA so they could cover their health care costs and they declined their request to cover a liver transplant?

  • Jonathan

    Which isn’t true – the family paid CIGNA to cover some of their care costs. I know of no health insurance plan which covers all costs, especially transplants.

  • Joe

    Katerina:

    Is an insurance company ever morally allowed to decline a claim, regardless of whether or not the contracting parties agreed to the policy limitations? If so, then an insurance company declining a claim can’t automatically bear the blame should someone die while insured by them. If, on the other hand, an insurance company does not have the moral right to deny a claim under any circumstances, then we are really saying that insurance companies as such are inherently immoral entities–which is actually itself an incredibly hasty generalization, as well as a possible calumny, without a more detailed account of who made what decision when based on what evidence.

    Further, you said “let’s not miss the big picture here and let’s not play the blame game.” Does the big picture include UCLA’s responsibilities at the administrative and medical levels, the particular individuals at said insurance company that may or may not have had culpability in a moral decision, the reporters relaying the details of the story accurately (or not), the laisons that served as intermediaries between the family and the company’s rep, the writers of the insurance company’s policy, the people of the LA basin that didn’t throw money in a hat for a liver transplant for such a dire case? Or is the “big picture” really just filled with a great amorphous insurance company, the blatant beast cloaked in black? OF COURSE we’re playing the blame game. That’s why this was posted in the first place.

  • Policraticus

    Joe,

    Katerina was writing about a specific case where death occurred. Don’t distract by speaking generally of insurance claims. While your questions are certainly important, they do not get to the heart of Katerina’s concern of bureaucracy deciding who needs what to live.

  • Donald R. McClarey

    “they do not get to the heart of Katerina’s concern of bureaucracy deciding who needs what to live.”

    Precisely why I am opposed to government health care.

  • Joe

    Policraticus:

    I think you’re misreading both me and Katerina. I won’t speak for her, but as for me, getting at the general principles this conversation is theoretically espousing is precisely the relevant point, not an anecdote. Anecdotes, strictly speaking, give us nothing in terms of developing a consistent philosophical critique of moral theology in the case of “health care,” whatever we mean by the term. Rather, then, my questions indeed get right to the heart of the issue at stake here: what, exactly, is the moral role of an insurance company (assuming it has one and is not a blatant beast, so to speak)? And how does such an incident allow us to move from the anecdotal to a global critique of health care without evidence?

    In other words, asking such questions IS getting at the heart of the issue vis-a-vis the anecdote. Unless, of course, getting at the heart of the issues beneath the anecdote through reason isn’t the point of this….

  • Policraticus

    Joe,

    Your questions here are new. And, no, you are not getting to the heart of Katerina’s issue, but the issue with which you are trying to supplant her issue. The “general principles,” likewise, are of your own issue, not that of Katerina.

    And, no, I am not “misreading” Katerina. I just spoke with her this evening. Like I said, the issue you bring up is a good one, it’s just misplaced in this thread.

  • http://www.ratzingerfanclub.com Christopher

    Katerina was writing about a specific case where death occurred.

    Insofar as Katrina’s chosen title can lead one to think she’s making a general indictment of evil miserly insurance companies (“Negligent Insurance Companies Claim Another Victim”) I think Joe’s questions (posed Dec. 21 8:19PM) are pertinent — and I would for one be curious if Vox Nova might take them up.

    If not in this comment-thread, then perhaps a post.

  • Jonathan

    One may also ask, in terms of subsidiarity, how the requirement of “temporary”which is discussed in Quadragesimo Anno will be met by a federal insurance program?

  • Shannon

    I wrote this story to Legislators when I was 14 years old,and I want to share it with you,today I am 26, and my family is still fighting to fix this system, so there will be no more victims.

    I am 14 years old and I am a victim of medical malpractice. I am writing to the Congress and the Senate because you need to help the victims of medical malpractice. I was ill, my head hurt and my mom took me to the doctor. I had frequent nose bleeds and bad headaches. I think this started in the end of 1992 or early 1993. They said I was okay, and I remember one doctor was so mean to my mom and me; she didn’t even want to talk about it. She said it was all in my head, that I was okay. 1993 and 1994 were not good years in my life. I was unhappy. My mom was always sick, always in bed coughing, always going to CIGNA getting medicine, always too tired. My mom was not the same mom any more; my head hurt on and off, and I tired not to bother my mom as I could see how ill she was. She was always depressed, always crying, and always moody and coughing. I would yell at her to shut up at night and she kept us all awake, now I feel bad.

    In February 1994, I was depressed, my head was hurting, and I took pills from the medicine cabinet, it wasn’t the first time I did this, but my mom was sick she didn’t even notice. Each time I took more and one day my mom came in to wake me up and I wouldn’t get up, I was too tired. My mom said that’s it, get dressed; we are going to CIGNA right away. I went there and CIGNA doctors saw me. They sent me to a mental health place and neither of these two places even knew what I had done. My mom walked me about and I told her what I ad done. Later that day she said how could she live if I died. My mom cried because she was so tired she blamed herself because she wasn’t doing enough. I made my mom a promise not to do this again. My mom called CIGNA and got upset about how they failed to see I had tried to kill myself, asking them what kind of doctors they were. My mom screamed so much they agreed to give me a complete physical. At the physical in early March, we complained so much about my head they agreed to do scans of my head. This went on for about two and a half months, one scan after another, and finally the doctor said I needed to have my sinus washed out, that was in the end of May. My mom asked if this was urgent, did it need to be done right away, the doctor answered it was not urgent. My mom said we would have it done in the summer vacation.

    From May to August, my mom got very ill. She went to the doctor and they put her on disability for 6 weeks. In the middle of July, I had a dream that my mom had lung cancer and she was going to die. My mom got very upset when I told her this. By the beginning of August, my mom sent me to Ireland for one month to visit my grandparents. When I came back from Ireland in the end of August, our home was in an uproar, for 2 weeks CIGNA had refused to give my mom all her x-rays telling her they were lost. She had just got them and it showed she had the lung cancer for almost 2 years. My mom had an operation and 20% of her lung was removed. She had a carcinoid tumor. When my mom was in the hospital, the surgeon told my step-dad he was not well either. It ended up that CIGNA refused to release my step-dad’s records for 2 weeks. When they went to an outside doctor, CIGNA had been treating him for asthma; he really has a very advanced case of COPD and had something on his left lung like my mom had.

    We went and got the records for all our family. When we saw mine, and we went to an outside doctor, after going outside doctors I know now what the difference is between a real doctor and a CIGNA doctor is, and I hope maybe one day I’ll get to tell you all about that. I had a problem where the bone was being destroyed, where the bone was pushing through the orbit, and the doctor said my eye would have been pushed out. I had my surgery at Cedar-Sinai. 1995 is not much better that 1993 as there seems to be no justice for all these things that CIGNA did to us. We want to get the laws changed so no one will ever have to suffer like this again. CIGNA abuses our family to this very day. They make my mom cry for hours and I hope you will let me tell you all about this too. CIGNA should also know if my parents die, where will I go, and what will happen to my brother and sisters? I’m an American, and when I grow up, I don’t want to live here. I want to move to where people are good and kind. I’ll move to Ireland.

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