Cigna Defends Administrative Decision That Leaves Girl Dead

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Cigna HealthCare is taking heat this Christmas but isn't backing down after its decision to deny a liver transplant to a teenager afflicted with leukemia left her dead.

Nataline Sarkisyan, 17, died last week after suffering complications following a bone marrow transplant. Cigna had refused to cover a liver transplant the girl's doctors had requested, dubbing it "experimental," only to reconsider at the last minute when the girl's parents had already decided to take her off life support.

After taking a beating in the press and on the Web, the Philadelphia-based insurance giant distributed a letter to the press Monday defending their decision.

In a letter cowritten by Cigna President David Cardani and Chief Medical Officer Dr. Jeffrey Kang, the company said they doubted the efficacy of the transplant procedure in Sarkisyan's case.

"In this case, rather than going through our standard method of appeal, we went directly to not one, but two independent experts in the field who agreed that the procedure in question, given the patient's particular circumstances, would not have been an effective or appropriate treatment," they wrote, evaluating her case on "evidence-based guidelines published by independent physician and medical organizations, as well as expert scientific journals."

Sarkisyan's family say they will sue the insurer. They allege Cigna twice took her off the transplant list and "purposely" waited until she was near death to approve the transplant because the firm didn't want to bear the costs of the procedure or rehabilitation following the operation.

According to the memo distributed to the press, the insurer approves "more than 90%" of all liver transplants requested by its subscribers.

"UCLA doctors put her on a list for a liver transplant Dec. 6 and a liver became available four days later, the family said," according to the LA Times. "Her doctors told Cigna in a letter that patients in similar situations had a 65% chance of living six months if they received a liver transplant."

Cigna refused the procedure, however, dubbing it experimental. Last Thursday, they reversed their decision, allowing the transplant to move forward even though they considered it experimental and outside the scope of her mother's policy.

By the time news reached Sarkisyan's family, however, the girl was already dead. Her parents opted to take her off life support earlier that day, seeing no hope of recovery.

In the letter, Cigna's officers said they would not comment on the family's specific charges, saying only some of the accusations "have mischaracterized our decisions and intentions."

"What is often misunderstood is that most health benefit plans, whether public or private, do not cover unproven and experimental treatment related to transplants or other treatments," they wrote. "Coverage decisions under these plans are based on the best scientific and clinical evidence available, often utilizing external experts, without consideration of cost."

During a candlelight vigil Sunday, family attorney Mark Geragos said he had evidence Sarkisyan's denial was part of a broader Cigna corporate policy.

"Within the last 48 hours, I received e-mails from CIGNA employees who said that this was a corporate policy - to deny, deny, deny," Geragos said, according to CBS.

Her case made the editorial page of the Houston Chronicle Christmas day.


Posted by Glis on 2007-12-31 20:54:21
She had a 65% chance of living 6 more months if she got the liver? I'm sure it got put to a better use.


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