Nataline Sarkisyan
Born
Nataline Mary Sarkisyan

(1990-07-10)July 10, 1990
Los Angeles, California, U.S.
DiedDecember 20, 2007(2007-12-20) (aged 17)
Los Angeles, California, U.S.
OccupationStudent
Parent(s)Krikor (also spelled Grigor) and Hilda Sarkisyan

Nataline Mary Sarkisyan (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

Sarkisyan was born to an Armenian-American family.[3] She was diagnosed with leukemia at age 14. She was covered under her father's health insurance, through his employer, Mercedes-Benz. The employer plan was administered by Cigna HealthCare.[4] During her treatment for leukemia, her liver deteriorated.

Sarkisyan's doctors at the UCLA Medical Center told the family and Cigna that they recommended a liver transplant, and patients in similar circumstances have a six-month survival rate of 65%. Different doctors gave different estimates of the likelihood of success. Dr. John Roberts, chief of the transplant service at UC San Francisco (not the transplant center treating Sarkisyan), said that his center generally does not accept a patient without a 50% or greater five-year survival rate. Dr. Goran Klintmalm, chief of the Baylor Regional Transplant Institute in Dallas, said this particular operation was a "very high-risk transplant," but that he would consider the same operation on a similar patient.[5] On December 11, 2007, Cigna rejected the request for coverage for the liver transplant. Sarkisyan's doctors at UCLA, 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.[6] Cigna said 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.[7]

Wendell Potter, a Cigna PR executive, advised the board to cover the cost of Sarkisyan's liver transplant as her situation became increasingly high profile. A flash point occurred during a protest for Sarkisyan in front of Cigna's offices in Glendale, California with live coverage from CNN. During the protest, the company agreed to reverse its decision and offered to pay for the transplant itself (independent of the insurance policy) when it made the exception to the policy. Potter advised a colleague from the regional office to inform the Sarkisyan family that Cigna would provide coverage, to which Hilda Sarkisyan, Nataline's mother, responded by jumping in joy and hugging supporters. [8][9] Nataline Sarkisyan died a few hours after Cigna's reversal of its policy.[10] Sarkisyan is buried at Forest Lawn Memorial Park (Hollywood Hills).[11]

Aftermath

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.[12][13][14]

Cigna PR Executive Wendell Potter resigned shortly after Sarkisyan's death and blew the whistle on the health insurance industry.[15]

Lawsuit

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.[16][17][18][19] 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.[20]

See also

References

  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. ↑ "Loved ones mourn loss of Nataline". Los Angeles Times. 29 December 2007.
  4. ↑ Hundreds attend funeral for Southern California teen who died during transplant delay, By Associated Press and Noaki Schwartz, Mercury News, December 28, 2007
  5. ↑ "Tough calls in transplant case - Los Angeles Times". Los Angeles Times. 2007-12-22. Retrieved 2012-10-08.
  6. ↑ "CIGNA document" (PDF). Cigna.com. Retrieved 2012-10-08.
  7. ↑ 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)
  8. ↑ Aronczyk, Amanda; Smith, Robert (2020-10-23). "Frame Canada". NPR. Retrieved 2021-10-15.
  9. ↑ Vanessa Fuhrmans & Laura Meckler; "A Medical Case Becomes Political"; The Wall Street Journal 2008-01-07, p. A1
  10. ↑ Pilkington, Ed (21 December 2007). Insurer's U-turn too late to save life of transplant teenager, The Guardian
  11. ↑ "Loved ones mourn loss of Nataline". Los Angeles Times. 29 December 2007.
  12. ↑ 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.
  13. ↑ Wendell Potter Deadly Spin: An insurance company insider speaks out how corporate PR is killing health care and deceiving Americans Archived 2011-01-24 at the Wayback Machine, Bloomsbury Press, November, 2010, chapters 8-9
  14. ↑ 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, The Philadelphia Inquirer
  15. ↑ Aronczyk, Amanda; Smith, Robert (2020-10-23). "Frame Canada". NPR. Retrieved 2021-10-15.
  16. ↑ (22 December 2007). Attorney Wants Criminal Charges Against Insurer , ABC News
  17. ↑ Hernandez, Miriam (21 December 2007). Teen's family plans to sue health insurer, KABC-TV
  18. ↑ Abram, Susan (10 July 2012). "Annual fashion show keeps Nataline Sarkisyan's story alive". Daily News Los Angeles. Retrieved 23 January 2013.
  19. ↑ (21 December 2007). Lawsuit promised in transplant case, USA Today
  20. ↑ Lisa Girion (2009-10-18). "Insurer's agreement to cover surgery comes too late - Los Angeles Times". Articles.latimes.com. Retrieved 2012-10-08.
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