CIGNA and the Death of Nataline Sarkisyan: When Both Sides Are Right… And Wrong

Seventeen-year-old Nataline Sarkisyan of Northridge, California, died last week, a victim of liver failure brought on by a failed bone marrow transplant. Nataline, having fought leukemia for the past four years, had received the transplant from her brother Nov. 21. Now, her parents are trying to sue Cigna HealthCare for her death, calling it “murder.” Cigna, the family’s insurer, had refused to cover the liver transplant Nataline’s doctors had recommended, calling the procedure “experimental” and noting that Nataline’s family did not have that level of coverage.

"All of the doctors there unanimously agreed that she needed and should have that liver transplant,” said the Sarkisyan family’s attorney, Mark Geragos, referring to the medical team at the University of California Medical Center, who had found a liver for Nataline and were ready to do the procedure. Geragos, quoted online at ABCNews.com, added, “And the only entity, if you will, who said no to that in the middle of that medical decision, was some piece of garbage who decided that making a couple of dollars, or saving them a couple of dollars, was worth more than the 65% chance over six months that she would survive."

Tough words. And a tough call. This case isn’t as “good guy, bad guy” as it appears, though it has polarized the public all over the world, if online comments to news stories (and blogs) are any indication.

There are a number of issues complicating the Nataline Sarkisyan case. To me, one of the most pressing is this: If the doctors all agreed that Nataline should have the transplant, why did they not go ahead and do it, Cigna be damned?

Don’t doctors do EVERYTHING in their power to save a patient in an emergency situation, and worry about the money afterwards?

Also, why did the highly respected transplant team at UC Medical Center approve the transplant in the first place, when other transplant specialists have noted that it would inevitably have failed? Observed Dr. Stuart Knechtle, who heads the liver transplant program at the University of Wisconsin at Madison, in recent Associated Press reports: “The immune-system-suppressing drugs… could make the cancer worse.”

Since Nataline’s leukemia was already deadly, taking the necessary immunosuppressants would probably have given her cancer the edge it needed to finally kill her. And if she didn’t take the drugs, the transplant would almost certainly have been rejected. She was in a no-win situation.

Karen Ignagni, speaking for America's Health Insurance Plans, an industry trade group, noted that while employers don’t want to pay for the extra coverage for experimental procedures (and few do); nor do employees want to foot the increased premiums, when someone’s life is on the line, everyone wants that coverage.

"We've been looking very seriously at this issue because [experimental coverage] is over and above what employers purchase," she said, quoted in the Los Angeles Times Saturday. "But individuals, when they are facing these extreme circumstances, want to have a place to go. They want solutions. We need to address this issue from a societal perspective."