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Thread: Attorney Wants Criminal Charges Against Insurer

  1. #1
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    Attorney Wants Criminal Charges Against Insurer

    Truly sad if what the family is saying is true. Doctors all agreed, but the insurer did not.

    [QUOTE]Attorney Wants Criminal Charges Against Insurer
    Geragos Calls Cigna Official Who Denied Teen's Transplant 'Garbage'
    Dec. 22, 2007 —


    The lawyer for California teen Nataline Sarkisyan charged today that the only reason Cigna Health Care officials changed their minds and approved a liver transplant for the desperate girl was they knew it was too late and they wouldn't have to pay for it.

    Sarkisyan, 17, died Thursday just hours after Cigna reversed its decision and approved the procedure it had previously described as "too experimental&and unproven." Now the Sarkisyan family hopes manslaughter or murder charges will be pressed.

    Their lawyer, Mark Geragos, says he will refer the case to prosecutors for possible criminal charges against the insurer, Cigna HealthCare.

    "All of the doctors there unanimously agreed that she needed and should have that liver transplant. 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," said Geragos.

    "The only reason they approved it is because we had organized a protest in front of Cigna's corporate headquarters& and in the face of public pressure, they did it," he said.

    By the time the approval came through Nataline had been on the liver transplant list for two weeks and her condition had deteriorated so badly that it was too late to have the procedure.

    "I believe, the corporation knew, powers that be knew, that at that point approving the liver transplant was a 'gimme' because her condition deteriorated to the point where she couldn't receive the liver&she didn't have any chance of either, one, getting a liver or, number two, actually being able to receive it," he says.

    Nataline, who was fighting leukemia, developed liver failure after complications from a bone marrow transplant she received from her brother last month.

    Despite her already fragile health, Geragos says, "all of the doctors at the University of California Medical Center unanimously agreed that she needed and should have that liver transplant."

    More than 6,000 liver transplants are performed in the United States every year, making it one of the most common organ transplants, according to the United Network for Organ Sharing.[/QUOTE]

  2. #2
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    Insurance companies.

    Give them money in case sh*t happens.

    The girl was very sick and had already had a bone marrow transplant and had been batting leukemia. She had already cost the insurance company enough money.

    Now the insurance company has more money to go around for old men to get boner pills.

    :rolleyes:

  3. #3
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    We should leave Flushing out of this.

    [QUOTE=PlumberKhan;2279952]Insurance companies.

    Give them money in case sh*t happens.

    The girl was very sick and had already had a bone marrow transplant and had been batting leukemia. She had already cost the insurance company enough money.

    [B]Now the insurance company has more money to go around for old men to get boner pills.[/B]
    :rolleyes:[/QUOTE]

  4. #4
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    That is pretty sad.

    Mark Geragos, that sounds familiar. Wasn't he Scott Peterson's lawyer?

  5. #5
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    Guaranteed her health care costs were vastly higher than what she or her family paid in.

    The trouble with these kinds of high profile cases, is that sometimes it really IS a decison of cost vs. likely outcome, something this doesn't address at all.

    Ok, she "needed" a Liver Transplant. Understood. But what was the post transplant prognosis? We don't know (althoygh one of our resident Docs might speculate, Kennyo or HD).

    How much more money, how many more transplants, how much more effort was this patient going to take? And after all was said and done, would she have still died anyway? No one ever wants to ask these questions, I know, but that does not make them less legitimate to ask.

    The alternative is simple: Any Care "needed" per Docs (any Doc) will be covered and paid for by the Govt. Health Care System. Efficiency and cost savings get tossed, only the Doc's opinion matters, right? And in order to have this great system, where all is covered, and WE all pay for this girl's new Liver, all we have to do is pay ~80% of our income in Taxes.

    Oh, and for the record, I guarantee that in a "Universal Health Care" system, she would definitely have been approved for the Liver........and died waiting the year or two it would have taken to get one, and get the procedure scheduled. Different system, same result.

  6. #6
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    Good questions, but as a father I would go balistic if my child died.

    [QUOTE=Warfish;2280082]Guaranteed her health care costs were vastly higher than what she or her family paid in.

    The trouble with these kinds of high profile cases, is that sometimes it really IS a decison of cost vs. likely outcome, something this doesn't address at all.

    Ok, she "needed" a Liver Transplant. Understood. But what was the post transplant prognosis? We don't know (althoygh one of our resident Docs might speculate, Kennyo or HD).

    How much more money, how many more transplants, how much more effort was this patient going to take? And after all was said and done, would she have still died anyway? No one ever wants to ask these questions, I know, but that does not make them less legitimate to ask.

    The alternative is simple: Any Care "needed" per Docs (any Doc) will be covered and paid for by the Govt. Health Care System. Efficiency and cost savings get tossed, only the Doc's opinion matters, right? And in order to have this great system, where all is covered, and WE all pay for this girl's new Liver, all we have to do is pay ~80% of our income in Taxes.

    Oh, and for the record, I guarantee that in a "Universal Health Care" system, she would definitely have been approved for the Liver........and died waiting the year or two it would have taken to get one, and get the procedure scheduled. Different system, same result.[/QUOTE]

  7. #7
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    [QUOTE=Warfish;2280082]Guaranteed her health care costs were vastly higher than what she or her family paid in.

    The trouble with these kinds of high profile cases, is that sometimes it really IS a decison of cost vs. likely outcome, something this doesn't address at all.

    Ok, she "needed" a Liver Transplant. Understood. But what was the post transplant prognosis? We don't know (althoygh one of our resident Docs might speculate, Kennyo or HD).

    How much more money, how many more transplants, how much more effort was this patient going to take? And after all was said and done, would she have still died anyway? No one ever wants to ask these questions, I know, but that does not make them less legitimate to ask.

    The alternative is simple: Any Care "needed" per Docs (any Doc) will be covered and paid for by the Govt. Health Care System. Efficiency and cost savings get tossed, only the Doc's opinion matters, right? And in order to have this great system, where all is covered, and WE all pay for this girl's new Liver, all we have to do is pay ~80% of our income in Taxes.

    Oh, and for the record, I guarantee that in a "Universal Health Care" system, she would definitely have been approved for the Liver........and died waiting the year or two it would have taken to get one, and get the procedure scheduled. Different system, same result.[/QUOTE]


    you're using to much sense...

    I especially like the mindless comment that "[B]doctors all agreed but the insurer did not[/B]" considering the only person quoted in the article is the lawyer representing the family, and lawyers are always on the up and up....

    people don't realize post diagnoses must always be a factor in these decisions....anybody remember the bruhaha after mickey mantle got his donated organ then died soon after????

    the sad truth is if the young girl had the small percentage of recovery after the transplant there may have well been someone with a much greater chance of recovery who could've used the donated organ- things that don't grow on trees....
    Last edited by Come Back to NY; 12-23-2007 at 01:43 PM.

  8. #8
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    Talking about a 17 year old girl, not a old baseball drunk. Yea, who cares if the kid could live another few years, not worth it money wise.

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    [QUOTE=Warfish;2280082]

    The alternative is simple: Any Care "needed" per Docs (any Doc) will be covered and paid for by the Govt. Health Care System. Efficiency and cost savings get tossed, only the Doc's opinion matters, right? And in order to have this great system, where all is covered, and WE all pay for this girl's new Liver, all we have to do is pay ~80% of our income in Taxes.

    Oh, and for the record, I guarantee that in a "Universal Health Care" system, she would definitely have been approved for the Liver........and died waiting the year or two it would have taken to get one, and get the procedure scheduled. Different system, same result.[/QUOTE]

    Completely agree with all that.

  10. #10
    flushingjet
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    [quote=cr726;2280054]We should leave Flushing out of this.[/quote]

    for the thousandth time
    please stop projecting your degenerate homoerotic fantasies onto
    me

    for the record,
    1) viagra uses some of my testosterone in their formula
    2) i might have a small pen!s, but i know how to use every foot of it

  11. #11
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    You should post more like this more often. It is refreshing to see you are a human.... Funny post.

    [QUOTE=flushingjet;2280126]for the thousandth time
    please stop projecting your degenerate homoerotic fantasies onto
    me

    for the record,
    1) viagra uses some of my testosterone in their formula
    2) i might have a small pen!s, but i know how to use every foot of it[/QUOTE]

  12. #12
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    [quote=pauliec;2280057]That is pretty sad.

    Mark Geragos, that sounds familiar. Wasn't he Scott Peterson's lawyer?[/quote]

    Lawyer to the stars

  13. #13
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    [quote=Warfish;2280082]Guaranteed her health care costs were vastly higher than what she or her family paid in.

    The trouble with these kinds of high profile cases, is that sometimes it really IS a decison of cost vs. likely outcome, something this doesn't address at all.

    Ok, she "needed" a Liver Transplant. Understood. But what was the post transplant prognosis? We don't know (althoygh one of our resident Docs might speculate, Kennyo or HD).

    How much more money, how many more transplants, how much more effort was this patient going to take? And after all was said and done, would she have still died anyway? No one ever wants to ask these questions, I know, but that does not make them less legitimate to ask.

    The alternative is simple: Any Care "needed" per Docs (any Doc) will be covered and paid for by the Govt. Health Care System. Efficiency and cost savings get tossed, only the Doc's opinion matters, right? And in order to have this great system, where all is covered, and WE all pay for this girl's new Liver, all we have to do is pay ~80% of our income in Taxes.

    Oh, and for the record, I guarantee that in a "Universal Health Care" system, she would definitely have been approved for the Liver........and died waiting the year or two it would have taken to get one, and get the procedure scheduled. Different system, same result.[/quote]

    Of course her health care costs were vastly higher than what her family paid in. It balances against the high number of people whose health care costs were vastly lower than what they paid in. That's what the insurance business is about - spreading risk so that you profit on the aggregate, not the individual (and on the float/investments you make before you pay out).

    I know you already know all this, 'fisher, so why the non-sequitur about what her family paid in?

    The fact is, the only bases on which an insurance company should be able to turn down a medical procedure are lack of necessity or futility (i.e. you don't approve a liver transplant for someone with terminal lung cancer). Medical necessity is obviously not an issue in this case, so the only question should be "did the insurer have a reasonable basis to believe that even with the liver transplant, she would die soon".

    Now, I know better than to take every word from an attorney as fact, but if they really denied the transplant as too experimental . . . well, that's pretty damning right there.

    Anyway, I assume you agree with the basic point - if they turned down the transplant purely because they didn't think it was cost effective, they should be punished?

  14. #14
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    I am guessing the insurance company will want to settle out of court. I do not think they want their records becoming official court records.
    What do you think?
    [QUOTE=doggin94it;2281791]Lawyer to the stars[/QUOTE]

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    [quote=cr726;2281800]I am guess that the insurance company will want to settle out of court. I do not think they want their records becoming official court records.
    What do you think?[/quote]

    No question they'll settle. Unless they have some pretty iron-clad reasons for the refusal, "cold insurance company turns down needed surgery for vibrant young woman" is not a battle they want going in front of a jury.

    Of course, threatening criminal punishment to obtain a civil advantage is a clear ethical violation that could get Geragos disbarred, so I wouldn't expect a settlement until, oh, 2-3 days after the prosecutor declines to pursue the case.

  16. #16
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    I would love to see the discovery from the insurance company.

    [QUOTE=doggin94it;2281804]No question they'll settle. Unless they have some pretty iron-clad reasons for the refusal, "cold insurance company turns down needed surgery for vibrant young woman" is not a battle they want going in front of a jury.

    Of course, threatening criminal punishment to obtain a civil advantage is a clear ethical violation that could get Geragos disbarred, so I wouldn't expect a settlement until, oh, 2-3 days after the prosecutor declines to pursue the case.[/QUOTE]

  17. #17
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    [QUOTE=Warfish;2280082]Guaranteed her health care costs were vastly higher than what she or her family paid in.[/QUOTE]

    Unless insurance companies are in the business of giving money BACK to people who never file claims...then I don't want to hear it.

    That's part of the risk of running an insurance company.

  18. #18
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    [QUOTE=Warfish;2280082]

    Ok, she "needed" a Liver Transplant. Understood. But what was the post transplant prognosis? We don't know (althoygh one of our resident Docs might speculate, Kennyo or HD).

    How much more money, how many more transplants, how much more effort was this patient going to take? And after all was said and done, would she have still died anyway? No one ever wants to ask these questions, I know, but that does not make them less legitimate to ask.

    The alternative is simple: Any Care "needed" per Docs (any Doc) will be covered and paid for by the Govt. Health Care System. Efficiency and cost savings get tossed, only the Doc's opinion matters, right? And in order to have this great system, where all is covered, and WE all pay for this girl's new Liver, all we have to do is pay ~80% of our income in Taxes.

    Oh, and for the record, I guarantee that in a "Universal Health Care" system, she would definitely have been approved for the Liver........and died waiting the year or two it would have taken to get one, and get the procedure scheduled. Different system, same result. [/QUOTE]

    Happy Holidays all. War, in regards to your question, I don't know all the details of the case, but someone who underwent a bone marrow transplant and then requires a liver transplant is a very sick individual. Don't know what the survival rates are, but I am sure it is not a slam-dunk livesaving venture. You are asking excellent and difficult questions. Who wants to say the prognosis is dismal for a 17 year old?

    That being said, you would be hard-pressed to find a doctor treating the patient who would say treatment for a 17 year old is futile. Not necessarily because they believe it would be successful, but because they don't want to be the "bad guy". I see this alot with older patients who are dieing and the family has unrealistic expectations. It is hard enough dealing with these dynamics in an 80 year old, I can only imagine things would be escalated in a 17 year old. So when Gergos says that "every doctor at UCLA" is in agreement, if you asked them privately and anonymously, their opinion may be different. In our set-up, the family or patient control medical decision making. I have seen many times a family decide they "want everything done" when in my medical judgement care is futile. And I can't do a thing about it. What is unique in this case is that an insurer balked.

    As far as socialized medicine solving these problems, these "difficult decisions" are made all the time in these societies. Often patient care decisions are taken out of the hands of the family and patient. In Germany for example, if your kidneys fail and you need dialysis, if you are 75 years old it is not a sure thing that you will get this service. And I know about this because my wife's family lives there. The problem here is that Americans want "everything done" but do not recognize the costs involved because they feel it does not affect them. Patients complain if their co-pay goes up Five dollars. Imagine the outrage at European tax rates to pay for "everything being done". This attitude is what is crushing the medicare system. I saw somewhere once that over 50% of medicare expenses are utilized in the last 6 months of life. Much of this can be attributed to what I call "futile care".

    So while this is a sad situation on an individual level, if you look at it from a universal perspective the answer is not so clear cut. As doctors, we deal with the individual level. If this was the only way to save this girl's life, I am not surprised that the doctors were pushing for it, even if it raised her chance of survival from 0% to 2%.

    Hope this answered your question. Sorry for the long-winded response.

  19. #19
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    [QUOTE=Warfish;2280082]Guaranteed her health care costs were vastly higher than what she or her family paid in.

    The trouble with these kinds of high profile cases, is that sometimes it really IS a decison of cost vs. likely outcome, something this doesn't address at all.

    Ok, she "needed" a Liver Transplant. Understood. But what was the post transplant prognosis? We don't know (althoygh one of our resident Docs might speculate, Kennyo or HD).

    How much more money, how many more transplants, how much more effort was this patient going to take? And after all was said and done, would she have still died anyway? No one ever wants to ask these questions, I know, but that does not make them less legitimate to ask.

    The alternative is simple: Any Care "needed" per Docs (any Doc) will be covered and paid for by the Govt. Health Care System. Efficiency and cost savings get tossed, only the Doc's opinion matters, right? And in order to have this great system, where all is covered, and WE all pay for this girl's new Liver, all we have to do is pay ~80% of our income in Taxes.

    [B]Oh, and for the record, I guarantee that in a "Universal Health Care" system, she would definitely have been approved for the Liver........and died waiting the year or two it would have taken to get one, [/B]and get the procedure scheduled. Different system, same result.[/QUOTE]

    First, you are wrong about the time it would take for a Liver transplant in a universal health care system. Liver transplantation for Refractory Acute GVHD of the Liver (what she had) is a medical emergency and she would not have had to wait any longer, just as she would not have to wait for any medical emergency in a universal health care system.

    You do bring up alot of good points. One of the major complications of allogeneic stem cell transplants is developing GVHD (skin, liver, GI tract being the most common sites affected). This has a lot of morbidity and a significant mortality associated with it and is why allogeneic stem cell transplants are so risky/dangerous. People (including the insurance companies) know this ahead of time. Its a potential risk associated with the procedure. So the question is why agree to a procedure if you are not willing to treat the potential side effects associated with it??

    What are the chances of her dying w/o the Liver transplant?? 100%. With the Liver Transplant?? This is really unknown and difficult to predict. But given her young age, and with adequate immunosuppresion I would venture to say she has a decent (20-40%) chance. Of course i dont know her entire history so that is a wild guess.

    So Fish, what are you willing to pay for? I mean this is a good question. Should we be paying for the treatments of complications associated with Alzheimer's Disease knowing full well that they will never get better and just die anyways? How about old people with significant comorbidities. Should we be paying thousands of dollars per day for them to have prolonged ICU stays on mechanical ventilators? Should an insurance company pay for a knee replacement surgery on an obese, hypertensive diabetic with little motivation for post-op rehab when they can simply keep it on the cheap by treating him with less costly pain medications? When is a disease "worth the cost of treatment" and who should decide it?? This is a good and important question that we must ask ourselves.

  20. #20
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    [QUOTE=kennyo7;2281965] When is a disease "worth the cost of treatment" and who should decide it?? This is a good and important question that we must ask ourselves.[/QUOTE]

    Agreed.

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