(Untitled)

[anax]

Yesterday there was a big hullabaloo about this teenager with leukemia who was being denied a liver transplant by her insurance company (Cigna). Here's the story on Crooks and Liars and there are links to other stories about it. You can also pray to google for info on Nataline Sarkisyan for more stories

Comments

[jamalyn]

It is a sad case, and whilst I will never be one to tell you insurance companies do not make money (they do), I think people need to remember that they can only spend a finite amount of money before collapsing. No company will risk that happening. Truth is, you can shame and hairy them into making just about any decision you want, but do so realizing that those dollars could (and yes, I think should) be spent on something or someone who has an honest fighting chance. It's a cold opinion, I know. But I deal with this day in and day out on the medication side. Prior authorizations are nothing new for us. But this is today's sad truth: many medications (and I might be using what I know of human nature to falsely extrapolate to medical procedures) are NOT necessary. No, tamiflu will not help you get over the flu. No, meridia is unlikely to help you obtain any significant weight loss. No lunesta does not work any better than generic ambien or, for that matter, cutting back on the caffeine and taking a warm bath. So why pay

[anax]

By the point where they were recommending a liver transplant, it's my understanding that she'd lapsed into a vegetative state and didn't know any more what was going on around her. That would make it very easy on her, and I hope that was, in fact, the case.

Let's not forget that, by not giving her the transplant, that liver is now available for someone else, someone who has better odds. I think that's another factor that everyone who is raising a hue and cry is forgetting.

I can't disagree with you about the meds, btw. Some meds are DEFINITELY life-saving, but it seems like a lot are just patient convenience. There's a lot of stuff that we see on the major medical side that makes me squint sideways, too, like an MRI to disgnose generalized ankle pain.

Insurance creates a "tragedy of the commons" situation, and I think that is a major contributor to high insurance premiums, and high health care costs in general.

[herongale]

they want to be able to claim to the girl's parents that they "tried everything" in order to head off allegations of malpractice, possible lawsuits, and also just so that they can look the family in the face.

And, lest we all forget, surgeons make their money DOING procedures. Not talking about them. I would never allege that the transplant surgeons who planned to do the procedure in this case were motivated by unethical considerations. But people forget that surgeons have a bias to do things, sometimes unnecessarily so. Look at all the unnecessary tympanostomy tubes that are placed in kids, or the epidemic of unnecessary cesarean sections... and these are so often truly elective procedures.

When a surgeon thinks that the procedure they can do can possibly save a life, even if the chances are extremely small and not medically supportable, there are surgeons who are willing to take the risk. And, well... being willing to take the risk is fine. I think that if a surgeon and a patient want to try a medically unproven procedure

[anax]

I thought about making this point, but I'm glad you did it instead. :D

Do we now want to go into the fact that nobody is directing any outrage toward the HOSPITAL, which had this liver on hand and was refusing to release it without cold cash on the table?

[emeraldsword]

I agree with the basic thrust of your post, though I know nothing about the case, but not with this:
So, I really wish the girl had survived long enough to get the transplant, so that we could check back with her in a couple of weeks to see if getting the transplant helped her. Because if she had had that liver then someone else, someone who it could actually have helped, would have been denied it and so would have died. So maybe that's a better way of thinking of it - her death saved someone else almost as much as the death of the original donor did.

[anax]

Well, let me qualify that statement.

I went around a couple of websites, and everywhere I found this story, I found the assumption that getting the transplant would save the girl's life. So I made that statement in that context - kind of a "I wish I could show you what morons you all are" kind of way. That is, admittedly, selfish of me, and I am of course very happy that the eventual recipient of the liver is going to get it ... someone that I presume has a million times better chance of benefiting from it.

[emeraldsword]

I think it should be the doctors who decide, rather than the insurance companies, and as you say, transplants don't always save lives - my friend's mum had a kidney transplant and it made a magical difference to her life and her health but she has to take the immuno-suppressents all the time and so on.

[anax]

I think it should be the doctors who decide, rather than the insurance companies

Well, this is a little bit of a false dichotomy, because the people who make the decision at the insurance company are also doctors. So it's not a dispute of opinion between doctors and insurance companies, but between doctors and a different set of doctors.

I think that the decision in this case was made because her prognosis was so poor with or without the transplant. :/ It's pretty much a waste of a precious organ to put it into someone who has almost no chance of survival WITH it ... and then, like you said earlier, someone else doesn't get it. That's a pretty high cost to give the girl's family peace of mind.