Remember Nataline Sarkisyan? If the name rings a bell, it should. Nataline was a seventeen year old girl who needed a liver transplant. Only when they finally found a donor her parent's insurance company, CIGNA, which provided full coverage through her father's insurance refused to pay. After a lot of bad press they relented nine days later but by the time the procedure was performed, Sarkisyan was literally hours away from death and did not survive.
Her parents went to court to sue CIGNA for damage caused by the company's denial of their daughter's transplant. The court threw out the complaint, not because they hadn't caused her death but because of a 1987 Supreme Court decision that prevents victims from suing over coverage decisions. The decision relates to 1974's Employee Retirement Income Security Act, or ERISA, which governs employee retirement funds and benefit plans.
So last year Nataline's parents, Hilda and Krikor Sarkisyan went to CIGNA's corporate headquarters on October 29, 2008 to ask for an apology. What they got was a front man who came out and told them that he was very sorry but that the company would not even offer them an apology, and further that the CEO or anyone involved with the decision would not come out and talk to them. Not that they didn't see someone higher up, of course. What they got was the man upstairs throwing them 'the bird.'
Hilda and Krikor Sarkisyan are not giving up in trying to change things though.
The catalyst for this came not only in the judge being forced by the 1987 court decision to have to dismiss Nataline's wrongful death suit, but also from CIGNA's official press release after this.
"Cigna said the dismissal of the wrongful-death case in April showed that the court "agreed with our position that the Sarkisyans' claims regarding Cigna's decision making were without merit."
In fact, the court did not consider the merits of the family's wrongful-death claims. Instead, it decided those claims could not be heard.
Not heard because of the Supreme Court decision!! If it were based solely on the merits of the case then it could be heard. The pure and unadulterated arrogance and contempt on display CIGNA, knowing very well that they have nothing to fear if they do kill someone, is stunning.
The Sarkisyans have proposed 'Nataline's law,' whereby Congress would put in place a mechanism by which insurance companies like CIGNA will be held accountable (even if it is by fines rather than by direct compensation to victims or their families) for injuries or death that it can be proven was caused by withholding payment for a procedure.
According to the linked article, at least one CIGNA employee did have a conscience and quit his job so he could stand with the Sarkisyans:
"ERISA is a license to kill," Glovsky said. "The companies know that they can deny treatment with the sick or dead member having virtually no recourse."
Wendell Potter, a Cigna spokesman who quit after handling the publicity surrounding the Sarkisyan case, agreed.
"HMOs and insurers are largely free to deny access to care without fear of reprisal or financial consequences," Potter said in a speech to the Civil Justice Foundation in San Francisco.
Right now, as Congress debates health care overhaul it is time to undo the disastrous ERISA provision. The truth is that tort reform is long overdue-- instead of aiming lawsuits at doctors whose hands may well be tied by the knowlege that some procedures will likely be denied even if they ask for them, maybe the truth is that it is the insurers who should be included in these suits.
Santa Monica-based Consumer Watchdog sent a letter to key congressional leaders urging them to undo the ERISA ruling, and group President Jamie Court said Nataline's case shows why such a move is crucial to any healthcare reform.
"If the insurer decides they don't want to pay for the treatment because they can save a lot of money, there is not a dime available in damages if the person dies or is injured," Court said. "It's cheaper to kill you. If you die, you can't go to court.