Health Insurer to be Charged with Teen's Murder

[Dr. McDreamy]

"Health Insurer to be Charged with Teen's Murder"

I would love to know the details of this case. And I hope the insurance company loses. Think of how much money this insurance company is saving now that this girl is dead. Post leukemia and post liver transplant this girl would have had pretty monumental ongoing medical bills if she had lived. Sounds like a pretty shrewd business decision to delay approval till the 11th hour.

Discuss.

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[Pinkertinkle]

Is it just me or did they spell CIGNA wrong like five times.

 

[TheWowEffect]

"Health Insurer to be Charged with Teen's Murder"

I would love to know the details of this case. And I hope the insurance company loses. Think of how much money this insurance company is saving now that this girl is dead. Post leukemia and post liver transplant this girl would have had pretty monumental ongoing medical bills if she had lived. Sounds like a pretty shrewd business decision to delay approval till the 11th hour.

Discuss.

This is quite sad but interesting. I would like to know how this thing turns out. Health insurance companies have it way too easy. Some sort of oversight and accountibility would be good.

It is said that lawsuits are generally directed towards the deeper pockets. May be it should set some sort of precedence to go after the insurers more.

 

[kdburton]

Nothing will happen to the insurance company. Plus the cost of a transplant is a drop in the bucket for insurers, so thats not a big deal either. The way I look at it is that [assuming this girl was in good enough shape to receive a liver and they had one that matched well enough] its the doctors' faults for not doing the transplant anyways. Unless of course the doctors found that this girl was medically unfit to go through a liver transplant (which happens quite a bit) and chose to give the liver to the next person down on the list who had a better chance of survival with it.

 

[Dr. McDreamy]

Nothing will happen to the insurance company. Plus the cost of a transplant is a drop in the bucket for insurers, so thats not a big deal either. The way I look at it is that [assuming this girl was in good enough shape to receive a liver and they had one that matched well enough] its the doctors' faults for not doing the transplant anyways. Unless of course the doctors found that this girl was medically unfit to go through a liver transplant (which happens quite a bit) and chose to give the liver to the next person down on the list who had a better chance of survival with it.

Because the doctors should be expected to pick up the tab for the salaries of the nurses and techs, the anesthesiologists, the cleaning crew, the OR suite fee and the supplies used? Not to mention that all these fees would be multiplied x2 becuase they must also have an OR with a donor in it at the same time? Give me a break, you obviously have no idea of the costs associated with this type of procedure. The average liver transplant costs between $100,000 to $400,000 (http://www.emoryhealthcare.org/departments/transplant_liver/patient_info/faqs.html).

As of 1997, the cost of a liver transplant in the United States was $314,500, including the evaluation, procurement of the liver, hospitalization, physician fees and follow-up care and medications for the first year. As of 2002, the cost of a liver transplant in the United States averaged about $250,000 for immediate hospital and doctor expenses. Necessary pre- and post-operative expenses brought the total to about $314,500.


The fees that the surgeons collect are a very small portion of that. Nor do they have any means of forcing the hospital to allow use of 2 OR's and the associated ancillary staff for free.

 

[gujuDoc]

Because the doctors should be expected to pick up the tab for the salaries of the nurses and techs, the anesthesiologists, the cleaning crew, the OR suite fee and the supplies used? Not to mention that all these fees would be multiplied x2 becuase they must also have an OR with a donor in it at the same time? Give me a break, you obviously have no idea of the costs associated with this type of procedure. The average liver transplant costs between $100,000 to $400,000 (http://www.emoryhealthcare.org/departments/transplant_liver/patient_info/faqs.html).

As of 1997, the cost of a liver transplant in the United States was $314,500, including the evaluation, procurement of the liver, hospitalization, physician fees and follow-up care and medications for the first year. As of 2002, the cost of a liver transplant in the United States averaged about $250,000 for immediate hospital and doctor expenses. Necessary pre- and post-operative expenses brought the total to about $314,500.


The fees that the surgeons collect are a very small portion of that. Nor do they have any means of forcing the hospital to allow use of 2 OR's and the associated ancillary staff for free.

I'm with you on this one too.

 

[dilated]

is there any other country in the world where they do liver transplants to vegetative people with leukemia?

the best part is where they reversed their decision and offered to pay for it due to public pressure. gee, can't imagine why US health care costs more than other countries.

 

[Doctor Bagel]

is there any other country in the world where they do liver transplants to vegetative people with leukemia?

the best part is where they reversed their decision and offered to pay for it due to public pressure. gee, can't imagine why US health care costs more than other countries.

I read the article again, and it looks like she was placed in a medically induced coma, which I think is a little different from what one thinks of when they hear the word vegetative.

Either way, I agree that we need more information to determine the correctness of the original insurance denial.

 

[Doctor Bagel]

OK, I just read this article which said she was in a vegetative state.

http://news.wired.com/dynamic/stori...ME&TEMPLATE=DEFAULT&CTIME=2007-12-21-07-23-27

 

[EMH]

How is it the media can take the information they want about a story and then write the story they want. The Jena six media frenzy is a perfect example. You've got to actually do your own research to get the real story.

 

[45408]

The case raised the question among at least one medical expert over whether a liver transplant is a viable option for a leukemia patient because of the immune-system-suppressing medication such patients must take to prevent organ rejection.

Such medication, while preserving the transplanted liver, could make the cancer worse.

Transplantation is not an option for leukemia patients because the immunosuppressant drugs "tend to increase the risk and growth of any tumors," said Dr. Stuart Knechtle, who heads the liver transplant program at the University of Wisconsin at Madison and was not commenting specifically on Nataline's case.

The procedure "would be futile," he said.

Nataline was diagnosed with leukemia at 14 and received a bone marrow transplant from her brother the day before Thanksgiving. She later developed a complication that caused her liver to fail. She was in a vegetative state for some time, her mother Hilda said.

Nataline was taken off life support at the University of California, Los Angeles Medical Center on Thursday, her mother said. Nataline died within the hour.

In a Dec. 11 letter to Cigna, four doctors had appealed to the insurer to reconsider. They said patients in similar situations who undergo transplants have a six-month survival rate of about 65 percent.

I get the feeling that the likelihood of a positive outcome was overstated by those involved with her care. It seems VERY unlikely that she would have ever come out of a vegetative state, and yet her doctors were campaigning for the liver transplant. I'd be interested to know the whole story though.

 

[gujuDoc]

I get the feeling that the likelihood of a positive outcome was overstated by those involved with her care. It seems VERY unlikely that she would have ever come out of a vegetative state, and yet her doctors were campaigning for the liver transplant. I'd be interested to know the whole story though.

This reminds me of another Terry Sciavo sort of case. A person not willing to let go.

 

[kdburton]

.

 

[wanabdoc]

the best part is where they reversed their decision and offered to pay for it due to public pressure. gee, can't imagine why US health care costs more than other countries.

I'm with you, you can put a price on human life, and it is 100-400k. Screw that, she deserves to die.

I just hope you are not my doctor.

 

[MattD]

it took 14 posts for the first 'you're gonna be a bad doctor' accusation? wow, you guys showed restraint!

 

[Tired]

I get the feeling that the likelihood of a positive outcome was overstated by those involved with her care. It seems VERY unlikely that she would have ever come out of a vegetative state, and yet her doctors were campaigning for the liver transplant. I'd be interested to know the whole story though.

How about this scenario (all hypothetical, of course):

1) Doctors perform BMT on patient

2) Patient develops rare, but essentially terminal, complication from procedure

3) Doctors, out of a combination of guilt and fear of liability, offer inappropriate salvage procedure with very low chance of success (liver transplant)

4) Insurer makes correct medical decision that transplant is ill-advised and not covered by policy (they do have doctors on staff, after all).

5) Voila, new patsy for the death!

 

[nekrogg]

it took 14 posts for the first 'you're gonna be a bad doctor' accusation? wow, you guys showed restraint!

really. even more ironic is the "wanabe" doc avatar. how about getting into med school and knowing something saying such things

 

[Perrotfish]

3) Doctors, out of a combination of guilt and fear of liability, offer inappropriate salvage procedure with very low chance of success (liver transplant)

Wouldn't the decison to award this girl the liver have had to have gone through a transplant committee? I mean it's a liver, you know it's not a live donor. The people who may have been guilty/liable for her complications would not have been the ones to decide that she gets the liver. If a group of neutral, competent doctors really did decide that she was a good candidate for a transplant, is it really the insurance company's place to contradict them?

 

[45408]

Wouldn't the decison to award this girl the liver have had to have gone through a transplant committee? I mean it's a liver, you know it's not a live donor. The people who may have been guilty/liable for her complications would not have been the ones to decide that she gets the liver. If a group of neutral, competent doctors really did decide that she was a good candidate for a transplant, is it really the insurance company's place to contradict them?

It's part of checks and balances, ideally. In some situations, I would expect that the insurance company could legitimately refuse a procedure/test on the grounds that it would be ineffective that another physician thought was necessary. And seriously, if she was in a vegetative state, giving her a liver transplant seems completely uncalled for. Her brain is gone, and now they're worried about her liver?

 

[gujuDoc]

It's part of checks and balances, ideally. In some situations, I would expect that the insurance company could legitimately refuse a procedure/test on the grounds that it would be ineffective that another physician thought was necessary. And seriously, if she was in a vegetative state, giving her a liver transplant seems completely uncalled for. Her brain is gone, and now they're worried about her liver?

True! Good point. It seems like at that point the liver would be more useful to someone who would actually have a true second chance at life.

I don't know what suing anyone is going to do for this situation.

 

[wanabdoc]

really. even more ironic is the "wanabe" doc avatar. how about getting into med school and knowing something saying such things

Irony is inane people with stock avatars...ooops, didn't mean to type that. Since I have not had the idealism thoroughly beaten out of me yet, and since you are a MS1 UM student, neither should you. I still like the idea of being able to save a life without somebody looking over my shoulder and cuffing my hands. Insurance companies have to let the outlyers die, ironically the people who are supposed to benefit most from all the research of modern medicine. If the outlyers aren't let go, premiums would/will go up. So, yes, there is a price on life and if you are ok with that, more power to you. It is all fine and good until it happens to you or your family (statistically it won't happen to me or you, but it might.) Should doctors be realists? When a patient comes to you, are you going to give your medical opinion based solely on how much a service costs (within reason of course?) If this is true, may I suggest working for an insurance company?

I know that since I haven't finished medical school, I am in no position to to speculate on or add sarcastic levity to ethical issues. This definitely requires the completion of an advanced degree or someone "in the know".

 

[wanabdoc]

it took 14 posts for the first 'you're gonna be a bad doctor' accusation? wow, you guys showed restraint!

There is no Godwin'w law for this!! (I already checked

And to be serious, there are definitely good and bad doctors, and I have been to both. And yes the ones I liked were the ones who at least made an effort to go the extra mile and not give the wishy-washy "well, what do you want, lunesta or ambien" answer (just an example) How the he** am I supposed to know? That is why I came to you. If you are just an overpaid pill pusher, I vote to replace you with a prescription vending machine that takes a scantron of my past history and then asks if i prefer a raspberry or orange flavored chewables.

Sorry to vent, I think i went off on a tangent.

 

[MattD]

Wouldn't the decison to award this girl the liver have had to have gone through a transplant committee? I mean it's a liver, you know it's not a live donor. The people who may have been guilty/liable for her complications would not have been the ones to decide that she gets the liver. If a group of neutral, competent doctors really did decide that she was a good candidate for a transplant, is it really the insurance company's place to contradict them?

Um, there are live donor liver transplants done quite often....

 

[gujuDoc]

There is no Godwin'w law for this!! (I already checked

And to be serious, there are definitely good and bad doctors, and I have been to both. And yes the ones I liked were the ones who at least made an effort to go the extra mile and not give the wishy-washy "well, what do you want, lunesta or ambien" answer (just an example) How the he** am I supposed to know? That is why I came to you. If you are just an overpaid pill pusher, I vote to replace you with a prescription vending machine that takes a scantron of my past history and then asks if i prefer a raspberry or orange flavored chewables.

Sorry to vent, I think i went off on a tangent.

Well on the issue of doctors just randomly treating patients without insurance agreement and without charging this could cost them dearly.

My family physician used to take us without charging us any money at all though we had insurance. We'd use the insurance though to get prescriptions so they nearly charged him with fraud and he ended up having to charge us otherwise he could have lost his practice and been charged with all sorts of fraud by insurance companies. He wasn't taking payments from other family friends either and ended up having to charge them.

Yeah you are right that there should be no pric on human life but get one thing straight, as a physician I'll be damned if I'm going to jail for not charging someone for treating them. I'll also be damned if I have to lose my license for doing such. So I don't blame the physicians for not wanting to do it without consent. By doing the procedure that might not have worked, it could have cost physicians more then monetary or time concerns that wasn't worth losing. That's just something to think about there.

 

[gujuDoc]

Um, there are live donor liver transplants done quite often....

How is that possible when th liver is needed to live.

Nevermind I just looked it up and realized it was only a portion of the liver not the whole liver in live donor transplants.

 

[TMP-SMX]

Well on the issue of doctors just randomly treating patients without insurance agreement and without charging this could cost them dearly.

My family physician used to take us without charging us any money at all though we had insurance. We'd use the insurance though to get prescriptions so they nearly charged him with fraud and he ended up having to charge us otherwise he could have lost his practice and been charged with all sorts of fraud by insurance companies. He wasn't taking payments from other family friends either and ended up having to charge them.

Yeah you are right that there should be no pric on human life but get one thing straight, as a physician I'll be damned if I'm going to jail for not charging someone for treating them. I'll also be damned if I have to lose my license for doing such. So I don't blame the physicians for not wanting to do it without consent. By doing the procedure that might not have worked, it could have cost physicians more then monetary or time concerns that wasn't worth losing. That's just something to think about there.

It's fraud. If there is a copay you have to charge them if you submit to the insurance company. It's stupid, but you have to do it.

 

[kronickm]

Somehow I doubt that Cigna is going to get 5-10 for manslaughter.

Very sad case and I am curious to see what happens, but filing criminal charges against an insurance company is laughable.

 

[gujuDoc]

It's fraud. If there is a copay you have to charge them if you submit to the insurance company. It's stupid, but you have to do it.

Yeah. That's my point that its stupid but we can't do anything about it and just treat people for free because it will be fraud for us and hence cost us our license. So its not like physicians could have just done anything without insurance giving the go.

 

[gujuDoc]

Somehow I doubt that Cigna is going to get 5-10 for manslaughter.

Very sad case and I am curious to see what happens, but filing criminal charges against an insurance company is laughable.

I agree with you competely especially considering the patient in question was already brain dead and could not live without life support even with a liver transplant.

 

[gujuDoc]

Going back to the original post, you know what I don't get? I don't get how there are people that actually believe that going to universal healthcare means that this girl would have lived and insurance companies were the blame.

This girl was severely sick with cancer. There was a 65% chance of success for ONLY 6 MONTHS!

She would have died in another 6 months anyhow. Life is unfair and its hard to deal with loss of a loved one but while insurance companies can be blamed for many things this is not one situation where I think they were truly in the wrong.

That liver could be used to save a life of someone else who had a higher chance of living more then 6 months. To someone who could actually use it and continue living. This girl was comatose. She would've been living like Terry Schiavo. People always use the excuse of god in comatose patients but then they forget in the true day and age of religion and only religion people would be dead because life support did not exist back then.

People don't want to hear it but there is no utopia where things just come free or discounted so easily even in a universal healthcare system.

I'm sorry I had to vent this because I was reading blogs on this case and the comments were annoying.

My heart goes out to the patient and her family but I dont' think the liver transplant would have made any difference one way or another.

 

[gujuDoc]

Actually, one more thought on this case.

The girl had leukemia. Organ transplants don't alway work and when you have someone who is severely immunosuppressed like HIV/AIDS patients and cancer patients the chances of success is even less then for someone who is otherwise healthy outside of the failed organ.

So that was something else to consider.

 

[A18Devil]

.....im not sure the girl was in permanent vegativie state

in the first article i read it said the doctors had her in an induced coma.

 

[Perrotfish]

Anyone else notice Edwards mentioned this in his speech after Iowa?

 

[rachmoninov3]

If this were my family member I'd be doing everything I could to get the $400K. Sell the house, beg and plead for loans, sell my soul to drug companies, do porno, *****, do whatever it took. The last place I'd put my trust is in health insurrance.
However, please feel free to lambast me any way you like. I find all the bickering on this thread highly entertaining!

 

[def jeff]

If this were my family member I'd be doing everything I could to get the $400K. Sell the house, beg and plead for loans, sell my soul to drug companies, do porno, *****, do whatever it took. The last place I'd put my trust is in health insurrance.
However, please feel free to lambast me any way you like. I find all the bickering on this thread highly entertaining!

How ironic considering of all of the things you just mentioned, health insurance is the only one set up specifically to pay for medical bills

But seriously, a health insurance company must keep their end of the bargain and pay out when a procedure or visit is warranted. I'm not so sure that it was warranted in this case though.

 

[PeepshowJohnny]

Anyone else notice Edwards mentioned this in his speech after Iowa?

You know his crooked lawyer heart just had him dreaming about making a big payday off of this one...and maybe sharing some of it with the family.

 

[elwademd]

if everyone's so worried about the insurance company and their practices and thinks the girl should have received the transplant (which seems debatable), why is no one accusing the doctors of anything? after all, the doctors and the hospital could have done the transplant and worried about getting paid after the fact. you don't need pre-authorization from an insurance company on every single thing done on a patient in the hospital.

as a physician, i don't understand why the physicians and the hospital (if they truly felt so compelled) didn't just do the surgery and worry about the financials later... which makes me think they weren't that compelled to do it in the first place.

 

[45408]

as a physician, i don't understand why the physicians and the hospital (if they truly felt so compelled) didn't just do the surgery and worry about the financials later... which makes me think they weren't that compelled to do it in the first place.

Give me a break, and read the thread a little more closely, because this idea was thoroughly shot down in this post - http://forums.studentdoctor.net/showpost.php?p=5999806&postcount=5

 

[elwademd]

Give me a break, and read the thread a little more closely, because this idea was thoroughly shot down in this post - http://forums.studentdoctor.net/showpost.php?p=5999806&postcount=5

i did read that. my comments of "everyone" was more about society, rather than the people specifically responding in this thread.

living in la, and being a physician in la, people were up in arms about this case. people, right or wrong, are blaming the insurance company alone. no one is/was saying anything about the doctors and hospital involved... which makes me wonder if charging the insurance company with murder is nothing more than a tactic to get money from the insurance company.

surely the insurance company isn't going to jail. and mark geragos knows that. to prove malicious intent upon the part of the insurance company seems laughable at best. it would likely be a far easier thing to prove the inactions of the doctors and hospital leading to the patient's death... but that's an entirely different beast.

the crux of the issue simply seems to be payment. the hospital and doctors felt the surgery was indicated... the insurance company didn't... and so rather than perform the surgery and worry about it later, the argument appears to have been over pre-authorization.

typically, you need pre-authorization for non-emergent/elective services, but not for emergent services... which leads back to the issue of the true need of the surgery for the girl in the first place.

 

[Perrotfish]

You know his crooked lawyer heart just had him dreaming about making a big payday off of this one...and maybe sharing some of it with the family.

After all, doctors are good and lawyers are bad, right? That's why Bill 'I campaigned for torture' Frist is such a good guy and John Edwards is a bad guy.

Read Edward's book, Four Trials, if you get a chance.

 

[PlAnEjaNe]

Did anyone else find it a bit ironic that Mark Geragos is the family's attorney?? I actually laughed out loud when I read that he was their attorney.

PlAnEjaNe

 

[Green Chimneys]

Somehow I doubt that Cigna is going to get 5-10 for manslaughter.

Very sad case and I am curious to see what happens, but filing criminal charges against an insurance company is laughable.

Criminal charges can usually be brought against corporations, and if convicted fines take the place of jail sentences. That said, there's absolutely no case for murder/manslaughter here. I imagine the family's attorney is simply talking this way to light a fire under cigna's butt to expedite talks of a settlement. Criminal charges will never see the light of day in this case, and I imagine a wrongful death civil case will be settled out of court for an undisclosed amount of money.

Sad story, but all the talk and all the hype is just business speak. Even in death, money talks.

Edit: By the way, I am not a lawyer nor did I attend law school. My knowledge base on law, especially California law, is limited. If someone else with a more solid background could clear up exactly how criminal charges work against a corporation, it would be much appreciated.