edwardsliar: Edwards Invokes Teenager’s Death in Campaign
Posted by Shirley S. Wang
The death of 17-year-old Nataline Sarkisyan (pictured) has been placed front and center by presidential hopeful John Edwards. Her tragic story is packing an emotional punch in his campaign, providing extra oomph to his call for an overhaul of the health-care system, the WSJ reports.
Sarkisyan died on Dec. 20 after Cigna initially denied her coverage for a liver transplant, citing insufficient evidence that the procedure would be safe or effective. Cigna defended its handling of the case.
“I’m perplexed that this has become a campaign issue,” Jeffrey Kang, Cigna’s chief medical officer, told the WSJ. “It is highly unlikely that any health-care insurance system, nationally or internationally, would have covered this procedure.” Cigna reversed its decision, but she died later the same day.
The case raises the question of whether insurance companies are offering adequate coverage to Americans, and how decisions should be made about which patients should get covered and for what procedures.
Edwards advocates a government-run health plan open to all Americans, rather than the current system in which insurers decide on patient eligibility. He also thinks that insurers should be cut out of discussions about health-care reform, a more stringent stance against insurance companies than, for instance, Barack Obama, the WSJ writes.
Sarkisyan’s emotionally evocative story may bring the issue of health care to the forefront — and, importantly for candidate, call more attention to Edwards’s stance on the issue.
Sarkisyan’s father, Grigor, addressed the crowd at Edwards’s rally in New Hampshire yesterday, and said, according to the WSJ: Instead of buying a car for her birthday, “after she passed away, I bought a coffin for her because Cigna – they killed my daughter. I don’t have a daughter any more.”
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I can’t believe that the focus is on whether the procedure would be worth it for her- what about the thousands of other people who have been on the UNOS list waiting for a transplant for years? Even if Cigna had paid for it, I doubt she would have gotten an organ in time. Organs are in short supply, and this is further evidence we need to revamp our system of doling them out to prevent them from going to “test” cases who might live a few months instead of people who could live for many years.
Comment by Seriously? - January 7, 2008 at 9:38 am
Why isn’t UCLA Medical Center to blame for demanding $75,000 before providing the transplant? Everyone’s screaming at CIGNA, but UCLA Medical Center is a non-profit, government-run entity — precisely the kind of institutional that somebody like Edwards wants to have run our health care and make health care decisions for us. Sounds kinda ironic to me!
Comment by A Commenter - January 7, 2008 at 9:49 am
Sen Edwards is part of problem:
1. He made his fortune suing doctors and insurers in the art of second-guessing decisions made in which he has expert 20-20 hindsight vision.
2. Sen Edwards wants to cap profits of insurers. Let’s see him step up front and center to cap lawyer contingency fees at which he has made his fortune.
3. American society has come to believe, thanks to the Sen Edwards of the world, that the insurance bucket and supply of organs is limitless.
4. My insurance premiums pay for these expensive procedures and to expend my limited resources on lives that are going to end shortly anyway is poor stewardship. However, the rhetoric of the Sen Edwards of the world buys him votes! what a deal!
Comment by maccarthur - January 7, 2008 at 9:50 am
There will always be some therphy that may have some probability of some level of success.
We must address the expectations of our society.Now with 16% of GDP going to health care can we really afford providing unlimited resources to everyone.
Perhaps we need some level of “excess coverage” for those willing to pay for these extraordinary endeavors.
Not everyone can afford a Mercedes.
Comment by Andy - January 7, 2008 at 9:54 am
Sen. Edwards and the rest of the democrats need to understand the healthcare system is just that, a system. You cannot fix it by adjusting just one piece, the insurance companies. Instead you have to change the entire system.
If you are going to put limits on the insurance companies, then why not put limits on the drug companies, the hospitals, and the doctors?
Why not put rewards systems place for proper care?
Somebody in the system has to make decisions on care and cost. My opinion is that this decisions is better placed anywhere than Washington, DC.
Comment by jhannon - January 7, 2008 at 9:58 am
1. The implication is that Edwards would have the government expand medical coverage to include people and procedures beyond what the insurance companies currently cover. Where does the money come from?
2. At the margins, there is always going to be some procedure that doesn’t make sense to the insurer, but makes perfect sense to the emotionally tied family. How would the government make these decisions? How would it be better than it is now.
3. I lived in Canada for three years under their government plan, OHIP. The system was clogged with mothers with kids with runny noses while you had to wait weeks for an MRI for a serious disease. Somehow health care must be allocated because the demand is virtually unlimited, but the resource is not. How would the government solve this problem?
Comment by M Lasher - January 7, 2008 at 10:08 am
America needs a government-controlled fee schedule…for lawyers. For instance, if lawyers knew they would only be paid $1,000 per divorce, feuding spouses’ attorneys would have every incentive to reach a settlement rather than prolonging litigation. That would wipe the smirks off the shysters’ faces!
Comment by Litigation Victim - January 7, 2008 at 10:08 am
Without going into the details of this case, I am concerned about populist commentary and the need for resource allocation. We are fast arriving at a day when we cannot do everything for everyone. In a complex case such as this, what degree of success and for how long is needed for allocating a scarce organ and substantial financial resources? If the underlying disease has a 30% chance of long term survival and the weakened patient has only a 40% chace of a successful transplant, is that an appropriate operation — 25% X 40% is a 10% chance of long term survival — Substitute other numbers and play with the odds — What is a good decision when so many have unmet medical needs>
Comment by William Golden MD MACP - January 7, 2008 at 10:14 am
I can’t comment on the details of this particular case (e.g., appropriateness for transplant), but there is clearly a dearth of organs for transplant. Unfortunately, policy development — in this area as in others — is often driven by bad outcomes in particular cases. Regarding organ transplantation, generally, as an earlier commenter noted, there is a long waiting list — due to the dearth of organs. If the patient in question were eligible for transplant under UNOS rules, an insurer really shouldn’t have a separate set of rules by which it determines the medical appropriateness of the transplant. In any event, increasing organ supply is a key issue here: whether by promoting paired donors (I want to donate a kidney to my brother, you want to donate to your daughter, we don’t match our kin, but we match each other’s); donor registries like Lifesharers (I’ll agree to donate an organ, so if I ever need one I can get one I need from the pool of Lifesharers donors); or a change in the legal presumption on organ donation to presumed consent, together with a commitment to abide by that consent rather than allowing family members to override a donor’s decision (instead of the current presumption of no consent). For more info on this issue, see my HealthBlawg post on the subject here, and posts on Maggie Mahar’s Health Beat blog here and here.
Comment by David Harlow - January 7, 2008 at 10:19 am
Given the rapidity of the patient’s death, it is highly unlikely that a donor liver could have been obtained in time to save her life, unless her sibling (the one who provided the bone marrow for transplant) agreed to a living donor transplant proceedure, which has considerable risk to the donor. To state a 65% 6-month survival with a liver transplant seems completely egregious. One wonders what the interest of the physicians involved in doing the bone marrow transplant were, given that the bone marrow transplant resulted in the liver failure. Perpetrator guilt, or the treating physician concern that the patient was going to die from the transplant proceedure that they performed, may have had too much of an emotional, and professional, tie to the case to make rational recommendations. A liver transplant under conditions of complete liver failure due to a bone marrow transplant, which itself has a high mortality would be the highest of high risk approaches. Cigna didn’t kill the patient. The disease and its treatment did. The 65% six month survival statistic is likely related to the data on survival with the type of leukemia the patient had with a successful bone marrow transplant, without figuring in the liver failure and the risk attendent on a liver transplant. Liklihood of survival in this case was more probably very low. To ask a living related donor to incur the risk of a liver transplant donation in this case is going for heroics and probably not justified. One has to consider the ego of the surgeons, and their desire to “make medical history.” If they succeeded, they would be heroes–if not, no one would take notice, and it would be on to the next case. Surgeons at academic medical centers tend to like to “push the envelope” for their own professional self-aggrandization. UCLA is no exception. In this case, the guaranteed outcome without transplant was death, so the surgeons would argue that the benefits, whatever they may be, would outweigh the risks, but that isn’t necessarily so. The University may be on the hook if this goes to litigation, for over-promising results, which would then have led to the litigation. A liver transplant was the only possible intervention in the circumstance, with no data at all on potential outcome. If the insurance refused coverage, the University could have still gone ahead with the proceedure, on a pro bono basis if it wished. Why is it that the medical facility bears no criticism for failing to proceed at its own expense, as opposed to vilifying the insurance company who has no obligation to cover what can only be considered an experimental approach with unknown risk and benefit? Oncologists are also notorious for “doing everything possible” and in my experience, have often recommended completely unproven and ineffectual treatments simply because they exist, in order to maintain hope and to be able to affirm that they “did everything possible’ even though the treatments often cause great suffering and hasten the patient’s demise. Bone marrow transplant has become a much less used treatment than in the past because of its lack of success and high risk, although approaches have improved. A thorough review of the case by appropriate independent specialists would be the basis for review in such a case, not egregious polilticization with demagoguery and legal hucksterism on the campaign trail by a trail lawyer. Obviously once a trial lawyer, always a trial lawyer. Edwards’ behavior is completely unconscionable–he’s trying to drum up business for himself or his contributor trial lawyers with the forum of a presidential campaign, a conflict of interest if there ever was one. Disbarment proceedures should proceed apace. Mike Nifong never did anything so egregious.
Comment by Kent J. Lyon, M.D. - January 7, 2008 at 10:20 am |
