How Cigna HealthCare killed Nataline Sarkisyan

I had a very pleasurable break visiting family and friends in the United States for Christmas and then visiting an old friend in Roma for New Year’s. Back in Paris, awaiting my eventual departure for Congo, the skies roll across the city, briefly blue in the morning and then various shades of gray for the rest of the day. 2008 stretches out before us all, with presidential elections this fall capping off what I hope will be a gentler, more humane and healthier year, with greater freedom married to a greater sense of local and global community than we saw in the one that just passed.

It is fitting I suppose, to this hoped-for sense of shared community, that my first post of the year pay tribute to the 150-odd people, including nurses, students and relatives, who rallied in front of the headquarters of Cigna HealthCare in Glendale, California last month, to demand that the health insurance company reverse its refusal to pay for an emergency liver transplant for 17-year-old Nataline Sarkisyan . The California teenager, who wanted to be a fashion designer and had battled leukemia for three years, was fully insured by Cigna when her brother became a donor for a bone marrow transplant that doctors hoped would save her life. When complications arose after the transplant and Sarkisyan’s liver failed, doctors recommended the emergency transplant procedure

Cigna, which expects to earn an income of around U $1.2bn next year, thought otherwise, though, and refused to pay for the liver transplant on December 11th, on the grounds that Sarkisyan’s health plan "does not cover experimental, investigational and unproven services.”

The doctors at UCLA's Pediatric Liver Transplant Program and elsewhere at the hospital called CIGNA begging them to reconsider their decision but, to their own eternal shame, if true, would not perform the procedure unless the Sarkisyan family placed an immediate down payment of US$75,000 which it was, needless to say, beyond their power to do.

Faced with over a hundred protesters on its front law, CIGNA finally reversed itself, but only after Sarkisyan had lapsed into a coma while her fate was decided. CIGNA’s momentary drift into magnanimity came too late, though, and Nataline Sarkisyan died on December 20th, the liver transplant having never been performed.

As one of the nearly 50 million Americans without health insurance, I know that this is the nightmare that many Americans dread every day. But even for the Americans, like Nataline Sarkisyan's family, who are lucky enough to have health insurance, what is the value of that insurance when it lets you die in a hospital while denying you a life-saving procedure? What kind of country would allow such a system to flourish in the first place? How do CIGNA executives like CEO H. Edward Hanway and Executive Vice President Michael W. Bell not throw themselves from the windows of their lavishly appointed offices when they realize what they have overseen?

In this election year, perhaps the American public’s patience with the malevolent joke our health care system has reached its limit. The three major Democratic candidates - Barack Obama, Hilary Clinton and John Edwards - all have substantial plans to revise the nation’s avaricious, inefficient health care industry, although none go as far towards the French model of low-cost (though paid through taxes), high-quality, universal health care as I would like them to.

In the meantime, Nataline Sarkisyan has been laid to rest and the family’s attorney, Mark Geragos, has announced his intention to press the Los Angeles district attorney to press murder or manslaughter charges against Cigna, on the grounds that the firm "maliciously killed" Nataline Sarkisyan with its unconscionable refusal to provide her with treatment. I hope that he succeeds in getting the courts to act and hold the executives of CIGNA responsible for its murderously adversarial and exploitative relationship with its customers (behaviour which, among health insurance companies, is the rule rather than the exception). And I hope that someone is elected in the United States this fall with the courage to implement the radical change that such a faltering system demands.

Here we come, 2008. Deye mon gen mon.