Wednesday, May 02, 2012

Book Review Number 5. Remember When CIGNA Killed Nataline Sarkisyan?

I do. I wrote about it at the time and hope to never forget it. Nataline was a 17 year old California girl who fell seriously ill and needed a liver transplant. At least that's what her doctors said. A paper pusher at CIGNA said she didn't though, and I'll bet you know who won that argument. Nataline is dead. A massive public outcry that did manage to embarrass CIGNA into changing its mind wasn't enough to save her. She died two hours after the company reversed its decision. A story that is literally uniquely American.

Wendell Potter remembers too. He was head of corporate communications for CIGNA at the time, and as such, it was his job to put the best possible spin on this story. To make the company that denied a teenage girl her last chance at life somehow look not evil. "Our deepest sympathies are with the Sarkisyan family" Potter wrote after Nataline's death. Sympathies so deep evidently, that a few months later CIGNA employees heckled and gave the finger to the dead girl's mother when she came to CIGNA's headquarters to talk about what happened.

I'm not kidding you. Employees of CIGNA gave the "fuck you" gesture to the mother of the girl they helped kill. If this Obamacare thing stands though, we might have heartless bureaucrats making life or death decisions about our healthcare. Can't have that.

Dealing with the Sarkisyan story broke Potter. He doesn't write about the heckling in his 2010 book Deadly Spin, An Insurance Company Insider Speaks Out On How Corporate PR Is Killing Health Care And Deceiving Americans, he does write about being relieved at the time that CIGNA wasn't mentioned by name in most of the headlines in the first wave of news stories and blog posts that followed Nataline's death, and he does tell of how the whole experience managed to finally awaken the long dormant humanity that was present in an insurance executive's soul. How a process that began the day he witnessed Americans desperate for medical treatment line up at a county fairground a day in advance of a charity health clinic...

The scene inside was surreal. I felt as if I'd stepped into a movie set or a war zone. Hundreds of people, many of them soaking wet from the rain that had been falling all morning, were waiting in lines that stretched out of view. As I walked around, I noticed that some of those lines led to barns and cinder block buildings with row after row of animal stalls, where doctors and nurses were treating patients. other people were being treated by dentists under open-sided tents. Many were lying on gurneys on rain soaked pavement. Except for curtains serving as makeshift doors on the animal stalls, there was little privacy...Dentists were pulling teeth and filling cavities, ...doctors and nurses were doing Pap smears and mammograms, surgeons were cutting out skin cancers.

  ...came to fruition when he had to become the point man for the company that denied a chance at life to a fully insured client. Wendell Potter quit his job, testified in front of a Senate Committee on how insurance companies "confuse their customers and dump the sick, all so they can satisfy their Wall Street investors", and he wrote this book  Wendell Potter was broken, and he confessed.

He confessed to the ways you are manipulated by the modern corporate public relations machine. Ever wonder why so many people insist that the government "Keep their hands off my Medicare?" Why so many people continued to believe cigarettes and cancer weren't related even after being buried in an avalanche of evidence? After reading this, you'll have an inkling as to how people can be convinced to say and believe the absurd. You'll learn how the demise of the Clinton health care reform plan led to a significant factor in today's health care mess, the transformation of Blue Cross and Blue Shields from an association of non-profit health insurers into for-profit public stock companies. You'll find out that because of a law intended to protect retiree's pension plans, you have for all intents and purposes no right to sue your health insurer when it denies you care, even if it leaves you looking death square in the face.  Like any confession, it is informative, educational, and a voyeuristic window into how things really work on the dark side.

It's also unsatisfying. It should feel better to have Wendell Potter on our side, able to bear witness to the truths we have been shouting from rooftops for so long, but I found the book depressing, merely reinforcing my belief that to be on the opposite side of money in a fight is to be a permanent underdog, no matter if truth is in your corner. For every Wendell Potter there are hundreds if not thousands just like he used to be, bought and paid for and kept in line with a river of dollars, while Wendell will spend the rest of his life with nothing but the meager power of truth on his side.

If you are the type that is interested in the truth though, then by all means give the book a read. Remember as you do though, Nataline Sarkisyan is still, and will always remain, in her grave.

Deadly Spin on Amazon.      

On Barnes and Noble

Or find it at a library near you. 


Anonymous said...

Drugmonkey, the doctors were wrong. Cowboys not willing to admit defeat and willing to be well compensated for torturing a dying girl who would have taken a valuable organ from a person who had a chance to live. Sorry, Cigna is evil, but they were absolutely right to deny coverage. Potter is probably just trying to cash in on a disaster.

DrugMonkey, Master of Pharmacy said...

Care to enlighten us with the particular knowledge of this case you evidently have?

Anonymous said...

And, another thing. 'My Man Mitch' sent as many retirees as he could, a little booklet touting the benefits of long-term health care insurance. Over the years, my 80 year old father (who had done everything he could in remaining happy, healthy and active) spent more than $20,000 buying this insurance. Guess what? When he died over the course of six-seven months, he did not get one red cent of the money he put into the insurance because he was not totally broke. He tried to stay up and walking as long as he could and when he got too weak to get out of the house to the doctor, the doctors enrolled in hospice ((which meant that he was expected to live less than six months). The oxygen equipment, wheelchair, hospital bed, and extra nursing to help assess when he should use the morphine, lorazepam, and haloperidol, assist in foley catheter care all were paid in cash by his widow. Where did the $20,000 go that he'd been paying for years? And, this crock is being promoted by 'My Man Mitch' under the auspices of the State of Indiana. Who ever gets to use it? Who profits?

Is it fair that care at the end of life is like a lottery? Sure, my father's family did as much as we could physically, but it sure would have been nice to market the long-term health care as 'just another death insurance policy' since a person may as well be dead, if they can't use it or the family of the deceased can't use it to pay the bills.

DrugMonkey, Master of Pharmacy said...

Anonymous 10:59,

Yeah, didn't think so. The fact you think quitting a job of the type that flies a person around in corporate jets is in any way "cashing in" showed me your level of ignorance. Potter had plenty of cash in the days before he wrote this book, and will probably never make that kind of money ever again.

Still, I thought I'd give you a chance. Just in case your knowledge of medicine was greater than your knowledge of finance. You pretty much performed as expected.

Anonymous said...

Anonymous said...


1. UCLA was the one who cared more about money than the insurance company. They outright refused to proceed without being paid 75,000.

2. CIGNA was the administrator of the Sarkisyan's insurance policy. The decision to approve or deny had no impact on the dollars either way for them. All direct medical costs are paid by the employer in such cases.

3. No transplant expert supported UCLA's decision to aggressively treat Sarkisyan. Most were equivocal because the colleagality among doctors rivals the "Blue wall of silence" for cops. Read between the lines of what was quoted publicly by John Roberts of UCSF and Goran Klintmalm of Baylor and it is pretty clear that they were not in the same camp as UCLA.

Anonymous said...

Also, in this country, no viable liver for transplant is wasted so that means that if Sarkisyan would have gotten a liver, somebody would have either not gotten one or had to wait. That person would have had a better chance of survival because Sarkisyan was below the threshold criteria for almost every program in the country (and was probably below UCLA's own criteria).

DrugMonkey, Master of Pharmacy said...

1) To expect a hospital to take what would have eventually been a 6 figure loss is ridiculous. The UCLA medical center doesn't do anyone any good if it goes bankrupt. This is why we have insurance. To make sure these types of situations are not financially catastrophic to the insured. Not to practice medicine, but to spread the financial risk to as many people as possible.

2) Is flat out wrong. Unfortunately the original mission of insurance companies has mutated from "spread the financial risk" to "spend as few dollars as possible" CIGNA most certainly does have an incentive to keep expenses down for employers in these cases. That is how they compete for those employers business. This is explained in the book, which also points out that the very point you try to make here was right out of CIGNA's spin playbook. Potter was successful in planting this spin right into your own brain. Which makes you a tool.

3) "No transplant expert supported UCLA's decision to aggressively treat Sarkisyan" -except for the doctors actually treating her. Who, of course, where the ones most familiar with her case. You hire a doctor to practice medicine. You hire an insurance company to manage the financial risk of the doctors decisions. CIGNA was practicing medicine. That is what's wrong with this picture. Professionals will always disagree. That's why it's called "practicing," but CIGNA doesn't get to practice, that's not their job.

Except they do.

Damn good thing we never got those government death panels though, you know?

Pharmacy Mike said...


The article previously posted in this comments section was well written and pretty unbiased. It makes a good case that the transplant most likely at best would have given her 6 more months with probably a poor quality of life.

I'm not letting insurance companies off the hook here. By and large the way we pay for health care in this country is atrocious. However, the article brings up a point that not many people like to talk about. It seems that we hold onto life in this country much more strongly than most others, including those with universal health care. A country with a superior single payer system probably would not allowed that transplant to happen either because statistically, the best case scenario wouldn't have been worth the cost of the procedure to the nation as a whole.

My mother works as a respiratory therapist in a special care hospital. She constantly tells me about nearly comatose patients with no change for recovery are kept on ventilators for years. The hospital performs procedure after procedure on these kinds of patients in an attempt to keep their hearts beating, but very little consideration is given to quality of life. Families routinely do not get adequate counseling on end of life decision making. This kind of health care is not good for patients and it wastes enormous amounts of money.

Countries with universal health care mostly do not make as strong an effort to keep a patient's heart beating as long as we do in the U.S., and I believe that's a good thing. We like to scoff at the whole death panels thing, but government provided health care does indeed have policies and guidelines in place that tell people when enough is enough.

I think that's a good thing, but it's a tough sale politically in this country where most people have an absurdly high fear of death.

DrugMonkey, Master of Pharmacy said...


There's a hell of a difference between an elderly comatose patient on a respirator and a 17 year old kid with a fighting chance who never got to fight.

65% chance of making it 6 months? There are cancer patients who faced slimmer odds years ago who are with us today.

They probably had a different insurance plan.

Pharmacy Mike said...

I'm not really debating that. Of course, maybe she would have been the one in 10,000 that defied the odds. I also don't think that it's even close to ethical that a for-profit insurance company gets to make that decision.

I was just pointing out that in cases like this, the outcome may still have been the same even with a universal health care system. In a system that supports everyone and the cost is shared among everyone, rationing the most.expensive care to those who will benefit the most is a necessity.