The unnecessary death of Nataline Sarkysian … or is it murder?
We extend our condolences to the family and friends of Nataline Sarkysian.
The Hippocratic Oath: “First, do no harm” has evolved into “America can’t afford some of its lives.”
And I have questions that rise above the presidential campaign that goes to America’s clergy and the “values voters” who dominated the headlines a few short years ago: “You fought so hard for the continued life support of Terry Schiavo, so where your voices and energy for Nataline Sarkysian?
Are you telling us that Terry’s husband could not make decisions in Terry’s interest but some graysuit beancounter in the insurance racket gets to decide that Nataline Sarkysian must die???
On the eve of the celebration of Jesus Christ’s birth, who is it you’ve abandoned?
This was murder for profit and your silence betrays the emptiness of your values.
December 23rd, 2007 at 1:37 pm
The system as it is now, with for-profit health insurance, the insured are not clients or a patients, they are “risks”. And, like any good insurance company, their obligation is to minimize risk.
So, by letting Nataline Sarkysian die, the insurance company, CIGNA Healthcare, tried to limit its risk of having to provide the liver transplant and the long post-operative period as well as the risk of having additional organ failure. Letting her die prevents her from getting a second transplant, should the first fail, again limiting risk.
Health insurance companies have to be competitive with their rates, so where they make their money is by competing to not pay benefits.
There could be an argument made that her chances of survival weren’t high and her pain level high, too, thereby making the decision of CIGNA the right one. But only accidentally, as their motive is to keep from paying for expensive procedures.
These types of decisions are best made by the patient, the family and doctors of the patient, not by, as Kevin put it, “greysuit beancounter”.
December 24th, 2007 at 8:22 pm
Great post, Kevin. With a brevity of words you have asked THE question that must be asked. Where were you, values voters/George Bush/Jeb Bush/Tom Delay????? Where were you, Congress, when you could have been passing laws that would require insurance companies to pay for any and all life saving procedures?
December 27th, 2007 at 2:28 pm
It’s a common misconception, but “first, do no harm” (primum non nocere) is not part of the Hippocratic Oath.
It actually didn’t come into use until the 19th century.
December 31st, 2007 at 10:30 pm
Most busy liver transplant centers do well under 100 cases a year, commonly in the 60-70 range. Their numbers are limited by organ availability. A good center has a one year survival rate of 85-90%. Nataline’s 6 month survival rate was estimated by her physicians at 65%; it can only be assumed that her 1 year survival rate would have been substantially lower. Vegetative for weeks after bone marrow transplantation. Where I trained, admittedly years ago, at one of the three busiest BMT centers in the US, with a very active liver transplant service as well, if your liver went bad after BMT for leukemia (commonly due to a condition known as venooclusive disease) ,you were not registered for a liver transplant. Go ahead and re-read sentence #2. Imagine being next in line with a reasonable (85-90%) chance at one year post liver transplant survival and getting bumped by this unfortunate person, then dying. People die waiting for transplants, got that? It’s not a matter of saving a life here, but whose, and making an active decision about who can best benefit. Here’s another way to view this: Let’s say you show up in an ER needing emergent life saving surgery. Do you think that the surgeon waits for your insurance precert to come through before booking OR time? No. He assesses the situation and wheels you into the OR. Now don’t get me wrong here. The insurer sucks for all sorts of reasons that have nothing to do with this individual case. But if I’m the surgeon, I’m not feeling too comfortable about the position I’ve placed myself in here- that is to say because the insurance company won’t pay me and my hospital, I’m not going to do the life-saving surgery I recommended for your daughter. Likewise, if I’m Dad and I have the financial wherewithal I’m taking out that second mortgage and we’ll work out the details later. Because all I care about is my daughter, and certainly not the person she’s transiently bumping off the front of the transplant list, whose life is at stake here too. “First do no harm”- it’s a little more complex than a simple appendectomy.
January 1st, 2008 at 6:10 am
I had a family member die from the procedure, not the disease it was supposed to cure. From what I’ve read the survival chances are no better than doing NOTHING. Considering that most of the data for survival rates comes from those with a vested economic interest in the procedure I doubt its that good. CIGNA was correct in refusing to authorize it.
January 1st, 2008 at 6:16 am
You can say it was no use in this case. You wouldn’t be saying that if it was your daughter. You’d want everything possible to be done.
Have any of you seen Sicko?
Watch a conservative Canadian guy talk about why they take care of EVERYONE. See a Dr in another country (sorry, I forget if it was the UK or France) say he wouldn’t want to work within a system that turns some people away.
Then watch sick people in the USA being dropped off in skid row, in hospital gowns and barefoot.
We can do better than this.
January 1st, 2008 at 7:42 am
In reply to Jeff Hoffman regarding the person waiting for a liver after Natline Sarkysian and the issue being “whose life to save”: that’s not the insurance company’s call or motivation here. That kind of prioritizing is what United Network For Organ Sharing does and she’d been cleared for a liver transplant. The insurance company didn’t deny her claim because it thought someone next in line had a better chance of survival, it just didn’t want to pay. You can’t clean up that callous decision by saying it was about whose life to save.
January 1st, 2008 at 11:58 am
That’s right, Sue. I understand what the odds are of surviving a liver transplant or lasting 5 years post-op. Of course, I compared it to the Schiavo situation, too. What were her chances of survival? Did her parents or the pro-life-support crowd suggest cost was a factor at all?
Cost is only an issue when Republicans make it so. Treatment should always be the first option and the only economics that should be employed is the economics of time (as in, triage says save this one first before we try to save that one because there’s not enough surgeons on hand to do both).
January 12th, 2008 at 7:30 pm
Great post! I hadn’t even thought about the analogy to T. Schiavo! That is some hypochrisy! I am still trying to get to some of the posts that Jon had on his Best of 2007″ There are some really great interesting blogs out there that I hadn’t the pleasure of checking out, but now that Jon had us on there, I am trying!
PS: I am supporter of Edwards but was disappointed in the lack of support in Iowa and NH! He seems to have his head on right about the health care situation and the plight of the working people in this country. Too bad others don’t seem to feel that that is so important.