Family may pursue manslaughter or murder charges against Cigna for delaying transplant.
By Ryan Vaillancourt
LOS ANGELES — Attorneys for the family of 17-year-old Northridge resident Nataline Sarkisyan, who died Thursday hours after Cigna HealthCare reversed a decision to deny coverage for a potentially life-saving liver transplant, said Friday they will seek murder or manslaughter charges against the Philadelphia-based insurance provider.
Nataline's parents and only brother were joined by some 150 supporters in Glendale on Thursday to demonstrate at Cigna's office on North Brand Boulevard, and urged the company to reverse a decision to deny coverage for a liver transplant recommended by Nataline's doctors at UCLA Mattel Children's Hospital.
Supporters credited the rally as what sparked a change in heart for the company, which put out a statement less than an hour after the event announcing its decision to cover Nataline's surgery if doctors could proceed with the operation.
But Nataline, a leukemia patient who was besieged by a lung infection while on life support, took a turn for the worse Thursday night and the family took her off life support at about 5:15 p.m. Thursday, said Mark Geragos, the attorney planning to present a murder or manslaughter case to the Los Angeles district attorney. She died at 5:50.
The Sarkisyan family blamed Cigna for Nataline's death, which they said could have been averted if doctors had been able to proceed with a liver transplant.
Doctors first sought coverage from Nataline's family's insurance provider on Dec. 10 for the transplant, but the coverage was denied.
Nataline, who has suffered from recurrent leukemia since age 14, received a bone-marrow transplant from her brother on Nov. 21.
But complications tied to the surgery and ensuing chemotherapy caused her to develop veno-occlusive disease, a condition that shut down her kidneys and liver, Hilda Sarkisyan said.
Doctors immediately sought approval from Cigna to perform the liver transplant, a procedure they describe in a Dec. 11 letter to the insurance company as having a six-month survival rate of 65% in similar medical scenarios.
The company denied coverage, twice, calling the procedure "experimental, investigational and unproven."
During the 10-day period between when doctors first sought to operate and the company's decision Thursday to provide coverage, Nataline developed a lung infection that would have had to subside before doctors could proceed with a transplant.
The company's statement on Thursday defended the initial decision to deny coverage and called their reversal a rare exception.
"Based on the unique circumstances of this situation, and although it is outside the scope of the plan's coverage and despite the lack of medical evidence regarding the effectiveness of such treatment, Cigna HealthCare has decided to make an exception in this rare and unusual case and we will provide coverage should she proceed with the requested liver transplant," the statement said.
Nataline's liver-attacking disease, combined with her respiratory and kidney failure after the bone-marrow transplant, "is associated with an extraordinarily high mortality rate regardless of intervention and would be expected to substantially negatively impact the successful completion and/or outcome of transplant surgery," Cigna officials said in a Dec. 10 memo to Nataline's doctors on behalf of the company's medical director, Stephen Crawford.
The company's delay amounted to criminal behavior, enacted in order to save money, Geragos said.
"It's not only callous, it's not only conscious disregard for life, I believe it's also criminal," he said.
Nataline's brother, Bedig Sarkisyan, 21, said the surgery would have cost $300,000.
Cigna did not return calls seeking comment.
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