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Teen Dies due to Insurance Company refusal to pay - Page 4

post #91 of 102
I'm getting depressed on Christmas Eve. I just want my Christmas present to be perfect health for everyone, so nobody ever has to tell a story like that again. Santa, just come down the chimney and leave me a note "Your wish has been granted: these things will never happen again. No more suffering, no more pain, no more loss. No more waste of human potential"
post #92 of 102
I don't think Santa can do that. People, however, can. Especially if they work together.
post #93 of 102
Quote:
Originally Posted by jenniferd View Post
I still don't see how not paying for the procedure could be considered murder. And if not performing some procedure on someone could be considered murder, then a lot of doctors and nurses could end up behind bars.
I guess we have to wait and see for any criminal charges, but I am not holding my breath.
I'm not sure either if this is `strictly' a murder case. I think perhaps that the crux of it lies with the issue that had she had the operation, she would have survived (albeit for perhaps only a little longer). Everything was set to go, the donor organ was there, the patient was waiting, and the only thing that prevented her from having this surgery was the refusal to pay for it by the company. Had this not happened, everything would have gone ahead.

So it is arguable that this one, single incidence led directly to this patient's life ending. In that sense, yes, there is a potential for a criminal charge. Nothing else got in the way of saving this girl's life except for this one factor. The company had to know that refusal to pay could result in death. Knowing this, and refusing anyway, could quite easily constitute a homicide charge.

Note I said `homicide' rather than murder. Even through the different `degrees' of murder, an intent or malice aforethought is required for this charge. Manslaughter (culpable killing which is not murder) or reckless endangerment or any other lesser charge of negligence and knowing endangerment is highly appropriate and I would think most likely to succeed in a case like this.

After all, the company are responsible entirely for her death in this manner. Had she fallen out of bed and sustained a head injury, no. Had she had a heart attack, no. Had she died through lack of a suitable donor, no. But the ONLY reason she died on this day in this manner was because the insurance company wouldn't pay. Are they culpable? You betcha they are.
post #94 of 102
Well, using your logic, if your un-insured friend who was sick asked you for money so she/he could put a down payment on a surgery, and you refused,
you could be charged with homicide. After all, if everything was in place for your friend's surgery, and only the money were lacking, but you refused to give it to him/ her, you are responsible for his/hers demise. It'd be the same thing.
O'key.
post #95 of 102
Not at all. Because it is not my role as an individual to provide funds for other individuals to go ahead with surgery. It is not the stated intent of my existence and it is not the reason for my business. This is an insurance company - it is their job to provide payments for such things, and their responsibility.

If I were a stated insurer, and my `friend' was actually my client, and I refused to fund the surgery, then yes, I would be responsible.

Asking for a favour and having a professional responsibility to discharge the due care entitled to clients are two different things.
post #96 of 102
Quote:
Originally Posted by KitEKats4Eva! View Post
Not at all. Because it is not my role as an individual to provide funds for other individuals to go ahead with surgery. It is not the stated intent of my existence and it is not the reason for my business. This is an insurance company - it is their job to provide payments for such things, and their responsibility.

If I were a stated insurer, and my `friend' was actually my client, and I refused to fund the surgery, then yes, I would be responsible.

Asking for a favour and having a professional responsibility to discharge the due care entitled to clients are two different things.
Well, the insurance company is claiming they are not responsible for providing funds for that surgery because it'd be experimental, and the contract the girl's family had with the insurance does not cover experimental surgery.
post #97 of 102
Which would make their claim more shaky, I agree. But transplant surgery is hardly still classed as `experimental' surgery. I am sure the family could cite numerous expert medical opinions to support this. However, it is something that would give the insurance company much more weight in legal proceedings - even though technically it sounds like a `loophole' argument.

But many, many lawsuits have been filed and won on loopholes, so it will be interesting to see the outcome.
post #98 of 102
Quote:
Originally Posted by KitEKats4Eva! View Post
Which would make their claim more shaky, I agree. But transplant surgery is hardly still classed as `experimental' surgery. I am sure the family could cite numerous expert medical opinions to support this. However, it is something that would give the insurance company much more weight in legal proceedings - even though technically it sounds like a `loophole' argument.

But many, many lawsuits have been filed and won on loopholes, so it will be interesting to see the outcome.
I beleive the insurance company claimed the procedure was experimental not because it's a liver transplant, but because it's a liver transplant into leukemia patient. One expert unrelated to the case was quted in the article saying liver transplant into leukemia patient would be "futile."
post #99 of 102
That's interesting then - I wonder what the doctors would have to say. It's pretty hard to reconcile the two - the doctors wanting and needing to do everything possible to save or in this case prolong a life, and the insurers needing to protect their investments, so to speak. The more they pay out on such things the higher their premiums go, so they have to make some hard decisions, too. A tough one, this one.
post #100 of 102
Quote:
Originally Posted by KitEKats4Eva! View Post
That's interesting then - I wonder what the doctors would have to say. It's pretty hard to reconcile the two - the doctors wanting and needing to do everything possible to save or in this case prolong a life, and the insurers needing to protect their investments, so to speak. The more they pay out on such things the higher their premiums go, so they have to make some hard decisions, too. A tough one, this one.
It sure sounds to me like not all experts agree on whether someone in this girl's condition should have been getting a liver transplant. Her doctors wanted her to get one. I've seen another doctor quoted in the article saying he'd also consider a liver transplant for someone in her condition. Yet another doctor was quoted saying liver transplant into someone with leukemia is futile.
I imagine in a civil trial insurance company would put on a defense by using experts who think someone with leukemia is not a candidate for a liver transplant.
While Geragos would be putting on experts saying otherwise.
Personally, I would like to know if this girl ever had a chance of having something resembling a normal life, assuming the best possible outcome.
Or was it all about giving her some extra months to live?
post #101 of 102
I think the doctors at the hospital had an emotional tie to the patient, since she has been receiving treatment since she was 14 for leukemia and to some extent that played a role in their agreeing to the transplant.

From the articles I read, it seems that she had a 65% chance of surviving 6 months, plus the transplant drugs would kill the work done by her leukemia drugs and bone marrow transplant which would have to be redone.

If they found an organ for her on the 11th, would it have not been used by someone else in the mean time? If the insurance company agreed a few days earlier, would an organ have still be available? From what I have read, the organ people who someone linked to above call several hospitals who have patients matching and of the highest priority and whichever one agrees first gets the organ.
post #102 of 102
I'm too tired and too behind to reread the news articles, but I'm fairly sure I remember reading that the organ went to someone else.
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