Deadly Spin (20 page)

THE FAMILY FIGHTS BACK

The Sarkisyans were devastated when they got the news that CIGNA wouldn’t cover the transplant—but they were not about to give up hope, Hilda in particular. She believed that she and her friends in the Armenian community might be able to mount a campaign to shame CIGNA into approving the transplant. So she immediately began contacting family and friends in the close-knit community in Los Angeles and asking them to do anything they could to draw public attention to Nataline’s plight.

Nataline’s godfather started making calls to reporters and TV news producers throughout L.A. and the San Fernando Valley, where the Sarkisyans live. The TV reporter who left that first voice mail message for me had just talked to him. (The information that the Sarkisyans owned a second home—actually a rental property—apparently came from a hospital employee who noticed that Nataline’s mother had listed it among the family’s assets on a form the hospital had asked her to fill out when Nataline had been admitted. Whether CIGNA had access to that information is unclear, but the company denied that the family’s rental property was a factor in its decision.)

Nataline’s story likely would have stayed local had it not been for the California Nurses Association, a politically active and media-savvy union that represents thousands of nurses throughout the state. A co-worker of Hilda’s who had been a nurse contacted CNA’s leadership in Oakland and asked them to get involved in the Sarkisyans’ campaign. It didn’t take much arm-twisting. CNA spokeswoman Liz Jacobs said the organization never considered
not
doing all it could do for Nataline.

“We’ve taken our oath to be patient advocates,” she said, “and we will be advocates wherever the need takes us. So we were up for this.”

Early on Thursday morning, December 20, CNA blanketed the media with a news release announcing a protest that would be held at eleven
A.M.
that day in front of CIGNA’s California headquarters, in Glendale, which happens to be in the heart of the Armenian American community. The headline was sure to get the media’s attention: “Life Denied: Nurses, Family of Sick Teen March on Health Insurance Company; 17-Year-Old Girl Needs Liver Transplant, CIGNA Denies.”

“My daughter survived two bouts of cancer,” the release quoted Hilda as saying, “and against all odds has been stable even with so many of her organs not working, only to now be told that she cannot get the only treatment that will save her life because some administrator in some office thinks it is too expensive. We needed help in standing up against this insurance provider, and of course it was the nurses who stepped forward.”

My phone started ringing off the hook as soon as the nurses’ release went out. I knew I had a crisis on my hands when calls poured in not only from local TV and radio stations but also from the
Los Angeles Times
, CNN, and NBC—and even from the general public. The release, which was posted on the home page of CNA’s Web site, also appealed to the public to call CIGNA demanding that it “provide the care Nataline needs.”

The nurses were also making a political statement with the protest. The California legislature was embroiled in a debate on reforming the state’s health care system, and CNA, which has long supported a single-payer system that would ban private insurers, cited Nataline’s situation as a reason why state lawmakers should reject a reform plan supported by Governor Arnold Schwarzenegger and some legislative leaders.

“CIGNA’s refusal of Nataline’s liver transplant—overruling the urgent appeals of an array of doctors and nurses—is indicative of the failures of the new health care plan sponsored by Arnold Schwarzenegger and [Assembly Speaker] Fabian Núñez” the release said. “That plan, which is actively supported by CIGNA, requires every single Californian to purchase insurance products from companies like CIGNA, but does not address the problem of denial of care evident in this situation.”

As soon as I heard about the news release—from a reporter who called asking for CIGNA’s reaction to it—a colleague and I immediately began alerting the company’s top executives. The first person I forwarded the release to, of course, was my boss, Carol Ann Petren.

When Petren responded to my e-mail by asking if I would have the draft of a policy paper on her desk first thing the next morning, I knew she hadn’t grasped the significance of what was happening. I immediately ran up the stairs from my office on the sixteenth floor to hers on the seventeenth and interrupted a meeting she was in.

After I stressed what it meant that the national media was covering a protest at our headquarters in California, she realized she had better brief our CEO, Ed Hanway, whose office was on the other end of the hall from hers. She called him herself and then asked her assistant to track down two other executives: David Cordani, then president of CIGNA HealthCare, and Dr. Jeffrey Kang, the company’s chief medical officer. Hanway was in Petren’s office in a matter of minutes. Cordani and Kang, who worked in Bloomfield, Connecticut, where CIGNA’s health care operations were based, joined us by phone.

Kang, whom CIGNA’s transplant medical director had briefed a few days earlier, explained the reasoning behind the denial and said that based on what the medical director had told him about Nataline’s worsening condition, he supported the decision not to cover the transplant. He added, however, that he had ordered an expedited external review of the case, and the results were expected the next day.

Waiting until the next day to hear from the reviewers was completely out of the question. TV crews were already setting up in front of CIGNA’s Glendale offices, so our discussion quickly turned to the PR damage that Nataline’s story would do to the company. As I always did in situations like this, I explained the PR consequences—the likely damage to the company’s reputation—if we didn’t relent and agree to cover the transplant. I noted that it would be different if the patient were an older person. Reporters probably would not have found the story at all compelling if the patient had been a forty-five-year-old man. The fact that the patient was a sweet-looking seventeen-year-old girl, whose smiling face had been seen by thousands of TV viewers in Southern California, made the story irresistible to the media. There was no way the company would be perceived as anything other than a cold, heartless corporation if we didn’t give a teenage girl a fighting chance to live, even if the odds weren’t that good that she’d survive.

Because the scheduled protest was attracting so much media attention, it was clear we would need outside public relations support to help deal with what could become the biggest PR crisis in company history. The first person Petren mentioned was Larry Rand, highly regarded in the corporate world for his crisis communications skills. Rand was one of the founders of Kekst and Company, a New York firm that specializes in investor relations and financial PR for publicly traded companies. CIGNA had Kekst on retainer so that Rand and his staff would be available whenever we needed them.

Hanway agreed that we needed them now.

Rand was in a meeting when Petren called him. His assistant said she’d have him call her back later.

“No, I need him right now,” Petren told her. “It’s urgent. Tell him Ed [Hanway] is here with me.”

Rand was on the phone in minutes, and when Petren told him about the protest, he didn’t need to hear anything else.

“Look, Carol, you have to make this go away. Approve the transplant—now.”

Although I had given the same advice, Hanway and Petren needed to hear it from an outside expert. If Nataline died, CIGNA would be blamed for her death, and the resulting publicity would be so bad that the company could lose customers. I added that it would just be a matter of time before one of the presidential candidates seized on the story—possibly elevating it to a disaster for the entire industry.

The group quickly agreed that damage control was of paramount importance. Cordani, who as president of CIGNA’s health care division had the most to lose, made the decision: CIGNA itself would pay for the transplant, using its own money rather than asking Mercedes-Benz to cover it. I was relieved. I was certain that even though the media would report that CIGNA had caved to pressure, the bad publicity would be over soon and people would forget the case or at least forget that CIGNA was the insurance company involved. There would be no long-term reputational damage.

I was just as relieved, though, for Nataline’s family. This harrowing and frightening episode in their lives just might have a happy ending. I imagined how joyous and hopeful my wife and I would be to hear from our insurance company—which would be CIGNA—that a procedure that might save Emily’s life had been given “clearance.”

I sent a quick e-mail to AHIP’s PR staff to let them know that CIGNA would soon notify the family that it would cover the transplant, because they, too, were being inundated with calls. Before we could say anything about it to the media, however, someone had to get word to Nataline’s family and doctors. Kang said he would make sure that the transplant case manager reached out to them right away. The other thing that needed doing right away was crafting the words to explain why we had changed our minds. We’d have to explain it in a way that didn’t look like we were caving in—or setting a precedent that could nip us in the future.

It was my job to figure out how to say that CIGNA was now agreeing to approve a transplant even though we still believed we’d been right to deny it in the first place—and that our change of heart had nothing to do with the bad publicity.

RIGHT DECISION, BUT A LITTLE TOO LATE

As I ran downstairs to start writing, I knew my staff would be happy to hear about the reversal. We had all gotten caught up in the story emotionally and were hoping that Nataline would be able to get the transplant and that it wouldn’t be too late. Although the prevailing belief was that Nataline’s chances of survival were slim—even if she got the transplant—I didn’t want to believe it. I still imagined a happy outcome, with Nataline walking out of the hospital in a few weeks with her mom and dad and brother.

I also knew that no one would really believe that CIGNA had changed its mind solely out of empathy for Nataline and her family. But I was willing to spin it that way.

I was under the gun to write the statement and get it to Petren and the others for their review, but I decided to quickly check my e-mail first to see if there were any new developments or media inquiries. I couldn’t believe what I saw. E-mails were literally pouring in—at least five hundred more than when I had left for Petren’s office. A few were from the media, but most were from people all over the country who’d heard about CIGNA’s refusal and were writing to express their anger and outrage. I read a few and then alerted security because some were wishing harm to my family and me. I had to ignore most of them, for the time being anyway, because I had to begin writing what CIGNA as a company would say to the Sarkisyans and the world. About an hour before the start of the protest in California, I finished a draft of what would be the core of both our media statement and the letter to Nataline’s father.

The letter was the first priority, and after numerous edits it was ready to go. “Dear Mr. Sarkisyan,” it began. “We received an appeal request on Dec. 17, 2007. We understand you are appealing the medical necessity denial for a liver transplant for your daughter, Nataline. After reviewing the information submitted with your appeal request and the terms of your benefit plan, I am pleased to let you know that on Dec. 20, 2007, CIGNA HealthCare has decided to make an exception in this rare and unusual case, and we will provide coverage should Nataline’s health care providers determine to proceed with the requested liver transplant. We are making this decision on a one-time basis, based on the unusual circumstances of this matter, although the treatment, if provided, would be outside the scope of the plan’s coverage and despite lack of medical evidence regarding the effectiveness of such treatment.”

I also had my media statement ready to blast to the media as soon as the letter was hand delivered to the Sarkisyan home.

With just ten minutes to go before the protest was to begin, I still didn’t have confirmation that the letter had been delivered, so I started calling around to find out what was going on. There was a hitch no one had anticipated: The Sarkisyans were not at home, and no one knew where to find them.

It occurred to me that they probably were on their way to the protest. So I turned on the TV in my office, and sure enough, CNN was broadcasting live from the front of CIGNA’s Glendale offices, and I could see a woman in the crowd who I assumed was Nataline’s mother amid what looked like scores of nurses carrying signs with Nataline’s picture and the message
CALL CIGNA TODAY
. The crowd was chanting, “No more denials, no more denials, health care for all
now
.”

I called CIGNA’s top lawyer in California, Bill Jameson, and told him he would have to send someone right away to tell the Sarkisyans that CIGNA would pay for the transplant. Hilda had already been interviewed on camera and clearly didn’t know.

A few minutes later, I saw someone whisper in her ear. I could tell she was getting the good news. “CIGNA just approved!” she screamed.

The campaign had worked. CIGNA had been pressured into reversing the denial. Grigor Sarkisyan gave his wife a big hug. They looked so relieved and so happy.

The crowd cheered. Tears were streaming down the faces of many of the protesters.

I was just as happy as they were—and just as relieved.

Within an hour, CNA issued a news release with the headline “CIGNA Capitulates to Patient Revolt. Following Massive Protest, Insurer Authorizes Transplant for 17-year-old Nataline Sarkisyan. CNA-Sponsored Protest Sparks Flood of Calls from Across U.S.”

“CIGNA had to back down in the face of a mobilized network of patient advocates and health care activists who would not take no for an answer,” the release quoted CNA executive director Rose Ann DeMoro as saying.

I would never acknowledge it publicly, but DeMoro, of course, was right. CIGNA had capitulated. My job now was to spin the reversal in a convoluted way that would make people think the media attention, the protest, the calls, and the e-mails had nothing to do with it.