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Jury delivers $25.5 million ‘statement’ to Aetna to change its ways

A jury awarded $25.5 million to the family of Orrana Cunningham, who was denied a targeted radiation treatment by Aetna.

The award is believed to be the biggest verdict in a person “dangerous religion” insurance coverage case in Oklahoma historical past, one court docket observer stated, and will have main ramifications throughout the nation for a type of most cancers remedy referred to as proton beam remedy.

The case revolved across the 2014 denial of protection for Orrana Cunningham, who had stage four nasopharyngeal most cancers close to her mind stem. Her medical doctors wished her to obtain proton beam remedy, a focused type of radiation that might pinpoint her tumor with out the potential for blindness or different unwanted side effects of ordinary radiation.

Orrana and her husband, Ron Cunningham, a retired Oklahoma City firefighter, had been collectively since 1987. He was decided to do no matter it took to get the love of his life the remedy she wanted. The couple mortgaged their dream house and arrange a GoFundMe web page to assist pay the $92,082.19 to get the remedy her medical doctors had prescribed on the MD Anderson Cancer Center in Texas.

However, Orrana died May 30, 2015, on the age of 54, partly from a viral an infection that reached her mind.

Ron Cunningham stated this week’s verdict was vindication for the struggling his spouse went via. She had filed the preliminary paperwork to sue Aetna, saying that if her case helped save the life of 1 particular person, it could be value it.

“My spouse began the case, and I’m simply ending the battle,” he stated. “We did her proud. My spouse wished to guarantee that it acquired out. Her remark was ‘if we might simply save one particular person.’

“As far as the cash, I’d give all of it again to spend only one extra day along with her.”

Aetna lawyer John Shely stated in closing arguments that the insurance coverage large was pleased with the three medical administrators who denied protection, even turning to thank them as they sat within the entrance row of the courtroom, in accordance to jurors and different witnesses in court docket.

It was a message that did not sit properly with the 12 jurors, who discovered that Aetna “recklessly disregarded its obligation to deal pretty and act in good religion with the Cunninghams.”

“I simply felt like Orrana Cunningham was failed at each flip,” forewoman Ann Schlotthauer stated.

She stated the decision “was undoubtedly a message to Aetna. We mentioned that in jury deliberations — that we wished to make a press release. We wished to make some extent and get their consideration.”

‘Aetna wanted to pay’

Schlotthauer stated it was clear from professional testimony that proton beam remedy was not experimental in any respect. She stated jurors have been turned off by one Aetna medical director who acknowledged dealing with 80 instances a day and by the truth that all three medical administrators acknowledged they spent extra time getting ready for the lawsuit than on Orrana’s medical case.

Schlotthauer stated she believed that Aetna’s medical administrators “rubber-stamped” the denials with out doing their due diligence. “No one was taking a look at her particular case,” she stated. “That’s the place we determined that clearly they have been in breach of contract and may’ve paid for that remedy. It was medically needed in her state of affairs.

“I hope [the verdict] does end in large modifications,” she stated. “I hope it ends in Aetna re-evaluating how they consider appeals and requests.”

Juror Ora Dale cried and hugged Cunningham after the trial. She was certainly one of two jurors who believed the financial award ought to’ve been a lot larger than the $25.5 million handed down.

“I simply wished to let him know that I used to be on his facet,” Dale stated. “Those medical administrators didn’t exhaust each measure like they stated that they did. They didn’t spend sufficient time on her declare. It simply stored getting denied and denied.

“Aetna wanted to pay. They have been within the fallacious, and he deserved all the pieces that he was asking for.”

Her only chance at life is a new liver, but her insurer said no. Then she wrote a powerful plea to the CEO

Cunningham had one other encounter in court docket. He stated Shely, Aetna’s lead lawyer, walked up to him and congratulated him after the decision earlier than telling him he’d lose on appeals.

Cunningham was an Oklahoma City firefighter when the Alfred P. Murrah constructing was bombed on April 19, 1995, killing 168 individuals and wounding tons of extra in one of many deadliest terror assaults in American historical past. The day after the bombing, he was assigned to comb via the wreckage of the day-care middle on the second flooring to seek for our bodies of youngsters. He stated he would spray corpses with Lysol to forestall the unfold of micro organism.

He’d seen the worst of the worst. But little might’ve ready him for that encounter with Aetna’s lawyer within the courtroom. He stated he stood, shocked, making an attempt to grasp what he’d simply heard.

“That confirmed how callous these persons are,” he stated.

Shely didn’t reply to a request for remark.

Aetna, the nation’s third-largest insurer, declined to touch upon the encounter however maintained that it acted appropriately in denying protection on this case, saying there’s a “lack of medical knowledge supporting proton remedy for treating nasopharyngeal tumors.”

“While now we have no touch upon the ruling, juror motives or a possible attraction, we do need to make it clear that the correct steps underneath the well being plan have been adopted on this occasion,” Aetna stated in a written assertion. “As our chief medical officer famous in a submit earlier this 12 months, it is by no means straightforward to inform a person or household {that a} remedy or process shouldn’t be permitted — it is the toughest factor now we have to do.

“However, our guiding rules will proceed to be confirmed effectiveness and member security, as decided by rigorous scientific research.”

Doug Terry, the lead lawyer for the Cunninghams, provided a a lot completely different take.

“We consider this case pulled the curtain again on what goes on at a medical health insurance firm when claims are being denied,” Terry stated. “The jury’s verdict delivered the message that the general public won’t stand for insurance coverage corporations placing earnings earlier than policyholders.”

Defense lawyer: Aetna did ‘nothing fallacious’

It shouldn’t be unusual for individuals with most cancers to be denied proton beam remedy by insurers, regardless of the suggestions of their treating physicians. Many radiation oncologists specific frustrations concerning the denials, and web sites exist providing suggestions and suggestions on how to strive to get insurance coverage corporations to pay for protection of proton remedy.

Other most cancers sufferers typically flip to websites like GoFundMe to increase cash for his or her remedy. Some insurers finally agree to cowl remedy for grownup sufferers after a prolonged appeals course of.

Ron Cunningham said that his wife was his "rock" and that the verdict was justice.
Daniel E. Smith, government director of the Alliance for Proton Therapy Access, applauded the decision and referred to as on insurance coverage commissioners in all 50 states to be certain the remedy will now be lined by insurance coverage corporations when treating medical doctors consider that it’s the finest out there remedy for his or her sufferers.

“We applaud Ron Cunningham for standing up to Aetna, and the jury for recognizing and holding Aetna to account for his or her damaged system,” Smith stated in a press release. “We’ve seen the same sample of betrayal throughout the business, the place insurers use outdated data and medical employees with little information of proton remedy to finally deny as many as 4 in 10 sufferers searching for the remedy. It’s previous time to maintain insurers accountable.”

Some jurors stated that one of the convincing consultants was radiation oncologist Dr. Andrew L. Chang, who defined why proton beam remedy was one of the best remedy for Orrana Cunningham. He was not concerned in her care however was referred to as as an impartial professional by her attorneys.

“The factor I attempted to illustrate to the jury is that proton remedy shouldn’t be a brand new, experimental approach, like Aetna needs to declare,” Chang stated. “Proton remedy is a well-established remedy for most cancers and has been for many years. … Nobody within the oncology neighborhood considers proton remedy experimental for the remedy of most cancers.”

He stated he informed jurors that Medicare covers proton remedy and that insurance coverage corporations typically cowl it for an array of cancers for pediatric sufferers, usually up to the age of 21.

“One factor we identified is that as a lot as Aetna and these different insurance coverage corporations like to say proton remedy is experimental, they at all times put a caveat in there that it isn’t experimental for pediatric sufferers,” Chang stated. “We identified Medicare pays for it for 65 years or older. So, what’s it about 22-year-olds to 64-year-olds that makes proton remedy experimental? There is not any good reply for that; insurance coverage corporations name it that as a result of they determined to deem it as such.”

Two prime most cancers specialists, not affiliated with the trial, informed CNN they agreed with Chang’s evaluation.

In Orrana’s case, Chang stated, the tumor was proper subsequent to her mind stem and optic nerve, and it had been rising up towards the bottom of her cranium. He stated he informed jurors that commonplace radiation might’ve been used, as Aetna wished, however the “dangers have been extreme.”

“She would go blind. She would lose a good portion of her reminiscence on the left facet of her mind and nonetheless not have an excellent probability at a remedy,” Chang stated. “For her explicit tumor, [proton therapy] was extraordinarily priceless.”

Before Orrana died, he stated, scans confirmed that the tumor was shrinking and the remedy was working.

Aetna lawyer Shely informed jurors that this was a case “of misplaced blame by Mr. Cunningham and his legal professionals,” in accordance to the official court docket transcript.

“Aetna has full confidence in your capacity to hear the proof from that witness stand after which later examine it to the opening assertion you simply heard,” Shely stated throughout his opening assertion. “In brief, the proof that you will note and listen to will persuade you that Aetna has carried out nothing fallacious, nothing.”

After contemplating the proof, the jury did, the truth is, discover fault with Aetna’s dealing with of the case, voting on Monday to award $15.5 million in emotional misery damages and on Tuesday tacking on $10 million in punitive damages.

Kent McGuire, a private harm lawyer in Oklahoma who watched elements of the trial, referred to as the decision the most important dangerous religion insurance coverage verdict for a person case in Oklahoma historical past. “It was definitely a surprising verdict to award that a lot cash, and it was a message, too,” he stated.

Ron Cunningham stated his spouse could be happy with the decision.

She used to consolation him on onerous days — whether or not it was within the months after the 1995 bombing or after he’d discover a youngster badly injured in a home fireplace. He’d come house, place his head in her lap and inform her all the pieces on his thoughts.

“She was a rock for me, particularly via my dangerous instances,” he stated.

The previous two weeks at trial, he stated, have been particularly onerous as a result of it introduced again so many reminiscences. Of his personal battle with most cancers in 1998, when she caught by his facet. Of washing her physique as she weakened from most cancers. Of merely lacking the gal who stole his coronary heart 4 many years in the past.

Orrana was identified to soak up stray animals. Cats, canines, you identify it. Ron would inform her he was the most important stray she ever took in. He laughed whereas recalling that second.

He then talked concerning the three Aetna medical administrators; he stated every testified that “they would not change something they did.”

When the jury stated Aetna “recklessly disregarded” Orrana’s case, Ron Cunningham stated, he lastly felt justice.

“When they stated that, it was like, ‘I feel we did her proud,’ ” he stated.

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