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An Oklahoma jury has awarded $ 25.5 million to the family of a cancer patient denied coverage by Aetna, with jurors saying that the insurer acted "recklessly" and that the verdict was meant as a message for Aetna to change its ways.
The award is believed to be the largest single verdict in a "bad faith" insurance case in Oklahoma history, one short observe said, and could have major ramifications across the country for a proton beam therapy.
The case revolved around the 2014 denial of coverage for Orrana Cunningham, who had stage 4 nasopharyngeal cancer near her brain stem. Her doctors wanted her to receive proton beam therapy, which could have the advantage of having radiation.
Aetna denied her coverage, calling the investigational and experimental therapy.
Orrana and her husband, Ron Cunningham, retired Oklahoma City firefighter, had been together since 1987. He was determined to do whatever it took. The couple mortgaged their dream home and set up GoFundMe page to help pay the $ 92,082.19 to get the therapy her doctors had presided at the MD Anderson Cancer Center in Texas.
However, Orrana died on May 30, 2015, at the age of 54, in part of a viral infection that reached her brain.
Ron Cunningham said this week's verdict was vindication for the suffering his wife went through. She had filed the initial paperwork with Aetna, saying that if she helped save the life of a person, it would be worth it.
"My wife started the case, and I'm just finishing the fight," he said. "We did not proud. My wife wanted to make sure that it got out. Her how was 'if we could just save one person'
"As far as money goes, I'd give it back to spend just one more day with her."
Aetna attorney John Shely said in closing arguments that the insurance companies are losing their coverage, they are also turning to face-to-face sufficiency.
It was a message that did not sit well with the 12 jurors, who found that Aetna "recklessly disregarded its duty to deal fairly and act in good faith with the Cunninghams."
"I just felt like Orrana Cunningham was failed at every turn," forewoman Ann Schlotthauer said.
She said the verdict "was definitely a message to Aetna. We discussed that in jury deliberations – that we wanted to make a statement. We wanted to make a point and get their attention. "
'Aetna needed to pay'
Schlotthauer said it was clear from expert testimony that proton beam therapy was not experimental at all. She said that she is one of the most qualified medical advisers in the world.
Schlotthauer said she believed that Aetna's medical directors "rubber-stamped" the denials without doing their due diligence. "No one was looking at her specific case," she said. "That's where we decided that they were in breach of contract and should have paid for that treatment. It was medically necessary in her situation.
"I hope [the verdict] does not result in huge changes, "she said. "I hope it results in Aetna re-evaluating how they evaluate appeals and requests."
Juror Ora Dale cried and hugged Cunningham after the trial. She was one of two jurors who believed the monetary award should have been much higher than the $ 25.5 million.
"I just wanted to let him know that I was on his side," Dale said. "Those medical directors did not like every measure they said that they did. They did not spend enough time on her claim. It just kept getting denied and denied.
"Aetna needed to pay. They were in the wrong, and he deserved everything that he was asking for. "
Cunningham had another encounter in court. He said Shely, Aetna 's lead attorney, who' s up to him and congratulates him after the verdict.
Cunningham was an Oklahoma City firefighter when the Alfred P. Murrah building was bombed on April 19, 1995, killing 168 people and wounding hundreds more in one of the deadliest terror attacks in American history. The day after the bombing, he was assigned to combating the wreckage of the day-care center on the second floor to search for children. He said he would spray corpses with Lysol to prevent the spread of bacteria.
He'd seen the worst of the worst. But little could have been prepared for him with Aetna's attorney in the courtroom. He said he stood, stunned, trying to grasp what he'd just heard.
"That showed how callous these people are," he said.
Shely did not respond to a request for comment.
Aetna, the nationâ € ™ s third-largest insurer, declined to comment that it was appropriately used in this case, saying there is a lack of clinical data for proton therapy for treating nasopharyngeal tumors.
"While we have no comment on the rulings, we can say that we have a good motive, that we have the right to do so." "As our chief medical officer noted in this year, it is never easy to tell that this is the case.
"However, we will continue to be effective and secure, as determined by rigorous scientific studies."
Doug Terry, the lead attorney for the Cunninghams, offered a much different take.
"We believe this case is backed by a claim to a health insurance company when claims are denied," said Terry. "The jury's verdict delivered the message that the public will not stand for insurance companies putting profits before policyholders."
Defense attorney: Aetna did 'nothing wrong'
It is not uncommon for people with cancer to be denied proton beam therapy by insurers, despite the recommendations of their treating physicians. Many radiation oncologists express frustrations about the denials, and websites exist providing tips and recommendations on how to get insurance for proton therapy.
Other cancer patients often turn to sites like GoFundMe to raise money for their treatment. Some insurers eventually agree to cover the treatment of patients after a lengthy appeals process.
Daniel E. Smith, Executive Director of the Alliance for Proton Therapy Access, applauded the verdict and called on insurance agents in all 50 states to make sure that treatment is the best treatment for their patients.
"We applaud Ron Cunningham for standing up to Aetna, and the jury for recognizing and holding Aetna to account for their broken system," Smith said in a statement. "We have seen a lot about betrayal in the industry, where insurers use information and medical care with little knowledge of proton therapy. It's time to hold insurers accountable. "
Some doctors said that one of the most convincing experts was radiation oncologist Dr. Andrew L. Chang, who spoke about proton beam therapy was the best treatment for Orrana Cunningham. He was not involved in her care but was called an independent expert by her attorneys.
"The thing I tried to illustrate is that the proton therapy is not new, experimental technique, like Aetna wants to claim," said Chang. "Proton therapy is a well-established treatment for cancer and has been for decades. … Nobody in the oncology community considers experimental proton therapy for the treatment of cancer. "
He said that he is one of the most frequently diagnosed patients in the field of cancer for patients with pediatric cancer, typically up to the age of 21.
"One thing we pointed out is that they are more likely to have proton therapy is experimental, they are still caving in it's not experimental for pediatric patients," Chang said. "We pointed out Medicare country for it for 65 years or older. So, what is it about 22-year-olds to 64-year-olds that makes proton experimental therapy? There is no good answer for that; insurance companies call it that because they decided to deem it as such. "
Two top cancer specialists, not affiliated with the trial, told CNN they agreed with Chang's assessment.
In Orrana's case, Chang said, the tumor was right next to her brain stem and optic nerve, and it had been growing up towards the base of her skull. He said that this was a standard practice that could have been used, but Aetna wanted, but the "risks were severe."
"She would go blind. She would like to have a significant portion of her memory at the heart of her brain, and said, "Chang said. "For her particular tumor, [proton therapy] was extremely valuable. "
Before Orrana died, he said, scans showed that the tumor was shrinking and the treatment was working.
Aetna attorney Shely told that this was a case of misplaced blame by Mr. Cunningham and his lawyers, according to the official short transcript.
"Aetna has full confidence in your ability to hear the testimony of the witness." "Shely said during his opening statement. "In short, the evidence that you will see and hear will convince you that Aetna has done nothing wrong, nothing."
After considering the evidence, the jury did, in fact, find fault with Aetna's handling of the case, voting on Monday to $ 15.5 million in emotional compensation and on Tuesday tacking $ 10 million in punitive damages.
Kent McGuire, Oklahoma, Oklahoma, The Oklahoma History of Oklahoma. "It was certainly a big deal, it was a message, too," he said.
Ron Cunningham said his wife would be pleased with the verdict.
It was used in the aftermath of the 1995 bombing or after he'd find a child badly injured in a house fire. He'd come home, place his head in her lap and tell her everything on his mind.
"She was a rock for me, especially through my bad times," he said.
The past two weeks at trial, he said, were especially hard because it brought back so many memories. Of her own battle with cancer in 1998, when she stuck by her side. Of her body as she weakened from cancer. Of just missing the gal who stole his heart
Orrana was known to take in stray animals. Cats, dogs, you name it. Ron would tell her he was the biggest stray she ever took in. He laughed while recalling that moment.
He then spoke about the three Aetna medical directors; he said each testified that "they would not change anything they did."
When the jury said Aetna "recklessly disregarded" Orrana's case, Ron Cunningham said, he finally felt justice.
"When they said that, it was like, 'I think we did it proud,'" he said.
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