(CNN)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 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, a targeted form of radiation that could pinpoint her tumor without the potential for blindness or other side effects of standard radiation.
Aetna denied her coverage, calling the therapy investigational and experimental.
Orrana and her husband, Ron Cunningham, a retired Oklahoma City firefighter, had been together since 1987. He was determined to do whatever it took to get the love of his life the treatment she needed. The couple mortgaged theirdream home and set up a GoFundMe page to help paythe $92,082.19 to get the therapyher doctors had prescribed at the MD Anderson Cancer Center in Texas.
However, Orrana died May 30, 2015, at the age of 54, in part from 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 to sue Aetna, saying that if her case helped save the life of one person, it would be worth it.
“My wife started the case, and I’m just finishing the fight,” he said. “We did her proud. My wife wanted to make sure that it got out. Her comment was ‘if we could just save one person.’
“As far as the money, I’d give it all back to spend just one more day with her.”
Aetna attorney John Shely said in closing arguments that the insurance giant was proud of the three medical directors who denied coverage, even turning to thank them as they sat in the front row of the courtroom, according to jurors and other witnesses in court.
It was a message that didn’t 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 jurors were turned off by one Aetna medical director who acknowledged handling 80 cases a day and by the fact that all three medical directors acknowledged they spent more time preparing for the lawsuit than on Orrana’s medical case.
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 obviously they were in breach of contract and should’ve paid for that treatment. It was medically necessary in her situation.
“I hope [the verdict] does 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’ve been much higher than the $25.5 million handed down.
“I just wanted to let him know that I was on his side,” Dale said. “Those medical directors did not exhaust every measure like 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, walked up to him and congratulated him after the verdict before telling him he’d lose on appeals.
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 comb through the wreckage of the day-care center on the second floor to search for bodies of 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’ve prepared him for that encounter 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 nation’s third-largest insurer, declined to comment on the encounter but maintained that it acted appropriately in denying coverage in this case, saying there is a “lack of clinical data supporting proton therapy for treating nasopharyngeal tumors.”
“While we have no comment on the ruling, juror motives or a potential appeal, we do want to make it clear that the proper steps under the health plan were followed in this instance,” Aetna said in a written statement. “As our chief medical officer noted in a post earlier this year, it’s never easy to tell an individual or family that a treatment or procedure is not approved — it’s the hardest thing we have to do.
“However, our guiding principles will continue to be proven effectiveness and member safety, as determined by rigorous scientific studies.”
Doug Terry, the lead attorney for the Cunninghams, offered a much different take.
“We believe this case pulled the curtain back on what goes on at a health insurance company when claims are being denied,” Terry said. “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 offering tips and recommendations on how to try to get insurance companies to pay for coverage of proton therapy.
Other cancer patients often turn to sites like GoFundMe to raise money for their treatment. Some insurers eventually agree to cover therapy for adult 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 commissioners in all 50 states to make sure the treatment will now be covered by insurance companies when treating doctors believe that it is the best available 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’ve seen a similar pattern of betrayal across the industry, where insurers use outdated information and medical staff with little knowledge of proton therapy to ultimately deny as many as four in 10 patients seeking the treatment. It’s past time to hold insurers accountable.”
Some jurors said that one of the most convincing experts was radiation oncologist Dr. Andrew L. Chang, who explained why proton beam therapy was the best treatment for Orrana Cunningham. He was not involved in her care but was called as an independent expert by her attorneys.
“The thing I tried to illustrate to the jury is that proton therapy is not a new, experimental technique, like Aetna wants to claim,” Chang said. “Proton therapy is a well-established treatment for cancer and has been for decades. … Nobody in the oncology community considers proton therapy experimental for the treatment of cancer.”
He said he told jurors that Medicare covers proton treatment and that insurance companies often cover it for an array of cancers for pediatric patients, typically up to the age of 21.
“One thing we pointed out is that as much as Aetna and these other insurance companies like to say proton therapy is experimental, they always put a caveat in there that it’s not experimental for pediatric patients,” Chang said. “We pointed out Medicare pays for it for 65 years or older. So, what is it about 22-year-olds to 64-year-olds that makes proton therapy experimental? 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 toward the base of her skull. He said he told jurors that standard radiation could’ve been used, as Aetna wanted, but the “risks were severe.”
“She would go blind. She would lose a significant portion of her memory on the left side of her brain and still not have a very good chance at a cure,” 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 jurors that this was a case “of misplaced blame by Mr. Cunningham and his lawyers,” according to the official court transcript.
“Aetna has full confidence in your ability to hear the evidence from that witness stand and then later compare it to the opening statement you just heard,” 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 award $15.5 million in emotional distress damages and on Tuesday tacking on $10 million in punitive damages.
Kent McGuire, a personal injury attorney in Oklahoma who watched parts of the trial, called the verdict the biggest bad faith insurance verdict for an individual case in Oklahoma history. “It was certainly a stunning verdict to award that much money, and it was a message, too,” he said.
Ron Cunningham said his wife would be pleased with the verdict.
She used to comfort him on hard days — whether it was in the months after 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 his own battle with cancer in 1998, when she stuck by his side. Of washing her body as she weakened from cancer. Of simply missing the gal who stole his heart four decades ago.
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 talked about the three Aetna medical directors; he said each testified that “they wouldn’t 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 her proud,’ ” he said.
The MOST POWERFUL App on Planet That Builds a Fully Functional Affiliate Shoppe in 60 Seconds Flat That Gets You Products from Top E-com Giants, Unique Content, Video Reviews, TRAFFIC and COMMISSIONS, All Hands FREE…
Handy Video Kit Volume 1 is a hand gesture, green screen video kit designed to work with Easy Video Lab and Easy Video Lab Lite. Handy Video Kit can be used to create hand gesture videos. Handy Video Kit also comes with free software, Easy Video Lab Lite
Moto Theme DFY Basic ServiceHere's Your Ultimate Turn-Key Solution, Ready To Set Up Your WordPress Sites, And Relieve You From All Your Workload And Team Management Headaches!
Pixamattic BLACK Edition PROBRAND NEW PARALLAX *2.5D* Creator To Significantly BOOST Your Traffic With Fortune 500 SECRET Technology For MASSIVE Clicks, Conversions and Sales. LOWEST EVER One-Time Launch Special Price Today. Rises To $297 ONLY!
Viral Reach Elite YEARLYViral Reach is a Facebook marketing 100% automation tool. Once you type in the keyword Viral Reach will get you content from high-authority and non-spammy sources for maximum organic reach and post it on its own.Get the full variety of content including t
SociLiveStream Unlimited1. No of streaming and Syndication Campaign: Unlimited
2. No of Social Media Account: UNLIMITED ACCOUNTS
3. Multiple campaign support
4. Youtube Live Stream Syndication to twitter, Tumblr, Reddit, Linkedin, Pinterest, Blogger, Wordpress, Medium
TV Channel Master DeveloperTV Channel Master Developer lets you create the app to power your own TV channel on Roku in minutes, with NO programming.Having your own TV channel means AUTHORITY.
You/your business are the industry leaders.Also, TRAFFIC: 10k+ first month.
GB Cracked OTO 2 Inner Circle GroupLearn How To Generate Your First Dollar Using Gearbubble Platform and Facebook Ads Following an Over The Shoulder's Proven Case Study.This is Access to the VIP Inner Circle Group for one on one coaching where needed
Blogashop AgencyBlogashop PRO is a WP plugin that allows users to search from our db of over 60K articles, spin them (with a free Spinner Bros account), add royalty free images, YT vids, push posts to their Shopify Store Blogs, and manage all Shopify posts from a central
IPL Gold - PRO DSInstant Product Lab - The Newbie-Friendly, Cloud Based Software That Creates High-Quality Info Products You Can Sell In Just 60 Seconds
Affiliate Rex V2Ultimate affiliate Sales System. Web based software with pre-build affiliate funnels, link cloaking and tracking. Automatic list building and autoresponder integration. Build a list while promoting internet marketing affiliate products with built in lead
Quotamator DIAMOND PROQuotamator DIAMOND PRO - 15X Your Traffic With The BIG Publishers SECRET Formula, Instantly!
Pixamattic VIDEO Edition PROGet BUYERS Hands-FREE With Your Unique Mini-Video Gifs and Moving Images On Social Networks For More Profits On Autopilot. LOWEST One-Time Launch Special Price Today ONLY! Increases To $197.00!
Bing Bang ProfitsBing Bang Profits Software and Training INSTANTLY Creates Profit-Optimized Ads On Bing! With One Click...That Brings You Massive ROI !
Viral Autobots Training OTO2Viral Autobots Is The First and Only Software To Find, Upload, Schedule and Monetize The Most Viral Content and Videos On Facebook, Twitter and YouTube For Your Facebook Fan Pages, while shooting your ORGANIC reach into the millions instantly.
Insta-Stories Upgrade 3The Commercial License At Your Disposal, Allows You to Sell unlimited Videos To All Your Videos To Clients!
AdSmartly - Whitelabel Rights (100 Licenses)AdSmartly Is a NEW 1-CLICK SOFTWARE THAT CAPTURES Email Leads Of Clickers, Likers and Commenters Of Your FB Ads Instantly on Complete Autopilot Without a Landing Page or Optin Form.
DropGecko Pro AnnualGroundbreaking software for the easiest access to profitable Dropship stores, complete with 1-click shipping and customer fulfilment.
MailPrimo ScaleGive Your Subscribers the World's No.1 and Most Powerful Cloud Based Email Marketing Software to make them STOP Losing their Leads, STOP Paying Heavy Monthly Fees and Generate More Leads,
Gets them Better Delivery, More Opens and Clicks completely hassle
Flickstr Premium Edition LITEFlickstr LOCAL Edition: BRAND NEW, DONE-FOR-YOU Local Niche Videos With Developer and Commercial License To Sell For 100% Profits. Includes INTERNATIONAL RIGHTS, 100?itable Project Files, Voiceovers and Scripts. LOWEST Price TODAY Ever. Rises To $197 ONLY!
Splash Video ElementsIntroducing Splash Video Elements -- a beautifully crafted video kit based on watercolor and animated ink elements. Splash Video Elements contains templates and assets compatible with Easy Video Lab (formerly known as Kinetic Text Animator, Easy Video Lab
EZ Reputation ManagementLearn how to increase your profits by offering high-converting reputation management services to businesses.
Sellin Messenger Commercial1st Ever Facebook Messenger Sales Automation Software!
Let Messenger Chat - Engage, Sell Products to Your Website and Facebook Visitors and Handle Support On Autopilot Even While You Sleep
Sell Products or Services in 1 Click with Upsells via Fb messenger an
ATL - DIAMOND Upgrade - PRO DSThe Affiliate Traffic Lab is a 100% cloud based software that creates traffic getting videos that you can rank on Google and Youtube in minutes to get you free traffic, leads and sales.
LeadFunnelCloud EliteGet this Cloud Based App That Creates INSTANT Done-For-You UNLIMITED Profitable Lead Funnels To Build A HUGE List,Drive Targeted Social Traffic and Affiliate Commissions In Just 60 Seconds
SyndRanker Unlimited - YearlySyndRanker Unlimited - YearlyWith this upgrade, you will get:
- Unlimited Syndications
- 500 RSS Feeds Campaigns
- Recurring Syndications
- Post Spinning
TweetPush Pro One TimeTake a look at the powerful professional features of Tweetpush Pro Version. With this version you can automate and publish content for 25 Twitter accounts. Create multiple IDs for your business, and generate traffic through all of them targeting different
My Unfair Advantage - Special Blow Out $297.Omar and Melinda Martin's highly regarded flagship product has everything a marketer needs under one roof. This membership site includes LIVE weekly coaching webinars and hundreds of archived episodes. Includes access to core products for free!
Credi Response AceCredi Response Ace version gives you the additional capability to personalize messages with visitor’s name, lets you set default response on page level thus your audience will receive a response no matter which post they comment on.You also get enhanced
Email Jeet 2 ResellerEmail Jeet PRO is a proven software with amazing capabilities, and you know it. That’s why you have bought it. It is an only viable desktop autoresponder and anyone would pay for it, as it is that’s unique.So, here we bring you an amazing opportunity wi
LetMailbox OTO2 LiteLetMailbox - Your All-In-One TOOLBOX for RAPID Returns on ANY EMAIL Broadcasts!!
Video ToolChestVideo ToolChest is a collection of 10 main tools and some tools can be used for multiple purposes. Each tool provides a solution for a problem we've been asked about repeatedly by users of our other applications and by users of video and animation tools b
Vizully DIAMOND LiteVizully DIAMOND Edition. Significantly BOOST Your Traffic With Fortune 500 SECRET Technology For MASSIVE Clicks and Conversions.
APS Elite Members Package+The APS Super Simple Squeeze Page Builder Software
+10 templates and Giveaways
+The Auto Profit System Solo Ad Mastery Guide
+The APS Follow up Email Sequence
XFUNNELS Pro Commercial- Million Dollar Template ClubGet Our Best 500 High Converting Funnel and Page Templates?That Have Generated US Over $3 Millions and Over 200,000 Customer Leads In Last 6 Months
With Over 5000 Stock 4K Videos + 5000 Stock HQ Audio Sounds +?5 Million 4K UHD Stock Images + Premium Photoshop
Social Daddy- [Consultant ToolKit] Downsellhe Ultimate Consultant Marketing Toolkit For Social Media Managers And Local Business Consultants To Market More Effectively, Attract More Local Business Clients and Position Themselves As Social Media Marketing Experts.