AETNA

damages. Two of the dissenting jurors Tuesday had wanted to award even more.

‘Worst suspicions’ confirmed

An Aetna doctor in 2014 denied Orrana Cunningham coverage for proton beam therapy for her stage 4 nasopharyngeal cancer on grounds it was experimental and investigational.

Two other in-house doctors reviewed that decision separately and upheld the denial.

Jurors told The Oklahoman they were swayed by evidence the Aetna doctors spent only minutes reviewing Orrana Cunningham’s records before denying coverage even though her case was rare because her tumor was so close to the brainstem.

“They’re professionals, they’ve been to college, this is what they do for a living,” one juror said. “They could have reviewed the policies more than 20 to 30 minutes.”

One doctor had complained to Aetna about having to review more than 80 cases a day, according to evidence presented at the trial.

“She was failed just at every turn,” jury forewoman Ann Schlotthauer said. “It was sad.”

Some jurors described the Aetna doctors as “rubber stamps,” just doing what Aetna wanted them to do.

“All of your worst suspicions about the health insurance industry have been confirmed in this case,” the Cunninghams’ attorney, Doug Terry, told jurors Monday.

On Tuesday, Terry said justice was done.

“There’s not been a verdict of this size in some time in the state of Oklahoma,”

Terry said. “I’m really hoping — hoping — that the jury’s voice is heard beyond the walls of this courtroom and into the boardrooms of insurance companies around the country.”

He disputed that proton beam therapy is experimental and accused Aetna of denying coverage for profit reasons. He accused Aetna doctors of being unqualified to make their decisions, overworked and biased because they get profit-based bonuses.

The attorney pointed out to jurors that proton beam therapy has the approval of the Food and Drug Administration. He also pointed out Medicare pays for the treatment for its patients.

“My wife, her goal, was to make this fight,” Ron Cunningham, 56, said after the verdict. “Her comment was, ‘If we can save one person and stop Aetna from doing what they traditionally do on every claim, it was worth the battle.’”

The widower also said he hopes the verdict will inspire others to stand up to insurance companies and not be bullied.

In closing remarks to jurors Tuesday, an attorney representing Aetna said the company tries to do the right thing and the verdict stings a lot.

“If it’s in our control to change, that’s what we’re going to do,” attorney John Shely said. “Aetna has learned something here.”

Jurors were told Aetna makes $3.6 million in profit every day.

In a statement Wednesday, Aetna said, “We are disappointed with the verdict and are weighing our options for appeal.”

Attorney Justin Meek, who also represents the Cunninghams, said an appeal could take years.

“But I am confident the appellate courts will affirm the trial court verdict,” Meek said Wednesday.