Case II
Christopher McNaughton
State College, Pennsylvania · UnitedHealthcare / Penn State Student Plan
The Story
Christopher McNaughton was 20 years old, 6'4", playing college basketball at Bard College, when he returned from winter break in 2014 and couldn't stop going to the bathroom. Within days he was diagnosed with severe ulcerative colitis — a chronic inflammatory bowel disease with no cure. What followed was six years of his life effectively erased: up to 20 bouts of bloody diarrhea a day, severe arthritis, dangerous blood clots requiring hospitalization, loss of 50 pounds, and confinement to his parents' house in State College. For two years he ate the same meals every day — Rice Chex and scrambled eggs, white rice with chicken — because he couldn't risk anything else.
He worked through a series of failed treatments until a specialist at the University of Pittsburgh referred him to Dr. Edward Loftus at Mayo Clinic — one of the leading gastroenterologists in the country. Dr. Loftus found a combination of two biologic drugs at above-standard doses, an off-label regimen. It worked. For the first time in years, McNaughton could function. He enrolled at Penn State in 2020. He was attending class in person. He was living something like a normal life.
His medical bills were running nearly $2 million a year. UnitedHealthcare — which provided Penn State's student health plan — flagged his case as a "high dollar account."
🎙️ The Recorded Phone Call
In May 2021, UHC nurse Victoria Kavanaugh called her colleague Dave Opperman to share news about the McNaughton case. The call was recorded, as UHC routinely recorded internal calls. Through McNaughton's subsequent lawsuit, that recording became public.
Kavanaugh told Opperman that a doctor contracted by United had reviewed the case and concluded McNaughton's treatment was "not medically necessary." Opperman reacted with a long laugh. He then complained about McNaughton's mother, calling her "this woman" and mocking her for "screaming and yelling" and "throwing tantrums" on calls with United.
"We're still gonna say no."
— Dave Opperman, UnitedHealthcare, May 2021 (recorded internal call)
The pair agreed that any appeal would be a waste of the family's time and money — before the appeal had been filed.
What the Lawsuit Uncovered
- United buried its own doctor's report. A physician paid by UHC reviewed the case and concluded that denying McNaughton's treatment could put his health at risk. UHC did not consider this report. They did consider a report from a different company doctor who copied and pasted a nurse's recommendation and typed "agree."
- United misrepresented the treating physician's position. Court records show UHC inaccurately reported to Penn State and the McNaughton family that Dr. Loftus — the Mayo Clinic specialist — had agreed to lower the medication doses. Dr. Loftus had not agreed. He had warned that altering the treatment "would have serious detrimental effects on both his short term and long-term health and could potentially involve life threatening complications."
- The cost calculus was explicit. Internal UHC emails show officials calculated exactly what McNaughton was costing them and how much they would save by forcing him onto a cheaper treatment that had already failed him. The company said publicly the denials weren't about cost. The documents said otherwise.
- The case was monitored at the highest levels of the company. Despite the public claim that this was routine utilization review, UHC's internal records show McNaughton's case reaching senior leadership.
The Reviewing Physician — Dr. Cates Under Oath
Through the lawsuit, the reviewing physician — Dr. Cates — was deposed. His testimony is a verbatim description of exactly what the Clinical Integrity Amendment § 2 was written to prevent:
- Dr. Cates testified he had not treated patients with ulcerative colitis in his practice and had referred those cases to gastroenterologists — meaning he was not a peer of Dr. Loftus and had no relevant specialty expertise.
- His review of the McNaughton case "primarily involved reading a United nurse's recommendation to deny his care and making sure there wasn't a decimal place that was out of line."
- He copied and pasted the nurse's recommendation and typed "agree." He does approximately 100 reviews per week.
- UHC's policies "prevented him from considering that McNaughton had failed other treatments or that Loftus was a leading expert in his field."
"You are giving zero weight to the treating doctor's opinion on the necessity of the treatment regimen?"
— Attorney, in deposition of Dr. Cates
Under the Clinical Integrity Amendment § 2, Dr. Cates' denial would have been void from the moment it was issued — he lacked board certification in gastroenterology, he had not reviewed the full clinical record, and he had certified none of the submitted evidence under penalty of perjury. The denial itself would have triggered mandatory State Medical Board reporting.
Outcome
McNaughton filed suit. The lawsuit forced UHC to release its internal communications. Shortly after ProPublica published its investigation in February 2023, UHC settled. The terms are confidential.
McNaughton is still on his treatment. He is still enrolled in school. He has stated that he fears having to fight this same battle every year for the rest of his life — because nothing structural changed. The settlement resolved his case. It didn't change the system that produced it.
What This Case Proves About the Mechanism
The McNaughton case is the Wrongful Denial Echo Chamber with the lights on. Every element of the system is visible: the "high dollar account" flag, the buried favorable report, the misrepresentation of the treating physician's position, the reviewing doctor who copied and pasted a nurse's note, the pre-decided appeal outcome on a recorded call. This is not a case where the system malfunctioned. This is a case where the system worked exactly as designed — and someone happened to have the resources, the will, and the extraordinary good fortune that a national news organization investigated it and published. Most people don't.
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