Aetna Insurance has given a blow to its reputation. This comes from the admission of a former medical director that he never reviewed patients' records before turning them down for procedures. Rather, he let nurses on staff make the decisions and he validated them. California's insurance commissioner expressed outrage over the disclosure and has launched an investigation into the company. Aetna's black eye was self-inflicted. It should have known that allowing someone other than a doctor to deny medical procedures was not going to work for the long term. Now the company has to defend itself in court and before the commissioner and try to regain its footing. It might not be easy.