Thursday, July 28, 2011

Health bill to approach 20 percent of spending by 2020

Health bill to approach 20 percent of spending by 2020
By Andrew Seaman
Jul 28, 2011

(Reuters) - The U.S. health bill will account for 19.8 percent of the nation's spending by 2020, up from 17.6 percent in 2009, outpacing projected average annual GDP growth, researchers said on Thursday.

The report, published online in the journal Health Affairs, looked at projected U.S. health spending through 2020 and estimated about 30 million people will gain health insurance by the start of the next decade due to President Barack Obama's healthcare overhaul.

According to the report, the average annual growth in national health spending is expected to be 5.8 percent, or 0.1 percentage point higher than it would be without the Affordable Care Act.

"We are projecting a decline in the out-of-pocket share, but that doesn't mean that the consumer's burden is going to be substantially reduced," said Sean Keehan, an economist at the Centers for Medicare and Medicaid Services (CMS) and co-author of the report. "Especially since we're projecting health spending to grow at a faster rate than economic growth and disposable personal incomes."

For 2010, the researchers estimated that health spending grew at a historically low rate of 3.9 percent over the previous year to $2.6 trillion, which they attributed to a weak economy that has led many consumers to delay medical treatment.

But future spending will likely grow at a faster pace, fueling concerns over how to cut the country's deficit, now the subject of fierce debate among lawmakers ahead of a deadline for raising the government's borrowing limit.

The largest increase in healthcare spending in a single year is expected in 2014, when CMS forecasts a rise of 8.3 percent from 2013 as much of the new U.S. health law is implemented. The law's provisions include introducing state-based insurance exchanges and increased access to the government's Medicaid insurance plan for the poor. Spending growth will then average 6.2 percent annually from 2015 through 2020.

According to the report, some large employers with low-wage employees are expected to stop offering health insurance in 2014. An estimated 13 million employees would then likely seek insurance in the new exchanges or by enrolling in Medicaid, according to Rick Foster, CMS's chief actuary.

Increased access to health insurance is another explanation for the high growth rate, because with access comes demand.

The researchers estimated that doctor visits, clinical services and prescription drugs will be some of the largest growth areas, because of the comparably young age of the newly insured population. The report said younger patients tend to require less acute care.

(Editing by Michele Gershberg and Steve Orlofsky)

Friday, July 22, 2011

Chief at Kaiser: doctors aware when hired that they would be required to violate professional standards

Dennis Cook, M.D., coordinating chief of psychiatrists for Kaiser’s Southern California division, is quoted by the Times as saying that Jensen was well aware of the policy when he was hired.

Kaiser's Prescribing Policy Leads To Lawsuit, Ethics Concerns

Psychiatric News
May 5, 2000

One of the nation’s best-known HMOs has ignited a furor by requiring psychiatrists at one of its California facilities to write prescriptions for patients they have never seen.

Kaiser Permanente’s policy for psychiatrists in its San Diego area facilities stipulates that when they receive a request for a prescription for a patient that a staff psychologist, social worker, or family therapist is seeing, they are to comply with the request and write the prescription without scheduling a visit with the patient.

Widespread publicity about the policy, which was the focus of an April 13 Los Angeles Times article, has generated heated responses from psychiatrists and others concerned about how such a policy could seriously compromise patient care and put psychiatrists in ethical jeopardy.

The article revealed that a state agency was investigating this practice and that a psychiatrist who lost his job after refusing to follow the policy was suing Kaiser Permanente.

The day after the article appeared, APA issued a press release strongly condemning the policy as an example of "unethical" medical practice.

In that statement APA President-elect Daniel Borenstein, M.D., a private practitioner in Los Angeles, said it is "unethical and substandard practice for a psychiatrist to prescribe medication for a patient without personally examining that patient and determining the necessity for medication."

He emphasized that Kaiser Permanente’s practice "trivializes mental illness and the special medical skills of psychiatrists in diagnosing and treating it."

APA’s press release cites two paragraphs of its ethics code that may be violated by Kaiser’s prescribing policy. One states, "When the psychiatrist assumes a collaborative or supervisory role with another mental health worker, he/she must expend sufficient time to assure that proper care is given. It is contrary to the interests of the patient and to patient care if he/she allows himself/herself to be used as a figurehead."

Another relevant paragraph says that in relationships between psychiatrists and psychologists, "The physician should not delegate to the psychologist or, in fact, to any nonmedical person, any matter requiring the exercise of professional medical judgment."

Psychiatrist Fired

The San Diego psychiatrist who filed suit against Kaiser, Thomas Jensen, M.D., wants the court to step in and order the HMO to stop the practice, which he contends violates state law about prescribing and dispensing drugs. Kaiser fired Jensen in December after he refused to prescribe medications for HMO patients he had never seen.

Dennis Cook, M.D., coordinating chief of psychiatrists for Kaiser’s Southern California division, is quoted by the Times as saying that Jensen was well aware of the policy when he was hired. In his suit, Jensen said that on his first day on the job, he received medication requests from social workers, social work interns, and marriage and family therapists.

"I was astounded that this was happening," Jensen said. "I was trained that you don’t prescribe medicines for patients you’ve never seen." He said he had seen drug recommendations from nonphysicians that if prescribed would have jeopardized patients’ health.

Oliver Goldsmith, M.D., medical director and chair of the board of Southern California Permanente Medical Group, said in an April 20 press release that contrary to reports, Kaiser does not have an official policy of requiring psychiatrists to prescribe without seeing the patient. He said psychiatrists in the medical group developed a "multidisciplinay team-based approach" in which "psychiatrists in San Diego work very closely on a regular basis with other mental health professionals in a group practice. It is a physician-designed and physician-driven approach in which physicians exercise their medical judgment and authority in rendering care."

Joel Hyatt, M.D., assistant associate medical director for the Southern California Permanente Medical Group, said that "all decisions to examine the patient or to prescribe medication are made by physicians."

In defending the policy, Cook stated that he believes "it’s very ethical." He noted that all of its psychiatrists are informed of and agree to the prescription policy before they are hired. He explained that Kaiser psychiatrists can refuse to follow through on a prescription request from a nonphysician therapist if they believe that medication is not appropriate for a particular patient. If medication is likely to benefit the patient, however, they are obligated to prescribe one.

While psychiatrists may be well informed about the policy, as Cook said, there is a serious question about how well informed patients are.

Sam Muszynski, director of the APA Office of Healthcare Systems and Financing, raised the issue of whether patients are getting any meaningful informed consent when their medication information comes from nonphysicians. "It is hard to believe," he said, that psychologists, social workers, and other therapists can describe the wide range of side effects for which patients need to be alert or can diagnose symptoms that may be the result of interactions with other drugs with anywhere near the degree of competency that a physician can provide.

Kaiser did acknowledge after the suit was filed that it is aware that its prescribing standards differ from those used by other treatment facilities in the region. Cook told the Times that the policy allows psychiatrists to see more patients by eliminating the need for them to conduct duplicate interviews for patients who have already been assessed by a nonphysician therapist. He also called the attacks "self-serving" since, he said, they come from private practitioners who stand to gain from additional office visits if Kaiser is forced to alter its policy.

Comments About Policy

The president of the San Diego Psychiatric Society (SDPS), Kenneth Khoury, M.D., does not see any benefit for patients or physicians in the policy. The policy clearly fails to meet the standard of care in the community, he told Psychiatric News, and "exceeds the boundaries" of what goes into providing "quality care and safe care." There is no room for negotiation on this issue, he noted. He said that the district branch has asked the Medical Board of California to clarify its understanding "that the standards of care and state law say that physicians must conduct face-to-face interviews" with patients before they write prescriptions for them.

Khoury has also asked Michael Newhouse, M.D., chair of the SDPS Ethics Committee, to "review the concerns" raised about possible ethical violations and report his findings to the SDPS Council. He said that 15 San Diego psychiatrists work for that area’s Kaiser Permanente group, of whom three are members of the district branch.

Yvonne Ferguson, M.D., president of the California Psychiatric Association (CPA), said she was "shocked to learn that Kaiser, which enjoys a good reputation in California, had such a policy." She suggested that the controversy "will bring the whole scope-of-practice issue into bold relief," adding that psychiatrists "cannot shrink from confronting this issue. Also, legislators will have to look at [scope of practice], and the public will have to be educated about implications of Kaiser’s policy."

The suit also charges Kaiser and the Southern California Permanente Medical Group with violating consumer protection laws by engaging in deceptive advertising, such as touting that at its HMOs "physicians alone manage all aspects of care" and that "medical decisions are made by physicians in consultation with their patients, not by health plan administrators. . .no third party comes between medical decisions."

Jensen, who moved from Maine to work for Kaiser, now teaches part time in the psychiatry department at the University of California at San Diego. Explaining why he chose to go the legal route, he commented, "As a physician I was required not only to refuse to [prescribe without seeing the patients], but to do what I could to end the practice because it endangered patients."

Kaiser is the nation’s largest not-for-profit HMO and has 8 million subscribers.—K.H.

[Thomas S. Jensen, M.D., v. Kaiser Foundation Health Plan, et al.; case no. 825090-6]

October 6, 2000
San Diego Psychiatrist Settles Lawsuit With Kaiser
Psychiatric News

Psychiatrist Thomas Jensen, M.D., agrees to a settlement of his lawsuit against Kaiser, his former employer. The suit stemmed from the HMO's policy of compelling its psychiatrists to prescribe drugs for patients they had not evaluated.

By Ken Hausman

A San Diego psychiatrist who ignited a furor earlier this year when he blew the whistle on the questionable prescribing policies of Califor-nia’s largest HMO has settled his lawsuit against that organization.

Soon after he was hired by Kaiser Permanente’s San Diego HMO, Thomas Jensen, M.D., protested his employer’s policy of requiring psychiatrists to prescribe medications for patients they had never evaluated on the recommendation of psychologists, social workers, or marriage and family counselors (Psychiatric News, May 5, May 19).

Jensen maintained that Kaiser’s prescribing policy violated state law governing how medications can be prescribed and dispensed. He said as well that he had seen medication requests from nonphysician therapists that could have harmed patients’ health if a psychiatrist had complied with the prescribing recommendation. Moreover, he and other California psychiatrists questioned whether complying with the prescribing policy was in fact a breach of medical ethics, and APA issued a press release condemning it as just such a violation.

Last December, Jensen maintained, Kaiser, the nation’s largest not-for-profit HMO organization, responded to Jensen’s airing of the policy by firing him.

After his firing, Jensen filed suit against Kaiser and asked the court to order the organization to halt its prescription policy. Kaiser officials defended the policy, explaining that it was based on a "multidisciplinary team-based approach" developed by psychiatrists at the HMO. At the time Jensen filed his suit, Kaiser employed 22 psychiatrists at its San Diego HMO.

Kaiser Retracts Policy

In early May, several weeks after the prescribing policy and the subsequent lawsuit were described in a Los Angeles Times article—and amid considerable fingerpointing about who developed and knew about the policy—officials of Southern California Permanente Medical Group (SCPMG), which owns the San Diego HMO, announced that the organization was going to change its prescription policy to require that all new psychiatry patients will have "to be examined by a physician before medication is prescribed."

While he was pleased about its reversal on the psychiatrist prescribing requirement, Jensen vowed to proceed with his lawsuit against Kaiser, saying he was unwilling to drop it based on the promise contained in a press release to retract its policy...

[Maura Larkins' comment: It appears that part of the settlement, which was probably very lucrative for Jensen, involved a requirement that Jensen say nice things about Kaiser. Sorry, Dr. Jensen. Anything you say after being paid must be taken with a grain of salt.]

Thursday, July 21, 2011

Health Administration Responsibility Project

Health Administration Responsibility Project

HARP is a resource for patients, doctors, and attorneys seeking to establish the liability of HMOs, Managed Health Care Organizations, and Nursing Facilities for the consequences of their decisions.

We are concerned that in the headlong rush to "Efficient" Medical care, the organizations involved are losing sight of the "Quality" of the care they provide.

As more and more "Incentives" to cut back on medical care are put in place by the new class of medical entrepreneurs, the patient often suffers. We feel that Counter-incentives must be applied, and they must be financial. The only such Counter-incentives available under our system are lawsuits for damages caused by excessive cost-cutting measures.

However, many obstacles protect corporate providers from being held responsible for their acts. ERISA drastically limits the remedies available to injured workers, as well as preempting State regulations designed to control the more egregious problems. Rigged Mandatory Arbitration gives injured patients the illusion of justice. Strict application of state Tort laws holds doctors responsible for actions forced on them by Managed Care Organizations, which themselves escape liability...

Wednesday, July 20, 2011

Patient is shocked when reviewing medical record

Medical Malpractice/False Medical Records
posted by Yoko
30 Mar 2006
Medical News Today

When I was pregnant with my 4th child, I was told I was "slightly" high-risk. My OB doctor did not want me to take amnioscentesis test right away. He recomended me to go to this specialist who had 3-D fetal ultrasound. This specialist told me that my baby did not have Down syndrome or any other health problems. When I went back for the second time, she confirmed that everything was just fine. "No problem."

She also told me NOT to take amnioscentesis test since she did not see any signs of Down syndrome or any other problems. I did not reply that time since I believe my OB doctor would follow up with me. However, nobody did.

Three months later, my baby was born with Down syndrome and two VERY large heart defects, which needed to be repaired within 3 months.

A few weeks after, I went back to my OB's office to view my medical records. I was shocked to find out that both my OB doctor and this specialist were filling false statements in my record. For example, "she recommended me to take amnioscentesis test, but the patient declined it." And my OB doctor also stated he showed this report from the specialist to me - he never did. I was also shocked to find out I had been at higer risk than my actual age and after the blood test, the lab was suggesting I should get amnioscentesis test.

I am a teacher and finishing up my graduate school work, but with the unexpected pregnancy and a baby born with these problems, I cannot pursue my career any more.

I had a neighbor whose daughter had Down syndrome, which made her severley retarded. Every day I go through a very tough time to understand my family has to go through what this family went through. My baby is precious and I really want to do my best for him, but it is very very hard. What upsets me most is that I was never given an option and time to prepare for this.

Dr Mark Midei's medical license revoked

Dr Mark Midei's medical license revoked
July 13, 2011
Shelley Wood

The Maryland Medical Board has concluded its review of Dr Mark Midei, deciding to revoke his license, calling his violations of the Medical Practice Act "repeated and serious."

The disciplinary actions alert published on the board's website today notes that the board will not accept any application for reinstatement by Midei for at least two years. At that time, it is up to the board whether it will consider reinstatement of his license.

As previously reported by heartwire, Midei is alleged to have implanted hundreds of unneeded stents when he worked at St Joseph Medical Center in Towson, MD. The imbroglio was ultimately taken up by the US Senate Finance Committee, which issued a damning report back in December 2010.

For years, however, watchers have been waiting to hear what the Maryland Board of Physicians concluded, having charged Midei with violating the Medical Practice Act back in July 2010, focusing specifically on five patients it was alleged may have received stents unnecessarily. A subsequent seven-day hearing before an administrative law judge (ALJ) led to her issuing a 77-page "proposed decision" that Midei have his license revoked for having violated five provisions of the act, specifically those prohibiting:

* Unprofessional conduct in the practice of medicine.
* Willfully making a false report or record in the practice of medicine.
* Gross overutilization of health care services.
* Violations of the standard of quality care.
* Failure to keep adequate records...

NYC Doctor Accused of Falsely Telling Patients They Had HIV

NYC Doctor Accused of Falsely Telling Patients They Had HIV
June 4, 2011
Billy Hallowell

It’s a hard-to-believe accusation, but one that prosecutors believe to be true. A New York City doctor allegedly told about a dozen patients that they were infected with the HIV virus. Then, he purportedly treated them and billed Medicaid $700,000. As a result, he may face 15 years behind bars. FOX News has more:

Suresh Hemrajani, 57, was arraigned Friday in Manhattan Supreme Court on felony charges of grand larceny, fraud and falsifying business records. He was being held in lieu of $250,000 bail…

The doctor also created false records of his purported repeated treatments of the patients, even though most of them never visited his office more than once.

The scam was only revealed after the patients later attempted to obtain prescriptions from a hospital, were tested, and found to be HIV-negative, Vance said...

Doctors falsely diagnose patient HIV positive based on claims by Sheriff's deputy

Dr’s Falsely Diagnosed Larry HIV+ Positive Based On Claims of Sheriff Deputy???
Larry Sinclair
Apr• 05•11

Today we received records which were requested concerning Larry’s suicide attempt last September 27th. While reading the records we came across not one, not two, but four (4) Progress Reports and one (1) Discharge Summary where West Virginia Doctors “diagnosed” Larry as being HIV Positive. Not only did these Doctors make this incorrect diagnosis repeatedly, they did so without EVER having performed a single HIV test.

Today we contacted one of the Doctors who reported this false diagnosis to ask how they had come to such a diagnosis. The Doctor was kind enough to take our call and after reviewing the file called back and apologized for the diagnosis. The Doctor informed us they did not know exactly where the information had come from, but they believed it was relayed through the Emergency Room by the Deputy who had Larry taken to the hospital.

Larry is NOT HIV Positive nor has he ever been HIV Positive and to have a medical facility and multiple Doctors record such a diagnosis without ever conducting a test is reckless an unacceptable.

We have just received a call from the Hospital Administrator concerning the HIV Positive diagnosis entered in their records. They too have confirmed that upon review of all notes, reports, and diagnostic test there is NOTHING whatsoever that would suggest a diagnosis of HIV Positive. However, they explained that the diagnosis cannot be removed from the records but the Doctor can go back an add an amendment to the record noting it is erroneous. Anti-Sinclair bloggers have since 2008 posted on the Internet statements that Larry was HIV Positive and now we have a University Medical facility and Doctors placing the same in Larry’s medical records without any medical evidence to support it. This facility even transmitted the false diagnosis to a second medical facility.

We have sent a written request to Jefferson County Sheriff Robert Shirley to inquire as to whether his employee Cpl. Kevin J. Boyce told medical personnel that Larry was HIV Positive (which he is not) and why.

Death case doctor "knew he had made false record"

Death case doctor "knew he had made false record"
28 January 2010
Dewsbury Reporter

A JURY is deciding if a doctor lied to an inquest about signing the medical form of a woman who died after leaving hospital.

Dr Rohit Sinha has pleaded not guilty to perjury at the inquest of Wanda 'Jenny' Murphy, a widow from Brunswick Street, Westborough, in 2008.

Mrs Murphy cut short a trip to Malta in 2007 when she began having dizzy spells.

She was seen by Sinha at Dewsbury and District Hospital on August 13, and allegedly signed a self-discharge form and went home.

She later fell and broke her neck, and died in hospital on September 1 after contracting bronchial pneumonia.

A medical form suggested that Mrs Murphy had discharged herself from hospital, but after a complaint by her family who claimed that was not true, an inquiry started.

Prosecutor Paul Williams said: "Dr Sinha said he had signed her record card on August 13, 2007, to witness her signature and decision to self-discharge. But he had in fact signed it at a later date.

"He had made a false record and he knew it."

He said a photocopy of the form did not show Sinha's signature.

Leeds Crown Court heard Susan Terry, a friend and neighbour of Mrs Murphy, saw her the day after she left hospital, and she was clearly unwell.

She said: "She said she had been discharged and was very angry."

During the inquiry a senior nurse was asked to retrieve the document on August 24 and showed it to Sinha, of Hopton Drive, Sunderland. At that stage it had not been signed.

Mr Williams said: "When it appeared later in the investigation it had a signature. The doctor realised his mistake and put the signature in later."

Sinha then requested the contact details of a nurse involved in the inquiry, Nicola Royal.

Mr Williams said: "He said there should be no discrepancies between his statement and that of nurse Royal. There is an indication that he knew he had done wrong and was trying to cover up."

Sinha, 31, has no previous convictions. Christopher Hague, consultant gastroenterologist at Wansbeck Hospital, worked with him between August 2008 and August 2009.

"I would call him an excellent junior doctor and someone who should have an excellent future in the medical field. I would work with him again at any time," he told the court.

Michael Bowes QC, defending Sinha, said Sinha had never told the coroner he had 'definitely' signed the card on August 13.

He added: "Being pretty sure he signed it, is not the same as definitely signing it. Therefore, it is not perjury."

UCI doctor disciplined for false surgery record

UCI doctor disciplined for false surgery record
May 20, 2010

An anesthesiologist at UC Irvine Medical Center was disciplined Thursday by the California Medical Board for falsely pre-filling out a patient record before surgery.

Dr. Peter Breen, former chairman of the anesthesiology department, reached a settlement with the board for a public letter of reprimand, the least severe form of discipline. Neither Breen nor his attorney, Peter Osinoff, could be reached for comment Thursday.

In 2008, inspectors for the Centers for Medicare and Medicaid Services discovered that UCI anesthesiologists were attempting to save time by filling out operating room records in advance. In one case, inspectors found a completed form that said a patient left the operating table that day at 10:30 a.m. However, it was 9:30 a.m. and the patient was still in surgery.

A short time later, the board sought to discipline Breen.

According to legal documents, Breen admitted that in 2006 he falsely filled out a surgery form for a cataract patient in advance of surgery, indicating that the patient was stable and comfortable.

Tuesday, July 19, 2011

Group visits for urology deliver efficiency, patient satisfaction

Group visits for urology deliver efficiency, patient satisfaction

Feb 1, 2011
Philip M. Hanno, MD, MPH
Source: Urology Times

Group shared appointments are an increasingly popular way to improve patient access for busy practices. Simultaneously giving patients added contact with their physician while also allowing them to talk about their condition with others, group shared appointments are applicable to a number of urologic conditions.

In this interview, Eugene Rhee, MD, MBA, explains how shared appointments work, what their advantages are, and how they can be applied to your practice.

Dr Rhee is chief of urologic surgery at Kaiser Permanente, San Diego. He was interviewed by Urology Times Editorial Consultant Philip M. Hanno, MD, MPH, professor of urology at the University of Pennsylvania, Philadelphia...

Sunday, July 17, 2011

Falsifying records and hiding x-rays in the Kaiser Permanente Urology Department?

See two more pages related to this report HERE.

UPDATE OCT. 15, 2011
Kaiser publishes newsletter contradicting repeated statements that x-rays were saved only on thermal paper.

Click HERE (and then go to bottom of new page) to see US News and World Report statistics comparing urology departments in San Diego hospitals.

What's going on in the Kaiser Permanente Urology Department?
by Maura Larkins

I have discovered some things that may help explain why Kaiser Permanente San Diego Medical Center has worse than expected survival rates for urology patients.

I visited Dr. K in May. (I won't give his name here, largely because I feel that the real problem is Kaiser itself. I'd like to think that Dr. K might have developed different habits, attitudes and practices at a better institution.

In February 2011, I had developed a painful problem with urination. It was not an infection, but my urine was extremely cloudy. I began using Bactine to help with the pain. Dr. K said he'd never seen urine as cloudy as mine. He later asked me, "What is Bactine?" Obviously, he had no idea what was going on, but that didn't stop him from making an instant diagnosis: the cloudiness was caused by the Bactine! He either assumed that Bactine has white stuff in it rather than being clear, or he opined that the Bactine had caused the original problem for which the Bactine was used (he couldn't have come up with more perfect circular reasoning if he had tried.) Or maybe he was thinking both things.

A urethrocystogram (VUCG), a test in which dye is injected into the
bladder, and x-rays are taken, was ordered by Dr. K on May 26. The
procedure was done on June 15. (These two dates will become
important later on in this story.)

After the test, I saw the final two images of my bladder and urethra
on the two computer monitors in the x-ray room. The technician
told me the images would be available to any Kaiser doctor. (These
facts will also become important later on.)

But Dr. K had made clear to me that he was only giving me the VUCG to
prove to me that there was nothing wrong with me. He made no
appointment to discuss the results with me. I was to be given the results by
the nurse. But I wanted to see the x-rays, so I ordered a CD of the results.
That's when things started to get very interesting.

The Records lady who said on June 30 that she'd send me the CD called
me back on July 1. She said that the results of my VUCG had not
been digitized! She said that only a few images had been saved on
thermal paper, but that she'd be happy to send me Xerox copies of the
images. I received five images a few days later. None of them included my
urethra. Luckily, as it turned out, she also included a printed report titled
"Outpatient Diagnositc Imaging." That report was the key to exposing Dr. K's bizarre antics.

I complained to Member Services. A lady at Member Services said
X-rays were often available only on thermal paper, and, in fact,
she had recently had surgery and the only x-ray images she was
able to show her surgeon were on thermal paper. I asked her,
"Didn't your doctor want a sharper image?" She said, "Well, no, he
was an older gentleman, so it was fine with him."

Then a man called me from Member Services. He said the images were
never digitized. But this time the story was that some images had
been saved on glossy paper. He said, "You're not going to get a CD!"

Why didn't they want me to have a CD of those images? After all, the CD
should be quite reassuring, since the written report came back completely

Two very odd--and oddly different--printed reports

Perhaps a clue as to why I was not given the CD of the VUCG can be found
by looking at the following written report(s):

Click HERE to see the Kaiser VUCG reports.

I made an appointment with a different urologist. When I went to that
appointment, I was told no images were available.

I had so much pain one night that I went to the Emergency Room.
There were no VUCG images available to the ER doctors, but those
doctors said they weren't concerned since the report assured
them that all was normal. They completely ignored me when I
pointed out errors in the report. (Related story:
Kaiser retaliated against one of its emergency room physicians
when he complained about quality of care in the ER.)

I went to a new primary care doctor on July 12, and he was completely
uninterested in the missing VUCG images and the anomalies in the
report. He said the report was normal, and he "didn't have the
resources" to investigate anything.

I went home and wrote emails to doctors. I noted the following:

1) Dr. K co-signed my report on June 17, but that report is

2) It has been replaced by a report created on June 20 for a
patient whose VUCG was ordered by a different doctor on a
different date and was done the day after mine was done.

3) Dr. K obviously could not have co-signed the June 20 report
three days before it was written.

4) All the digitized images of my VUCG are "unavailable."

Finally, on July 12, after I presented the above information to my new
urologist, he emailed me to say that he had ALL THE DIGITIZED
IMAGES FROM MY VUCG, and he would show them to me at my
next appointment.

I emailed Dr. K about these discrepancies on July 12, but he has not
responded as of July 17.

I wonder if I will actually see these mysterious images.

Update August 1, 2011
No, I didn't see the images--even after talking to the head of the Urologic Surgery Department, Dr. Eugene Young Rhee. See full story HERE.

Kaiser Permanente San Diego Medical Center
Urology Score Card 2010-2011

U.S. News Hospital Score

Worse than expected

Patient safety

Patient volume

Level of nurse staffing

Nurse Magnet hospital

Number of important technologies available in this specialty

With executive pay, rich pull away from rest of America

Special Report: Breakaway Wealth
With executive pay, rich pull away from rest of America
By Peter Whoriskey
Washington Post
June 18, 2011

It was the 1970s, and the chief executive of a leading U.S. dairy company, Kenneth J. Douglas, lived the good life. He earned the equivalent of about $1 million today. He and his family moved from a three-bedroom home to a four-bedroom home, about a half-mile away, in River Forest, Ill., an upscale Chicago suburb. He joined a country club. The company gave him a Cadillac. The money was good enough, in fact, that he sometimes turned down raises. He said making too much was bad for morale.

Forty years later, the trappings at the top of Dean Foods, as at most U.S. big companies, are more lavish. The current chief executive, Gregg L. Engles, averages 10 times as much in compensation as Douglas did, or about $10 million in a typical year. He owns a $6 million home in an elite suburb of Dallas and 64 acres near Vail, Colo., an area he frequently visits. He belongs to as many as four golf clubs at a time — two in Texas and two in Colorado. While Douglas’s office sat on the second floor of a milk distribution center, Engles’s stylish new headquarters occupies the top nine floors of a 41-story Dallas office tower. When Engles leaves town, he takes the company’s $10 million Challenger 604 jet, which is largely dedicated to his needs, both business and personal.



Weigh In



2010 Forbes richest Americans: Meet the top 20: The net worth of these 20 Americans ranges from $12.4 billion to $54 billion.

More on this Story

PHOTOS: The region’s most highly compensated executives
Is there a pay gap at your firm?
Stock awards and bonuses push up compensation totals

View all Items in this Story

CEO pay

Who makes what in the Washington area

The evolution of executive grandeur — from very comfortable to jet-setting — reflects one of the primary reasons that the gap between those with the highest incomes and everyone else is widening.

For years, statistics have depicted growing income disparity in the United States, and it has reached levels not seen since the Great Depression. In 2008, the last year for which data are available, for example, the top 0.1 percent of earners took in more than 10 percent of the personal income in the United States, including capital gains, and the top 1 percent took in more than 20 percent. But economists had little idea who these people were. How many were Wall street financiers? Sports stars? Entrepreneurs? Economists could only speculate, and debates over what is fair stalled.

Now a mounting body of economic research indicates that the rise in pay for company executives is a critical feature in the widening income gap.

The largest single chunk of the highest-income earners, it turns out, are executives and other managers in firms, according to a landmark analysis of tax returns by economists Jon Bakija, Adam Cole and Bradley T. Heim. These are not just executives from Wall Street, either, but from companies in even relatively mundane fields such as the milk business.

The top 0.1 percent of earners make about $1.7 million or more, including capital gains. Of those, 41 percent were executives, managers and supervisors at non-financial companies, according to the analysis, with nearly half of them deriving most of their income from their ownership in privately-held firms. An additional 18 percent were managers at financial firms or financial professionals at any sort of firm. In all, nearly 60 percent fell into one of those two categories.

Tuesday, July 12, 2011

BofA settles on mortgage repurchase claims

BofA settles on mortgage repurchase claims
Jun 29, 2011

Bank of America Corp settled nearly all of the claims related to the legacy Countrywide-issued first-lien residential mortgage-backed securitization (RMBS) repurchase exposure for $8.5 billion in cash.

The largest U.S. bank by assets said it intends to record an additional $5.5 billion provision to its representations and warranties liability for both Government-Sponsored Enterprises (GSE) and non-GSE exposures in the second quarter of 2011.

On Tuesday Reuters reported that Bank of America was close to a settlement agreement with a group of powerful group of investors that lost money on mortgage-backed securities.

Friday, July 8, 2011

Medical technology at Kaiser Permanente

Link: x-rays saved only on thermal paper at new Kaiser Garfield Specialty Center in San Diego

Invasive cancer urinary Tests can have little diagnostic value, Kaiser Permanente study warns

Hematuria, or blood in the urine can trigger a battery of urinary tests for cancer are invasive and unnecessarily expose patients to radiation, but the procedures contribute little to the diagnosis, according to a study conducted by Department of research & evaluation of the Kaiser Permanente Southern California published in May the issue of the Journal of Urology...

VCUG is a common x-ray that shows the bladder and lower urinary tract. Using motion x-ray called fluoroscopy, the radiologist is able to view and assess the function of the bladder and urinary tract, watching as the bladder is filled and emptied with a water-based contrast solution.

Urol Radiol. 1992;14(1):56-8.
Digital radiography in urologic imaging: radiation dose reduction on urethrocystography.

Digital luminescent radiography (DLR) is a new form of digital radiographic technology which can be used as an alternative to conventional radiologic systems; it replaces conventional screen-film systems by photostimulable phosphorus. Due to the linear dynamic range of photostimulable phosphorus, x-ray examinations can be performed with significantly lower radiation exposure. In this study radiation dose was reduced by about 90% using DLR for urethrocystography.

Medicaid improves health and budgets of poor

Medicaid improves health and budgets of poor
Jul 7, 2011

Medicaid, a government health insurance program designed to help the poorest of the poor, is giving people unprecedented access to doctors and also improvi their finances, a study co-authored by the Harvard School of Public Health has found.

The study, released on Thursday, showed that new recipients of Medicaid reported better physical and mental health and were less likely to go into debt to pay their medical bills.

The fate of Medicaid -- the health program for people and families with low incomes and resources -- has been hotly debated for its role in the ballooning U.S. deficit. The Obama administration's healthcare overhaul passed last year requires all U.S. states to extend eligibility to millions more people by 2014.

The study followed health outcomes a year after a 2008 Medicaid expansion in Oregon, where 10,000 uninsured low-income adults won coverage through a lottery.

The results show that Medicaid helps poorer Americans well beyond the default safety net options that exist for people without coverage, according to the researchers from Harvard, the Massachusetts Institute of Technology, the National Bureau of Economic Research and Providence Health & Services...