Friday, October 28, 2011

Tri-City reinstates Horton but not Sterling

Tri-City reinstates Horton but not Sterling
Both board members had been excluded from public health district’s closed sessions
Aaron Burgin
Oct. 27, 2011

The Tri-City Healthcare District Board of Directors voted Thursday to reinstate elected colleague Randy Horton to closed-session meetings, but extended Kathleen Sterling’s ban until the end of her term.

The public health board voted 4-2 to allow Horton back in closed-session meetings, but voted 5-1 to maintain Sterling's ouster from the sessions. Each vote had one abstention.

Board members said Sterling’s behavior and breaches of confidentiality had spanned her entire term on the board and had gone on long enough.

“Although what (Horton) did was egregious, I do believe a second chance is in order,” Charlene Anderson said before voting in favor of Horton’s reinstatement. “Kathleen has been doing this for 12 years.”

The board nearly voted to remove her from office, but deadlocked 3-3 after Greg Moser, the board’s legal counsel, said that such a vote would be “unprecedented.” Horton, Larry Schallock and Dr. Cyril Kellett voted against removal; Anderson, RoseMarie Reno and George Coulter voted in favor; Sterling abstained.

Thursday’s actions might also keep the district from being hit with a lawsuit because Carlsbad attorney Leon Page had given the district until Friday to reverse the ban against Sterling and Horton or he would sue the district to do so.

Page has said that the board’s ban disenfranchised voters who elected both members to have a seat at the table in public sessions and closed-door hearings.

Page’s attorney Ronald Cozad said Thursday that he might not go forward witha lawsuit because Sterling is already challenging the board’s discipline in court.

“The board made a strategic decision today,” Cozad said.

Thursday’s decisions came after CEO Larry Anderson implored the board to ban both members for the rest of their terms, calling Sterling and Horton’s actions despicable and illegal.

He reserved his harshest words for Sterling, whom he called a “double agent” for disclosing information to attorneys and clients suing the district.

“It is time for the world to learn the stories of two directors, whom the public unwittingly elected to the board … without knowledge of their attempt to deceive the public. The deception comes in the form of their repeated violations of their duties of care, loyalty and obedience,” Anderson read from a prepared statement.

The board has censured Sterling eight times on allegations of being disruptive and hostile to staff. The board has filed several lawsuits against her and sought restraining orders to keep her off hospital grounds except for an emergency.

The courts have ruled against the district in its request for a permanent restraining order.

Horton has been censured once.

Anderson and Allison Borkenheim, a labor attorney with the district, each took about 10 minutes outlining Horton’s and Sterling’s alleged misconduct.

Borkenheim offered case law that she said supported the board’s actions, including a Virginia case in which a judge upheld a Board of Supervisors’ effort to strip a supervisor of his committee assignments.

“There is a legal precedent for Tri-City’s exclusion of directors Sterling and Horton for their misconduct,” Borkenheim said.

Before the meeting, the board took an unusual step to publicly disclose information discussed in closed session that hospital administrators said showed Horton and Sterling violated the closed-session confidentiality on multiple occasions.

Horton, according to the documents, informed a doctor that the district was firing him and said he would continue to divulge information to Sterling despite being told not to.

Sterling, according to the documents, repeatedly disclosed information to parties suing the district.

“What we have here is the tip of the iceberg,” Coulter said.

Sterling, who was elected to the board in 1998, 2004 and 2008 and is up for re-election in 2012, denied the allegations and argued that the information the board presented lacked appropriate foundation. Many of the affidavits were from people repeating secondhand information and the board’s own lawsuit filings, she added.

Several members of the audience spoke in defense of Sterling and Horton.

Silvia Peters, a local activist, said Tri-City’s accusations lacked substance and pointed out that Sterling has defeated the district in several legal actions against her.

“I am appalled and sickened by all of you,” Peters said. “I have seen your circus in the courtroom, and it does not amount to anything.”

Several other members of the public spoke in favor of the district, which serves Vista, Carlsbad and Oceanside, commending it for its work.


The Tri-City Healthcare District is governed by publicly elected Board of Directors, who represent the residents of Carlsbad, Oceanside and Vista.
RoseMarie V. Reno Chairperson
Larry Schallock Vice Chairperson
Cyril Kellett, MD Secretary
George Coulter Treasurer
Charlene Anderson Assistant Secretary
Randy Horton Member, Board of Directors
Kathleen Sterling Member, Board of Directors



...So what exactly is at the crux of all the fighting over Tri-City?
Randy Dotinga
Voice of San Diego
May 30, 2011

...This one's a toughie. Here are some theories:

• Mutual disregard: Jerry Salyer, a local insurance broker who unsuccessfully ran for the board in 2002, blames the unusually large size of the board for some of its dysfunction. (It has seven members instead of the usual five.) He also points to a toxic atmosphere of disrespect. "They don't respect one another," he said in an interview, adding: "I think they're fighting to fight."...

Tuesday, October 25, 2011

My doctor said I was paranoid to doubt medical report--but I was proved right

My primary care doctor, Jae Kyo Lee of Kaiser Permanente in San Diego, said that I was paranoid when I didn't believe that a medical report could be signed three days before it was written. It turned out I was right. My urologist, Dr. Huathin Khaw, had supposedly co-signed a report on June 17, 2011. The report had supposedly been written by Dr. Jay Grimaldi on June 20, 2011. I was also suspicious because the date of the X-ray procedure was wrong and the name of the referring doctor was wrong.

It turned out I was right. The original report had actually been written on June 16, 2011 by a completely different doctor. That's the report Dr. Khaw co-signed. Then somehow large parts of it got erased. NONE of my digitized X-rays were ever made available on the Kaiser server--not even Emergency Room doctor could see them.

Dr. Jae Kyo Lee and Dr. Eugene Rhee told me I should accept the report "because it had my name on it." Why would they both make the same bizarre statement? They must be trained to say that when documents are obviously compromised.

Dave Horton, who is in charge of Radiology and Radiology Files, has refused to respond to a letter and an email. His underlings obediently spout a ridiculous story about my X-rays, taken at the brand new Garfield Specialty Center, having been saved only on thermal paper. But Kaiser's own newsletter says all X-rays at the new center are digitized. Is Kaiser guilty of false advertising? I don't think so. I think they're guilty of covering up incorrect diagnoses.

My digitized X-rays remain "unavailable". Why the cover-up, guys? (Well, I shouldn't say "guys" since Lynette Seid and Mary Ann Barnes have supported the cover-up.) I'd say these folks are a bit paranoid if they're afraid of a few X-rays.

Sunday, October 23, 2011

Employers to continue raising rates, shifting cost to workers

About 31 percent of workers are in so-called high deductible plans this year, up from 10 percent in 2006, according to a Kaiser Family Foundation survey. Such policies are sometimes accompanied by a tax-sheltered savings account that can be used for health expenses.

Employers to continue raising rates, shifting cost to workers
Jim Gallagher
STLtoday.com
October 23, 2011

As open enrollment for health insurance approaches, employees can expect the same-old same-old — paying more for less coverage.

The real cost of health insurance will rise an average of 7.1 percent nationally for 2012, based on early results from a Mercer survey of employers.

That's actually an improvement. Costs have been spiking annually at 9 percent for about five years, said Mercer, the big human resources company.

Companies are responding by cutting benefits, urging employees into lower-cost plans and charging employees a bigger share of premiums. Only 39 percent of companies will not shift costs to employees next year, according to the survey.

Usually starting in November, open enrollment allows workers to choose from a menu of plans offered by their employer. As cost rise, many employees are moving into plans with deductibles of at least $1,000 for single coverage, and higher for families. About 31 percent of workers are in so-called high deductible plans this year, up from 10 percent in 2006, according to a Kaiser Family Foundation survey. Such policies are sometimes accompanied by a tax-sheltered savings account that can be used for health expenses.

Cost-shifting maneuvers are helping companies hold their own cost increase down to an average of 5.4 percent, according to Mercer...



Employer Health Plans Often Omit Part-Timer Workers
Kaiser Health News.org
Oct 23, 2011

Several news outlets this weekend covered work-based insurance issues, including reaction to the Wal-Mart announcement that it would be cutting back coverage for new part-timers and what workers in a number of places should expect as their bosses roll out policies for the coming year.

The Washington Post: Health-Care Coverage Still Eludes Some Part-Time Workers
The news came as a shock: Wal-Mart, the nation’s largest private employer, would not offer health benefits to new part-time employees, the company said Friday. But perhaps it shouldn’t have been so surprising, since the retailer was among a minority of U.S. businesses. Only 16 percent of employers offer health insurance to part-timers, according to the Kaiser Family Foundation’s most recent Employer Health Benefits Survey. The number increases to 42 percent among large employers. ... The health-care law that Congress passed last year is unlikely to change that. While part-time workers will have access to new, subsidized coverage on the individual market, the Obama administration’s signature legislative achievement provides little incentive for employers to cover workers who are not full-time staff (Kliff, 10/22)...

Wednesday, October 19, 2011

Kaiser Permanente sues patient who didn't pay $10,000 for Kaiser's failure to diagnose

Kaiser said – we don’t know what’s wrong with you – now give us our money.”...He thought he could win in court because they never did anything for him and he was continuing to get sicker...Kaiser said he owed them about $10,000 for all the tests, CAT scans, MRIs. The bills kept piling up. He couldn’t pay it.

Adara believes that if we had a single payer national health insurance system, her father might still be alive.


October 19, 2011
Adara Scarlet, Suicide and Single Payer
by RUSSELL MOKHIBER
Counterpunch.org

...[Martin] Goldstein graduated from the University of Louisville School of Law. He was a member of the Colorado Bar. But he found out that he didn’t like practicing law – so he did odd jobs – as a stock broker, taxi driver, and dispatcher.

When he lost his jobs as a dispatcher, he lost his health insurance.

But he had this amazing ability to count cards at the Blackjack table...

And he made on average $200 a day.

“He had an amazing memory,” Adara says. “He was a walking talking encyclopedia. He taught me how to count cards when I was ten years old. He could beat the system and he did.”

Adara says that it’s a myth that counting cards at a casino is illegal...

“Back then, there was a $5 betting minimum and maximum per hand. If you were to do this today, he would be much more prosperous. Now you can bet up to $100 per hand. Back then, it was just strictly five dollar ante.”

“And he played blackjack. He was clearing $1000 a week. The rent on the house was $1195 a month. He never seemed to have a problem with the grocery shopping. And buying clothes for me and my sister.”

He was able to pay the bills – including $600 a month to Kaiser Permanente for health insurance for himself and the girls.

Then Goldstein started getting sick – and running up medical bills.

“He was having a whole bunch of medical problems,” Adara says. “They never figured out what was wrong with him. We never found out.”

The illness started in about 2000 or 2001...

What were the symptoms?

“Legs swollen,” Adara says. “Calves were so swollen they were bigger than his thighs.”

“And he couldn’t eat. He couldn’t keep food down.”

“His circulation was all screwed up, so he was always cold.”

“Kaiser bounced him around to a whole bunch of specialists. But nobody could figure out what was wrong with him – they pretty much gave up after a certain point.”

“Kaiser said – we don’t know what’s wrong with you – now give us our money.”

“But he said he was not going to pay them. He thought he could win in court because they never did anything for him and he was continuing to get sicker. He lost a whole bunch of weight. He was overweight most of his life. He actually got pretty skinny toward the end.”

“He got fed up with Kaiser. He paid all of this money into the system. Not only the premiums, but the co pays. He said – I’m not going to pay this bill – you haven’t figured out what is wrong with me.”

“I assume they wouldn’t cover him anymore, or he just refused to give them any more money.”

“Kaiser said he owed them about $10,000 for all the tests, CAT scans, MRIs. The bills kept piling up. He couldn’t pay it.”


“It was something around $10,000. He couldn’t pay it. He refused to pay it.”

“Kaiser sued him. He went to court and fought them. But Kaiser won the lawsuit.”

“But he didn’t pay. He couldn’t pay.”

“They put bill collectors on it. He was in debt to them. He had bill collectors calling him.”

“Kaiser Permanent is a horrible horrible company,” Adara says.

In early April 2003, Marty Goldstein was eating a bowl of chili in the kitchen. And he said to Adara that he was going to kill himself.

“It was the most casual thing,” Adara said. “He said – I want to talk to you about something. I don’t want you to tell your sister because she is kind of emotional. I don’t want her to get bent out of shape. But I’m sure you’ll understand.”

“And he said – I’ve decided that I have lived my life, it’s time to go, I’m going to stick around for one more birthday.”

“His birthday was April 30.”

“My birthday is May 11.”

“He was 53 that year. I was 18.”

“My response was to freak out and tell my sister, which was exactly what he asked me not to do.”

“He was sitting there eating a bowl of chili while he was talking about it. He was just blowing on the chili, eating the chili, like it was nothing.”

“I went down and told my sister – Dad is talking about killing himself.”

Did he say how he was going to do it?

“No he didn’t. He just said – it was time to bow out. It was so casual.”

“He said that he had lived his life. He said all he had done was get himself into debt. And there was no way he would be able to pay Kaiser. He said – what do I have in my future other than bankrupting my family?”

“He suffered from depression. I’m sure if we had a better mental health care system, he wouldn’t have thought this was the only way out.”

“When I told my sister, she panicked. We went upstairs and cornered my dad and said – you have every reason to live. That kind of thing.”

“He acted like we convinced him. After we were at it for a while, he said – you are absolutely right, I don’t know what I was thinking. I was just talking crazy talk. And he never brought it up again.”

That was April 2003.

Did he say anything after that date?

“Never. He never brought it up again.”

But less than a year later – on February 4, 2004 – Marty Goldstein killed himself.

How did he kill himself?

“He shot himself in the head. I got a call from my aunt. It was the cops who called her. He had left a note. He called 911 first. He said – I’m about to kill myself. Please collect my body so my daughters don’t find it. He left a short note for the emergency people. He said – here are the keys to the house for my daughters. He even said what day the trash pick up was. He said – please don’t let my daughters find my body here.”

Did he leave a note for you?

“Yes, a long note in a sealed envelope. It was a 22-page hand written letter.”

“He said when bill collectors come around, they can come and collect my TV, bed, everything like that. I have a small life insurance policy that will pay collectors off at about 75 cents on the dollar.”

“I guess he must have been about $40,000 debt in total, because it was a $30,000 life insurance policy. The life insurance company of course managed to screw us – we didn’t get that.”

“He had actually gotten life insurance with a company that covered suicide. God knows where he found that. It was some place out of Texas. He had done that specifically in the early 1990s.”

“He had this policy for years. Maybe he had suicide on the back of his mind.”

An aunt told Adara that her father’s bills wouldn’t pass on to the family.

“But collectors called me and my sister anyway. They tried to trick us into thinking that we owed it. I’m really glad my aunt told me – you don’t owe anybody any money. Don’t let anyone talk you into thinking that you do. My sister and I just hung up on them. And finally after about a year, they quit calling.”

Adara believes that if we had a single payer national health insurance system, her father might still be alive.

“He was really depressed and he considered suicide as a possibility. But I don’t think he would have done it. The Kaiser Permanente bills were on his mind. He didn’t want to burden his family with bills.”

“My dad’s main killer was depression. And no health insurance. If had been able to pay those bills, he would have stuck it out.”...

Tuesday, October 18, 2011

Board of Nursing complaint against Tri-City Healthcare board member Charlene Anderson

Two of the Tri-City Healthcare board members are in line to have their licenses revoked, but these are NOT the two board members banned from closed-door meetings. It would seem that the wrong people are running the show.

Here's the June 2011 complaint against Charlene Anderson.

Also, the Board of Nursing has an action against another Tri-City board member, George Coulter.

Why Are Customers of This Health Insurer So Happy?

Here's a puff piece about Kaiser Permanente. This is clearly not investigative journalism. The article doesn't mention the downside of Kaiser's "guidelines for treatment." The biggest downside is that Kaiser Permanente makes its profits by offering assembly-line care. It has lists of symptoms that it checks for and treats. But if you have symptoms that differ from the guidelines, you may well end up dead. Kaiser is playing the percentages. It sacrifices patients with problems that don't fit the pre-determined process.

Electronic records are interesting. They can be easily altered, and Kaiser takes full advantage of this when a patient presents with a problem that Kaiser doesn't want to deal with.

If Kaiser is at the top in customer ratings, there must be a lot of really bad plans out there.

Why Are Customers of This Health Insurer So Happy?
By Maggie Mahar
Time Magazine
October 18, 2011

Kaiser Permanente’s stand-out performance in Consumer Reports’ national rankings of some 830 insurance plans raises an obvious question: What makes Kaiser so different? In a word: collaboration.

Kaiser is distinctive among the major health insurers in that it’s not just a health insurer. While the non-profit Kaiser Foundation Health Plans provides coverage for its 8.8 million patients, Kaiser also offers an integrated network of doctors and hospitals. The insurer and the providers share one goal: keeping patients healthy over the long term.

(MORE: We’ve Been Wasting a Ton on Vitamins and Dietary Supplements)

Because Kaiser is both the insurer and the provider, it has a larger incentive to invest in preventive care, wellness classes and free smoking clinics. Many other insurers and health systems avoid sinking money into such programs because patients switch insurers so frequently that such spending winds up benefiting another company. But as the Consumer Reports’ ratings show, Kaiser patient satisfaction is high and patient turnover low, so it makes more sense for the insurer to invest for the long haul.

Founded in 1945, the California-based plan was one of the earliest “health co-operatives” that, instead of charging fee-for-service, accepted a lump-sum payment of, say, 85 cents per patient per month. The American Medical Association objected; it insisted that doctors should be free to set prices for each procedure, thus leaving total health care costs open-ended. The AMA had great clout: By 1950, most states had passed laws that barred the co-ops. Kaiser was one of the few that survived.

Today, Kaiser’s physicians are still on salary, treating patients in nine states, plus D.C. Each year Kaiser Health Plan (the insurer) and the Kaiser Permanente Medical Group (the doctors) in each region negotiate and agree on a lump sum that the Health Plan will pay the Medical Group on a monthly basis for each patient. Rather than compensating doctors for volume (fee-for-service) the goal is to hold physicians “accountable” for keeping patients well. If they succeed, fewer patients will need to be hospitalized or undergo expensive procedures, and the payment will turn out to be greater than the actual cost of necessary medical care. When that happens, the Medical Group, as a whole, shares in some of the surplus. Thus, rather than having an incentive to “do more” tests and procedures, Kaiser’s doctors have an incentive to “do less, and do it right.”

(MORE: Patients Prefer HMOs (And Other Healthcare Surprises))

Nationwide, many doctors prefer working fee for service, running their own business and competing for market share with an eye to increasing their income. But others compete for jobs at Kaiser: In California, Kaiser hires just 11 percent of the doctors who apply for positions. These tend to be physicians who don’t want the hassle of running a business.

Kaiser also makes very effective use of information technology in coordinating patient care. It maintains a single computerized record for each patient, so all physicians are looking at the same chart, where they can read their colleagues’ notes and know what they are thinking. In other healthcare “systems,” patients can often be seeing five doctors, none of whom have no idea what the others are planning or prescribing.

Perhaps just as important, Kaiser uses that electronic database of patients’ records to determine which treatments work best for which patients. By mining that medical evidence, it is able to create “guidelines” — they’re careful not to call them rules — for consistent standards of care. Without such guidelines, many experts agree, U.S. healthcare can be frighteningly idiosyncratic, particularly when doctors are working alone. It is impossible for any single physician to keep up on all of the newest research. But when doctors are working elbow to elbow in large multispecialty groups, they share their knowledge.

Over time, a combination of teamwork, guidelines and computerized records has helped Kaiser achieve remarkable results that go well beyond the Consumer Reports findings. For example, in Northern California, Kaiser has reduced death from heart disease among its 3 million members so significantly that it is no longer the leading cause of death. In fact, after adjusting for age and gender, death from heart disease is more than 30 percent lower among the Kaiser population than among Northern Californians who receive care through another insurer.

Maggie Mahar writes the HealthBeat blog for The Century Foundation, where she is a fellow.
Read other related stories about this:

Health-Insurance Plan Rankings from the NCQA Consumer Reports

Let board members in, attorney tells Tri-City

See all posts for Larry Anderson.
See all posts in SDER blog re Tri-City Healthcare.

Let board members in, attorney tells Tri-City
Two have been exluded from public health board’s closed session meetings
Aaron Burgin
SDUT
Oct. 17, 2011

Carlsbad attorney Leon Page is demanding that the Tri-City Healthcare District reopen its closed door meetings to two board members who have been excluded.

Page argued in a cease-and-desist letter to Tri-City on Saturday that he is being disenfranchised as a constituent of Randy Horton and Kathleen Sterling. The letter is a required step before filing a lawsuit.

The two have been kept out of closed session meetings since April as a disciplinary action by the public health board, which provides hospital service for Oceanside, Carlsbad and Vista.

The Watchdog earlier this month wrote a story in which experts questioned on what grounds Tri-City was excluding the elected board members, whose attendance at board meetings is granted by the voters who elected them.

The agency declined to cite a legal justification, as the action was taken in a closed session.

Sterling has been censured by the board for allegedly being disruptive and hostile to agency executives. Horton was accused of leaking information from a closed session meeting.

Tri-City’s board attorney, Greg Moser, said that the district would “consider this threat of litigation in due course.”

Members of the board majority say they believe the punishments handed down against Horton and Sterling are justified to protect the integrity of the district’s executive process.

Board member Charlene Anderson has been among the most outspoken critics of the two. She said she stands by the legal advice that Moser has given.

“I believe that Greg Moser knows what he is doing, and so everything that we’ve done he has advised us to do,” Anderson said. “I feel that we are on solid ground. We have to take steps to protect the district when you have board members who are working against the district.”

Page’s letter gives the board until Oct. 28 to reopen closed sessions to Horton and Sterling, or face a lawsuit. A seven-page draft of the lawsuit is attached to the three-page letter.

Page also demands that $100-per-meeting board meeting stipends, withheld from Sterling and Horton, be reinstated with back pay.

“Simply stated, your board lacks the authority to nullify the results of an election,” Page wrote. “Especially for what appears to be a politically motivated effort by the board majority to silence those dissident directors.”

Horton, reached Monday, said he applauded Page’s actions, but was disappointed that it took a citizen to stand up for him and Sterling.

“I just think it’s a shame that the grand jury and DA aren’t representing elected officials and you have a member of electorate spending their own money and time,” he said. “It’s just not fair.”

The courts are currently sorting through a maze of lawsuits and counter lawsuits dealing with the board’s previous discipline of Sterling, who must attend public sessions of board meetings from a video hookup from across the street. She is barred from hospital property (except in emergency) by a temporary restraining order, which the district is hoping to make permanent.

Page said he believes the board’s actions are an attempt to silence viewpoints critical of the hospital administration’s bonuses and salary increases, viewpoints he shares. The closed session issue, he said, has not been discussed in any of the existing lawsuits.

The board met in closed session last month and authorized CEO Larry Anderson to launch a study of whether he should be given a raise. Anderson last received a raise in November, when his base pay increased to $500,000 from $480,000 and a bonus option was added. He was given a $115,000 bonus in August.

Anderson was one of the highest-paid public officials in the state in 2009; his pay ranked 20th among more than 800,000 local government officials listed in a database compiled by the state controller and reviewed by The Watchdog.

“We are litigating my rights as a taxpayer to equal representation,” Page said. “There is an effort to exclude certain viewpoints from that board room, and those directors are being prohibited from meaningfully representing their constituents.”

Page is the attorney who successfully sued the MiraCosta College District to void its $1.6 million severance to former President Victoria Richart.

In 2007, Page sued MiraCosta to invalidate the settlement with Richart, who had fallen out of favor with school officials after a scandal involving the school’s horticulture department and the illegal sale of taxpayer-funded palm trees broke out under her watch.

Page’s lawsuit argued that the settlement was the fruit of illegal secret meetings held by board members in the months leading up to Richart’s resignation.

In 2010, Page backed a slate of candidates who swept out incumbent members of the college board linked to the settlement.

Saturday, October 15, 2011

As Kaiser Workers Face Cuts, Execs Have Enjoyed Lavish Benefits

See Kaiser executives.

As Kaiser Workers Face Cuts, Execs Have Enjoyed Lavish Benefits
Dave Jamieson
Huffington Post
7/12/11

Despite strong profits and robust executive compensation at Kaiser Permanente, workers for the Calfornia-based health care giant say they're facing down cuts to their health and retirement benefits in pending contract negotiations.

Proposed cuts include freezing employees' defined-benefit pension plan and switching to a less desirable defined-contribution plan, according to a flier circulated by the National Union of Healthcare Workers. Workers are being asked to accept a more costly employee health insurance plan and cuts to their retirement health benefits, the union says.

While those cuts get debated, Kaiser executives have been living well. Pay and perks for high-ranking officials at the nonprofit have been generous in recent years, according to disclosure forms.

In 2009, the most recent year for which figures were available, George Halvorson, the CEO for Kaiser Foundation Health Plan & Kaiser Foundation Hospitals, received compensation of $6.7 million. Halvorson's package included a $1.2 million payment to his "supplemental non-qualified retirement plan." More than 40 other officers and employees received payments to such retirement stashes -- several of them in the hundreds of thousands of dollars.

Members of management have also received large "relocation" loans from the nonprofit. Philip Fasano, the chief information officer and vice president, was given such a loan for half a million dollars, according to Kaiser's IRS filings. Disclosure forms with the State of California indicate that two of those relocation loans -- including one for $500,000 -- are forgivable, meaning that the principal of the loan can eventually be forgiven, so long as conditions are met in the short-term. (The state filings do not name the officers who received the forgivable loans.)

John E. Nelson, a Kaiser spokesperson, told HuffPost that the nonprofit's executive compensation is fair and reasonable, given that between its hospital network and health plans Kaiser is "by far the largest and most complex health care organization in the nation."

"Compensation paid to senior management is substantially less than that of many for-profit health plans, and less than would be expected when compared to nonprofit health care companies, once the size and complexity of Kaiser Permanente is taken into account," Nelson wrote in an email. "Kaiser Permanente's senior management have unique leadership positions, in that they have the equivalent of two roles: overseeing a major health plan with 8.8 million members, as well as a total care delivery system in multiple states with 36 hospitals, 450 medical office buildings, and 500 pharmacies."

Kaiser reported a net income of $921 million for the first quarter of 2011. Last month the non-profit announced it would be raising premium rates by about 11 percent on 300,000 Californians enrolled in plans through small businesses -- a hike much smaller than some other insurers have recently implemented, but a hike nonetheless.

Turusew Gedebu-Wilson, a Kaiser dietician who's been involved in the bargaining talks between workers and management, says she finds the prospect of cuts to employee retirement and health benefits "shocking."

"If the organization is making a lot of money, if the executives are making a lot of money, then why do they want to take away so much?" Gedebu-Wilson said. "To tell us that we have to be paying more is really mind-boggling to me."

Nelson would not say whether Kaiser management indeed seeks concessions from workers, noting that the negotiation process is not complete. The nonprofit intends to bargain with workers "in good faith," Nelson said, and it plans on providing "market-competitive" employee benefits to attract the best talent possible. Nelson declined to say whether executives would take cuts to their benefits if employees were asked to do so.

"Kaiser Permanente sets senior management compensation levels so that the organization can successfully attract and retain the leadership it needs to deliver affordable, high quality health care," Nelson said.

California Medical Board goes easy on Kaiser Permanente Dr. Hamid Safari

See all posts re Dr. Hamid Safari.

Last January, federal health inspectors found that if the hospital had acted on complaints and kept a closer watch over its medical staff, the two babies might still be alive.

Medical Board of California dismisses accusations against Kaiser doctor
Perinatologist Hamid Safari had been accused of negligence in the deliveries of two babies who died in 2004 and 2005. A judge found that he complied with standards of care.
February 14, 2009
Jia-Rui Chong
Los Angeles Times

After a vigorous debate among experts, the state medical board this week dismissed accusations of negligence against a perinatologist at Kaiser Permanente's Fresno Medical Center who was involved in two tragic deliveries.

The Medical Board of California had accused Dr. Hamid Safari of mishandling the procedures. One child died in the delivery room in April 2005, and the other died months after her January 2004 birth.


Kaiser Plans Start @ $75Get Free Instant Quotes. Find Affordable Kaiser Permanente Plans! KaiserQuotes.com

The Times published a front-page story about the cases in October 2007, reporting that doctors and nurses had complained repeatedly to higher-ups about Safari's medical and interpersonal skills before the deliveries, according to internal documents, a lawsuit and interviews. Federal health inspectors subsequently faulted Kaiser Fresno's medical oversight.

In the medical board case, however, "the evidence established that the respondent complied with applicable standards of care," wrote Cheryl R. Tompkin, the administrative law judge who heard the case and recommended dismissal to the board.

The case pitted two sets of medical experts against each other in a debate over what precisely constituted the standard of care in complex deliveries.

In her written opinion, Tompkin said Safari could have kept better records establishing the patients' understanding of medical risks, but she did not see "any cause for discipline of the respondent's license." The board, which has final say on the discipline of doctors, adopted the verdict Tuesday.

Safari, who has been suspended from treating Kaiser patients for the last year, was relieved and gratified by the ruling, said his lawyer Stephen Schear.

"This is a complete vindication of Dr. Safari by a neutral, unbiased judge," Schear said. "I'm extremely happy to see justice really working."

The allegations have given rise to conflicting responses. Last January, federal health inspectors found that if the hospital had acted on complaints and kept a closer watch over its medical staff, the two babies might still be alive.

Although the Kaiser hospital suspended Safari from caring for patients, the affiliated physicians group continued to pay his salary.

The Times' story from October 2007 reported that Safari repeatedly and vigorously attempted to draw out a baby boy, a twin, with a vacuum extractor in 2005. The first twin had been delivered naturally, but the second died in the delivery room because of a severed spinal cord.

The year before, The Times reported, the doctor had waited more than three hours to do a cesarean section even though a baby girl was in distress and her family said they had been pleading for the procedure.

Obstetrician-gynecologists testifying for the medical board said that Safari made "extreme departure[s] from the standard of care" in the two cases.

But experts testifying on Safari's behalf argued that in the 2004 delivery, Safari could not force a patient to undergo a procedure against her will and the cesarean section was done in a "timely" manner. The judge accepted Safari's contention that he had recommended the C-section numerous times to the patient.

In the 2005 delivery, Safari's experts said, the doctor's use of the vacuum extractor was appropriate.

"The reasoning of [Safari's] experts is found to be persuasive," the judge wrote.

It is unusual for the board to dismiss an accusation. In the last two years, only about 3% have been dismissed, according to Debbie Nelson, associate analyst at the board.

Dr. Robert L. Rusche, one of the doctors who spoke against Safari, said he was stunned by the judge's decision.

Rusche retired in 2006 shortly after reporting Safari's actions to the medical board and, with a former colleague, has sued Kaiser for alleged retaliation.

The suit is expected to be settled soon, Rusche said.

He said he was not sorry for raising an alarm, noting that federal investigators backed up his group's claims.

"I'm concerned for patients' well-being," Rusche said. "The facts of the case speak for themselves. I'm not sure the facts were really understood at the judicial level."

Safari still faces two internal hearings at Kaiser to decide if his credentials as a Kaiser doctor should be revoked and whether his suspension is fair, Schear said.

"We're hoping the medical board decision will influence them to stop what they're doing and allow Dr. Safari to go back to work," Schear said.

A Kaiser spokeswoman said the company cannot discuss the internal proceedings involving Safari under California law but said it was reviewing the medical board decision.

"At this time the Medical Board's finding will not change Dr. Safari's status at Kaiser Permanente," said spokeswoman Gerri Ginsburg, in a statement. "Our internal processes adhere to different legal standards than that of the Medical Board, and there may be no implications."

Kaiser doctor Hamid Safari was accused of negligence but remains on the job

'No one would listen'
A TIMES INVESTIGATION
Kaiser doctor is accused of negligence but remains on the job
October 16, 200
Tracy Weber and Charles Ornstein
Los Angeles Times Staff Writers

Late one April night, the first of Sarah Valenzuela's twins arrived with little trouble, but the second stayed put.

Though the baby was not in distress, Kaiser Permanente perinatologist Hamid Safari attached a vacuum extractor to the boy's head to draw him out. Again and again he tugged, but still the baby would not come.

He vigorously shook the vacuum, up and down, side to side, according to government documents and hospital incident reports.

It took 90 minutes and six tries -- the last with Safari on his knees, pulling. Horrified staffers -- and the boy's father -- looked on as baby Devin finally emerged. His skin was a bloodless white, his neck elongated and floppy.

His spinal cord had been severed.

Safari lashed out at a nurse. "What did you do to that baby? I gave you a good baby," he said, according to a complaint letter the nurse sent to her union representative.

Staffers at the Fresno birthing center were devastated and angry -- and not just because of the twin lost that night in 2005.

Over the years, doctors and nurses repeatedly had complained to higher-ups -- including Kaiser's top medical officer in Northern and Central California -- about problems they saw in Safari's skills and behavior, according to interviews and documents.

This is a story not just of tragic medical outcomes, but of a health plan that did not prevent them.

A year before Devin's death, the doctor had waited more than three hours to do a Caesarean section even though the baby girl was in distress and her family said they had been pleading for the procedure, according to interviews and government records. She was severely deprived of oxygen and died months later.

As far back as 2002, a physician review committee at the hospital concluded that Safari provided "inappropriate" care and that his "conduct needed significant improvement," according to a lawsuit later filed by two of his peers.

Still, the doctor continues to work at Kaiser Fresno, practicing under restrictions that staffers say have not been explained to patients.

Regulators acted only recently. This July, the state Department of Managed Health Care fined Kaiser a record $3 million for its haphazard handling of complaints and physician errors throughout the state. Officials said in an interview that the Safari matter played a significant role in their decision to investigate the HMO's practices.

Late last month, the state medical board accused Safari of gross negligence, seeking to revoke or suspend his license.

The board also has faulted Kaiser, the nation's largest HMO with 6.5 million members in California. The health plan made the board's investigation of Safari "protracted and difficult" by providing incomplete medical records, a spokeswoman said.

Kaiser did not allow senior officials to be interviewed for this story -- and warned staffers at Kaiser Fresno not to talk, several said. In a statement, hospital administrator Susan Ryan said the HMO has cooperated with the medical board and is "committed to ensuring the safety of our patients."

In July 2005 -- three months after Devin's death -- Kaiser imposed its restrictions on Safari, barring him from performing vaginal deliveries and requiring him to be monitored by another physician or an advanced-practice nurse, Ryan said. The restrictions became permanent in April 2007. Kaiser and other hospitals typically do not notify patients of such actions, officials said.

Safari, 49, declined to comment. His lawyer, Stephen D. Schear, said the accusations are "completely unwarranted" and that Safari intends to challenge the medical board's action in a hearing. Safari, he said, has the support of many at the hospital and in his department.

"If you're doing thousands of high-risk deliveries over the years, it's almost inevitable that there's going to be some unfortunate cases where children die, where things don't go right," Schear said.

"You're talking about one minute maybe where he pulled too hard to try to extract this baby. . . . Just look at his whole record, 10 years."

But doctors and other staffers allege that Devin's death was the culmination of Safari's troubles, not a fluke.

"We do not feel that our perinatologist is competent," reads an August 2005 petition signed by eight of Safari's peers, about half of the ob-gyn department. "Over and over again he put our patients at risks and most recently with the undeniably terrible outcome."

Kaiser was "misleading our patients and the public" by advertising that it had a perinatalogist on staff even though his practice was restricted, said the petition, which was addressed to the hospital's medical director.

The petition, complaint letters, depositions and other documents used in preparation of this story are part of the ongoing lawsuit by the two doctors and arbitration cases against Kaiser, or have been provided to state regulators investigating Kaiser and Safari.

Is Kaiser Permanente violating the California Business and Professions Code with false advertising about digitized x-rays?

Kaiser Permanente boasts about its new Garfield Specialty Center in its October 2011 e-newsletter: "All our X-rays and imaging tests are digital and become part of your electronic health record, which can help speed diagnosis and treatment."

But Kaiser Member Services wrote to me on August 3, 2011 that x-rays taken on June 15, 2011 at the Garfield Specialty Center were not available to my urologist or to Emergency Room doctors because they were saved only on thermal paper! No images at all were available to Emergency Room doctors.

Kaiser wrote:
"Per our records I understand that you spoke with...the X-ray Department on July 11, 2011 where it was explained that the urethra cystogram could not be downloaded to a CD due to it was not digitized. Urethra cystogram was not saved electronically and
we can provide medical record on thermal paper."


(Click on image to enlarge.)


Which is it, Kaiser? Are all x-rays at Garfield Specialty Center digitized, or did Kaiser move some old machines into the new building, and those machines can only save x-rays on thermal paper? Obviously, both claims can not be true.

Kaiser tampered with medical records and created a bizarre series of paper images to hide x-rays. Kaiser was determined to prove that the patient did not have the problem she claimed to have. This plan was written down by the referring doctor in an email to the Department Administrator before the procedure was done. I have written to Dave Horton and Rhianne Steins, who head the Diagnositic Imaging Department, but I've received no response. Chief Financial Officer Lynette Seid was kind enough to respond to me, but she admits she doesn't know much about the issue, and says it will take her two to four weeks to sort it out. And as one can see from the above image, Liza Zinola, Service Area Assistant Administrator for Member Services, is actively supporting the cover-up.

What possessed some Kaiser administrator to plan such an incompetent hoax? I think they are used to having patients who ask no questions.

Here's the Kaiser article:

Garfield Specialty Center in full bloom
Partners in Health e-newsletter
October 2011

If you live near Central San Diego, you’ll be happy to hear that our Garfield Specialty Center is now fully open for business.

Our Garfield Specialty Center “offers a convenient, central location for members to receive same-day surgery and medical care from 58 specialty care providers,” says Mary Ann Barnes, senior vice president and executive director of Kaiser Permanente in San Diego.

(Click on image to enlarge.)



The Ambulatory Surgery Center has four operating suites, six gastrointestinal procedure suites, and pre- and post-operative patient care areas. Other services available include:

orthopedics
podiatry
pain management
plastic surgery
general surgery
head and neck surgery
audiology
gastroenterology
urology
pharmacy
laboratory
radiology

All our X-rays and imaging tests are digital and become part of your electronic health record, which can help speed diagnosis and treatment. In our laboratory, full-spin, adjustable chairs enable technicians to draw blood from either arm. Exam rooms are built for greater noise reduction and patient privacy.

“We’ve designed this building with a lot of windows and natural light,” says Barnes. “Our designers paid close attention to creating a comfortable, healing environment for our patients.”

The Garfield Specialty Center is at 5893 Copley Drive, about 8.5 miles from our San Diego Medical Center.

Thursday, October 13, 2011

Absolute greed: Michael Moore supports Kaiser workers in Los Angeles

Kaiser Permanente: Absolute Greed
By Patricia Tamayo
Michael Moore.com
October 4th, 2011
(included video)

If I told you that thousands of healthcare workers who provide care to patients at Kaiser Permanente hospitals and clinics every day are routinely forced to work short staffed, to defer patient appointments, to float to unfamiliar departments we're not adequately trained for and to work long hours of overtime while fatigued, you might say, “Well, that’s not Kaiser’s public image.”

Those of us who have seen Michael Moore’s outstanding film ‘Sicko’ know the real Kaiser that hides behind its feel-good ad campaign. While the work conditions above may not fit Kaiser’s promotional self-image, Kaiser RNs and psychologists have repeatedly made all of the above complaints to Kaiser management. The problem is that Kaiser isn’t listening.

That’s why, together with more than 1,100 of my brother and sister RNs, we took the streets outside Kaiser Los Angeles Medical Center for three days last month. For two of those days we were joined by Kaiser psychologists and health professionals from across Southern California. And for one of those days, we were joined by more than 20,000 other RNs, psychologists and optical workers from all over California in the largest strike in Kaiser history.

We had good reason to strike against Kaiser.

Kaiser has made $5.7 billion dollars in profits in the last 30 months. Yet Kaiser refuses to agree to reasonable safe staffing language that would protect patients and workers. Just a small part of those billions of dollars in profit could go a long way to ensuring safe staffing at Kaiser Permanente. But when we propose using profits to protect patients and workers, Kaiser just says, “No.”

Kaiser also wants cutbacks. Even though Kaiser is rolling in money, Kaiser wants to eliminate our secure retirement plan and make deep cuts to our health benefits! There’s a simple explanation for this. And it’s not pretty.

Greed.

Kaiser’s CEO, George Halvorson makes $8 million a year and Kaiser executives have no fewer than 8 separate pension accounts. George Halvorson will never have to worry about making a co-pay or the elimination of his retirement plan. Worse, when George Halvorson refuses to listen to our patient care complaints and our reasonable safe staffing proposals, he’s turning his back on healthcare workers and the patients we care for.

That’s not thriving, that’s absolute greed.

That’s why 21,000 Kaiser workers took to the streets last week. We want to tell the world about Kaiser Permanente, and let folks know how they can help us make things better.

We were thrilled when Michael Moore showed his incredible commitment to workers and to safe patient care by joining us on the picket line. In fact, we made a short video to share with you that we think you’ll like.

Wednesday, October 12, 2011

Notice of availability of contracted practitioners and providers list from Kaiser Permanente

Kaiser Permanente is required by California law to provide members and prospective members, upon request, a list of medical practitioners and providers contracted to provide health care services to Kaiser Permanente members in a general geographic area.

The list includes certain information about these contracted health care practitioners and providers, including which primary care practitioners may be accepting new patients.

To receive a copy of this list, call our Member Service Call Center and ask for the contracted providers list.

[Dial 1-800 464 4000, and be sure to wait until after the menu goes all the way to "press 9." Then there is a pause. Don't hang up! The recording will then tell you to press 0 to speak to a representative.]

I called and asked for my list on October 12, 2011. I wonder if and when I will receive it.

Selected Kaiser Employees Will Strike for 24 Hours Starting Wednesday

Selected Kaiser Employees Will Strike for 24 Hours Starting Wednesday

National Union of Healthcare Workers says San Diego will not see pickets, but local teachers' union leader urges members to respect picket lines.

By Ken Stone
May 17, 2011

Kaiser-Permanente health-care workers will stage a 24-hour strike starting at 6 a.m. Wednesday throughout Southern California, including offices in San Diego County, union officials say.

Kaiser has hospitals and clinics in Carlsbad, La Mesa, Point Loma, Bonita, El Cajon, Escondido, Oceanside, San Diego, San Marcos and Vista.

About 200 San Diego employees of Kaiser-Permanente will walk off the job barring a “miracle,” a union spokesman said Tuesday.

The staffers—social workers, psychologists, speech pathologists, audiologists, health educators and dieticians—will conduct a one-day strike at Kaiser facilities around San Diego County, and throughout Southern California, said Leighton Woodhouse of the National Union of Healthcare Workers.

“It would be close to a miracle for it not to happen,” Woodhouse told City News Service.

Kaiser’s Point Loma Medical Offices will be most affected, with 52 employees not reporting to work, he said.

According to Woodhouse, the union and Kaiser disagree over staff levels and proposed cuts to health-care coverage and retirement benefits.

The company is in negotiations with three NUHW bargaining units, said Kaiser spokeswoman Mina Nguyen.

She said all facilities in San Diego County will operate normally and patients should keep their physicians appointments. However, routine nonemergency appointments to see social workers and psychologists may need to be rescheduled, she said.

Tuesday, the National Union of Healthcare Workers said: “2,500 Kaiser Permanente healthcare workers throughout Southern California will go on strike for 24 hours. Our strike will be the single largest work action by NUHW members since the founding of our union. We’re telling the world the truth about Kaiser Permanente.”

Other unions were asking their members to respect picket lines at Kaiser facilities—even though NUHW said no picketing would occur in San Diego.

“If you have a non-urgent medical appointment scheduled during that 24-hour period, please consider rescheduling it,” wrote Jim Mahler, president of San Diego Local 1931 of the American Federation of Teachers. “Please honor the picket line of our brothers and sisters at Kaiser.”

Kimberly Tubbs, a registered nurse at Kaiser Permanente’s flagship Los Angeles Medical Center, wrote on the union website:

“It is AMAZING to me that Kaiser has been unwilling to reasonably discuss fair wages at the bargaining table. This month Kaiser reported $10 million per day in profits for the first quarter. This is the same company who wants to cut our pensions, reduce our benefits and not fairly compensate us!

Tubbs, a recovery room nurse, said she works eight-hour shifts on weekdays, and “it is my responsibility to care for patients who are coming right out of surgery as they are emerging from their anesthesia-induced sleep. This requires skilled training in Critical Care and Pediatrics. There are many complications that can arise after surgery, and as a ‘post-op’ nurse, I have to be skilled and prepared to handle any complication or emergency that comes up.

“Most days at work, I start to worry about IF I’m going to be able to leave on time around 3 in the afternoon, which is two hours before my shift ends. It is a regular occurrence that most of my fellow nurses and myself are required to stay past our shift because there isn’t anyone to take our patients.”

She argued that Kaiser can no longer claim financial hardship.

“They are surviving quite well through this economic hard times. In fact, I think they are THRIVING. Thriving to the tune of $10 million a day! I can’t really say that the nurses are thriving; in fact we’re barely surviving with the added workload and forced overtime.”

COMMENT

Ken Stone

4:39pm on Wednesday, May 18, 2011

At 3:30 p.m. Wednesday, building administrator Michelle Gibson said the Kaiser La Mesa primary care offices she oversees had seen no picketing, and nobody's scheduled appointment had to be canceled.

Monday, October 10, 2011

Scripps, Kaiser Permanente Extend Cardiovascular Partnership Another Decade, Keeping It the Region’s Largest Heart Program

See Kaiser Permanente administrators in San Diego.

Scripps, Kaiser Permanente Extend Cardiovascular Partnership Another Decade, Keeping It the Region’s Largest Heart Program
November 9, 2010
New agreement also includes bariatric surgery and hospital services

La Jolla, Calif. – Scripps Health and Kaiser Permanente announced today the two non-profit health systems have signed a 10-year comprehensive agreement, the longest-term contract in a 30-year partnership that continues a legacy of working together for the good of the community.

Under the agreement, Scripps will be the exclusive provider of cardiac surgery and interventional cardiology (at Scripps Memorial Hospital La Jolla) and bariatric services (at Scripps Mercy San Diego) to the more than 500,000 Kaiser members across San Diego County. Scripps also will provide hospital services to Kaiser Permanente members transferred to a Scripps facility or who are treated in a Scripps emergency department. Scripps is the region’s largest provider of cardiovascular services and the only San Diego provider recognized by U.S. News & World Report as among the best for heart and heart surgery in 2010, a distinction reflective of the exceptional skills of the cardiovascular physicians of Kaiser Permanente and Scripps Health.

“This agreement extends our close working partnership that has been built over the past 30 years around quality, medical management, and patient satisfaction,” said Scripps President and CEO Chris Van Gorder. “In an era of health care reform, collaboration is more important than ever before. Through it, we are able to maintain our standing as the largest cardiovascular program in the region, which allows us to make the best use of our infrastructure and leverage our expertise to best serve the community.”

“Kaiser Permanente and Scripps have worked in partnership for the past three decades to provide premier cardiovascular services to San Diego County,” said Mary Ann Barnes, Senior Vice President & Executive Director for Kaiser Permanente San Diego. “Through this new agreement, we look forward to even greater opportunities to provide innovative, leading edge cardiovascular health care.”

Scripps will break ground next year on a new eight-story, 383,000-square-foot hospital tower on the campus of Scripps Memorial Hospital La Jolla. The new tower, estimated to cost $398 million, will serve as the hub of the Scripps Cardiovascular Institute, which will combine the cardiovascular programs of Kaiser Permanente, Scripps La Jolla and Scripps Green Hospital.

The institute will feature 108 in-patient beds in private rooms, 60 intensive care beds, 10 state-of-art operating rooms and cardiac catheterization labs with the most advanced medical technology, centralized cardiovascular research labs, and a center for graduate medical education.

Computerized room-level observation stations, a decentralized medication dispensing process and decentralized nurses stations allow caregivers to closely monitor patients and improve communications with family members. Rooms include a variety of amenities for families, including wireless internet access, plasma screen televisions and comfortable pullout couches for overnight stays.

Scripps performs more cardiovascular procedures than any other heart care program in California, last year providing cardiovascular care to more than 45,000 patients. In 2010, Scripps was recognized by Thomson Reuters as one of the Top 10 health systems in the nation for quality care. Scripps has also achieved the gold standard for stroke care with Primary Stroke Center designation. Scripps Mercy Hospital in San Diego has been designated as a Bariatric Center of Excellence by the American Society for Bariatric Surgery and the Surgical Review Corporation.
About Scripps Health

Founded in 1924 by philanthropist Ellen Browning Scripps, Scripps Health is a $2.2 billion nonprofit community health system based in San Diego, Calif. Scripps treats a half-million patients annually through the dedication of 2,500 affiliated physicians and 13,000 employees among its five acute-care hospital campuses, home health care services, and an ambulatory care network of physician offices and 22 outpatient centers and clinics.

Scripps is also at the forefront of clinical research, genomic medicine, wireless health and graduate medical education. Scripps has been recognized by Thomson Reuters as one of the Top 10 health systems in the nation for quality care. With three highly respected graduate medical education programs, Scripps is a longstanding member of the Association of American Medical Colleges. More information can be found at www.scripps.org.
About Kaiser Permanente

Kaiser Permanente is America’s leading integrated not-for-profit health plan. Founded in 1945, it is a group practice prepayment program headquartered in Oakland, Calif. Kaiser Permanente began serving San Diego in 1967, and currently provides care for nearly 500,000 members throughout the county. More than 7,400 staff and 3,200 physicians provide quality care at 20 medical facilities conveniently located throughout the county and at San Diego’s Kaiser Foundation Hospital. The hospital has 392 licensed beds and a 78-bed Emergency Department. To learn more, visit the web site at kp.org.

Scripps Media Contact: Janice Collins
Phone: 858-678-7486
E-mail: Collins.Janice@scrippshealth.org

Kaiser Permanente Media Contact: Rodger Dougherty
Phone: 619-528-7783
E-mail: rodger.w.dougherty@kp.org

Scripps Green Hospital, Scripps Memorial Hospital La Jolla, Heart Care, Heart Care (Scripps Memorial Hospital La Jolla)

Friday, October 7, 2011

Many U.S. surgeries on elderly may be unwanted: study

Many U.S. surgeries on elderly may be unwanted: study
Oct 6, 2011

(Reuters) - One out of three elderly Americans covered under Medicare plans undergo surgery in the last year of their life, a new study shows.

Medicare reimbursement and the availability of hospital beds are more likely to influence a doctor's decision to operate than a patient's need or desire, according to the study published in the latest issue of Britain's Lancet medical journal.

"While some of these surgeries are clearly needed and helpful to patients, probably a substantial portion are not," lead researcher Ashish Jha of the Harvard School of Public Health told Reuters.

"We (physicians) don't really ask patients what they want and we end up doing a lot of procedures," he said.

The number of patients receiving surgery toward the end of their lives is higher in regions with high total Medicare spending, the study found.

For example, the rate of end of life surgeries was three times greater in the Munster, Indiana region than in Honolulu.

The study, which looked at data from more than 1.8 million beneficiaries of the government's Medicare health plan who were aged 65 years or older and died in 2008, also found that about one in five elderly patients underwent a surgical procedure in the last month of life.

Doctors should consider the benefits of surgery on elderly patients more carefully before performing procedures that may not improve their quality of life, Jha concluded.

In addition to regional differences, the study found decisions to perform surgery on elderly Americans during the last year of their lives are more likely to be influenced by the patient's age than a patient's need or desire for such procedures.

The likelihood of undergoing a surgical procedure declined significantly as patients get older, Jha's team found.

About 38 percent of patients underwent surgery at age 65, 35 percent by age 80, while only 24 percent had surgery when they lived to between the ages of 80 and 90.

Jha said physicians need to talk to patients who are about to die and inform them that a procedure may not necessarily improve their quality of life.

Insurers Banking their Cash

Insurers Banking their Cash
By The Palm Beach Post
Sept. 30, 2011

Critics of the Affordable Care Act pounced last week on the news that health care premiums went up 9 percent this year. According to the Kaiser Family Foundation, the average family health plan in the U.S. now costs $15,073.

What the critics didn't say was that the year before President Obama signed the law, the cost of an average family policy rose 5 percent. That same year, 2009, the five largest U.S. health insurance companies earned a record $12.2 billion - as 2.7 million Americans lost their private health coverage in the worst year for the economy since the Depression.

This year, some insurers reported double-digit profit increases during the second quarter, and expect to exceed expectations for the year. One reason may be that fewer consumers are seeking medical care in the still-weak economy.

Some of the Affordable Care Act's key portions - the individual mandate, the marketplace-like exchanges - came from Republicans two decades ago. Gov. Scott and other current Republicans who want the health care law repealed say premiums will go down if insurers can compete by selling policies across state lines. Most insurers, however, already have licenses in multiple states. Blue Cross and Blue Shield of Florida recently gave its mental health policies for Florida residents to a Kansas-based company in which it has part ownership.

Objective analysts attribute only about 1 or 2 percentage points in premium increases to the new law's mandates, notably those that require insurers to provide preventive services at no out-of-pocket costs and add adult children to their parents' policies. Those are good changes.

Some analysts believe that insurers are charging more to hedge their bets for when the economy improves and more people seek treatment, and that companies are banking cash before next year, when the law requires them to justify increases. In this case, the health care law is more the target than the problem.

- Rhonda Swan,

for The Palm Beach Post Editorial Board

Thursday, October 6, 2011

Encinitas psychiatrist reportedly prescribed wrong dosage to patients; admitted drinking problem

Doctor’s License Suspended, Alcoholism Alleged
By Lauren Steussy and Paul Krueger
NBC San Diego
Oct 5, 2011

An Encinitas doctor’s license was temporarily suspended by a state judge, after several patients and an investigator presented evidence that he was practicing while intoxicated.

Patients allege that Dennis M. Pavlinac, a psychiatrist, wrote incorrect prescriptions, could not remember who his patients were and had difficulty recalling what he was doing, according to court documents.

His office assistant was often concerned about Pavlinac, and says in the complaints that the doctor admitted to having an alcohol abuse problem several times over the past year.

Pavlinac was also arrested in 2005 for driving under the influence.

The Medical Board of California filed a petition against Pavlinac at the end of September. Since many of the accusers believed Pavlinac was a danger to his patients, the board asked for an immediate suspension of his license.

Judge Robert Walker granted the suspension on September 20. Pavlinac now awaits a hearing to determine whether his license will be permanently suspended.

NBCSanDiego contacted Pavlinac for a comment, but the call was not immediately returned. A voicemail recording stated that he will be out on medical leave for three weeks.

The office assistant quoted in the petition heard many complaints from patients – for example, on August 16, Pavlinac arrived late to an appointment, but was unable to fit the key in the door because his hands were shaking, the petition said. A patient described Pavlinac as acting drunk. He reportedly ran into his desk and often asked repeated questions.

The same day, Pavlinac told a patient he was sorry he missed her appointment, to which the patient responded, “Dr. Pavlinac, I saw you yesterday. We met for 45 minutes, remember?”

Later, an investigator arrived to collect a urine sample. Pavlinac told her that he was “having a heck of a time getting sober,” the complaint read.

Julie D'Angelo Fellmeth with the USD Center for Public Interest Law said that if the allegations are true, there could be dire consequences.

"If a doctor prescribes the wrong dose for someone, that could be a matter of life and death."

Fellmeth added that although the Medical Board is likely understaffed and underfunded, delaying the suspension as long as they did was potentially dangerous. There ought to be a more direct process for cases in which doctors might be practicing under the influence, she said...

Wednesday, October 5, 2011

Facing Government Scrutiny, Kaiser Backs Off Rate Increases

Facing Government Scrutiny, Kaiser Backs Off Rate Increases
by Leighton Woodhouse, NUHW
Oct. 05‚ 2011

Emeryville, CA - Kaiser Permanente recently announced that it will roll back $30 million in premium increases it imposed this summer on hundreds of thousands of Californians, in order to avoid further examination of its rates by the California Department of Managed Health Care (DMHC).

The $30 million rate rollback will affect more than 300,000 Californians employed by small businesses and nonprofit organizations whose monthly rates were boosted by an average 10.7% on July 1, 2011. Kaiser has reduced rates for these consumers by 1.2% across the board going forward, and will refund that portion of the premiums it has collected since July.

In June, the National Union of Healthcare Workers (NUHW) and the Courage Campaign submitted formal letters of complaint to the Governor's office regarding Kaiser's plans to boost these consumers' monthly premiums by an average 10.7 percent. The complaint letters requested an examination of Kaiser's rate hike by the DMHC and explained that Kaiser’s rate review filings to the DMHC “demonstrate significant data deficiencies, and the evidence they do contain makes it hard for anyone to conclude that the rate hikes are justified.”

The letters cited Kaiser’s failure to disclose information about its massive profits ($5.7 billion since the beginning of 2009) and executive compensation practices as well as its failure to provide historical data on prior rate hikes. Furthermore, the letters noted that Kaiser sought rate hikes that were more than triple the rate of medical cost inflation.

Kaiser’s decision to roll back its rate increases, described in this sample letter to customers, follows a review of the HMO's rate hikes by DMHC conducted as requested in the letter from NUHW and The Courage Campaign. Kaiser's letter states that "Kaiser Permanente has undergone a highly complex rate filing and review with the Department of Managed Health Care. As a result, we've agreed to this small rate reduction."

Kaiser’s action is described in a recent press release issued by KaiserQuotes.com, which reports "the information that they [Kaiser] provided to the DMHC presented challenges and delays," as Kaiser does not report financial data "broken down by specific department classifications" as required of other insurers.

Kaiser’s tacit recognition that its rate hike was too high points to a need for further scrutiny by purchasers of the giant HMO's rate increases on other groups. Two weeks ago, a teachers union that represents tens of thousands of classroom instructors sent a letter to Kaiser taking it to task for seeking double-digit rate increases on cash-strapped school districts facing massive budget deficits.


The letter, dated September 22, 2011, states in part:

“Despite this enormous profitability, Kaiser currently seeks a 10% hike in the monthly premiums for health care from Los Angeles Unified School District employees. As you can imagine, this proposed premium hike – which would drain an additional $40 million a year – could not come at a worse time. In the midst of the Great Recession, our city’s school district has laid off 1,400 teachers and other staff and has forced our children to endure ballooning class sizes that deprive them of the education they deserve. In fact, last month Kaiser reported that it earned $1.6 billion in profits during the first six months of 2011 – a 45% increase compared to the same period in 2010. In this context, it’s difficult to understand how Kaiser, which we understand is a nonprofit, can rationalize the boosting of its rates on consumers…”

While Kaiser’s rate rollback is an important victory for California consumers and will save $30 million for small businesses and nonprofit organizations, NUHW and the Courage Campaign seek further investigation of Kaiser's rate hikes, in addition to Kaiser's compliance with DMHC reporting requirements.

“Last week's rate rollback is just the first step we must take to bring Kaiser in line,” said Rick Jacobs, chair and founder of Courage Campaign, a 700,000 member grassroots, progressive, online organization based in California. “Even after returning $30 million to consumers, Kaiser’s will still reap nearly $350 million in profits from its remaining rate hikes, making it the most profitable HMO in California — and it pays no taxes. And with those profits and tax savings, they buy a vast lobbying machine to kill rate regulation, just as they did with AB 52. Californians are struggling with the worst economy since the Great Depression, and Kaiser is acting like the most rapacious hedge fund manager, making money as its members struggle to make ends meet."

Sunday, October 2, 2011

Kaiser rolling back its outrageous 10.7% rate hike on 300,000 Californians to 9.5%

Courage Campaign
October 2, 2011

Last week, Kaiser, a publicly subsidized healthcare provider that pays no taxes, quietly announced that it's rolling back its outrageous 10.7% rate hike on 300,000 Californians to 9.5%.

That may not sound like much, but it amounts to at least $13 million that struggling Californians can keep for their families instead of handing over to multimillionaire Kaiser executives.

Why did they do it? Because you made them. It's a victory, but we can't stop here.

Thousands of Courage Campaign members stepped up, emailed Kaiser's CEO, and told him they oppose raising rates on employees of small businesses and non-profits at a time of record profits for Kaiser. Along with our friends at the National Union of Healthcare Workers, we wrote to Governor Brown, asking him to instruct the Department of Managed Health Care (DMHC) to examine Kaiser's rate hike to see if it was justified.

That's exactly what the DMHC did, and Kaiser is trying to do damage control by reducing its rate increase on hundreds of thousands of people. This is what can happen when we stick together and raise our voices.

We've got to keep pushing them. We won't rest until Kaiser's rates are subject to sensible regulation. Please support our ongoing efforts to stop obscene rate increases for Californians with legislation like AB 52.

Kaiser made $1.6 billion in profits in the first half of 2011 without paying a dime in taxes. Measures like AB 52, which would allow the state to reject health insurance rate increases, are the only way to stop their greed.

Rick, Domingo, Eddie and the Courage team

Saturday, October 1, 2011

Kaiser Permanente and the bizarre saga of Dr. Hamid Safari

What does it take to get Kaiser doctors to fall in line? In my experience, most doctors and administrators at Kaiser will do what they're told even if it harms patients.

My guess is that administrators pressured doctors to sign the second letter. Why? Because Kaiser could be held liable for patient deaths if one of their doctors was found to be unprofessional. Kaiser seems to have a knee-jerk response to criticism of Kaiser doctors: deny any problem, cover it up, and don't let reason or ethics interfere with decisions.


More about this letter can be found at The Kaiser Papers.


Hamid Safari: Kaiser tried to bribe baby-killing doctor
Kaiser Permanente Thrive Exposed
March 8th, 2008

[How do you like that? Only at Kaiser can you kill two babies and endanger countless others, only to be handed $2 million of member money to quietly resign. The pattern should be glaringly obvious by now. Kaiser always tries to lie and buy its way out of a scandal, and only does the right thing when its malfeasance becomes a media event. Note that even after Safari turned down the settlement, Kaiser still would have declined to suspend him if only CMS hadn't rejected the first plan of correction (pdf).]

From the Fresno Bee:
Kaiser doctor rejected a deal

Hospital offered beleaguered Safari $2 million to resign.

By Tracy Correa

Three months before Kaiser Permanente suspended a Fresno physician at the center of a state investigation into the deaths of two babies, the hospital offered him $2 million to resign.

Dr. Hamid Safari, who treated high-risk pregnancies, said he refused the Nov. 28 offer because he wanted to continue working and believes he has done nothing wrong.

“I have spent my life to be a perinatologist and help patients, mothers and babies. The money was not my intention or my goal in life,” Safari said.

Kaiser officials acknowledged that they have discussed a settlement with Safari, but would not confirm the $2 million figure. The hospital suspended the doctor last week.

“We have considered many alternatives over time regarding Dr. Safari leaving the organization, including settlement, because we believed it was in everyone’s best interest,” Linda Monte, interim senior vice president and area manager for Kaiser’s Fresno hospital, said in a written statement.

The doctor and his lawyer, Stephen Schear, said Kaiser buckled under the pressure of bad publicity. They also criticized Kaiser for telling reporters about the suspension.

Schear said Safari was not interested in taking any amount of money in exchange for his career.

“Our counteroffer was to sit down and work things out so he could continue to treat patients at Kaiser Fresno,” he said.

Safari said a Kaiser representative showed up at his home about 5 p.m. on Feb. 29 and handed over a letter stating that he was suspended, effective immediately. He had been off that day for his deposition in a lawsuit filed by two Kaiser doctors who said they were retaliated against by hospital administration for questioning Safari’s competence.

The suspension followed months of criticism and public pressure on the doctor and Kaiser Permanente since details of the deaths — in 2004 and 2005 — became public late last year.

In September, the California Medical Board accused Safari of gross negligence — charges that could lead to loss of his California medical license. A hearing is pending.

In 2004, Safari waited more than three hours before performing a Caesarean section on a patient even though the baby was in distress, according to the accusation. The baby girl, who was deprived of oxygen, died 10 months later.

The other case occurred in 2005, when Safari allegedly severed the spinal cord of a baby boy, a twin, in what has been described by investigators in documents as a brutal delivery.

Medical staff and nurses have said they had raised questions about Safari’s competence but hospital administration failed to act.

Drs. Gilbert Moran and Robert Rusche are now suing Kaiser for retaliating against them after they complained about Safari.

Safari, in turn, accuses Moran — the former head of the OB/GYN department — and Rusche of complaining to the state medical board as part of a vendetta against him. He said they did so after he complained to superiors that one of the doctors was abusing his power on a quality review committee to go after doctors he didn’t like.

In January, federal health officials issued a critical 68-page report following an investigation into the situation. The report suggested that if Safari had been monitored more closely, the deaths might have been prevented.

Days later, Susan Ryan, the hospital’s then-top administrator, stepped down.

Schear said the bad publicity had become too much and Kaiser was determined to get rid of Safari. He also said that even though the doctor is suspended, he is collecting his Kaiser paycheck and is still entitled to due process, involving hearings and appeals, that can take months or years.

Schear said the $2 million settlement offer was an attempt to quickly disassociate the hospital from Safari and shortcut that process.

Schear provided The Bee a copy of a Nov. 28 letter from a Los Angeles law firm he said represented Kaiser. He blanked out all but one passage in the letter, which reads, “Kaiser will pay Dr. Safari $2 million, provided Dr. Safari complies with all conditions set forth herein.”

Schear said the letter also set forth conditions, including a confidentiality agreement and a pledge that Safari wouldn’t sue Kaiser.

“The essence was, you leave and we give you the money,” Schear said.

He said $2 million was a starting point and that the offer came “with indications they would pay him significantly more than that if he immediately resigned.”

Schear said he believes Kaiser moved to suspend Safari because it doesn’t think the medical board will end up revoking his license when all the facts come out.

“They just decided to throw him overboard,” Schear said.

Safari said he has performed well in recent months and that there have been no reports of any problems since 2005. He said his patient satisfaction rates are the highest they have ever been and only eight Kaiser patients have asked to be reassigned to another doctor.

“I think the action [suspension] was taken because he’s performing too well and building up a track record,” Schear said. “The longer he goes without problems, the harder it is to get rid of him.”

Safari now serves primarily as a consultant in high-risk births. Kaiser restricted Safari in July 2005 from performing vaginal deliveries and made the restrictions permanent in April 2007.




Doc’s credentials terminated due to negligence
21 October, 2010

fresnobee.com on October 18, 2010 reported that Kaiser Permanente in Fresno has terminated the hospital privileges and credentials of Dr. Hamid Safari after a nearly three-year fight by the beleaguered perinatologist to keep his job following allegations of negligence. Kaiser’s action comes despite the California Medical Board’s decision last year to clear Safari of negligence related to the deaths of two babies in 2004 and 2007.