Tuesday, January 31, 2012

200 San Diego Kaiser Workers Strike for Fourth Time

I am personally familiar with Mary Ann Barnes' level of honesty. She supported the actions described here.

200 Local Kaiser Workers Strike for Fourth Time
24-hour strike aims to protect health care and retirement benefits
By Lauren Steussy
Jan 31, 2012

Over 200 Kaiser workers went on strike Tuesday.

Workers at Kaiser Permanente are lining up in front of facilities across California to bring awareness to contract disputes with Kaiser's mental health and optical employees.

Statewide, 4,000 National Union of Healthcare Workers (NUHW) employees will strike for 24-hours Tuesday. It is expected to be one of the biggest strikes in Kaiser's history, since two other unions will also walk out.

The disputes center around proposed cuts to retirement and health care benefits.
Over 200 of those NUHW employees work in San Diego. It's the group's fourth walkout since contract negotiations began in 2010. The most recent one since Tuesday's was in September.

Workers on strike say Kaiser's disputes affect not only their own health care and benefits, but also patient care.

"We've worked hard to make Kaiser successful," said Sarah Eberst, a Lincensed Clinical Social Worker with NUHW, "but we don't want that to come at the cost of pateint care or at the cost of our own retirement benefits or healthcare."

In April, Kaiser sent an economic proposal back to the unions, which have not negotiated since, according to MaryAnn Barnes, Senior Vice President and Executive Director Health Plan and Hospital for Kaiser in San Diego.

"We're very disappointed, and we need to see movement in the negotiations," Barnes said. "We're willing to negotiate in good faith, but we are not getting the same kind of reaction from NUHW."

All Kaiser hospitals and medical offices are expected to remain open during the strike, with Kaiser relying on replacement workers and nurse managers for additional staffing. This is possible because a very small group of the workers are actually on strike today, Barnes said.

"When Kaiser is making billions of dollars of profit per year," Eberst said, "It's not okay to be cutting back on employees retirement and health care."

Source: 200 Local Kaiser Workers Strike for Fourth Time | NBC San Diego

Saturday, January 28, 2012

$1.2 million Judgment Against Southern California Permanente Medical Group

Penney and Associates, Obtains $1.2 million Judgment Against Southern California Permanente Medical Group
The law firm of Penney and Associates reported an award of $1.2 million entered against Southern California Permanente Medical Group, in a wrongful death claim for medical malpractice following an over prescription of medication for a thyroid condition.
Orange County, CA (PRWEB)
January 28, 2012

The law firm of Penney and Associates reports that in the matter of Fitzgerald v. Kaiser Foundation Hospitals, et al, Case. No. OIA #10177, at the Office of the Independent Administrator, the arbitrator awarded the Fitzgerald family $1.2 million in a wrongful death action. Attorney Arnold Hernandez from the law firm of Penney and Associates reported that its attorneys were successful in proving that an endocrinologist at a Kaiser facility in Irvine, California committed medical malpractice when she over prescribed medication for a thyroid condition.

According to Penney and Associates' wrongful death lawyer, Arnold Hernandez, in a medical malpractice claim involving prescription of medication the standard of care is relatively simple. According to Mr. Hernandez, the medical provider should follow the manufacturer instructions in determining what dosage is appropriate. He states that in this case, the manufacturer specified what would be an appropriate starting dosage accounting for the age of the patient, medical history of the patient, and pre-existing medical conditions.

Mr. Hernandez states that the deceased's family claimed the endocrinologist failed to follow the manufacturer’s instructions and prescribed a dosage several times higher than recommended. He states that in a matter of a few days the patient suffered a massive heart attack and died. He reports that the family was fortunate in contacting a wrongful death attorney at Penney and Associates soon after the incident. He explains that had the family taken a year to seek advise it may have been too late to proceed with a wrongful death claim.

Mr. Hernandez reports that in this case a claim was filed against the various Kaiser entities, but through agreement the arbitrator dismissed claims against Kaiser Foundation Hospitals, and Kaiser Foundation Health Plan, Inc. and judgment was against Southern California Permanente Medical Group only.

Tuesday, January 24, 2012

Kaiser Permanente and Bridgepoint come together with incentives for Kaiser employees to transfer


Ashford University is proud of our alliance with Kaiser Permanente San Diego!
All Kaiser Permanente San Diego employees who successfully apply to and attend Ashford University will receive:

5% tuition grant
Technology Services Fee waiver
Free required course materials for all mandatory courses

For more information or to receive these benefits, click here or call 800.408.7113 to speak to a dedicated Admissions Counselor at Ashford University. For detailed instructions on how to submit the required documents to ensure you receive your alliance benefits, please visit our eligibility page.

Ashford University
From Wikipedia, the free encyclopedia
Not to be confused with the unaccredited entity with the same name doing business from the United Kingdom.

Ashford University is a private, for-profit university located in Clinton, Iowa. It is the largest educational holding of Bridgepoint Education (NYSE: BPI).[3] Although the university is regionally accredited by The Higher Learning Commission of the North Central Association of Colleges and Schools,[4] it has begun the process of seeking regional accreditation from the Western Association of Schools and Colleges.

The university offers Associate's, Bachelor's, and Master's degrees in more than 50 degree programs on campus and online. The majority of the student population is enrolled in online courses but[3] the campus has experienced growth in recent years.

As for-profit colleges have come under increasing scrutiny, a U.S. Senate report in 2011 revealed that Ashford has one of the highest withdrawal rates of any publicly traded school in the industry.[7] Ashford has also been faulted for its recruiting and finance practices in a U.S. Department of Education audit. Bridgepoint Education responded in March 2011 with a report asserting that the information used in the Senate hearing was either inaccurate or incomplete...

Tuesday, January 17, 2012

US to Force Drug Firms to Report Money Paid to Doctors

US to Force Drug Firms to Report Money Paid to Doctors
January 17, 2012
by: Robert Pear
The New York Times News Service

To head off medical conflicts of interest, the Obama administration is poised to require drug companies to disclose the payments they make to doctors for research, consulting, speaking, travel and entertainment.

Many researchers have found evidence that such payments can influence doctors’ treatment decisions and contribute to higher costs by encouraging the use of more expensive drugs and medical devices.

Consumer advocates and members of Congress say patients may benefit from the new standards, being issued by the government under the new health care law. Officials said the disclosures increased the likelihood that doctors would make decisions in the best interests of patients, without regard to the doctors’ financial interests.

Large numbers of doctors receive payments from drug and device companies every year — sometimes into the hundreds of thousands or millions of dollars — in exchange for providing advice and giving lectures. Analyses by The New York Times and others have found that about a quarter of doctors take cash payments from drug or device makers and that nearly two-thirds accept routine gifts of food, including lunch for staff members and dinner for themselves.

The Times has found that doctors who take money from drug makers often practice medicine differently from those who do not and that they are more willing to prescribe drugs in risky and unapproved ways, such as prescribing powerful antipsychotic medicines for children.

Under the new standards, if a company has just one product covered by Medicare or Medicaid, it will have to disclose all its payments to doctors other than its own employees. The federal government will post the payment data on a Web site where it will be available to the public.

Manufacturers of prescription drugs and devices will have to report if they pay a doctor to help develop, assess and promote new products — or if, for example, a pharmaceutical sales agent delivers $25 worth of bagels and coffee to a doctor’s office for a meeting. Royalty payments to doctors, for inventions or discoveries, and payments to teaching hospitals for research or other activities will also have to be reported.

The Obama administration estimates that more than 1,100 drug, device and medical supply companies will have to file reports, generating “large amounts of new data.” Federal officials said they would inspect and audit drug company records to make sure the reports were accurate and complete.

Companies will be subject to a penalty up to $10,000 for each payment they fail to report. A company that knowingly fails to report payments will be subject to a penalty up to $100,000 for each violation, up to a total of $1 million a year.

Top executives are potentially liable because a senior official of each company — the chief executive, chief financial officer or chief compliance officer — must attest to the accuracy of each report.

The new requirements, or something very similar, will take effect soon; in fact, they are overdue. Under the new health care law, the administration was supposed to establish payment-reporting procedures by Oct. 1, 2011. The public will have until Feb. 17 to comment on the proposals, which are broadly consistent with the expectations of industry and consumer groups. After considering the comments, Medicare officials will issue final rules with the force of law.

Consumer advocates have long demanded details of the financial ties between doctors and drug and device companies.

Allan J. Coukell, a pharmacist and consumer advocate at the Pew Charitable Trusts, said: “Patients want to know they are getting treatment based on medical evidence, not a lunch or a financial relationship. They want to know if their doctor has a financial relationship with a pharmaceutical company, but they are often uncomfortable asking the doctor directly.”

In an introduction to the proposed rules, the Obama administration says that patients can benefit when doctors and the industry work together to develop life-saving drugs and devices. But, it said, these relationships can also “lead to conflicts of interests that may affect clinical decision-making” and “threaten the underlying integrity of the health care system.”

The administration does not try to define the difference between proper and improper payments. It says simply that public reporting of the financial ties between doctors and drug and device companies “will permit patients to make better-informed decisions when choosing health care professionals and making treatment decisions.”

The new standards carry out legislation championed by Senators Charles E. Grassley, Republican of Iowa, and Herb Kohl, Democrat of Wisconsin. The legislation was included in the 2010 health care overhaul.

“The goal is to let the sun shine in and make information available to foster accountability,” Mr. Grassley said.

Christopher L. White, executive vice president of the Advanced Medical Technology Association, which represents makers of medical devices, said the payment data could be used by federal law enforcement agencies, plaintiffs’ lawyers and whistleblowers.

“Some companies fear that doctors may no longer want to engage in consulting arrangements, and such reluctance could chill innovation,” Mr. White said.

Matthew D. Bennett, a senior vice president of the Pharmaceutical Research and Manufacturers of America, said the industry “supported transparency of physician payment information.” However, he said, it is important that payment data be presented in a proper context, emphasizing that interactions between doctors and drug companies played a critical role in improving care, educating doctors and fostering appropriate use of medicines.

Medicare and Medicaid, the programs for older Americans, the disabled and the poor, spend more than $100 billion a year on drugs and devices.

Although the Congressional Budget Office does not predict immediate savings, it has said that, “over time, disclosure has the potential to reduce spending,” by reducing instances of overprescribing.

The law also requires drug and device companies to report the amount of “any ownership or investment interest” held by doctors or their immediate family members, other than holdings of publicly traded stocks.

The administration intends to apply the same disclosure requirements to doctor-owned companies that distribute medical devices. Such companies allow doctors to benefit financially from sales of devices they use in surgery.

Wednesday, January 11, 2012

Sandy Santiago of CalPERS health benefits office directs me to call "hot horny girls"

CalPERS really loves coming up with pranks to fool members who are seeking help with health problems! First it was a fake 800 number to which I was directed to send faxes. It turned out it wasn’t even a fax number, and none of the faxes went through. Thank goodness I started faxing the day before my deadline for filing! I got it straightened out on time.

Sandy Santiago sent me a January 4, 2012 letter in which she directed me to call (888) 466 4000. This number directed me to call 1 800 834 TALK.

This is what Sandy Santiago apparently wanted me to hear:

“Hey, there, sexy guy. Welcome to an exciting new way to go live one-on-one with hot horny girls waiting right now to talk to you. Lie back, baby, relax! And get ready to meet real local students, housewives and working girls from all over the country. Hundreds of hot girls! Call free all day and night ‘cause we love nasty talk as much as you do. Hot amateur voice and personals for just 99 cents per minute… or live one-on-one talk with a nasty girl who’ll do anything you want for just $2.99 per minute!...”

January 12, 2012 UPDATE

I tried to fax a response to Sandy Santiago, but I couldn't get through at the (916) 795 1513 fax line. So I called CalPERS Customer Service at (888) 225 7377. What followed was interesting, as is always the case when one calls CalPERS.

Here's a letter I sent to CalPERS about what happened today:

Sandy Santiago
Sandy Santiago’s superior at CalPERS

Maura Larkins

Please consider the following to be a complaint and a request. I am requesting information on how to appeal Sandy Santiago’s bizarre decision expressed in her letter of January 4, 2012. In that letter she claimed that my complaint (that X-rays were not viewed by my doctors) was an administrative matter, not a health coverage issue. Her subordinate Salindra explained to me that Kaiser discharged its duties when it took the X-rays, and it had no obligation to view the X-rays or provide treatment for health problems revealed by the X-rays. In her letter, Ms. Santiago purportedly provided a CalPERS number for me to call, but it turned out to be a link to a “hot horny girls” phone sex line. Leeanne claimed today that she could not see Sandy Santiago’s letter on her computer. Anyone on the planet can easily see Ms. Santiago’s letter by Googling “CalPERS + Sandy + Santiago.” The first item that pops up in the results is my “Thank Heaven for Insurance Companies” blog featuring a scanned copy of the letter. Please also consider this letter to be a complaint about the unprofessional treatment, extending to outright sabotage, that I have received from Sandy Santiago and Customer Service. I have been given fake numbers to call and fax, and I have repeatedly received false information or no information at all. I request a response from Sandy Santiago’s superior.

Here is what happened today:

I called CalPERS and said, “I want to appeal a CalPERS rejection of my complaint regarding Health Benefits.”

CalPERS employee Leeanne put me on hold for several minutes while she “checked my account.”

She came back and said, “It looks like a letter was sent out on the 5th.”

I said yes, I had received the letter from Sandy Santiago. “How do I appeal Sandy Santiago’s decision?”

Sandy Santiago had opined that Kaiser Permanente had not violated its contract to provide health care for CalPERS members and families because once X-rays are taken, there is no obligation to allow Emergency Rooms doctors or other doctors to look at the X-rays or to treat the patient for problems revealed by the X-rays. The fact that Kaiser had taken X-rays was enough. Treatment is not required by the CalPERS contract with Kaiser!?! CalPERS often speaks of Kaiser as its “business partner.” I guess it’s a very, very close partnership.

Leeanne apparently did not want to tell me how to appeal Sandy Santiago’s decision. She said, “Just send in the correspondence you originally sent to the Health Plan, and the response you received from the Health Plan.”

“But I already did that.”

“When did you do that?” Leeanne spoke in a challenging, oppositional tone of voice.

“Around December 22.”

“Hold on a second. (Pause.) It’s not letting me view the information. Did you receive a response?”

“Yes, Leeanne, I received the response that you looked up a minute ago.” (Had she forgotten that she had just told me that CalPERS sent a response on the 5th?)

“I did not see the actual letter or the verbiage (pronounced “verbage”) in the letter.”

“Verbage?” I asked.

“Yes, verbage,” she said.

(I later looked up “verbiage” and found at DailyWritingTips.com that “three-syllable verbiage /vur bee ij/” is so frequently pronounced without its “i” that the non-standard mispronunciation is appearing in some dictionaries. I must bow to Leeanne for being on the cutting edge of our changing language.)

Leeanne then started speaking quickly, in a winding-things-up tone of voice, “That’s all I can tell you. There's nothing I can do--"

I could tell she was about to hang up on me.

“I want to speak to your supervisor.”

“Not a problem,” she said.

But apparently it was a problem. She hung up on me.

Saturday, January 7, 2012

San Diego Kaiser Permanente doctor turns in medical license for reportedly viewing child porn at work

Doctor turns in medical license for reportedly viewing child porn at work
Dave Thomas
San Diego News Examiner
December 22, 2011

An area doctor was prohibited from practicing medicine after he was reportedly nabbed viewing child porn in his El Cajon practice.

According to a 10News report, Dr. Mark Zweifach had to turn in his medical license earlier this month as a result of being caught looking at images of child porn while at work. Reports say Zweifach has been practicing medicine since 1982.

The California Medical Board records noted:

"In about July, August, and September 2007, Respondent, a physician with Kaiser Permanente in San Diego, California, used his Kaiser Permanente assigned computer in his office in the Kaiser Permanente Bostonia Medical Office Building, located in El Cajon, California, to access suspected child pornography websites on the internet. When confronted by Kaiser Permanente investigators, Respondent, admitted accessing the websites at work, and further admitted an addiction to internet pornography."

After it was discovered he had viewed child pornography, records show Zweifach -- who ceased working at Kaiser Permanente in 2007 -- voluntarily suspended his practice, but the board did not order him to surrender his license until this December. The board also required Zweifach to register as a sex offender.

Questions raised about Epic software – Kaiser official quits in flap on cost overruns

Questions raised about Epic software – Kaiser official quits in flap on cost overruns
November 13, 2006
By Jeff Richgels

Electronic medical records software from Verona-based Epic Systems Corp. is at the center of a controversy that has led to the resignation of a key executive at the nation’s largest nonprofit health organization.

J. Clifford Dodd, a senior vice president and chief information officer for Kaiser Permanente, resigned Tuesday, four days after another Kaiser employee sent a highly critical e-mail to most of the company’s 140,000 workers about his concerns over the $3 billion, high-profile technology project known as HealthConnect, the Los Angeles Times reported Wednesday.

In the e-mail, project supervisor Justen Deal said Kaiser’s switch to electronic medical records for its 8.6 million members was proving far more expensive and unreliable than anticipated.

In an interview with the Times, Deal said that cost overruns were common and that data showed the new Epic-based software system breaking down so frequently that doctors and patients were often left for long periods without access to medical records.

He told the Times that “the company is wasting hundreds of millions on the project and should consider scrapping it for a better one that can handle the scale of a company like Kaiser.”

Kaiser CEO George Halvorson defended the Epic system in an interview with the San Francisco Chronicle. He told the paper that power outages have caused recent reliability problems unrelated to the system, which is expected to be completed by 2009.

A Kaiser spokesman told the Times that despite minor problems, the HealthConnect rollout was exceeding expectations.

Epic spokeswoman Terri Leigh Rhody said today that the company, which recently moved to its new headquarters in Verona, declined comment and directed inquiries to Kaiser. Calls to Kaiser were not returned by deadline today.

Deal told Computerworld magazine that he has had access to “internal projections that show that we could lose $7 billion over the next two years. Losses of even a fraction of that amount could be destabilizing to the organization.”
Deal told Computerworld that he sent letters to Kaiser management expressing his concerns, but in internal memos, management said it had investigated Deal’s concerns and found them baseless.
Deal has not backed down.
“It’s chilling for anyone in the organization to see how far off-track this project has gone,” he told Computerworld.
Kathy Lancaster, Kaiser’s chief financial officer, confirmed to the Times that her office compiled the report last March but said it was only a “worst-case scenario” and that she expected cost-cutting efforts, as well as savings from the parts of the electronic medical records system now in place, to help.
Deal was put on administrative leave Monday pending an investigation and Kaiser said it is reviewing whether he violated company e-mail policies.
“What I’m doing is working to ensure the waste and abuse stops,” Deal told the Chronicle. “That’s not something you get fired for.”
Halvorson described the memo as alarmist and inaccurate, the Chronicle said.
“He has bits and pieces of information and has managed to construct a theory … but what he doesn’t have is any of the subsequent data about what we’re doing to manage those costs,” Halvorson told the Chronicle.
Kaiser has already started cutting costs, through measures such as hiring freezes, Halvorson told the Chronicle.
Kaiser faces the same cost pressures as other health care providers, and must find ways to reduce expenses rather than continuing to increase premiums for consumers, Halvorson told the Chronicle.
A Kaiser spokesman said Dodd’s resignation was not related to the e-mail but did not provide a reason for his departure, the Times reported. Bruce Turksta, vice president and program director of HealthConnect, has been named interim CIO, Computerworld reported.
Epic signed the 10-year, multimillion-dollar deal to provide its health care record management software to Kaiser in 2003.
At that time, Epic founder and CEO Judith Faulkner told The Capital Times that “I think that the Kaiser implementation would be challenging for any company, but I don’t think there’s any company better suited in the world to do it than Epic. It’s a matter of scaling it up and just hunkering down and doing the installations. There’s not much customization involved.”
Epic’s software handles everything from patient medical records and clinical information to scheduling, registration and billing. It also offers patients online access to their records and health care providers.
Kaiser began pursuing the vision of an automated medical record system in the 1960s, long before it was technologically possible, and had worked in the area for many years before contacting Epic in the summer of 2002, the Wall Street Journal reported in 2003. The paper said then that Kaiser expected to save $1 billion by going with Epic over its internal development path.
Oakland, Calif.-based Kaiser, the nation’s largest nonprofit health organization, is at the forefront of the electronic medical records effort, which Mike Leavitt, secretary of the U.S. Health and Human Services Department, recently said was “the most important thing happening in health care.”
Yet getting rid of pen-and-paper records is proving harder in practice than in theory. Only 20 percent of physicians today use electronic medical records, and many organizations are finding glitches.

Others worry that digital medical records pose risks to patients’ privacy, pointing to cases like that of the Veterans Administration, which lost personal data including medical information on millions of veterans last spring.

Link: http://www.madison.com/tct/news/index.php?ntid=106932&ntpid=2
Published: November 10, 2006

Child custody expert linked to lewd Web photos

Child custody expert linked to lewd Web photos
Joseph Kenan was removed from one case and has been challenged in others after posting the photos.
By Kim Christensen and Victoria Kim
Los Angeles Times
February 27, 2011

A prominent Beverly Hills psychiatrist who has helped decide hundreds of child-custody disputes was thrown off one recent case and has been challenged in at least two others after posting lewd photos of himself on Facebook and allegedly promoting illegal drug use, unprotected sex and male prostitution.

Dr. Joseph Kenan, president of the American Society for Adolescent Psychiatry, is also being investigated by the Medical Board of California on at least four complaints by parents who hired him to do custody evaluations, according to records and correspondence reviewed by The Times.

Among the postings on Facebook and other websites under the slightly different names of "Joe Kegan" and "Joe Keegan" were photos showing Kenan baring his buttocks to the camera in public and another of him posing with a friend holding a cake that explicitly depicted a sexual act, court records state.

The litigation over Kenan's fitness sheds light on a highly influential, but lightly regulated, group of experts — the evaluators who advise family courts in contested custody cases. Evaluators can earn fees of tens of thousands of dollars for assessing parents' fitness.

Critics of the system say the courts do a poor job of overseeing the work of people who often play pivotal roles in the lives of vulnerable children. A recent state auditor's report faulted two courts in Northern California for how they vet custody evaluators' qualifications and training.

Kenan's detractors have been particularly vehement.

"This man should not be allowed to determine whether any father or mother is a good parent," said Deborah Singer, who persuaded a court commissioner to remove Kenan from her child-custody case last year after she discovered explicit postings on Facebook and elsewhere on the Internet.

Singer and another parent who sought to disqualify Kenan, Deborah Zolla, say their concerns were sparked, in part, by his demands for tens of thousands of dollars, which they considered excessive fees, to develop custody plans for their children.

Kenan declined to be interviewed for this article. In a written statement submitted in Singer's case, he said the Facebook page was never meant for public viewing. He closed it and asked other websites to remove photos of him, Kenan wrote.

"Ms. Singer misunderstands the bawdy humor I occasionally present to my friends, as evidenced by some of those pictures. I do NOT promote what she is concerned I promote. My comments are entirely in jest. In fact, my comments serve to educate the community's problems through satire."

Kenan's lawyer, Donald S. Eisenberg, said the doctor's private life had no bearing on his professional performance. He said Kenan's detractors were unhappy with his evaluations or trying to avoid paying his fees. In court papers, he called the allegations inadmissible hearsay, conjecture and innuendo.

"His entire livelihood is being crushed by information … that is quite irrelevant to the work he does," Eisenberg said. "These allegations show what lengths, in some litigation, that people will go to try to unwind unfavorable opinions expressed by qualified experts in their child custody cases."

Singer and Zolla, who also cited the Internet postings, made their objections to Kenan before he completed evaluations in their cases.

At a hearing last Aug. 3, Family Law Commissioner Steff Padilla dismissed Kenan from Singer's case after reading descriptions of Facebook photographs in her disqualification motion.

In at least one other case, however, a court commissioner in Pasadena ruled the other way, denying a mother's request to remove Kenan from a case involving the custody of her 11-year-old daughter.

"You're saying Dr. Kenan should be disqualified because of a goofy Facebook page. What on earth does it have anything to do with this court?" Commissioner Mary Lou Katz asked in denying the removal motion.

State law sets requirements for evaluators, but county courts oversee their appointments and handle any complaints. The Los Angeles County Superior Court requires private evaluators like Kenan to submit sworn declarations detailing their training and experience, including at least three years of working with families in custody disputes, but does not vet the information or conduct background checks.

Court records show that Kenan, 41, has been involved in at least 250 custody cases in the last 10 years. Kenan began working with the court's custody evaluations office as a medical intern in 2002 and was a part-time employee there from 2004 to 2009, said Margaret Little, Superior Court family law and probate administrator.

When he became a private contractor, his name was added to a directory posted on the court's website, Little said. The list is for the convenience of parents seeking a private evaluation and is not meant to be an endorsement, she said.

Court officials told The Times they had received no complaints about Kenan.

Montebello doctor accused of molesting patient

Montebello doctor accused of molesting patient
By Brian Day, Staff Writer
San Gabriel Valley Tribune
Posted: 01/05/2012 09:28:47 PM PST

MONTEBELLO - Police arrested a doctor Wednesday on suspicion of sexually assaulting a female patient during an exam in July, authorities said.

Dr. Arturo Vargas, 41, was booked on suspicion of three felony sex crimes and was released from jail within hours of his arrest after posting $200,000 bail, according to Montebello police and county booking records.

The arrest came at the end of a six-month investigation after a patient who was examined by Vargas at the Kaiser Permanente Medical Offices, 1550 Town Center Drive, reported being assaulted by the doctor.

"We received a report from a woman in her 30s that during a routine medical examination, she was assaulted by a physician," Montebello police Lt. Luis Lopez said.

Vargas is due in East Los Angeles Superior Court on Feb. 6 to be arraigned on felony charges of sexual battery by fraud, sexual exploitation by a physician and sexual penetration by a foreign object, police said.

The woman reported the alleged assault immediately after it took place, Lopez said. The lieutenant declined to specify what type of exam the woman went to the office for, or on what specific date.

After being notified that a case was to be filed against him, "He (Vargas) came in cooperatively," Lopez said. "He came in with his attorney."

Defense attorney Brian Virag said Thursday that he had not yet seen the charging documents against his client, so he could not comment on any
specifics of the case.

"We'll be waiting to see what the charging documents, allegations, look like," he said. "I can indicate that Dr. Vargas intends to defend his reputation."

Vargas has worked for Kaiser Permanente since 2005, Virag added. Information on his employment before Kaiser was not available.

"He has no criminal history," Lopez said.

Vargas was placed on leave from his position at Kaiser in the early stages of the investigation, Montebello Police Chief Kevin McClure said.

"This has been a case in which everyone's been cooperative," he said.

Kaiser spokeswoman Reyna Del Haro said the hospital is and has been taking the allegations very seriously.

When the allegations first emerged, Kaiser "confronted the physician, required him to conduct all future sensitive examinations in the presence of a chaperone, reinforced the importance of professional communications, and warned him that failure to meet expectations could result in disciplinary action up to and including removal from the partnership," Del Haro said.

"We have placed the physician on administrative leave pending any additional information that we may learn from the legal process," Del Haro said. "We have compassion and sympathy for any patient who may believe that he or she has not been treated appropriately, and we investigate all allegations of improper treatment. In cooperation with the police, we will take all appropriate action to ensure continued high quality care and patient safety."

Police said investigators have not discovered any additional victims; however anyone who believes they may have had an inappropriate contact with Vargas is asked to call Montebello police Detective Javier Ornelas at 323-887-1262.

Friday, January 6, 2012

Hospitals Sue Kaiser Over Emergency Care

Hospitals Sue Kaiser Over Emergency Care
Courthouse News Service
January 05, 2012

(CN)- Three Los Angeles-area hospitals say Kaiser owes them at least $94 million for refusing to fully cover emergency services for its

Kaiser was legally required to encourage its members to use the hospitals,
but in some cases pressured patients to transfer before their emergency
conditions were stable, the hospitals say in their lawsuit.

"Because Kaiser elected to accept the benefit of the discounts available
under the Multiplan Contracts, Kaiser was required by law and the Multiplan
Contracts to actively encourage Kaiser Members to use the services of
Hospitals, which Kaiser failed and refused to do," the complaint says.

"On the contrary, Kaiser has directed its members to avoid going to
Hospitals, refused to allow its members who received emergency
services at Hospitals to complete their episodes of treatment at
Hospitals, and pressured Hospitals' physicians, patients' families, and
even patients themselves, to transfer patients out of Hospitals for non-
medical reasons before the patients' emergency conditions are
stabilized," the complaint continues.

The hospitals are Centinela Hospital Medical Center, Encino Hospital Medical
Center and San Dimas Community Hospital. They sued for eleven different
causes of action related to Kaiser's alleged breach of contract.

The hospitals are represented by Marcia Augsburger of DLA Piper's
Sacramento off

Wednesday, January 4, 2012

Bad news: if your doctor won't stand up for you to your insurance company, you're in trouble

New Year, New Deals? Breaking Down Health Plan, Doctor Alliances
by Dan Diamond
California Healthline Contributing Editor
January 04, 2012

The Washington Post's annual In/Out List doesn't crossover much with "Road to Reform." (Possibly for good reason; the latest edition says "wonks" are officially out this year.)

But this column is nothing if not occasionally gimmicky. So here's a one-time, two-line trend-spotting bonus for 2012:

Out: Physicians and insurance companies as mortal enemies.
In: Health insurers and physicians ... as partners.

Regular California Healthline readers know that several big payer-doctor deals were struck in 2011, disproportionately in the Golden State. UnitedHealth's Optum division acquired a handful of physician groups, most notably 2,300-member Irvine-based Monarch HealthCare. Other health plans teamed up with independent practice associations to launch accountable care organizations.

Are these deals an industry blip or the beginning of a boom?

Check back at year-end. For now, it's too soon to know.

The high-profile deals are garnering plenty of buzz, however. And given the rumblings, many other doctor groups and plans are scrambling to evaluate whether similar partnerships make sense.

Changes Afoot for Everyone

It's old news that industry players are taking on new roles.

Hospitals in 2011 ramped up the pace of physician acquisition, seeking to integrate care and gain reimbursement. More employers added responsibilities for their employees' wellness, hoping to cut costs.

But the physician and insurer deals are particularly striking because of the sectors' oft-contentious relationship. If doctors and health insurance plans aren't fighting over reimbursement, they're battling over paperwork or even public scorecards. Outside of Kaiser Permanente, many efforts at vertically integrated systems with insurers running doctor groups have largely failed.

Even the CEO of Monarch HealthCare is surprised by his own partnership with UnitedHealth.

"Not 10 years ago I would not have thought of something like this," Bart Asner told Modern Healthcare's Rebecca Vesely. But when seeking a partner, "[UnitedHealth] showed up on our doorstep."

What's Driving the New Partnerships

UnitedHealth's pursuit of Monarch -- and by extension, other plans looking to partner with physicians -- isn't a shock.

Given ongoing industry efforts to coordinate care, lock up primary care providers and cut costs, physician groups have many suitors.

But Vesely concludes that the reasons for physicians to team up with health plans, rather than merge with other doctors' groups or join a hospital, are less cut-and-dry.

One driver may be that national plans have much more financial wherewithal to meet the sales price for large groups, as well as their strategic ambitions. UnitedHealth projected profits of more than $5 billion in 2011. The average hospital clears about one-1000th of that per year.

Alternately, IPAs and health plans may be pushed together as dance partners while hospitals bulk up. The growing "dominance" of hospital-led health systems means that physician groups are losing market power and the ability to recruit new doctors, health care consultant Penny Stroud told American Medical News late last year, making plan ownership more appealing.

California at the Epicenter

These drivers can all be seen in the unlikely Monarch-UnitedHealth deal, which Vesely neatly breaks down in Modern Healthcare.

What UnitedHealth gains: Access to physicians for its members and better positioning in a new market of integrated care delivery.
What Monarch gains: Deep pockets to invest in electronic health records, clinical programs and its growth strategy.

A good share of these new physician-payer deals are unfolding in California.

That's partly because the state's long history with managed care offers fertile ground for such partnerships. The entrenched HMOs, large multidisciplinary physician groups and concentrated market have set up an ideal laboratory for attempting this kind of coordination.

CMS' efforts to reward integrated care also are pushing California's strong IPAs to the forefront. No state had more organizations named as Pioneer ACOs last month than the Golden State's six, which includes Monarch.

Reaction and Reassessment

Modern Healthcare calls the new deals a "marriage of convenience" -- and there's certainly little romance and a lot of number-crunching to the proceedings.

Monarch also leaves behind a pair of jilted ex-partners.

Blue Shield of California will end its contract with Monarch in May, citing the IPA's new relationship with UnitedHealth. Anthem Blue Cross has pulled out of the physician group's planned ACO pilot.

That ACO effort may become an early litmus test for the UnitedHealth-Monarch relationship. Other payers are watching how smaller-scale initiatives, like regional insurers' efforts to acquire physician clinics, are unfolding.

If the partnerships prove successful, expect a flurry of activity across 2012 as more payers and physicians make sure they're dealt in -- and not left out.

Here's what else to watch as the new year begins.

In the States

CMS on Dec. 20, 2011, approved a new three-year, $26.75 billion Medicaid waiver for Massachusetts that allows its 2006 health insurance law to continue and provides hospitals with incentives to offer quality-focused and cost-efficient care. The waiver will expire in June 2014 (Baker, "Healthwatch," The Hill, 12/20/11). The waiver is vital to the state law's primary goal of ensuring that most residents have health insurance (Conaboy, "White Coat Notes," Boston Globe, 12/20/11).
Texas Democrats in a recent letter urged HHS Secretary Kathleen Sebelius to reject the state's request for a waiver from the medical-loss ratio regulations under the federal health reform law (Pecquet, "Healthwatch," The Hill, 12/22/11).
The advocacy group Progress VA recently filed a petition seeking to pressure state lawmakers to disassociate with the American Legislative Exchange Council, a conservative, pro-business group that authored the state's lawsuit against the federal health care reform law (Pecquet, "Healthwatch," The Hill, 12/28/11).

Challenges to Reform

After more than a year of vowing to "repeal and replace" the federal health reform law, Republicans still have not developed a plan to substitute for it. Republican presidential candidates have proposed new tax credits and allowing residents to purchase health insurance over state lines as an alternative to the reform law. However, some conservative experts said the ideas might not work as intended and even if they did, they would be only the beginning of a true replacement for the Affordable Care Act (Fahrenhold, Washington Post, 12/24/11). In related news, a Kaiser Family Foundation survey shows that among opponents of the current reform law, most want the ACA repealed, but not replaced (Kliff, "WonkBlog," Washington Post, 12/26/11).

Inside the Industry

Health insurers in 2012 will start paying the federal government a $1 fee for each insured person to go toward funding the Patient-Centered Outcomes Research Institute, which aims to determine which medications, medical procedures, tests and treatments work best. While the Treasury Department said the fee would not likely be collected this year, insurers will still owe the federal government the amount. The fee rises to $2 per insured person in 2013 and rises with inflation each year thereafter (Alonso-Zaldivar, AP/Washington Times, 12/27/11).
CMS on Tuesday announced the names of 73 health care experts who will participate in its Innovation Advisors Program, which will support individuals who seek to pilot and refine innovative payment and delivery models. After an orientation phase, advisers will work with the CMS Innovation Center -- established through the health reform law -- to pilot health care delivery models in their local communities and create partnerships that can foster and disseminate successful ideas. Each adviser's organization will receive up to $20,000 to support his or her activities during their participation (CMS release, 1/3). The Innovation Advisors Program will select up to 200 participants within its first year. The agency is expected to reopen applications in Spring 2012 and select remaining advisors by June (CMS fact sheet, 1/3)...