Wednesday, December 18, 2013

Los Angeles doctor runs down pedestrian, then gets him arrested

Author Steve Bevilacqua

Doctor causes harm, then lies about it to escape blame. Haven't I heard this before?

"...road rage lunatic who happened to be a doctor...The driver also pulled the gender card and claimed that her actions were justified because she was "very afraid" of me, despite the fact that she was in a car and I was on my ass in the street."

Book: A Layman's Handbook for Those Falsely Accused of Felonies
Man Run Over By Doctor Faced Lengthy Prison Sentence & Was Then Redeemed On National TV By Judge Judy
Ryan McCormick
Nov 19, 2013

One day Steve Bevilacqua was hit by a car crossing the street and almost went to prison for it. The driver who ran him down was charged with nothing, and Steve spent months in court fighting mandatory prison sentences for imaginary crimes. His book "KAFKA AT THE BEACH: A Layman's Handbook for Those Falsely Accused of Felonies" offers a firsthand account of being on the wrong end of America's justice system.

In KAFKA AT THE BEACH Steve Bevilacqua reveals:

How & why he was facing an 18-month mandatory prison sentence for assault, battery, and strong-armed robbery against the woman who ran him over with her car - crimes he did not commit.

How after he was run over, the driver cursed him, got out of her car, and then attempted to physically assault him.

A corrupt LAPD detective adds more false charges to Steve's existing ones.

In court, Steve meet the alcoholic city attorney who, chomping on pretzels and nursing a hangover, keeps confusing his case with others and becomes hellbent on sending Steve to prison for two years.

Redemption: TV's Judge Judy ruled in Steve's favor as he was suing the driver for cost incurred of her making deliberate false statements.

Santa Monica courthouse

"In the bizarre totalitarian odyssey that devoured a year of my life. I fought off a ferocious campaign to put me in prison, experienced the joys of bankruptcy, and struggled through an absurd maze of court-ordered therapy. However, I ultimately triumphed, achieving vindication on national television at the hands of the snarling modern-day Solomon known as Judge Judy." Steve Bevilacqua

Lights, Camera, Justice: If Only the Los Angeles Court System Were More Like Judge Judy
Steve Bevilacqua
Huff Post

I was run down by a car while crossing the street, and almost went to prison for it, thanks to our local court system. Granted, what happened to me was an extreme incident, propelled by a road rage lunatic who happened to be a doctor yet should never have been listened to by anyone. The driver also pulled the gender card and claimed that her actions were justified because she was "very afraid" of me, despite the fact that she was in a car and I was on my ass in the street. But what transpired for the next 8 months in our city's court system was a totalitarian nightmare straight out of Kafka's The Trial.

Hundreds of hours, thousands of dollars, and one surreal stint in court-ordered therapy later, I was ravaged but free. Then this legal deathmarch was to play itself out again, on television. Amazingly enough, in one extremely loud afternoon, my fiasco was set right by the modern-day Solomon known as Judge Judy. The actual court system spent months squeezing every technicality in their agonized efforts to send me to prison at the expense of the obvious truth. Judge Judy was direct and ferociously sensible...

During my months in court, I endured City Attorneys defending a driver's right to run down a pedestrian with her car, while refusing to charge her with anything. The driver even admitted giving the finger to the downed pedestrian as she fled the scene, yet she didn't even receive a traffic ticket...

I have yet to see an argument based on some pigshit technicality succeed on Judge Judy while, in real courts, it seems to happen as often as not...

Thursday, December 12, 2013

Kaiser Settles Dialysis Patient Transport Payment Squabble

After years of scandals, it's becoming pretty clear that Kaiser Permanente prefers dead kidney patients to live ones.

Kaiser Settles Transport Payment Squabble
Courthouse News Service
December 06, 2013

(CN) - A stipulation agreement has led to the dismissal of claims that Kaiser Foundation Health Plan failed to pay a company that transported patients to dialysis.

ProTransport-1 LLC, which claimed to transport Kaiser patients with end stage renal disease, had filed the lawsuit under the False Claims Act in 2012.

It said that Kaiser takes hundreds of millions of dollars from the U.S. government to care for seniors and patients with special needs, but that it pockets the money and has contractors like ProTransport bill the California Medical Assistance Program, known as Medi-Cal, for services rendered. Claiming that the Medicare Act allegedly requires Kaiser to pay the company in the first instance, ProTransport said the insurer's conduct amounted to fraud.

The complaint spared no words in blasting Kaiser as an "unscrupulous" entity whose "greed" compels it to steal from and defraud the government.

This past August, U.S. District Judge William Orrick refused to let ProTransport advance claims that the alleged billing was part of Kaiser's plan to kill its patients.

The complaint had stated: "Of course, Kaiser knows very well that without dialysis, these patients will die within weeks. That is part of Kaiser's plan. Dialysis is expensive, so is transporting patients to and from dialysis. By killing off these patients, Kaiser is left with a much more profitable patient base, resulting in billions in profits."

But Orrick had no patience for the "scandalous" allegation.

"References to Kaiser welcoming deaths, causing deaths or profiting from deaths - unsubstantiated by factual allegations - are immaterial and scandalous and should be stricken," he wrote.

[Maura Larkins' comment: In fact, Kaiser treatment guidelines include delaying diagnostic tests and ignoring test results. Kaiser seems to have a particular antipathy toward helping patients with kidney issues. At one point, Kaiser actually kept many of them off eligibility lists for transplants. These policies have resulted in quick deaths rather than long years of care, producing a huge amount of profit for Kaiser Permanente. Kaiser is interested in finding cheap treatments for common diseases, but it carefully picks and chooses when it comes to treating patients who have expensive problems.]

ProTransport eventually dropped seven of its 10 claims.

The parties agreed to mediation in late August and ProTransport's attorney, George Azadian, of The Matthews Law Group in San Marino, Calif., revealed this week that they entered a stipulation agreement to dismiss the case.

Azadian stressed stipulation agreements are generally confidential and that he could not reveal the conditions of ProTransport's agreement with Kaiser.

Attorneys for Kaiser did not return a request for comment.

Orrick dismissed the case Tuesday.

See court order from August 2013 in this case.

Kaiser Contractor Can't Allege Schadenfreude
Courthouse News Service
September 03, 2013

(CN) - A federal judge sidelined "scandalous" allegations that Kaiser welcomes the death of its patients, but left room for amended claims under the False Claims Act.

In a 2012 complaint, ProTransport-1 LLC claimed that Kaiser Foundation Health Plan failed to pay for its services transporting patients with end stage renal disease to dialysis treatment.

The Oakland-based Kaiser allegedly required ProTransport to seek reimbursement from the California Medical Assistance Program, Medi-Cal.

ProTansport said it complained about the conduct and that Kaiser then retaliated by refusing to pay for any transports made by ProTransport and excluding ProTransport from bidding to provide future services to Kaiser.

Since the Medicare Act allegedly requires Kaiser to pay ProTransport in the first instance, the insurer's conduct amounts to fraud, according to the complaint.

Kaiser moved to dismiss the complaint and to strike references that it called "immaterial and improper," leading ProTransport to voluntarily dismiss seven claims. It wanted to preserve only its claims under the federal False Claims Act and California laws against retaliation and unfair competition.

ProTransport drew the court's ire with its claims that Kaiser welcomed, caused and profited from patients' death.

In its complaint, ProTransport said: "Of course, Kaiser knows very well that without dialysis these patients will die within weeks. That is part of Kaiser's plan. Dialysis is expensive, so is transporting patients to and from dialysis. By killing off these patients, Kaiser is left with a much more profitable patient base, resulting in billions in profits."

U.S. District Judge William Orrick on Wednesday called the allegations "immaterial and scandalous."

"References to Kaiser welcoming deaths, causing deaths or profiting from deaths - unsubstantiated by factual allegations - are immaterial and scandalous and should be stricken," the ruling states.

Though Kaiser claimed that the False Claims Act claim was just a disguised attempt by ProTransport to obtain payment for its services, ProTransport insisted that it is trying to secure recovery for the United States.

Orrick agreed that "payments to ProTransport for services provided in the past are not at issue. Nor are payments that might be made in the future, as ProTransport was allegedly barred by Kaiser from bidding to provide future services."

He nevertheless dismissed the claim as inadequately pleaded.

"While the complaint cites to various statutes and regulations to argue that Kaiser's Medical Advantage plan is required to provide the same level of coverage required under Medicare and that medically necessary transports are covered by Medicare, the complaint does not identify which law, rule or regulation Kaiser undertook to comply with that 'is implicated in submitting a claim for payment,'" the 18-page ruling states. "Moreover, the complaint does not identify what 'claims' Kaiser submitted that were 'impliedly' false."

In dismissing a claim for retaliation under the California Health and Safety Code, Orrick noted that the law does not cover "a non-contracted transportation service provider."

ProTransport can allege retaliation unfairness under the unfair competition law, but it cannot claim a violation under the illegal prong of that law, according to the ruling.

Orrick reasoned that this claim is barred because it stems from the nixed allegations under the False Claims Act and Health and Safety Code.

Monday, December 2, 2013

Hospital Lab Tech Gets 39 Years for Infecting Patients With Hepatitis

NH Hospital Worker Gets 39 Years in Hepatitis Case
Associated Press
December 2, 2013 (AP)

A traveling medical technician who stole painkillers and infected dozens of patients in multiple states with hepatitis C through tainted syringes was sentenced Monday to 39 years in prison.

"I don't blame the families for hating me," David Kwiatkowski said after hearing about 20 statements from people he infected and their relatives. "I hate myself."

Kwiatkowski, 34, was a cardiac technologist in 18 hospitals in seven states before being hired at New Hampshire's Exeter Hospital in 2011. He had moved from job to job despite being fired at least four times over allegations of drug use and theft. Since his arrest last year, 46 people have been diagnosed with the same strain of hepatitis C he carries.

U.S. Attorney John Kacavas said the sentence "ensures that this serial infector no longer is in a position to do harm to innocent and vulnerable people."

Kwiatkowski admitted stealing painkillers and replacing them with saline-filled syringes tainted with his blood. He pleaded guilty in August to 16 federal drug charges.

Before he was sentenced, Kwiatkowski stood and faced his victims, saying he was very sorry and that his crimes were caused by an addiction to painkillers and alcohol. He told investigators he had been stealing drugs since at least 2003 and swapping syringes since at least 2008.

"There's no excuse for what I've done," he said. "I know the pain and suffering I have caused."

Prosecutors asked for a 40-year sentence. Judge Joseph Laplante said he cut the last year as a reminder that some people have the capacity for mercy and compassion.

"It's important for you to recognize and remember as you spend the next 39 years in prison to focus on the one year you didn't get and try to develop that capacity in yourself," Laplante said.

The victims spoke angrily and tearfully of the pain that Kwiatkowski had inflicted by giving them hepatitis C, a blood-borne virus that can cause liver disease and chronic health problems. Authorities say the disease played a role in one woman's death.

"You may only be facing drug charges, but make no mistake, you are a serial killer," said Kathleen Murray of Elmira, N.Y., whose mother was infected in Baltimore and was too ill to travel to New Hampshire for the sentencing.

Linda Ficken, 71, said she is haunted by the memory of Kwiatkowski standing at her hospital bedside in Kansas for more than an hour applying pressure to the catheter's entry site in her leg to control bleeding.

"On one hand, you were saving my life, and on the other hand, your acts are a death sentence for me," Ficken, of Andover, Kan., told him. "Do I thank you for what you did to help me? Do I despise you for what your actions did and will continue to do for the rest of my life? Or do I simply just feel sorry for you being the pathetic individual you are?"

Prosecutors said Kwiatkowski deserved 40 years for creating a "national public health crisis," putting a significant number of people at risk and caused substantial physical and emotional harm to a large number of victims.

Assistant U.S. Attorney John Farley called Kwiatkowski's actions "exceedingly callous" and "unbelievably cruel" and noted that Kwiatkowski could've stolen painkillers without exposing his patients to hepatitis C.

Defense lawyers argued that a 30-year sentence would better balance the seriousness of the crimes against Kwiatkowski's mental and emotional problems and his addiction to drugs and alcohol, which they said clouded his judgment.

Hospital Lab Tech Gets 39 Years for Infecting Patients With Hepatitis
Dec. 2, 2013
ABC News

A New Hampshire hospital lab technician who pleaded guilty in August to infecting at least 46 people with hepatitis C was sentenced today to 39 years in prison.

David Kwiatkowski, 34, a former lab technician at Exeter Hospital, admitted to stealing syringes of the anesthetic fentanyl intended for patients, injecting his own arm and then refilling those empty syringes with saline, according to the United States Attorney's Office in New Hampshire.

Read about Kwiatkowski's indictment.

Kwiatkowski pleaded guilty in August exchange for a lighter prison sentence, according to the plea agreement obtained by

Kwiatkowski tested positive for hepatitis C in June 2010, and passed the infection on to the hospital patients who were injected with his used, saline-filled syringes, according to the plea agreement. At least one patient he treated died in Kansas, and a coroner determined hepatitis C played a role in that death.

According to the plea agreement, Kwiatkowski had been fired or forced to quit for stealing and replacing syringes at least as far back 2008, but he would simply move on to the next hospital.

For example, the University of Pittsburgh Medical Center fired Kwiatkowski in May 2008 after an employee saw him take a fentanyl syringe from the operating room, and he was later found with three empty syringes on his person, according to the plea agreement.

Less than two weeks after that, Kwiatkowski got a job at the VA Medical Center in Baltimore. A patient who received care from him on May 27, 2008, at the Baltimore hospital later tested positive for the same strain of hepatitis C that Kwiatkowski has.

"If he knew that he was infected and he put those needles back on the shelf, that is the definition of evil," Dr. Richard Besser, ABC News' chief health and medical editor, told "Good Morning America" last summer. "Anyone who was in those hospitals when he was working there is potentially at risk. We're talking tens of thousands of people."

Hepatitis C is a liver disease that can last a few weeks or for the rest of a patient's life, according to the Centers for Disease Control and Prevention. The virus is spread through blood, and there is no vaccine. Symptoms include vomiting, abdominal pain and jaundice.

Read about the thousands of patients who needed to be tested for hepatitis C.

The Associated Press contributed to this report

Sunday, December 1, 2013

Kaiser, which has long claimed to practice preventive medicine, to raise rates 9.2 per cent, on reinstated policies

Apparently, Kaiser Permanente wasn't so interested in preventive medicine as it claimed. When required to provide preventive care, it raises rates.

Kaiser to raise rates on reinstated policies
The proposed 9.2% boost would cover higher costs associated with Obamacare
By Kristen Consillio
Star Advertizer
Nov 30, 2013

Kaiser Permanente Hawaii plans to boost rates by an average 9.2 percent for 11,000 individuals who were earlier notified their health insurance policies would be canceled at year's end because they did not meet the minimum requirements of the federal Affordable Care Act.

The state's largest health maintenance organization said it filed the proposed rate hike this week with the Insurance Division to cover higher projected medical expenses next year, costs associated with an aging population and taxes and fees related to the federal Affordable Care Act...

Saturday, November 30, 2013

Strikes at University of California hospitals statewide

Second strike in 6 months at UCLA Medical Center
Some UC Hospital Workers To Participate In 1-Day Strike Wednesday
CBS Local News
Nov 20, 2013

Hundreds of replacement workers will fill in for workers on strike. Dr. Tom Rosenthal, the chief medical officer ...


UCLA Chief Medical Officer Says Strike Is About Pensions, Not Patient Care
May 21, 2013
WESTWOOD ( — As a two-day strike began Tuesday at five of the biggest medical centers in the University of California system, medical workers say they are protesting low staffing levels and patient care, while officials contend that the strike is about pensions.

Thousands of union medical workers walked picket lines throughout the state, including at UC Irvine and the Westwood and Santa Monica campuses of UCLA Medical Center. The strike officially began at 4a.m. Tuesday morning.

The strike comes after nearly a year of stalled contract negotiations with UC administrators. Striking workers said they are protesting a range of issues, including patient care and current staffing levels.

“I am here for my patients, I’m really concerned about their safety,” said radiation therapist Jenny Takakura, who administers radiation to cancer patients.

“We’ve had three therapists that have left, and each time they’ve left they have not been replaced,” she said.

UCLA Chief Medical Officer Dr. Tom Rosenthal said there are no issues with patient care...

[Maura Larkins comment: In fact, there are issues with patient care at UCLA, but they are hushed up. UCLA achieves this by working with other medical centers. UCLA hushes up other hospitals' problems, thus making sure other hospitals aren't motivated to improve, and keeping UCLA's reputation among the best. In fact, the grading is on a curve, so laziness and greed are allowed free rein.]

"The union representing patient care and service employees at UCLA Medical Center, Santa Monica held a strike last Wednesday. Strikes took place at each of the University of California hospitals statewide on the same day."

UCLA-Santa Monica Hospital Workers Participate In Strike
Parimal M. Rohit
Santa Monica Mirror
Nov. 29, 2013

For the second time in almost six months, some workers from the Santa Monica-UCLA Medical Center participated in a one-day strike last week.

The Nov. 20 strike, coordinated by the American Federation of State, County, and Municipal Employees (AFSCME) Local 3299, took place at each of the University of California hospitals statewide, including the UCLA-run facilities both in Santa Monica and in Westwood.

All hospitals remained open, with elective surgeries directly impacted by the one-day walkout, according to news reports.

Similar to the two-day strike at Santa Monica-UCLA Medical Center and other University of California hospitals in May, elective surgeries scheduled for Nov. 20 were reportedly rescheduled.

Union officials and the workers participating in the strike made demands for increased staffing, pay raises, and updated pension plans.

According to a statement released by UCLA Health, 325 replacement workers filled in for those who joined the picket line. Some administration staff members were “redeployed” to substitute for a variety of workers ranging from housekeeping staff to respiratory therapists and nursing assistants, according to UCLA Health.

“We sincerely apologize for any inconvenience this strike may cause our patients and their families and friends,” UCLA Hospital System’s chief medical officer Dr. Tom Rosenthal said in a released statement prior to the strike. “However, every effort is being made to ensure that the hospitals and clinics that are part of the UCLA Health System remain open and continue to deliver the highest level of patient care.”

In all, 20 percent of elected surgeries scheduled during the one-day strike were rescheduled.

It was estimated the one-day strike would cost the entire UCLA Health System $2.5 million, including lost revenue and compensation for replacement workers.

AFSCME represents about 22,000 patient care and service employees. About 3,800 of those employees work for the UCLA Health System.

Despite the strike, UCLA Health said approximately 75 percent of AFSCME employees still showed up for work.

Also on the picket line alongside AFSCME Local 3299 members were representatives of other unions representing teaching assistants, lecturers, librarians, nurses, and healthcare and research employees at the University of California.

A similar strike took place May 21 and 22, when nearly 30,000 people participated in a two-day strike at University of California hospitals across the state. Members of the second labor union, University Professional and Technical Employees (UPTE), joined the two-day strike in solidarity.

At Santa Monica-UCLA Medical Center, more than 100 hospital employees lined Wilshire Boulevard and 16th Street during the two-day strike last May in an effort to increase staffing, update pension plans, and demand raises.

In September, AFSCME Local 3299 filed a complaint with the California Public Employment Relations Board (PERB) and alleged representatives on behalf of the Regents of the University of California engaged in intimidation practices against hospital workers during the two-day strike in May.

Specifically, the complaint charged the Regents of the University of California with threatening “adverse action against employees for participating in a strike,” listing three scenarios where a UC representative allegedly singled out an employee to be terminated or reprimanded if they took part in the two-day walkout in May.

The Santa Monica-UCLA Medical Center is a 267-bed facility located at 16th Street and Wilshire Boulevard.

Strike news update at UCLA
By UCLA Newsroom
November 20, 2013

An estimated 230 UCLA service employees represented by the American Federation of State, County and Municipal Employees (AFSCME) did not report to work on Wednesday. Among them are cooks and food service workers, landscaping crews and custodial staff. (Staff at UCLA Ronald Reagan Medical Center are separate.)

To minimize the impact on campus operations, supervisors prioritized tasks, performed some duties and utilized temporary replacement workers.

In dining facilities operated by Housing and Hospital Services, meals were simplified. Four facilities representing about 30 percent of the operation were closed for the day: Bruin Plate, Feast at Rieber, Hedrick Test Kitchen and Café 1919.

Custodial service in on-campus housing was prioritized around the cleaning of restrooms and removal of refuse from living areas.

Cleaning priorities for other campus buildings were focused on the highest-demand classrooms, restrooms, libraries. UCLA attempted to provide some minimum amount of service to all buildings on Wednesday.

Landscaping crews focused on trash removal and key campus areas.

Tuesday, November 26, 2013

Perks Ease Way in Health Plans for Lawmakers

Perks Ease Way in Health Plans for Lawmakers
New York Times
November 19, 2013

WASHINGTON — Members of Congress like to boast that they will have the same health care enrollment experience as constituents struggling with the balky federal website, because the law they wrote forced lawmakers to get coverage from the new insurance exchanges.

That is true. As long as their constituents have access to “in-person support sessions” like the ones being conducted at the Capitol and congressional office buildings by the local exchange and four major insurers. Or can log on to a special Blue Cross and Blue Shield website for members of Congress and use a special toll-free telephone number — a “dedicated congressional health insurance plan assistance line.”

And then there is the fact that lawmakers have a larger menu of “gold plan” insurance choices than most of their constituents have back home.

While millions of Americans have been left to fend for themselves and go through the frustrating experience of trying to navigate the federal exchange, members of Congress and their aides have all sorts of assistance to help them sort through their options and enroll.

Lawmakers and the employees who work in their “official offices” will receive coverage next year through the small-business marketplace of the local insurance exchange, known as D.C. Health Link, which has staff members close at hand for guidance.

“D.C. Health Link set up shop right here in Congress,” said Eleanor Holmes Norton, the delegate to the House from the nation’s capital.

Insurers routinely offer “member services” to enrollees. But on Capitol Hill, the phrase has special meaning, indicating concierge-type services for members of Congress.

If lawmakers have questions about Aetna plan benefits and provider networks, they can call a special phone number that provides “member services for members of Congress and staff.”

On the website run by the Obama administration for 36 states, it is notoriously difficult to see the prices, deductibles and other details of health plans.

It is much easier for members of Congress and their aides to see and compare their options on websites run by the Senate, the House and the local exchange.

Lawmakers can select from 112 options offered in the “gold tier” of the District of Columbia exchange, far more than are available to most of their constituents.

Aetna is offering eight plan options to members of Congress, and Blue Cross and Blue Shield is offering 16. Eight are available from Kaiser Permanente, and 80 are on sale from the UnitedHealth Group.

Lawmakers and their aides are not eligible for tax credit subsidies, but the government pays up to 75 percent of their premiums, contributing a maximum of $5,114 a year for individual coverage and $11,378 for family coverage. The government contribution is based on the same formula used for most other federal employees.

In debates leading up to passage of the Affordable Care Act, members of both parties suggested that all Americans should have coverage as good as what Congress had. President Obama said in 2009 that people should be able to buy insurance in a marketplace, or exchange, “the same way that federal employees do, same way that members of Congress do.”

For decades, members of Congress have received coverage through the Federal Employees Health Benefits Program. They generally like their coverage, but — like millions of Americans facing the loss of their policies next year — they cannot keep it.

In the past, if lawmakers did nothing in the open enrollment period, their coverage would automatically continue. This year, by contrast, they must affirmatively pick a plan. Their coverage under the federal employee program will end on Dec. 31. If they do not choose a plan via D.C. Health Link by Dec. 9, they will lose the government contribution to their premiums and could lose their right to retiree health benefits as well.

In addition, lawmakers who go without insurance next year may, like other Americans, be subject to tax penalties.

Some congressional aides, especially older employees who face higher premiums, are unhappy about the changes. But some who carefully compare their options on the exchange find that they can save money. Contribute to Our Reporting

Jacqueline A. Thomas, a 26-year-old legislative correspondent for Representative Debbie Wasserman Schultz, Democrat of Florida, said she was able to reduce her monthly premium to $60, from $120, by switching to a Kaiser plan from a Blue Cross and Blue Shield plan.

“I’ll be paying half as much for comparable coverage,” she said.

The congressional work force is full of young, healthy people like Ms. Thomas, precisely the type of customer insurers want to attract.

Congressional aides naturally have a few complaints. Some are confused by the large number of options. When they sign up for a plan online, they get no confirmation, so they are apprehensive. In addition, the website for the local exchange does not display the government contribution for members of Congress and their aides.

It shows, for example, that a couple with one child may pay $1,300 a month for a plan, when, in fact, their share of the premium is only $352; the government pays $948. Local exchange officials said their website had not been set up to calculate premium contributions using the formula required for lawmakers and other federal employees.

One part of the new insurance program is veiled in secrecy. Lawmakers may allow some or all of their employees to keep their current insurance by declaring that they do not work in the “official office” of a member of Congress. Members do not have to disclose such decisions, though some have voluntarily done so.

Thus, for example, a spokesman for Representative Darrell Issa, Republican of California, said the congressman had decided that all of his staff members, including those who work in his personal office, could stay in the Federal Employees Health Benefits Program and would not have to go into an exchange.

By making it easier to compare the costs and benefits of different health plans, the exchange could make it e

asier for insurers to compete with Blue Cross and Blue Shield, which has long dominated the market on Capitol Hill. For its part, Blue Cross and Blue Shield says it can best meet the needs of lawmakers and their aides because its national plans have a large network of providers, including nearly 90 percent of all doctors in the United States.

One perk is not in danger. Lawmakers can receive care from the attending physician to Congress, conveniently located in the Capitol, for an annual fee of $576. And they can get care at military hospitals.

Settlement in case of former Delaware pediatrician Earl Bradley, guilty of raping or abusing patients

The lawsuits contended Beebe could have prevented future attacks by Bradley if the staff had reported him to Delaware's medical disciplinary board, which licenses and disciplines physicians.

Del. child abuse victims notified of settlement payouts
Cris Barris
The (Wilmington, Del.) News Journal
November 25, 2013

WILMINGTON, Del. -- More than 1,400 victims of former Delaware pediatrician Earl B. Bradley have been sent letters detailing the amount of money they will receive from a $122 million settlement from a class-action lawsuit against Beebe Medical Center, the Medical Society of Delaware and a handful of doctors.

Bruce L. Hudson, a Wilmington, Del., attorney who represented about 150 former patients of the Lewes, Del., doctor who filmed himself raping about 100 children, including babies, and abused hundreds of others, said victims and their families will finally learn how much they will be compensated.

"It's been a long time coming," Hudson said of the case, which began with 17 victims suing in March 2010, a few months after Bradley was charged with multiple counts of rape. "They are finding out for the first time that they are going to be awarded money and how much."

Beebe, which once employed Bradley and cleared him of wrongdoing involving his medical treatment of young girls, was accused along with other defendants of knowing he posed a threat but failing to report him to authorities.

Besides the allegations that occurred while he was employed at Beebe in the mid-1990s, Bradley abused patients at an office in Milford, Del., and also at his Disney-themed BayBees Pediatrics from the late 1990s until his December 2009 arrest.

The settlement money, from which attorney fees are being deducted, is roughly $112 million from Beebe's insurance carriers, $7 million from Beebe and $3 million from the Medical Society and other defendants.

“It's been 14 years and it will be a good thing to able to close this chapter and not talk about it again. ” — Mother of victim, now 21

Hudson said 1,402 patients filed claims, and all will get some compensation. Victims, almost all of whom are still minors, have been divided into five different categories depending on the degree of abuse a mediator determines they suffered, and all victims in that category will get the same award.

The exact amounts of the awards for those in each category have not been made public. But a source familiar with the case said those in the highest category, entitled, "Clear and Convincing Evidence of Intercourse," will get roughly $400,000 to $500,000.

Those in the lowest category, "Child Was Likely Not Abused," will get a nominal fee of about $1,000 to $2,500. The source was not certain of the exact amounts for each category, but wanted to stress that no victim is getting anywhere near $1 million.

"Of the hundreds of victims, not all were injured equally," Hudson told The (Wilmington, Del.) News Journal last year when the parties were negotiating the settlement. "Some are horrendously scarred. Others have more minor cases. There won't be an equal distribution but there is going to be an equitable distribution."

Victims and their families have until the end of the year to appeal their classification and once those appeals are finalized, attorneys said they expect to distribute the money early in 2014.

The handful of adults who filed claims will receive the money, but awards for minors will be overseen by Chancery Court and guardians assigned to each child. Families wishing to make withdrawals for expenses for health, education or other reasons must get permission from the court, Hudson said.

Bradley, who was convicted in August 2011 of raping or abusing 86 patients whose attacks he videotaped, was sentenced to 14 life terms plus 164 years in prison.

He often used promises of toys or candy or ice cream to convince parents to let him take their children to others parts of his office, which were equipped with video cameras, where he would rape or molest babies and toddlers. The average age of his victims was 3, prosecutors said.

“It's been a long time coming. They are finding out for the first time that they are going to be awarded money and how much.” — Bruce L. Hudson, attorney representing about 150 former patients

The mother of one victim who was 7 when she said she watched Bradley inappropriately penetrate her during a 1999 exam and screamed at him said she has not yet received her award but is satisfied the case is finally being resolved.

The woman, whose daughter is 21, said she expects her daughter to be in one of the top two categories and receive a six-figure settlement.

"It's been 14 years and it will be a good thing to able to close this chapter and not talk about it again," said the woman, who is not being identified in keeping with The News Journal's policy not to identify victims of sexual abuse.

The money will help pay educational expenses for the daughter, who is in college and considering graduate school and perhaps a down payment on a home. "She won't have to start at the bottom like most kids do when they get out of school," the mother said.

In the lawsuits, patients accused Beebe of negligence and dereliction of duty. Hospital officials investigated Bradley in 1996 after a nurse reported inappropriate vaginal exams -- specifically that he catheterized many of the girls he examined.

The lawsuits contended Beebe could have prevented future attacks by Bradley if the staff had reported him to Delaware's medical disciplinary board, which licenses and disciplines physicians...

Wednesday, November 20, 2013

Why are American doctors paid so damn much?

Chart: Why are there so few doctors in the US?

Because the medical establishment has intentionally limited the number of doctors in this country--so doctors could make more money by serving more patients. Of course, this has resulted in poorer medical care.

"This is yet another reason not to shed too many tears for doctors. They've basically brought this on themselves. If the market were allowed to produce as many doctors as there's demand for, they'd already be getting paid less. Right now they're enjoying the substantial rents that come from squeezing their own supply, and they've fought like lemmings for decades to keep it that way." -- Kevin Drum

Why Are American Doctors Paid So Damn Much?
By Kevin Drum
Mother Jones
Nov. 20, 2013

Conservatives have picked up today on a Kaiser Health News piece reporting on doctor complaints that insurers plan to pay them less for Obamacare patients than for other patients:

Insurance officials acknowledge they have reduced rates in some plans, saying they are under enormous pressure to keep premiums affordable. They say physicians will make up for the lower pay by seeing more patients, since the plans tend to have smaller networks of doctors. But many primary care doctors say they barely have time to take care of the patients they have now.

Matt Yglesias is unsympathetic. He says American doctors are very well paid and should quit griping: "If we ever reach the point where American doctors have been squeezed so badly that they start fleeing north of the border to get higher pay in Canada, then we've squeezed too hard. Until that happens, forget about it."

That's pretty cold. But if you really want to know what's going on, take a gander at the chart... [above]. It's from the OECD, so it includes all of the world's relatively rich countries:

That's damn peculiar, isn't it? If Econ 101 is to be believed, higher pay should produce more doctors. And yet, even though the United States pays doctors far more than any other country on the globe, we're in the bottom third. We have more doctors per capita than poorish countries like Mexico and Poland, but far fewer than Belgium and Britain and Germany—all of which pay doctors considerably less than we do here. So what's going on?

As Matt says, the basic answer is that U.S. doctors operate as a cartel. They artificially limit their own ranks, which drives up their compensation.

What we really ought to be doing is working to further pressure the incomes of doctors through supply-side reforms. That means letting nurse-practitioners treat patients without kicking a slice upstairs to an M.D., letting more doctors immigrate to the United States, and it means opening more medical schools. Common sense says that since the population both grows and ages over time, there should be more people admitted to medical school today than were thirty years ago. But that's not the case. Instead we produce roughly the same number of new doctors, admissions standards have gotten tougher, and doctors have become scarcer.

This is yet another reason not to shed too many tears for doctors. They've basically brought this on themselves. If the market were allowed to produce as many doctors as there's demand for, they'd already be getting paid less. Right now they're enjoying the substantial rents that come from squeezing their own supply, and they've fought like lemmings for decades to keep it that way. You can hardly blame them for that, but there's no reason the rest of us should put up with it. It's time to fight back.

Thursday, November 14, 2013

Former Quebec doctor in custody on murder warrant in fatal stabbing of his kids

People don't want to believe that some doctors are evil. In fact, just because a doctor is a cardiologist doesn't mean he has a heart.

What was the first judge in this case thinking? How can a blackout that occurred AFTER the killings make a man not criminally responsible??? Is the judge really confused, or did he have some motivation to exonerate a rich, important person?

Former Quebec doctor in custody on murder warrant in fatal stabbing of his kids
By Andy Blatchford
The Canadian Press
November 13, 2013

Former Quebec doctor in custody on murder warrant in fatal stabbing of his kids

MONTREAL - A former Quebec doctor ordered to face a new trial in the fatal stabbings of his children is in custody again.

Police in Quebec say Guy Turcotte surrendered Wednesday just hours after Quebec's top court ordered a new trial in the case.

The Crown said it intended to charge Turcotte, once again, with two counts of first-degree murder.

Police said Turcotte was to be arraigned on Thursday.

Turcotte is the former cardiologist who was charged after his children were repeatedly stabbed one night in February 2009.

He was found not criminally responsible at his 2011 murder trial, when a jury accepted his argument he could not recall the events and had experienced blackouts.

The case made Turcotte a household name in Quebec and the verdict provoked a torrent of outrage.

His case was one of several infamous court decisions that helped spur new federal legislation aimed at making it harder for those found not criminally responsible to gain their freedom.

Turcotte's first trial heard that his young son and daughter were stabbed 46 times.

He was freed after 46 months of detention in a prison and, eventually, a mental institution.

"An arrest warrant was issued today for Guy Turcotte so that he would appear before the courts to answer two charges of premeditated murder," Crown spokesman Jean-Pascal Boucher told reporters.

Boucher said only a Superior Court judge would be authorized to grant any request by Turcotte to be released pending his new trial.

He did not know when the case will be heard, but he insisted prosecutors would work to hold the trial as soon as possible.

The Crown welcomed the decision earlier in the day by Quebec's Court of Appeal with "satisfaction," Boucher said.

The court ruled that legal errors were committed in Turcotte's original trial — including by the Superior Court justice who presided over it.

In the 2011 trial, the jury heard Turcotte drank washer fluid later in the evening of the killings in what he said was an attempt to end his own life. The Crown said a not-criminally-responsible verdict should be reserved only for cases of mental illness, not ones where a suicide attempt might have triggered an after-the-fact blackout.

The appeals court verdict sided with such critics.

"The burden of proof was on the accused to show that he was suffering from an incapacitating mental illness — distinct from the intoxication symptoms — and it was the jury's job to decide," said Wednesday's ruling.

"But the judge did not remind jurors of that distinction."

The appeals court conceded that the judge had a difficult role, and wasn't helped by the fact that the Crown argued its points in a way that was "sometimes confused."

That being said, according to the appeals court, "his instructions (to the jury) were deficient, which necessarily had a major impact on the verdict."

The defence argued during the appeal process that the Crown had plenty of time to raise objections before the jury went into deliberations.

Attorney Pierre Poupart told the court in September that both sides agreed to the parameters of the trial and the Crown knew what was at stake when the not-criminally-responsible defence was introduced.

Poupart argued that the jury came to a reasonable verdict and he stressed it was important for the appeals court to avoid being used as an unofficial 13th juror.

The mother of the two children, Turcotte's ex-wife, told the French-language CBC TV network that she welcomed the appeals court decision to order a new trial as a "necessary evil."

Isabelle Gaston, who has become an outspoken advocate for justice reform, had been bracing herself for the possibility of living through another trial, proceedings that would once again hear the gory details of the killings.

Gaston, who gave the interview before the Crown announced it had issued an arrest warrant for Turcotte, said Wednesday's court decision took her by surprise, at a time when she had finally found inner peace for the first time since the deaths of her young children.

Turcotte's case has already prompted reaction from Ottawa.

Earlier this year, the federal government tabled the Not Criminally Responsible Act. The bill, C-54, would give the court fresh powers to create a new high-risk category that would hold mentally ill offenders longer, without a formal review, and make it far more difficult for them to leave psychiatric facilities.

It would also keep victims' families informed about the status of such individuals and alert them when they are released.

Wednesday, November 13, 2013

Experts Reshape Treatment Guide for Cholesterol

Experts Reshape Treatment Guide for Cholesterol
New York Times
November 12, 2013

The nation’s leading heart organizations released new guidelines on Tuesday that will fundamentally reshape the use of cholesterol-lowering statin medicines, which are now prescribed for a quarter of Americans over 40. Patients on statins will no longer need to lower their cholesterol levels to specific numerical targets monitored by regular blood tests, as has been recommended for decades. Simply taking the right dose of a statin will be sufficient, the guidelines say.

The new approach divides people needing treatment into two broad risk categories. Those at high risk because, for example, they have diabetes or have had a heart attack should take a statin except in rare cases. People with extremely high levels of the harmful cholesterol known as LDL — 190 or higher — should also be prescribed statins. In the past, people in these categories would also have been told to get their LDL down to 70, something no longer required.

Everyone else should be considered for a statin if his or her risk of a heart attack or stroke in the next 10 years is at least 7.5 percent. Doctors are advised to use a new risk calculator that factors in blood pressure, age and total cholesterol levels, among other things.

“Now one in four Americans over 40 will be saying, ‘Should I be taking this anymore?' ” said Dr. Harlan M. Krumholz, a cardiologist and professor of medicine at Yale who was not on the guidelines committee...

Sunday, November 10, 2013

Utah doctor Martin MacNeill guilty of killing wife, leaving her in tub

How many doctors are secret sociopaths? Is it possible that lack of ethics is an advantage for doctors in administrative positions? How much did Martin MacNeill care about his patients?

Utah doctor Martin MacNeill guilty of killing wife, leaving her in tub
A jury only took hours to convict a Provo, Utah doctor and former Mormon Church official in connection with his wife's 2007 death. NBC's Mike Taibbi reports.
By Paul Foy
The Associated Press
Nov. 8, 2013

PROVO, Utah - A jury convicted a doctor of murder early Saturday in the death of his wife six years ago, bringing an end to a trial that became the nation's latest true-crime cable TV obsession with its tales of jailhouse snitches, forced plastic surgery, philandering and betrayal.

Martin MacNeill was accused of knocking out Michele MacNeill with drugs after cosmetic surgery, then leaving her to die in a tub like one that was displayed during the trial.

...MacNeill was medical director of the Utah State Development Center, a residential center for people with cognitive disorders, who moonlighted in other medical jobs, once consulting for a laser hair removal clinic. He had a law degree but wasn't known to practice law and has since surrendered his law and medical licenses.

The highlight of the three-week trial was a mistress who MacNeill introduced as a nanny within weeks of his wife's death. His older daughters quickly recognized Gypsy Willis as his secret lover and said her mother had been arguing with her husband over the affair.

The daughters went to work uncovering what they call their father's secret life. They abandoned him while dogging authorities to open a murder investigation. It wasn't until MacNeill's release in July 2012 from a federal prison in Texas on charges of fraud that Utah prosecutors moved to file charges of murder and obstruction of justice.

Willis also served a federal sentence for using the identity of one of MacNeill's adopted daughters to escape a debt-heavy history. That daughter had been sent back to Ukraine, supposedly only for a summer.

For a time, MacNeill's only family defender was his only son. Damian, a 24-year-old law student, committed suicide in January 2010, according to his sisters, who have said he was haunted by their mother's death.

Prosecutors said MacNeill might have gotten away with a perfect murder, but his erratic behavior the day of his wife's death and shortly afterward was "dripping with motive."

They reminded jurors about testimony that MacNeill stood in the bathroom yelling what prosecutors called phony grief, "Why did you do this? All because of a stupid surgery," as paramedics tried to revive his wife.

Family testimony suggested it was MacNeill who insisted his 50-year-old wife, a former local beauty queen in her California hometown, get the surgery. Prosecutors said he used it as an excuse to mix painkillers, Valium and sleeping pills for her supposed recovery.

"Make no mistake, the defendant's fingerprints, if you will, are all over Michele's death," Grunander said.

Prosecutors say MacNeill contrived a medical condition in the weeks leading up to his wife's death, telling many around him he was dying of cancer or multiple sclerosis to absolve him of any motive in the death. He also made use of a cane and could be seen limping at times.

Investigators who subpoenaed MacNeill's own medical records found he was in good health. And they discovered something else: MacNeill had been collecting veteran benefits for decades, saying in an application he had bipolar or anti-social disorders.

MacNeill's arrest warrant contains a former girlfriend's explosive allegation — not used at the trial — that MacNeill killed a brother and tried to kill his mother long ago.

Utah investigators confirmed the brother, Rufus Roy MacNeill, was found dead in a bathtub in New Jersey. They determined MacNeill was never charged and found no indication he was ever under investigation for it.

Lowering urates reduces kidney disease

Urate-Lowering Cuts Complications From Gout
Alice Goodman
November 08, 2013

SAN DIEGO — Patients with gout who remain on urate-lowering therapy are less likely to develop kidney damage leading to chronic kidney disease than untreated patients, according to results from a large study.

There was an economic incentive to conduct this study, said lead investigator Gerald Levy, MD, a rheumatologist from Kaiser Permanente Medical Group in Downey, California. "Gout has increased dramatically over the past 20 years. With it, associated costs — including office visits, urgent care, emergency department visits, and hospitalizations — have gone up to about $1 billion per year."

Kaiser Permanente of Southern California covers 3.6 million people. "This is a big pile of patients," Dr. Levy told reporters attending a news conference here at the American College of Rheumatology (ACR) 2013 Annual Meeting.

"A number of studies show that people with renal disease can develop hyperuricemia, and some will also develop gout. We wanted to see if reversing uricemia would have an impact on renal disease," he explained.

Investigators identified 111,992 patients with serum uric acid levels above 7 mg/dL in the Kaiser Permanente database.

Of these, 16,186 had been tested for serum uric acid levels and glomerular filtration rates at least once in the 6 months prior to study entry and at least once during the follow-up period.

All of these patients were followed for 36 months from the first documented high serum uric acid level. Patients were grouped into categories: never treated with urate-lowering therapy (n = 11,192), on urate-lowering therapy less than 80% of the time (n = 3902), and on urate-lowering therapy more than 80% of the time (n = 1092).

Almost all of the patients receiving treatment were also on allopurinol (98.3%).

"Achieving serum uric acid below 6 mg/dL — as per ACR guidelines — was protective and associated with a 37% improvement in renal outcomes," Dr. Levy said. "These patients represent the real world."

Table. Effect of Urate-Lowering Therapy on Serum Uric Acid

Treatment Hazard Ratio 95% Confidence Interval P Value
Less than 80% of the time 1.27 1.05–1.55 .01
More than 80% of the time 1.08 0.76–1.52 .68
Serum uric acid at goal 0.63 0.50–0.78 <.0001

Patients taking urate-lowering therapy more than 80% of the time were older, sicker, and more likely to have a diagnosis of gout. They also initiated therapy earlier than patients in the other 2 groups.

Worse outcome was associated with age, being female, hypertension, diabetes, congestive heart failure, previous hospitalizations, higher serum uric acid level at entry, and rheumatoid arthritis. There was no difference in the number of deaths in the 3 groups.

A limitation of this study is that it was observational and retrospective, and some data points were missing, noted Dr. Levy.

"The next group of studies will assess whether we can actually improve renal function by lowering serum urate levels. We need to demonstrate this and see how long it takes to show improvement," he said. "We found changes in 36 months, and we believe these changes take place early. If we can prevent progression to chronic kidney disease and dialysis, this would have tremendous cost savings."

News conference moderator, Christie Bartels, MD, from the University of Wisconsin in Madison, noted that "the data for urate-lowering therapy in hyperuricemia are compelling, but we still need a prospective randomized controlled trial. The study findings are a plug for ACR guidelines for gout therapy, because many patients do not get to goal," she said.

Rheumatologists need to give patients a reason to stay on medications, Dr. Bartels added, and the fact that urate-lowering therapy might prevent a gout attack and preserve the kidneys could be that reason. " This is especially important in gout patients who present with kidney problems initially," she noted.

Dr. Levy and Dr. Bartels have disclosed no relevant financial relationships.

ACR 2013 Annual Meeting: Abstract 857. Presented October 27, 2013.

Saturday, November 2, 2013

Do doctors help medical students by allowing them to practice on patients who are not considered important? CA issues fines against hospitals

The California Department of Public Health usually relies on self-reporting by doctors and hospitals, which happens rarely, I have observed.

Adverse Events Draw $775K in Fines at 9 CA Hospitals
Cheryl Clark
HealthLeaders Media
October 28, 2013

The most recent round of administrative penalties for hospital deficiencies constituting immediate jeopardy includes two patient falls resulting in deaths, a wrong-site surgery, and a retained surgical object.

>>>Slideshow: CA hospitals penalized for medical errors

At Sharp Memorial Hospital in San Diego, a surgical team took out a man's healthy left kidney instead of his cancerous right one because the hospital didn't make imaging studies viewable in the operating room and because the surgeon "forgot" how to log-in to see them before cutting into the patient.

At Antelope Valley Hospital in Lancaster, a patient returned to the emergency department three times before doctors realized they had forgotten to remove a 9 x 6-inch surgical device. According to state officials, the device was not included in the instrument count.

And at Community Regional Medical Center in Fresno, a surgeon left the OR after instructing a physician's assistant to finish the surgery, which the assistant was not trained to complete. The patient suffered major blood loss, cardiac arrest, and loss of oxygen to the brain. At the completion of a state investigation, the patient remained on life support.

These major adverse events in California hospitals are among 10 detailed in state documents accompanying $775,000 in administrative penalties to these hospitals, which state officials announced last week. The fines are assessed once state investigators determine that lapses in regulatory compliance caused or likely caused serious injury or death to a patient.

Since these penalties began in 2007, the state had issued 295 penalties to more than 155 of the state's 400 acute care facilities, according to a statement issued Thursday by the California Department of Public Health.

Including the latest round of penalties, the state has assessed $13.3 million in fines and has collected $10.1 million. Most of the $3.2 million not yet collected is under appeal by the hospitals that dispute the state's findings.

The funds are to be used for programs to improve healthcare safety.

In a phone interview Thursday, Debby Rogers, deputy director for the state Department of Public Health's Center for Healthcare Quality, refused to comment on any particular hospital's harmful event, but acknowledged that some incidents are more serious than others.

New regulations due to take effect by the end of the year, will allow the state to consider how much patient harm was done "and how widespread inside the hospital a particularly deficiency is."

"We feel strongly that publicizing these deficiencies helps hold these facilities accountable but it also empowers consumers to speak to their providers to put protections in place so something like this doesn't happen," Rogers said.

...At Community Regional Medical Center, Fresno, Fresno County, a patient admitted for ascending aortic aneurysm repair suffered massive blood loss, cardiac arrest, and loss of oxygen to the brain after the heart surgeon left the operating room prior to the closure of the patient's chest during open heart surgery.

The surgeon instead directed a physician's assistant "to be left in charge,
an individual not qualified to be left in charge of the cardiovascular surgery."

State investigators said the patient's loss of blood "required reopening the chest and manual massage of the heart." The patient was subsequently placed on life support.

Asked for an explanation, the surgeon said he had allowed the physician's assistant "to practice above her privilege card as 'she was preparing for an advanced quality practice exam and for that, she needed so many cases with opening and closing the chest and to cannulate the heart." The surgeon said he had always been there when she did this procedure "until this time."

State investigators wrote that the incident was reported through "an anonymous complaint," suggesting that the hospital may not have properly reported the incident as required by law.

The penalty is $75,000. This is the hospital's second administrative penalty...

10 California hospitals fined a total of $675,000
August 15, 2013
By Ari Bloomekatz
Los Angeles Times

Ten California hospitals, including Ronald Reagan UCLA Medical Center and Hollywood Presbyterian Medical Center, were slapped with fines Thursday totaling $675,000 because they failed to follow certain licensing requirements that "caused, or was likely to cause, serious injury or death to patients."

The fines ranged from $50,000 to $100,000, according to a news release from the California Department of Public Health.

St. Jude Medical Center in Fullerton, for example, was fined $100,000 for its fifth administrative penalty, according to the release.

"Based on observation, interview and record review, the hospital failed to follow their policy and procedure to have relevant images and results properly labeled and displayed prior to a patient's surgery," according to documents provided by the public health department. "This failure resulted in the removal of the wrong kidney."

The penalty against UCLA's hospital was for not following the proper surgical policies and procedures that led to "a patient having to undergo a second surgery to remove a retained foreign object." The hospital was fined $50,000...

Cheryl Clark seems to be working for a magazine, Health Leaders, that is genuinely interested in improving the practice of medicine

Cheryl Clark seems to be working for a magazine, Health Leaders, that is genuinely interested in improving the practice of medicine.

Cheryl Clark
Health Leaders
Nov. 2, 2013

Are you a journalist interested in how doctors practice medicine?

A position is opening up at the company I work for that I would seriously consider applying for. You'd write for hospital providers and physicians about issues in service lines, ethics, physician culture and behavior, relationships with hospital administrators, care appropriateness, medical training and certification, fraud, regulatory changes that are pivoting doctor pay toward outcomes measurement for the whole patient and away from the "pay per visit" and lots of other stuff.

You'd write 50 weekly columns a year and 1,700 (or so) -word articles for our monthly print magazine, HealthLeaders.

Saturday, October 26, 2013

Class Action lawsuit filed against Kaiser over mental health care wait times

Class Action lawsuit filed against Kaiser over mental health care wait times
By Rachel Raskin-Zrihen

A lawsuit served at Kaiser Permanente's Oakland headquarters Thursday alleges that Kaiser Foundation Health Plan facilities, including Vallejo's, routinely deny its members timely access to mental health services.

Kaiser officials call the suit a ploy in ongoing contract negotiations.

The Oakland-based law firm of Siegel LeWitter Malkani that works closely with the National Union of Healthcare Workers (NUHW) -- which represents Kaiser's mental health professionals and optical workers -- filed the suit earlier this month on behalf of "three named plaintiffs and thousands of other Kaiser members who have been harmed" by this alleged practice, attorney Jonathan Siegel said Thursday.

The union represents some 70 members at Kaiser Permanente Vallejo Medical Center. The firm has sued Kaiser before, Siegel said.

Kaiser officials called the suit the "NUHW's latest attempt to use inaccurate claims about our mental health care services to apply pressure in their protracted labor negotiations with Kaiser Permanente."

The union's actions do "nothing to further the negotiations that should be taking place at the table," they said.

The lawsuit alleges that Kaiser routinely violates state law by refusing to provide critical mental health services to its members within the time frame set by law.

"As a result, Kaiser members have been denied urgent services, forced to wait for long periods of time to receive needed services, discouraged from seeking services altogether, or compelled to incur out-of-pocket expenses for treatment outside of the Kaiser system," according to the suit.

The lead plaintiff, Point Richmond resident Susan Futterman, said her husband, Fred Paroutaud, killed himself after "desperate" requests for an urgent mental health appointment were delayed until his psychiatrist returned from vacation.

Los Angeles area plaintiff Megan Mortensen wound up seeking an urgent mental health appointment outside the system after Kaiser allegedly "refused" her request for a timely appointment after the loss of her brother. The third plaintiff, Acianita Lucero of Oakland, allegedly "made repeated requests for Kaiser to provide her with an urgent mental health appointment but Kaiser refused to see her within the 48 hours required by law," according to the suit.

The suit follows a report from earlier this year by the California Department of Managed Health Care which suggested Kaiser needed to reduce mental health appointment wait times. Kaiser was fined $ 4 million -- the second largest fine issued by the Department -- and issued a Cease and Desist Order to correct the problems, Siegel said.

Kaiser officials say the report did not fault Kaiser's mental health care quality or member's ability to obtain urgent or emergency mental health care.

"What was identified in the DMHC survey were some areas where our non-urgent appointment wait times and data tracking needed improvement," officials said. "We took the findings seriously, have submitted a corrective action plan to the DMHC, and have worked to correct the issues identified in the survey."

The class action lawsuit seeks compensatory and statutory damages for class members as well as an injunction requiring Kaiser to comply with the law, Siegel said.

"We're suing for Kaiser to clean up there act and provide mental health services to their clients that complies with the law," he said. "And we want damage compensation for the tens of thousands of Kaiser members who have been victimized by this."

Wednesday, October 23, 2013

Kaiser wants the public to know the truth about Kaiser quality. So do I.

Here it is straight from the horse's mouth: Kaiser wants the public to have more information about the quality of medical care provided by Kaiser.

I'm happy to help with this blog. Of course, I agree that Covered California should post ratings of insurers. I'd also like to suggest that the California exchange public Kaiser's treatment guidelines and those of other insurers.

The desire for openness is a big change in attitude for Kaiser, a company that usually wants to keep secrets.

Kaiser faults California’s exchange for lack of quality ratings
Chad Terhune
Los Angeles Times
Oct. 22, 2013

Healthcare giant Kaiser Permanente and two other insurers say California’s insurance exchange is withholding crucial information from consumers by not posting quality ratings alongside health plan rates.

The insurance companies said “there has never been a compelling reason to deny this information to consumers…. On this issue, Covered California has surrendered its ‘pace car’ status.”

Sharp Health Plan in San Diego and Western Health Advantage in Sacramento joined Kaiser in criticizing the state’s position in a letter sent Monday to Covered California, the state health exchange. Some consumer advocates have also urged the state to reconsider, saying any delay rewards lower-performing insurers.

Thousands of people have been shopping for coverage at the state’s website at since enrollment opened Oct. 1 under the Affordable Care Act, also known as Obamacare.

Covered California ignited this debate in August when it backed off earlier plans to include insurance company ratings in its online enrollment system.

This came as a surprise because state officials had touted the idea of consumers choosing coverage based on the overall value, combining price and quality measures.

At the time, the exchange said it reversed course because the latest state rankings examine performance from 2011, and they don’t reflect many of the new health plans and provider networks being offered for the first time under the federal healthcare law.

Major insurers such as Blue Shield of California and Health Net Inc. have offered narrower networks for some exchange policies to help lower premiums. In contrast, Kaiser and its full provider network are often more expensive.

State officials have discussed including ratings for some health plans, such as Kaiser, that are using their current network and labeling newer products as “not yet rated.” Covered California’s five-member board is expected to consider the matter at a regularly scheduled meeting Thursday.

In their letter, the three insurers also point out that other state-run exchanges, such as those in Colorado, Maryland and Oregon, are displaying quality data prominently on their websites. Colorado’s website even sorts a consumer’s options by quality, rather than just price.

“The leadership of these three state exchanges faced a choice, as California’s does now – and they chose to put consumers first,” the insurers said.

Tuesday, October 8, 2013

California health insurance exchange opens October 1, 2013

Shop at the new health exchange,

In San Diego County, six insurance companies will offer plans in the exchange: Sharp Health Plan, Kaiser Permanente, Anthem Blue Cross, Blue Shield, Molina Healthcare and Health Net.

State health exchange opens Tuesday
By Paul Sisson
Sept. 30, 2013

Outreach worker Ghaith Al Obaidi of the Borrego Community Health Foundation, chats about the new Covered California health insurance exchange with two unidentified men at the El Cajon Farmer's Market Thursday. The exchange has spent millions on outreach to spread the word about he new exchange at community events, health clinics and other locations across the state.

Despite the political battles being fought over the new federal health care law in Washington, Covered California, the state’s new insurance exchange, is set to open as scheduled on Tuesday.

Californians will be able to sign up for health insurance either on the new marketplace’s website or over the phone. Consumers also can apply for income-based tax credits designed to keep premium costs affordable for families.

Peter Lee, Covered California’s executive director, said Thursday that he is confident the new marketplace will be fully functional in two days, as promised.

“We’re good to go on Oct. 1,” Lee said.

Covered California is a key component of the Affordable Care Act, the sweeping federal health reform law approved in 2010. At the core of health reform, often called Obamacare, is the tenet that most Americans have health insurance by Jan. 1, 2014, or pay a small penalty. Enrollment in exchange plans must occur by Dec. 15 for coverage to start at the first of the year.

While the budget brinkmanship in Washington, D.C., continues, states and the federal government are moving forward with implementation of health exchanges required by the Affordable Care Act.

California is one of 17 states, and the District of Columbia, to create its own exchange while seven more are operating in partnership with the federal government. The federal government will also run exchanges in the remaining 27 states where leadership has generally opposed health reform.

A place to shop Covered California takes an Internet commerce approach to selling health insurance. Uninsured residents can go online, specify their locations, and see the plans offered in their area.

Much of what consumers will see is already visible on the website. Those who visit today can enter their family size, household income and ZIP code and receive a list of plans displayed side-by-side, with the premium they would pay and whether they would qualify for a tax credit from the federal government.

Lee said that, on Tuesday, a new button will appear on the website allowing visitors to enroll for policies effective Jan. 1. A consolidated physician directory will also be posted Tuesday, which will allow applicants to search for doctors across plans, Lee said.

“We think it’s a big deal to have a consolidated directory,” he said.

For people without computers, the exchange has created two call centers staffed by 442 operators who can guide applicants through the process.

In San Diego County, six insurance companies will offer plans in the exchange: Sharp Health Plan, Kaiser Permanente, Anthem Blue Cross, Blue Shield, Molina Healthcare and Health Net.

On the exchange, each carrier is required to clearly list the premiums and copays it charges, as well as the out-of-pocket maximums, for each policy sold.

Health reform also requires all exchange plans to cover the same 10 categories of “essential health benefits,” which range from emergency services to prescription drugs.

Because the health reform law is so strict about which benefits must be included, consumers will largely be deciding on premiums, coverage levels and doctor networks when making a decision about which plan to purchase.

Sunday, October 6, 2013

Patients who were harmed can join class action suit against Kaiser Permanente

Chance to participate:

On October 2, 2013 a class action suit was filed in Alameda County, California - alleging denial of timely and/or appropriate care.

Filed by Siegel, Lewitter, Malkani of Oakland, California
Contact Information: Latika Malkani
Phone Number: 510-452-5000
1939 Harrison Street, Suite 307
Oakland, California 94612

California Class Action Case RG13697775
Filing found here for your viewing:

[The complaint is interesting reading, discussing the investigation of the California Department of Managed Health Care (DMHC).]

This suit consists of all current and former Kaiser members who have either been denied access to mental health services, dissuaded from pursuing mental health services, provided with delayed access to mental health services and/or provided with inaccurate and confusing information from Kaiser regarding mental health services available to them from October 2, 2009 to the present.

(Violations of Business and Professions Code, Section 17200 et seq., Violations of the Unruh Civil Rights Act, Breach of the Covenant of Good Faith and Fair Dealing, Breach of Contract)

--Vickie Travis

Thursday, September 19, 2013

Is Kaiser Permanente in cahoots with the Department of Managed Care? NUHW Files Complaint Over Hiring of DMHC Attorney

DMHC Director (and former Kaiser counsel) Brent Barnhart

I've known for a long time that the Department of Managed Health Care (DMHC or DOMHC) was in cahoots with Kaiser. DMHC responded to a complaint I filed by saying that Kaiser fulfilled its duty by taking X-rays, and was not obligated to look at them!

DOMC's actions shouldn't come a surprise, since Brent Barnhart,the Director of DMHC, is a former senior counsel at Kaiser Foundation Health Plan.

Having one of his attorneys move to Kaiser will make everything work smoothly. Marcy Gallagher will have access to Director Barnhart, and knowledge of the inner workings of DMHC. Although I can hardly imagine that things could actually get easier for Kaiser. After all, DMHC has to disapprove of SOMETHING every once in a while, just to pretend it's regulatory agency, right?

NUHW Files Complaint Against Kaiser Over Hiring of DMHC Attorney
California Healthline
September 19, 2013

The National Union of Healthcare Workers has filed a complaint against Kaiser Permanente alleging that the company hired an attorney who previously worked at a state regulatory agency to impede an investigation into its practices, Payers & Providers reports.

NUHW filed the complaint with the California Fair Political Practices Commission (Shinkman, Payers & Providers, 9/19).

The move comes only a few weeks after NUHW filed a lawsuit to keep Kaiser from participating in California's health insurance exchange
. Exchange officials have selected Kaiser to offer individual and small business policies (California Healthline, 9/6).

The union -- which represents about 5,000 Kaiser workers -- has been pressuring the organization since it lost an election earlier this year to represent about 45,000 employees, according to Payers & Providers.

However, John Borsos -- a spokesperson for NUHW -- said the complaint filed this week is unrelated.

The complaint highlights Kaiser's hiring of Marcy Gallagher, a former attorney with the California Department of Managed Health Care's enforcement division.

Kaiser hired Gallagher in 2012 while she was investigating the organization's health plan for issues related to mental health services access. She now serves as a practice leader in Kaiser's regulatory response business unit.

In a statement, NUHW said that Gallagher "reportedly trained Kaiser officials on how to answer questions posed by DMHC's investigators."

The union argues that the move violates the state's Political Reform Act, which regulates "switching sides by state officials" and "influencing prospective employment."

Gallagher, DMHC and Kaiser declined to comment on the complaint (Payers & Providers, 9/19).

Wednesday, September 18, 2013

Tri-City Medical Center in the top 100? Really? Or did someone do some fixing? Also: Larry Anderson placed on administrative leave

Larry Anderson, well-traveled hospital CEO

Click HERE for new video from the San Diego Union Tribune on Tri-City Healthcare's Larry Anderson.

Becker's Hospital Review, which came up with its own ratings, is a good pal of Larry Anderson. They paid him, for some reason, to visit Chicago and stay at a $569 per night hotel. But Anderson didn't report the gift until SDUT asked him about it.

US News and World Report wasn't quite as impressed with Larry Anderson and his hospital. In fact, Tri-City got a ranking of 1.1 out of a possible 100 in cardiology, with survival "much worse than expected. Tri-City's overall score was 20.5 out of 100.

Quite a discrepancy, wouldn't you say?

On the other hand, Scripps La Jolla received a ranking of 63.4 in cardiology with survival "much better than expected."

I've started preparing a comparison of local hospitals HERE.

Becker's also ranked Larry Anderson himself in the top 100 of hospital administrators, but it now reports that Mr. Anderson has been placed on leave:

Tri-City Medical Center CEO Larry Anderson Put on Administrative Leave
Written by Anuja Vaidya
Becker's Hospital Review
September 06, 2013

Larry Anderson, CEO of Tri-City Medical Center in Oceanside, Calif., has been put on paid administrative leave, according to a U-T San Diego report.

Hospital board chair Larry Schallock told U-T San Diego that Mr. Anderson was put on leave in relation to a personal matter and declined to comment further. He also said that Casey Fatch, the hospital's COO, will serve as interim CEO.

Monday, September 16, 2013

Routine use of antibiotics in livestock is killing at least 23,000 people a year

Also, use of antibiotics for viral infections in people is another practice that achieves absolutely nothing except to create drug-resistant bacteria.

Report links antibiotics at farms to human deaths
Carolyn Lochhead
San Francisco Chronicle
September 16, 2013

In this undated photo provided by the Centers for Disease Control and Prevention is one form of CRE bacteria, sometimes called nightmare bacteria. CRE bacteria is blamed for 600 deaths each year, and can withstand treatment from virtually every type of antibiotic. (AP Photo/Centers for Disease Control and Prevention) Photo: Associated Press

Washington -- The Centers for Disease Control on Monday confirmed a link between routine use of antibiotics in livestock and growing bacterial resistance that is killing at least 23,000 people a year.

The report is the first by the government to estimate how many people die annually of infections that no longer respond to antibiotics because of overuse in people and animals.

CDC Director Thomas Frieden called for urgent steps to scale back and monitor use, or risk reverting to an era when common bacterial infections of the urinary tract, bloodstream, respiratory system and skin routinely killed and maimed.

"We will soon be in a post-antibiotic era if we're not careful," Frieden said. "For some patients and some microbes, we are already there."

The discovery of penicillin in 1928 transformed medicine. But because bacteria rapidly evolve to resist the drugs, and resistance is encouraged with each use, antibiotics are a limited resource.

Along with the annual fatalities, the report estimated at least 2 million antibiotic-resistant infections occur each year. Frieden said these are "minimal estimates" because they count only microbes that are resistant to multiple antibiotics and include only hospital infections, omitting cases from dialysis centers, nursing homes and other medical settings.

At least 70 percent of all antibiotics in the United States are used to speed growth of farm animals or to prevent diseases among animals raised in feedlots. Routine low doses administered to large numbers of animals provide ideal conditions for microbes to develop resistance.

"Widespread use of antibiotics in agriculture has resulted in increased resistance in infections in humans," Frieden said...

Wednesday, September 11, 2013

Almost One-In-Five Intensive Care Patients May Be Getting Futile Treatment

Are 20% of intensive care dollars being wasted? Why do doctors send older patients to intensive care when nothing can be done for them? Would this money be better used on children whose improved health would benefit society? And wouldn't dying patients prefer the peace and comfort of hospice?
Almost One-In-Five Intensive Care Patients May Be Getting Futile Treatment
Howard Gleckman, Contributor

Almost one of every five patients in the intensive care units of a major teaching hospital got treatment that was futile or “probably” futile, according to the doctors who treated them. And older patients—especially those admitted from a nursing facility—were most likely to get care that does nothing to improve their quality of life, or even keep them alive for more than a brief period of time.

Those are the conclusions of a new study by a group of UCLA researchers published this week in JAMA’s Journal of Internal Medicine. This study will be extremely controversial but should not be ignored. It raises important questions about the hospital care given to very sick older patients.

First, take a look at the results, which were based on a survey of 36 critical care physicians who treated 1136 patients over a three-month period in 2011-2012. Of those ICU patients, 11 percent got care that their doctors deemed futile and another 9 percent received treatment that physicians considered probably futile. These patients accounted for about 7 percent of all ICU patient days. The cost of futile treatment in one hospital’s ICUs: about $2.6 million over 3 months.

While the researchers found that older patients and those admitted from long-term care facilities were more likely to get futile care, they saw no differences by race or ethnicity.

Importantly, the survey was done at the time treatment was being administered and not in retrospect. Thus, the ICU docs couldn’t know for sure what the outcomes would be for these patients.

However, the researchers were able to follow the patients and what they learned seemed to confirm the judgments of the physicians. Almost no patients had what most of us would consider a good quality of life six months after their ICU stay.

More than two-thirds (68 percent) of those receiving what was deemed futile treatment died before they could be discharged. An additional 16 percent died within 6 months. Of the remaining 16 percent, nearly all required ventilators, feeding tubes, or other life-sustaining devices to keep them alive.

Still, as the authors readily admit, some of this gets pretty murky. The researchers did not attempt to set objective criteria for futile or probably futile treatment. Instead, they relied on the subjective judgment of the surveyed doctors. And, of course, if ICUs provide less aggressive treatment to those patients whom doctors think are likely to die, their predictions could become self-fulfilling.

Did the patients or their families think the care was futile? The study did not say. If the intensive care docs thought treatment was a waste of time (or worse), why did they do it? The authors didn’t ask and can only speculate: Lack of agreement on whether to treat by the family or among the care team, or failure to address end-of-life issues (always a good guess). And of course money can’t be ruled out.

This study leaves a lot of important unanswered questions. But it highlights an issue we often prefer to ignore: Hospitals do over-treat patients who are near death. The only real question is how often. Many of these patients needlessly suffer even as the health system spends a significant amount of money that could be put to better use.

We know that at least some of this can be alleviated by good hospice or palliative care. This study helps us understand the consequences of failing to provide that care.

Thursday, August 22, 2013

Dead' man's recovery shows why prolonged CPR works

When you run out of air to breathe, apparently the best thing to do is to dip your head in ice cubes and hope that someone comes along and revives you.

Dead' man's recovery shows why prolonged CPR works
Barbara Mantel
NBC News
August 22, 2013

An Ohio man’s recovery several minutes after doctors declared him dead shows how murky the decision can be about when to stop resuscitation efforts.

While Anthony Yahle, 37, may not have been dead for 45 minutes, as was widely reported, his remarkable bounce back without suffering brain damage or other ill effects stunned doctors at Kettering Medical Center in Kettering, Ohio.

Yahle, a diesel mechanic from West Carrollton, Ohio, “coded” -- a term meaning emergency -- on the afternoon of Aug. 5, after arriving in the hospital that morning in cardiac arrest. A team of doctors rushed to his hospital bedside and used chest compressions, a bag connected to a breathing tube and medications to force blood and oxygen through his body. After 45 minutes, they gave up and declared him dead.

“He was truly flatlined at the end of that code. He had no electrical motion, no respiration, and no heart beat, and no blood pressure,” says Jayne Testa, director of cardiovascular services at Kettering.

But five to seven minutes later, the team noticed a trace of electrical activity on his heart monitor and resumed their efforts to resuscitate him. Yahle is now home recovering, according to Testa.

While Yahle "was not dead for 45 minutes," the Kettering doctors “have never seen somebody come back after the code was ended and especially after so many minutes,” says Testa.

Michael Sayre, a professor of emergency medicine at the University of Washington in Seattle and a spokesperson for the American Heart Association, says he has seen and heard of similar cases. It’s unusual but not unique, he says. Sayre doesn’t know what happened in Yahle's case, but sometimes during resuscitation air gets trapped and pressure builds in the lungs, preventing blood from flowing into the heart.

“So, I have seen once or twice where we would disconnect the bag from the breathing tube and push on the chest to let the air out, and then the patient would get a pulse and have a blood pressure because they were able to get blood back to the heart,” says Sayre.

In any case, Sayre says more hospitals may want to follow Kettering’s lead and sustain resuscitation efforts for longer than the typical 20 to 25 minutes. A 2012 nationwide study of hospitals showed that “in the hospitals where they worked for longer, they got more people back, who ended up surviving and going home,” says Sayre.

Technology can help a team decide when to stop. Most hospitals now have the ability to measure the amount of carbon dioxide in the air coming out of the patient. Carbon dioxide is a byproduct of living cells. No carbon dioxide would add to the evidence that the patient is dead. Kettering Medical Center does not continuously measure carbon dioxide levels during resuscitation.

“However, you can be faked out,” says Sayre. And sometimes even with fairly normal carbon dioxide levels, a team will stop resuscitation because “we still cannot get the heart to beat on its own,” says Sayre.

But in Yahle’s case, doctors were finally able to get his heart to beat spontaneously.

“This team did a really good job. They were able to keep his brain alive, and that’s why he survived,” says Sayre.

The Kettering doctors cooled Yahle’s body, and that may have preserved his brain function. “People can definitely go seven minutes without blood flow if the brain is cooled. That is something that is well known,” says Sayre. For example, during brain surgery, doctors cool the body and stop blood flow for even longer periods of time.

There are theories about why that works. “But no one really knows the answer to that,” says Sayre.

Wednesday, August 21, 2013

Thousands of doctors practicing despite errors, misconduct

These doctors are just the tip of the iceberg. Plenty of doctors who have negligently killed patients never even lose hospital privileges. The medical establishment has a remarkably high tolerance for mistakes. It's like a fraternity where they stand by each other.

Who's to blame? Largely, it's hospital peer review committees.

"Hospitals' peer review committees — the internal panels of medical staff that oversee and review complaints against clinical personnel — often do a poor job.

"'Much of the bottleneck in the physician discipline system is in the peer review committees,' says Philip Levitt, a retired Florida neurosurgeon who served as chief of the medical staff at two hospitals. 'Virtually everything of serious consequence gets balled up or blocked in the peer review process.'

T"he peer review system is rife with bias, Levitt says, noting that doctors on the committees often are inclined to protect their colleagues — or go after those who cross or compete with them. That dynamic invites lawsuits from doctors who say they've been treated unfairly, so hospitals generally are wary of suspending even those doctors who commit egregious misconduct, Levitt adds. Instead, they tend to look for a deal to persuade the doctor to leave quietly with no misconduct finding."

Thousands of doctors practicing despite errors, misconduct
Peter Eisler and Barbara Hansen
August 20, 2013

Source: USA TODAY analysis of the U.S. government's National Practitioner Data Bank public use file; data include reports filed from Sept. 1, 1990-March 31, 2013
Frank Pompa, Alex Gonzalez and Barbara Hansen

A USA TODAY investigation shows that thousands of doctors who have been banned by hospitals or other medical facilities aren't punished by the state medical boards that license doctors.

Story Highlights

Hundreds of doctors with multiple malpractice claims still have their licenses
Weak oversight by state medical boards has been a concern for decades
Cracking down on bad doctors can take years; meantime, they keep treating patients

Dr. Greggory Phillips was a familiar figure when he appeared before the Texas Medical Board in 2011 on charges that he'd wrongly prescribed the painkillers that killed Jennifer Chaney.

The family practitioner already had faced an array of sanctions for mismanaging medications — and for abusing drugs himself. Over a decade, board members had fined him thousands of dollars, restricted his prescription powers, and placed his medical license on probation with special monitoring of his practice.

They also let him keep practicing medicine.

In 2008, a woman in Phillips' care had died from a toxic mix of pain and psychiatric medications he had prescribed. Eleven months later, Chaney died.

Yet it took four more years of investigations and negotiations before the board finally barred Phillips from seeing patients, citing medication errors in those cases and "multiple" others.

"If the board had moved faster, my daughter would still be alive," says Chaney's mother, Bette King, 72. "They knew this doctor had all these problems … (and) they did nothing to stop him."

Mari Robinson, executive director of the Texas medical board, says the Phillips case took "longer than normal, but we followed what we needed to do (by law)." Phillips could not be reached for comment.

Despite years of criticism, the nation's state medical boards continue to allow thousands of physicians to keep practicing medicine after findings of serious misconduct that puts patients at risk, a USA TODAY investigation shows. Many of the doctors have been barred by hospitals or other medical facilities; hundreds have paid millions of dollars to resolve malpractice claims. Yet their medical licenses — and their ability to inflict harm — remain intact.

The problem isn't universal. Some state boards have responded to complaints and become more transparent and aggressive in policing bad doctors.

But state and federal records still paint a grim picture of a physician oversight system that often is slow to act, quick to excuse problems, and struggling to manage workloads in an era of tight state budgets.

USA TODAY reviewed records from multiple sources, including the public file of the National Practitioner Data Bank, a federal repository set up to help medical boards track physicians' license records, malpractice payments, and disciplinary actions imposed by hospitals, HMOs and other institutions that manage doctors. By law, reports must be filed with the Data Bank when any of the nation's 878,000 licensed doctors face "adverse actions" — and the reports are intended to be monitored closely by medical boards.

The research shows:

Doctors disciplined or banned by hospitals often keep clean licenses: From 2001 to 2011, nearly 6,000 doctors had their clinical privileges restricted or taken away by hospitals and other medical institutions for misconduct involving patient care. But 52% — more than 3,000 doctors — never were fined or hit with a license restriction, suspension or revocation by a state medical board.

Even the most severe misconduct goes unpunished: Nearly 250 of the doctors sanctioned by health care institutions were cited as an "immediate threat to health and safety," yet their licenses still were not restricted or taken away. About 900 were cited for substandard care, negligence, incompetence or malpractice — and kept practicing with no licensure action.

Doctors with the worst malpractice records keep treating patients: Among the nearly 100,000 doctors who made payments to resolve malpractice claims from 2001 to 2011, roughly 800 were responsible for 10% of all the dollars paid and their total payouts averaged about $5.2 million per doctor. Yet fewer than one in five faced any sort of licensure action by their state medical boards.

The numbers raise red flags for several experts in physician oversight, including David Swankin, head of the Citizen Advocacy Center, which works to make state medical boards more effective.

"Medical boards are not like health departments that go out to see if a restaurant is clean; they're totally reactive, because they rely on these mandatory reports — and they're supposed to act on them," Swankin says.

Not all doctors who lose clinical privileges or pay multiple malpractice claims necessarily should lose their licenses. In some malpractice cases, doctors or insurers may settle without admitting fault to avoid potentially expensive litigation.

Read the entire series: When Health Care Makes You Sick

When a disciplinary report shows up, "boards have a range of options," says Lisa Robin, chief advocacy officer at the Federation of State Medical Boards. "It could be a letter requiring that you get training, or it could be monitoring of (a doctor's) practices or, where there is patient harm, it could be something as severe as a (license) suspension or revocation."

The state boards "take their responsibility very seriously in taking actions, being thoughtful, and … protecting the public," Robin adds.


Concerns about medical boards' accountability date to 1986. That year, the Inspector General at the U.S. Department of Health and Human Services reported that the boards, typically comprising doctors and a lesser number of laypeople, imposed "strikingly few disciplinary actions" for physician misconduct. Several follow-up studies suggested improvements, but the reviews ended in the early 1990s after the Justice Department declared that an Inspector General would have no jurisdiction over state boards that are not funded or regulated by the federal government.

Some lawmakers disagree.

Early last year, Grassley and a bipartisan group of senators asked the Inspector General for a "comprehensive evaluation" of state medical boards' performance. But there's been no report, and the IG's 2013 work plan doesn't mention it.

Concerns about the boards resurfaced in a 2011 study by consumer watchdog group Public Citizen. The report was based on the same National Practitioner Data Bank records reviewed by USA TODAY, and it reached a similar conclusion: Medical boards "are not properly acting on (clinical privilege) reports after becoming aware of them."

Yet little has changed since Public Citizen's assessment — and the congressional concern it created. Physicians with records of serious misconduct are clearly still practicing:

• A California doctor made eight payments totaling about $2.1 million to resolve malpractice claims from 1991 to 2008. The doctor's hospital privileges were restricted twice in 2007, once for misconduct that posed an "immediate threat to health or safety" of patients, and surrendered for good in 2008. No action has been taken against the doctor's license.

• A Florida doctor made six payments totaling about $1.1 million to resolve malpractice claims from 1993 to 2009. In 2004, the doctor was hit with an emergency suspension of hospital privileges for misconduct that posed an "immediate threat to health or safety" of patients, and a managed care organization took similar action in 2005. He also kept a clean license.

• A Louisiana doctor made nine payments totaling about $2.7 million to resolve malpractice claims from 1992 to 2007, and at least five payments involved patient deaths, including two young girls. In 2008, a managed care organization indefinitely denied the doctor's clinical privileges. But the doctor's license remains unrestricted.

The doctors' names are a mystery: identifying information is stripped from the Data Bank's public file. Full access is limited to medical boards, hospitals and other institutions that are supposed to weed out bad doctors.

But the tracking system doesn't always work.


By the time Greggory Phillips began treating Jennifer Chaney in 2008, the Texas Medical Board had lifted the license restrictions stemming from his previous mismanagement of prescription drugs.

But more trouble was brewing. First, Phillips was caught pre-signing prescription pads, allowing a nurse to put "dangerous drugs" in the hands of patients who visited when Phillips was off and got no "adequate examination," board records show. Then, Debra Horn, a mother of two, died from an overdose of drugs Phillips prescribed.

Jennifer Chaney died after being prescribed a high dose of oxycodone, a narcotic more potent than morphine, plus an added prescription for hydrocodone — one the state medical board later described as "not medically indicated."

None of that was public when Chaney's family started seeing Phillips. He treated Jennifer for poor thyroid function and residual pain from neck surgeries after a car accident, board records show. He prescribed a mix of thyroid medicine, muscle relaxants, anti-anxiety drugs and painkillers.

Just before Christmas, Chaney fell in a parking lot and reinjured her neck. Phillips prescribed a high dose of oxycodone, a narcotic more potent than morphine, board records show. He also gave her an added prescription for hydrocodone, a painkiller already included in Chaney's ongoing drug regimen — and one the board later described as "not medically indicated."

A week later, Chaney complained one evening about feeling loopy from her medications. As her husband, three sons and mother headed to bed, she stayed up to watch TV.

She was still on the couch when her mother got up in the morning.

"I noticed Jennifer was on her back, and she never slept on her back, always her side," Bette King recalls. "I didn't think anything of it; I went into the kitchen, and then it dawned on me and I went back into the den and tried to wake her up. And I couldn't."

King yelled for Jennifer's husband, who tried CPR while King called 911.

The paramedics never found a pulse. The autopsy findings: "Cause of death: mixed drug intoxication. … Manner of death: Accident."

As weeks passed, Phillips' problems mounted.v The medical board, which fined him $1,000 in the prescription pad case, sent notice that it was preparing to charge him with substandard care and prescription drug violations in the death of Horn a year earlier. The Horn and Chaney families each filed malpractice claims, and Phillips' clinical privileges were terminated at North Hills Hospital in suburban Fort Worth.

Yet Phillips' license remained unrestricted. He would keep seeing patients — and mismanaging their medication.

"There's no question that Dr. Phillips had (practice) violations; the question is what authority does the board have to act once those are found out," says Robinson of the medical board. "We want something to happen and we want it as quickly as it can happen. But the system isn't always set up for that. ... That can be frustrating."


There's nothing tougher for state medical boards than competency and malpractice cases.

"There are laws, there is due process and there is confidentiality, and all those things make it difficult for state medical boards to do what they do," says Jon Thomas, a surgeon and past president of the Minnesota Board of Medical Practice.

"You have to get all the facts and you have to follow the law. And it's complicated," adds Thomas, an officer with the Federation of State Medical Boards. If a board is pursuing disciplinary action, "a good lawyer representing that physician will know all the appropriate levers to push, and they push every one of them. That can take a lot of time."

The cases typically require exhaustive investigation and legal preparation — a challenge for many boards wrestling with tight budgets and short staffs.

As the recession crimped state finances, "we saw a lot of boards having to do more with less," says Robin, the federation's advocacy officer.

With disparate funding and statutory authority, various boards use vastly different approaches to keep tabs on physicians.

Florida spends more than $200,000 a year to have the National Practitioner Data Bank continuously monitor the licenses of all of its physicians, so the board is alerted automatically when malpractice cases, hospital privilege actions and other problems are reported.

In Texas, doctors must submit a Data Bank report on themselves when they first apply for a license (the Data Bank allows doctors to query their own license records), but additional checks are not required for license renewals and are done only if a need arises, such as in complaint investigations. In California, there are no set requirements for checking the Data Bank and it is not queried routinely; officials check doctors' records on an as-needed basis.

"The states vary all over the lot in terms of the resources the boards have, whether they have good leadership, and whether they are regularly querying the (Data Bank)," says Sidney Wolfe, a physician and founder of Public Citizen's Health Research Group. "Some states do a pretty good job; a lot of them don't."

And it's getting more difficult to assess their work.

The Federation of State Medical Boards has stopped issuing medical board enforcement data that Public Citizen uses to rank the rate at which different boards discipline physicians. Wolfe says the federation wants to kill the state-by-state rankings because many boards detest them. The federation says it's figuring out how to release data that don't foster unfair comparisons between states that may have different disciplinary rules.


Phillips wasn't giving up his medical license without a fight.

In May 2009, nearly 14 months after Debra Horn's death, the medical board invited Phillips to a settlement conference. He accepted the board's invitation but didn't accept its deal. That left the board one option: to take the case to a judge.

In Texas, as in many states, medical board complaints are adjudicated in administrative hearings, with their own judges and all the trappings of a full-blown trial. The board spent five months gathering evidence and lining up expert testimony before filing formal charges: negligence, non-therapeutic prescribing, failure to meet standards of care and poor medical decision-making.

Then, just before the hearing, Phillips opted for mediation — and the case stalled again.

"If a physician takes advantage of every hearing, every right to trial, it takes much, much longer" to resolve a case, says Robinson, the medical board's director. "He took advantage of every hearing, everything."

At about the same time, Bette King filed her own, handwritten complaint with the board in the death of Jennifer Chaney. Another investigation was launched.

King wanted the board to exercise its power to issue an emergency suspension of Phillips' license. But the burden of proof is extremely high, and the board's staff concluded that his misconduct did not meet the two-pronged legal test for an emergency order: The conduct has to be egregious and the doctor has to be an imminent, present danger. In 2012, just a dozen cases met that standard.

By the time King filed her complaint, nearly a year had passed since her daughter's death.

"We rely on complaints to (start) investigations, and people often wait a year or more to file," Robinson says. "But to show that a physician is a present danger, it's got to be now. If we are monitoring a physician for drug use and he fails a drug test, we have recent proof that he's a danger today. If we're talking about (actions) many, many months ago, it has to go through the regular disciplinary process."

So the Phillips case dragged on. It would be another year before his mediation, and it wouldn't end there. Throughout the process, anyone who checked Phillips' status on the board's website saw a license in full force — no mention of the malpractice cases or the terminated clinical privileges, even though all of that should have been listed.

"I kept waiting for them to stop him," King says, "and they just let him keep going."


By law, hospitals and other health care institutions — from managed care operations to public health centers — must report to the National Practitioner Data Bank when doctors lose clinical privileges in connection with investigations of substandard care or misconduct. Insurers also must report any payments in a malpractice case, regardless of whether guilt was admitted.

In Texas and many other jurisdictions, state laws require similar reporting directly to medical boards, often by doctors themselves.

The reports are critically important — hospitals and other health care organizations typically are the first to know when a bad doctor is putting patients at risk. Yet they are notorious for skirting reporting requirements when they part ways with a physician.

At the start of 2011, more than 20 years after the National Practitioner Data Bank was set up, 47% of hospitals had never reported restricting or revoking a doctor's clinical privileges, according to data from the U.S. Health Resources and Services Administration, which runs the Data Bank. Public Citizen reported in 2009 that some hospitals mask cases by giving bad doctors a chance to resign before investigations are launched, or by restricting privileges for just under the 30-day threshold that requires reporting.

But the group also found another grave problem: Hospitals' peer review committees — the internal panels of medical staff that oversee and review complaints against clinical personnel — often do a poor job.

"Much of the bottleneck in the physician discipline system is in the peer review committees," says Philip Levitt, a retired Florida neurosurgeon who served as chief of the medical staff at two hospitals. "Virtually everything of serious consequence gets balled up or blocked in the peer review process."

The peer review system is rife with bias, Levitt says, noting that doctors on the committees often are inclined to protect their colleagues — or go after those who cross or compete with them. That dynamic invites lawsuits from doctors who say they've been treated unfairly, so hospitals generally are wary of suspending even those doctors who commit egregious misconduct, Levitt adds. Instead, they tend to look for a deal to persuade the doctor to leave quietly with no misconduct finding.

In the rare cases where a hospital does sanction a doctor, he says, "it usually means there were really bad things going on."

In the Phillips case, North Hills Hospital says the doctor's clinical privileges ended in May 2009, not long after Phillips was fined for signing blank prescriptions. The hospital would not comment on why it parted ways with him or whether it had anything to do with misconduct that would have required reporting to the medical board.

Whatever the circumstances, the board never heard about it. "There is no public information available to suggest that a report was ever made," says the board's Robinson.

To this day, Phillips' official profile on the board's website shows that he still has clinical privileges at North Hills. And the malpractice cases, which Phillips paid to settle years ago and was required to report to the board, are unmentioned.


Based on a negotiated agreement with Phillips, the Texas Medical Board finally ordered sanctions in the Horn and Chaney cases in April 2011 — more than two years after Chaney's death; three years after Horn's.

The order charged that he "prescribed excessive quantities of high dosages of controlled substances and dangerous drugs … and engaged in a pattern of non-therapeutic prescribing of narcotics that were being used by (both) patients at the time of their deaths by drug intoxication."

Phillips agreed to pay for independent monitoring of his practice for two years, including quarterly reviews of at least 30 patients' records. He also had to take classes to correct deficient practices, including instruction in treating chronic pain and medical record-keeping, and pay a $3,000 penalty.v But Phillips still was allowed to see patients and continue writing prescriptions.

Repeated efforts to reach Phillips for comment, including requests through his lawyers, were unsuccessful. But Jon Porter, one of his attorneys, said the sanctions were significant. He noted that paying to have a practice monitored and enrolling in the required courses can cost well over $10,000.

Still, the Phillips case wasn't over. In 2012, the board found that he'd continued to mishandle prescriptions while the Horn and Chaney investigations unfolded.

Phillips engaged in "non-therapeutic prescribing" for one patient and lacked documentation to justify the drugs he administered, the board found. In another case, he again prescribed drugs without documenting their necessity — and provided early refills without justification.

This time, the board struck a tougher deal: Phillips had to give up his certification to prescribe controlled substances.

Within a year, he'd stopped practicing, board records show. But last February, the board issued another, final order that forever bars Phillips from treating patients.

Phillips "prescribed controlled substances to multiple patients without documented medical justification … (and) without adequate evaluation and need," the order charged, noting that he also violated rules by prescribing drugs to family and close friends.

Again, though, the sanctions were negotiated and stopped short of revoking Phillips' license, allowing him to work in "administrative medicine" with no patient contact, such as evaluating insurance claims.

The deal reflects the tough choices the board often faces, Robinson says.

"This doctor was willing to agree to something that's very strict — he'll never be in contact with patients again — or we'd have to go to trial, which could take years, and he'd be practicing for all that time," she says.