Sunday, April 27, 2014

More scrutiny for UCLA's School of Medicine In the wake of a whistleblower lawsuit

The $10-million, mid-trial settlement this week between the UC system and the former head of orthopedic surgery Dr. Robert Pedowitz at UCLA has prompted a consumer group to seek an independent investigation by California Atty. Gen. Kamala Harris or Gov. Jerry Brown.

Dr. Robert Pedowitz

See also: UC OKs paying surgeon $10 million in whistleblower-retaliation case UC OKs paying surgeon $10 million in whistleblower-retaliation case

More scrutiny for UCLA's School of Medicine

A. Eugene Washington, MD, MSc
Dean, David Geffen School of Medicine UCLA
Vice Chancellor, UCLA Health Sciences

[Maura Larkins' comment: Dr. Washington's conflicts of interest
are particularly dangerous since he is in charge of inculcating
a culture of greed and disregard for many patients at one of the
country's premier medical schools.]

Photo by Elisabeth Fall

More scrutiny for UCLA's School of Medicine
...[A] new study raises a red flag about universities' financial ties to industry.
By Chad Terhune
Los Angeles Times
April 25, 2014

In the wake of a $10-million payout to a whistleblower, UCLA's School of Medicine is drawing more scrutiny over its financial ties to industry and the possibility that they compromised patient care.

A new study in this month's Journal of the American Medical Assn. raised a red flag generally about u niversity officials such as Eugene Washington, the dean of UCLA's medical school who also serves on the board of healthcare giant Johnson & Johnson.

The world's biggest medical-products maker paid Washington more than $260,000 in cash and stock last year as a company director.

"There are real risks here," said Walid Gellad, assistant professor of medicine at the University of Pittsburgh and co-author of the JAMA study. "Are the policies in place enough to govern these potential conflicts among the leadership of academic medical centers?"

Meanwhile, the $10-million, mid-trial settlement this week between the UC system and the former head of orthopedic surgery at UCLA has prompted a consumer group to seek an independent investigation by California Atty. Gen. Kamala Harris or Gov. Jerry Brown.

In a 2012 lawsuit against UCLA and UC regents, Dr. Robert Pedowitz, 54, alleged that they failed to act on his complaints about widespread conflicts of interest among the medical school faculty and that they later retaliated against him for raising those concerns as a whistleblower.

As department chairman, Pedowitz testified, he became concerned about colleagues who had financial ties to medical-device makers or other companies that could unduly influence their care of patients or research into new treatments.

University officials said they thoroughly investigated Pedowitz's claims and found no wrongdoing and no evidence that patient care was jeopardized. UC regents said they agreed to settle to avoid the time and expense of further litigation.

In a statement Friday, UCLA said Washington's work as a J&J director did not compromise the "integrity of operations" at UCLA, and that his outside activities complied with university policies.

"Dr. Washington has absolutely no oversight of purchasing decisions involving devices or supplies," UCLA said. "Dr. Washington's board service provides significant benefits to both UCLA and the wider field of medicine. As the only physician on the board, Dr. Washington provides a frontline perspective on patient care and the needs of doctors."

Such ties between healthcare companies and physicians have drawn increasing attention from government officials and patient advocates. Taking effect this fall is a provision of the federal Affordable Care Act that requires public disclosure of financial relationships between medical companies and doctors.

Consumer Watchdog, a Santa Monica advocacy group that asked for the state investigation, said the troubling nature of Pedowitz's allegations and the large settlement amount warrant further inquiry.

"It is apparent that UCLA's policies governing financial conflicts are either inadequate or unenforced," Jamie Court, president of Consumer Watchdog, wrote in a letter sent to state officials Thursday.

"Are the same failures happening at other hospitals in the UC system? Your independent investigation is needed to ensure that patients are not harmed," he wrote.

Consumer Watchdog said the investigation also should determine whether oversight of UC's relationships with medical companies should be taken away from university administrators such as Washington and given instead to an independent monitor.

A spokesman for the attorney general said Harris is reviewing the consumer group's request. He would not comment further.

Responding to the letter, UCLA said its "current policies and procedures represent best practices that have continued to become stronger and more rigorous in recent years.... We are always looking for ways to improve further."

In an interview last week, the chief compliance officer of the UCLA Health System said Washington encouraged her to investigate Pedowitz's claims fully. Washington testified at Pedowitz's trial, and his handling of the surgeon's allegations came up regularly.

The compliance officer, Marti Arvin, said industry relationships are unavoidable at universities and that patients benefit from that collaboration.

"Having those relationships with industry is a component of allowing us to meet our mission of leading-edge patient care, education and research," Arvin said.

Washington was reelected to J&J's board Thursday. The company said "we see absolutely no financial conflict of interest with Dr. Washington serving on our board."

He wasn't alone among academic medical center officials who served on the boards of major pharmaceutical companies in 2012, the year examined by researchers.

For instance, the dean of USC's School of Pharmacy, R. Pete Vanderveen, serves on the board of Mylan Inc., a major drugmaker based in Canonsburg, Pa.

A spokeswoman for USC said the university has policies in place to manage potential conflicts. But USC said that's "a moot point in this case because the School of Pharmacy has no business relationship with Mylan."

The study found that 41 board members at large drug companies held leadership posts at academic medical centers. Their average compensation for serving as a company director was $312,564.

"These leaders are wearing two very important hats at the same time," said Gellad, the study's co-author. "There are a lot of benefits from academic medical centers having interactions with industry, but we can't ignore the risks."

Friday, April 25, 2014

Kaiser Permanente San Diego CFO Lynnette Seid personally created a hoax CD of X-ray images

UPDATE APRIL 30, 2014:

CLICK HERE for a transcript of my bizarre adventures in the Kaiser Radiology Records Department in April 2014.

UPDATE APRIL 28, 2014:

I went to Kaiser today to get medical records that I thought might be interesting. I was not disappointed. I discovered that the last doctor I visited at Kaiser wrote this:

When asked how I could help her, [Maura Larkins] states that "really I just wanted to meet you because when I asked Dr. X for a transfer to another doctor, [Dr. X] said anyone except Dr. Z". Patient felt that...I would be honest and maybe go against what my supervisor's might want me to do. Discussed with the patient that this wasn't the case at all...

Is that cute or what? I don't think the doctor who wrote this meant to be quite so truthful about her inability to give an honest second opinion.


Lynette Seid, CFO and chief administrator
for San Diego Kaiser medical records

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

Lynette Seid is not only Kaiser Permanente San Diego Area's Chief Financial Officer. She's also the chief administrator in charge of medical records.

I asked for a CD of my digital VUCG X-ray images to take to an out-of-plan doctor, and in response, Lynette Seid created a CD with the following X-ray images.

It pretends to be a set of 13 images, but it actually consists of only 7 distinct images.

Four of the images appear twice, labeled with different numbers, but with the exact same time stamp:
#1 is identical to #4;
#2 is identical to #3,
#7 is identical to #9, and
#8 is identical #12.

One image appears three times!
(#10, #11 and #13 are identical).

Some of the copies have labels added (“scout,” “voiding,” and “post-void”), but the time stamped on each image identifies it precisely.

Image #6 is of particular interest; it is the one new image that Kaiser was willing to produce for an out-of-plan doctor.

See the 13 images--or rather, 7 images--here.

Nice work, Lynette! A particularly nice touch was the high-tech CD Lynetter sent me. When I open up the bizarre images, which were first printed out and THEN were scanned, and therefore provide extremely little information, I get a rapid slide show just by moving my cursor across the images. Lynette is pretending that someone might actually be looking at these images for the purpose of discerning information about the X-rays. In fact, the images only provide information about how desperate Kaiser is to conceal information about the X-rays it took.

Lynette Seid (Mulan7224) on Twitter

Life is truly wonderful when you love what you do and you have someone very special to share your life!

[Maura Larkins response: Seriously, Lynette? You love doing stuff like this? Do you get paid a lot to do it? And get lots of appreciation from other extremely highly-paid executives? Perhaps you are blocking out the reality that life isn't truly wonderful when one's medical records are concealed by happy folks like you.]

See all posts re Lynette Seid.


I believe the answer is YES. Kaiser Permanente, for example, has guidelines that require doctors to sacrifice many patients for the purpose of increasing profits. At the same time, Kaiser collects information that helps it improve the treatment of patients who can be treated without sacrificing profits.

"IN MAY 1988, Dr Robert Pozos, a hypothermia researcher at the University of Minnesota, said he planned to analyse and republish a contemporary 56-page report on infamous Dachau experiments in which almost 300 male prisoners were placed in vats of freezing water.

"The men were observed, measured and analysed, sometimes to the point of death; sometimes they were warmed up again with boiling water. Pozos said he could learn how to treat people with hypothermia better if he understood what went on at Dachau."

This sparked off a passionate debate about the ethics of knowledge. Conferences, seminars, letters and speeches the world over have struggled with what to do about Pozos's approach. Some argued the knowledge should never be used because it was gained immorally. Others asked: "Should we not look at the pyramids because they were built using slave labour?" Eventually, Pozos used the knowledge, but the debate continues. The New England Journal of Medicine, for example, does not publish citations of the work.

Contacts and staff : Information : Nature Reviews Urology‎
Chief Editor: Annette Fenner, MBBS, PhD Acting Chief Editor: Sarah Payton, PhD Senior Editor: Melanie ... PhD; David Killock, PhD Cross-Journal Associate Editors: Tim Geach, PhD Editorial Support Manager: ... Clinical Practice & Research.

Thursday, April 24, 2014

Obama administration set to take over Oregon's broken health insurance exchange

Obama administration set to take over Oregon's broken health insurance exchange

Washington Post
April 24, 2014

The Obama administration is poised to take over Oregon's broken health insurance exchange, according to officials familiar with the decision, who say that it reflects federal officials' conclusion that several state-run marketplaces may be too dysfunctional to fix.

The collapse of Oregon’s insurance marketplace comes as federal health officials are also focusing intensely on faltering exchanges in two other states, including Maryland.

Finally, a Kaiser doctor, oncologist Jennifer Lycette, speaks out about doctors forced to allow harm to patients to increase profits

"...Lycette’s suit states, however, that she became troubled by new Kaiser policies after [executive Jeffrey] Weisz was brought in.

"Among her other complaints, her suit alleges she expressed concerns about a ban on referring patients to non-Kaiser specialists or clinical trials outside of Kaiser -- even though doing so would be in the best interests of patients.

"She resigned in April 2013, because of her oath to do no harm and her belief that Kaiser policies were "making patients suffer," her suit states.

"According to the website for Oregon Health & Science University, Lycette relocated to Astoria and is now working at OHSU's Cancer Care Center at Columbia Memorial Hospital..."

Former oncologist claims Kaiser Permanente pushed profits over patient care, files $7 million lawsuit
Aimee Green
Oregon Live
April 23, 2014

A former oncologist at Kaiser Permanente is suing the health care company for $7 million, claiming she had no choice but to quit her job after complaining the organization was maximizing profits to the detriment of cancer patients.

Dr. Jennifer Lycette claims quality of care took a nosedive when Northwest Permanente Medical Group hired Jeffrey Weisz as its president and executive medical director in 2011. Weisz had previously worked for Kaiser in Southern California.

"During Dr. Weisz's tenure (in California), he established a reputation as a ruthless administrator who found ways to minimize payrolls by shrinking staff while patient loads skyrocketed, often leaving the remaining staff members trying to cope with impossible patient demands which ultimately harmed Kaiser's patients," reads Lycette's lawsuit, filed Tuesday in Multnomah County Circuit Court.

In an email statement, Kaiser spokesman Michael Foley said, "The care needs of our members, patients, and customers come first. Allegations that claim otherwise are not supported by fact.

"We're reviewing the lawsuit that was filed," he addied, "and will address its inaccurate allegations through the judicial process."

The suit was filed by Lake Oswego attorney Roderick Boutin.

Lycette's suits claims that during a November 2012 meeting, Weisz ordered Kaiser's Portland oncologists to cram an initial consultation and bone-marrow biopsy of patients -- something that should take two to 2.5 hours and be done over two visits -- into one, 60-minute visit. Lycette’s suit states pain medication that must be taken orally takes 30 to 60 minutes to kick in, so a 60-minute visit would leave patients rushed and in pain.

Lycette "openly and respectfully voiced her concerns," and Weisz responded by shouting at Lycette in "a very angry and threatening manner," her suit states.

Lycette's suit also claims she complained in April 2012 to the then-chief of medical oncology, Nagendra Tirumali, about understaffing. She says patients were struggling to schedule appointments and some chemotherapy patients were only seeing their regular oncologist every two or three months.

Tirumali responded that Lycette was being “emotional,” according to a copy of an email attached to the suit. Lycette’s suit characterizes Tirumali's response as a "veiled attack" on her gender. Her suit states she later asked Tirumali whether he would have accused a man of being "emotional" over the issue of understaffing.

Lycette, 40, worked for Kaiser for about seven years -- from 2006 until she resigned in spring 2013 -- at its Interstate medical offices in North Portland and Sunnyside Medical Center in Clackamas, according to her suit. Her suit states she had the highest patient satisfaction rating, 89 percent, in her department.

Lycette’s suit alleges that before taking the job in 2006, she asked several Kaiser doctors if they thought they could care for patients without feeling that financial overhead compromised care. They assured her they could, the suit states.

Lycette’s suit states, however, that she became troubled by new Kaiser policies after Weisz was brought in.

Among her other complaints, her suit alleges she expressed concerns about a ban on referring patients to non-Kaiser specialists or clinical trials outside of Kaiser -- even though doing so would be in the best interests of patients.

She resigned in April 2013, because of her oath to do no harm and her belief that Kaiser policies were "making patients suffer," her suit states.

According to the website for Oregon Health & Science University, Lycette relocated to Astoria and is now working at OHSU's Cancer Care Center at Columbia Memorial Hospital.

Lycette is seeking $2 million in economic damages and $5 million in non-economic damages.

Wednesday, April 23, 2014

UCLA pays $10 million for retaliation against surgeon who exposed industry payments that may have compromised patient care

This case is just a small part of a larger problem at UCLA. Another small part of the problem, the behavior of Eugene Washington, dean of the David Geffen Medical School at UCLA, is discussed HERE.


"Shortly before Pedowitz joined UCLA in 2009, the university was already facing criticism from Congress over the failure of a top spine surgeon to report nearly $460,000 in payments he received from Medtronic and other medical companies while researching their products' use in patients, government records show.

"Dr. Jeffrey Wang, who left for USC Spine Center last fall, stepped down as head of UCLA's spine program in 2009 after U.S. Sen. Charles Grassley (R-Iowa) publicized his lapse in disclosure as part of a larger investigation into medical conflicts of interest.

"Several patients are now suing Wang and UCLA in state court for negligence, fraud and malpractice in connection with surgeries involving Medtronic's controversial Infuse bone graft."

"...'What good are all the policies if they protect the wrongdoers and fail to protect the actual whistleblower?' Quigley said. 'The university wanted to cover it all up.'"

UCLA surgeon Dr. Robert Pedowitz, who said the medical school allowed doctors to take industry payments that may have compromised patient care

UC OKs paying surgeon $10 million in whistleblower-retaliation case
The settlement ends a case brought by the ex-head of UCLA's orthopedic surgery department
By Chad Terhune
Los Angeles Times
April 22, 2014

University of California regents agreed to pay $10 million to the former chairman of UCLA's orthopedic surgery department, who had alleged that the well-known medical school allowed doctors to take industry payments that may have compromised patient care.

The settlement reached Tuesday in Los Angeles County Superior Court came just before closing arguments were due to begin in a whistleblower-retaliation case brought by Dr. Robert Pedowitz, 54, a surgeon who was recruited to UCLA in 2009 to run the orthopedic surgery department.

In 2012, the surgeon sued UCLA, the UC regents, fellow surgeons and senior university officials, alleging they failed to act on his complaints about widespread conflicts of interest and later retaliated against him for speaking up.

UCLA denied Pedowitz's allegations, and officials said they found no wrongdoing by faculty and no evidence that patient care was jeopardized. But the UC system paid him anyway, saying it wanted to avoid the "substantial expense and inconvenience" of further litigation.

[Maura Larkins: Closing arguments were about to begin in the case. UCLA had already invested "substantial expense and inconvenience", and would have incurred very little expense or inconvenience if it had simply allowed the closing arguments to go forward. The reason it settled was that it realized that the weight of the evidence showed that UCLA did indeed jeopardize patient safety and certainly violated conflict of interest standards and the legal rights of the whistle-blower.]

As department chairman, Pedowitz testified, he became concerned about colleagues who had financial ties to medical-device makers or other companies that could unduly influence their care of patients or taint important medical research.

He also alleged that UCLA looked the other way because the university stood to benefit financially from the success of medical products or drugs developed by its doctors.

One of the orthopedic surgeons that Pedowitz complained about testified at trial about receiving $250,000 in consulting fees in 2008 from device maker Medtronic. In memos to university officials, Pedowitz raised concerns about the financial dealings of other doctors as well.

Inside the courtroom Tuesday, Pedowitz sat in the front row with his wife and daughter as the judge told jurors that a settlement had been reached. He said he felt vindicated by the outcome.

"These are serious issues that patients should be worried about," Pedowitz said in an interview. "These problems exist in the broader medical system and they are not restricted to UCLA."

The seven-week trial in downtown Los Angeles offered a rare glimpse into those potential conflicts at a time when there is growing government scrutiny of industry payments to doctors.

Starting this fall, the federal Physician Payments Sunshine Act, part of President Obama's healthcare law, requires public disclosure of financial relationships between healthcare companies and physicians.

Many doctors and universities defend long-standing industry arrangements as essential for carrying out cutting-edge research and top-flight medical education.

In a statement Tuesday, the UC regents said they "resolved this lawsuit to end a prolonged conflict and permit UCLA Health Sciences to refocus on its primary missions of teaching, research, patient care and community engagement."

The statement added that "multiple investigations by university officials and independent investigators concluded that conduct by faculty members was lawful. Patient care was not compromised."

This latest settlement eclipses a $4.5-million payout the UC regents made last year to resolve a racial discrimination lawsuit filed by another UCLA surgeon.

Pedowitz, as part of his settlement, left the UCLA faculty, effective Tuesday. He had agreed to step down as department chairman in 2010 after initially voicing his concerns to top UCLA officials. He filed a whistleblower retaliation complaint in March 2011.

Experts in medical ethics say the UCLA case shows much more needs to be done within academia and by government regulators to address potential conflicts of interest in medicine.

Susan Chimonas, associate director of research at Columbia University's Center on Medicine as a Profession, said some medical schools are still reluctant to take on specialists who bring in considerable money from patients, medical research and patents on breakthrough products.

"Institutions can be dependent on the money these big-earning specialties like orthopedic surgery bring in," Chimonas said. "They are the cash cows and they can set their terms. This is not the first time I've heard of medical schools having policies that are not well enforced."

In an interview last week, the chief compliance officer at the UCLA Health System flatly rejected the notion that the university didn't enforce its policies or look fully into Pedowitz's allegations. She also said industry ties are unavoidable at a big medical school and rules are in place to prevent conflicts.

"We have processes in place to identify those relationships in a transparent fashion and ensure they don't have any inappropriate influence on the actions of the university," said Marti Arvin, chief compliance officer. "In order to meet our mission, it is important we have both the brilliant minds we have at UCLA and collaboration with industry."

Arvin said the university "thoroughly and objectively investigated those allegations of noncompliance raised by Dr. Pedowitz. We were able to determine the vast majority were unsubstantiated."

She said two doctors fell short of university expectations in their handling of outside income, but there was no violation of law or university policy in either instance.

Arvin cited the case of Dr. Nick Shamie, the orthopedic surgeon who testified at trial about receiving $250,000 from Medtronic for consulting work. She said department policy at the time didn't require Shamie to send that outside income through UCLA's faculty compensation plan.

At trial, Pedowitz said he was deeply troubled by the large amount of money Shamie was paid. He testified that he was particularly concerned that Shamie was trying to enroll patients in a research study involving Medtronic at the time.

"I saw this as an obvious problem," Pedowitz testified.

In court, Shamie said he abided by university policy and didn't pursue the study further because finding patients was too difficult. He couldn't be reached for additional comment.

The other physician cited by Arvin for a potential shortcoming was Dr. David McAllister, vice chairman of clinical operations for the orthopedic surgery department.

He didn't report payments from the Musculoskeletal Transplant Foundation, a nonprofit tissue bank that does business with UCLA, because he didn't think disclosure was required in that instance because it didn't involve a for-profit entity, Arvin said.

McAllister also declined to comment, referring a call to UCLA.

Shortly before Pedowitz joined UCLA in 2009, the university was already facing criticism from Congress over the failure of a top spine surgeon to report nearly $460,000 in payments he received from Medtronic and other medical companies while researching their products' use in patients, government records show.

Dr. Jeffrey Wang, who left for USC Spine Center last fall, stepped down as head of UCLA's spine program in 2009 after U.S. Sen. Charles Grassley (R-Iowa) publicized his lapse in disclosure as part of a larger investigation into medical conflicts of interest.

Several patients are now suing Wang and UCLA in state court for negligence, fraud and malpractice in connection with surgeries involving Medtronic's controversial Infuse bone graft. UCLA said it doesn't comment on pending litigation. Wang couldn't be reached for comment.

Shortly after raising his concerns, Pedowitz said, he was pressured to step down as department chairman in 2010. Pedowitz said he was further retaliated against by being denied patient referrals and prevented from participating in grants and other activities.

Before UCLA, Pedowitz worked at UC San Diego and as chairman of orthopedics and sports medicine at the University of South Florida.

Mark Quigley, an attorney representing Pedowitz, said the case could have been avoided if the UC system enforced the policies it already has in place.

"What good are all the policies if they protect the wrongdoers and fail to protect the actual whistleblower?" Quigley said. "The university wanted to cover it all up."

Tuesday, April 22, 2014

How hard will a Republican work to deny a poor person health care? Pretty hard, if his name is Deal or Brownback

People wait to receive a wristband number for medical treatment at the Remote Area Medical (RAM) clinic in Wise, Virginia July 20, 2012. RAM clinics bring free medical, dental and vision care to uninsured and under-insured people across the country...

How hard will a Republican work to deny a poor person health care?
by Joan McCarter
Daily Kos
Apr 22, 2014

Back in February, news broke of Georgia Gov. Nathan Deal's efforts to make sure that no governor of Georgia could ever decide to take Medicaid expansion, giving the legislature veto power over any future governor's decision to do so. But it's not just Deal. Kansas's Gov. Sam Brownback (R) is doing it too.

Georgia and Kansas have left a combined 487,000 residents uncovered under Obamacare because they refused to expand Medicaid. And, though the law remains unpopular, a recent poll found that majorities of Georgians (54 percent) and Kansans (55 percent) support Medicaid expansion.

Health Insurance Complaints Skyrocket in CA, says DMHC (Department of Managed Health Care)

Apparently, insurance companies don't want to let customers cancel policies.

"Kaiser, the state’s third largest provider, doesn’t allow users to post directly to its Facebook page. It’s also where some callers complained they were receiving a pre-recorded message that ended with a dial tone when they called customer service."

Sadly, long before the new health care law went into effect, Kaiser was preventing patients from making complaints.

DMOC isn't likely to do much. There's a long history between DMHC and Kaiser.

Health Insurance Complaints Skyrocket in CA
Having trouble reaching your health insurance company? You're not alone. State regulators say in January alone, they've seen a 53% jump in complaints, in part because calls about Covered California. A little known state hotline can help
By Vicky Nguyen, Felipe Escamilla, Liza Meak, and Scott Pham
NBC News
Apr 22, 2014

The Investigative Unit has learned complaints to state regulators have skyrocketed as people find themselves unable to reach anyone at several major health insurance companies. Vicky Nguyen reports in a video that aired on April 21, 2014.

Even if you aren’t one of the 1.2 million people signing up for Covered California, chances are you’re feeling the pinch when calling your insurance company. The Investigative Unit has learned complaints to state regulators have skyrocketed as people find themselves unable to reach anyone at several major health insurance companies.

For some health insurance companies, the influx of calls is so bad, they’re hanging up on customers after a pre-recorded message, while others put callers on hold indefinitely.

“I’ve been put on hold anywhere from 15-40 minutes,” said Don Tran, a full-time grad student at San Jose State.

Tran said he wanted to cancel his individual health plan with Blue Shield of California because he was eligible for less expensive coverage through his employer. But getting in touch with Blue Shield turned out to be much more difficult than he anticipated. “It’s been over a month and a half and I still haven’t been able to reach anybody,” Tran said.

Tran's story is a familiar one to Marta Green, spokeswoman for the California Department of Managed Health Care. The agency regulates [or at least, it collects a lot of money from the taxpayers in exchange for promising to regulate] health care plans and protects consumers.

“We have seen our call volume go up quite a bit,” Green said. She attributes much of the increase to the sudden spike in health insurance enrollment due to Covered California.

The rise in complaint volume was so extreme, the department began tracking the number of complaints from people who said they couldn't even reach their insurance providers.

“It was never an issue before this year,” Green said. But the department is only tracking “can’t reach plan” complaints for customers enrolled in Covered California. Of the roughly 1,000 complaints received between January and March of 2014, 1 in 10 people said they were trying to cancel or couldn’t reach their plan.

Green said there’s little consequence at this point for health plans that aren’t responsive to consumers. “If a health care plan is found to have violated the law, they can face enforcement action…[but] there is no specific law in relation to wait times.” Green said consumers can call, email or even send postal mail to the department regarding any issues with their health insurance. She said the department is committed to helping consumers resolve their problems, a process that can take anywhere from a day to a month.

“Every complaint we receive is investigated,” Green said. She encouraged consumers to call the department’s hotline, 1-888-466-2219, where they are guaranteed to reach a human being during business hours.

Don Tran took his complaint online, joining dozens of others NBC Bay Area found on social media, who are posting pictures of their wait times and airing their complaints on Facebook and Twitter. A check of the Facebook pages for the two largest providers in California—Anthem and Blue Shield – revealed new complaints daily.

Kaiser, the state’s third largest provider, doesn’t allow users to post directly to its Facebook page. It’s also where some callers complained they were receiving a pre-recorded message that ended with a dial tone when they called customer service.

“It’s a real hassle,” Tran said, adding that Blue Shield only responded after he posted several comments on social media. Now, more than 2 months later, he finally has his cancellation notice, but didn't get a reimbursement check until a few days ago.

Blue Shield of California spokesman Sean Barry said via email the company has expanded its customer service staff, adding, “We’re committed to delivering a high-quality customer experience. We have put several measures in place to reduce the delays in resolving issues by phone, receiving new ID cards and making payments.”

He directed customers to this customer service home page with a list of contacts to help resolve issues.

Darrel Ng echoed a similar sentiment. In an emailed statement, the Anthem Blue Cross spokesman said, “At the beginning of the year, hundreds of thousands of Californians were added to the insurance rolls on Jan. 1 as our nation’s health care delivery system went through a complete transformation. Because of that, in the first two business days of January, our company received a million calls nationally. Since then, we hired and trained hundreds of additional customer service agents and reassigned hundreds of other internal assets to assist on our phone lines. Through those efforts, the average hold time for customer service was under 3 minutes in March and is down to less than 90 seconds thus far in April.”

Kaiser Permanente spokesperson Karl Sonkin emailed this statement. "Prior to the deadline for Affordable Care Act Kaiser Permanente experienced a higher volume of calls to our Member Services Call Center during peak hours than we typically receive in the first part of the year, and that had resulted in longer than normal hold times. However, now that the enrollment deadline has passed our call volumes have returned to more typical levels and we are no longer experiencing delays."

[Maura Larkins' comment: This seem to be Kaiser's way of saying that patients will be experiencing the same treatment that they received for years before the Affordable Care Act.]

Monday, April 21, 2014

Physician shortage and foreign-trained doctors are subject of talk

Physician shortage and foreign-trained doctors are subject of talk
La Mesa Courier
Apr 21, 2014

Challenges facing foreign-trained doctors eager to practice in California at a time when physician shortages are expected to get worse will be the topic of a forum sponsored by the Grossmont-Cuyamaca Community College District, the Grossmont College-based Welcome Back Center, and UC San Diego's School of Medicine on April 22 at UCSD.

The Association of American Medical Colleges has forecast a shortage of more than 91,500 doctors by 2020 and 130,600 by 2025, a shortage that could be exacerbated by the millions of Americans securing health insurance through the Affordable Care Act.

"Meanwhile, there are thousands of foreign-trained doctors that have scored well on U.S. medical exams but they cannot find residencies in the U.S., and there is little to no support for them to become doctors in this country," said Gail Patterson, program manager at the Welcome Back Center at Grossmont College, which was developed to aid internationally trained healthcare workers that have moved to California.

Speakers at the April 22 event include:

Dr. Wael Al-Delaimy, professor and division chief of Global Health at the UCSD Department of Preventative Medicine. Al-Delaimy practiced medicine in his native Iraq and then Jordan between 1991 and 1995 before finishing his Ph.D. from Otago University in New Zealand in 2000. He was a Research Fellow and Research associate at Harvard School of Public Health between 2000-2004, a scientist with the International Agency for Research on Cancer in 2003, and a faculty member at UCSD since 2004.

Dr. David E.J. Bazzo, a clinical professor in family and preventative medicine who has been named a Top Doctor in family medicine by the San Diego County Medical Society and San Diego Magazine every year since 2005.

Dr. Esmatullah Hatamy, assistant clinical professor of family and preventative medicine at the Global Health Initiative who graduated from Kabul Afghanistan Medical School in 1988 and has been a member of the Afghan Medical Association Board of Directors.

Dr. Dustin Lillie, a primary care physician who is an associate clinical professor of medicine at UCSD.

The April 22 forum is scheduled from 6 to 8 p.m. at the Medical Education and Telemedicine Building, Room 141, at 9500 Gilman Drive on the UC San Diego campus. Those attending can learn about what foreign-trained doctors need to do to secure residencies in the United States and discuss the general U.S. health care system's pending challenges.

UCSD Medical Center is interested in developing a program with the Welcome Back Center that would help foreign- trained doctors traverse the complex path of U.S. medical exams and residency applications that would increase their chances of getting a residency and becoming licensed to work in California.

The Welcome Back Center offers a wide range of services to immigrant healthcare workers who wish to obtain professional credentials. The Welcome Back Center is a division of the Health Workforce Initiative (HWI) program of the California Community Colleges. Ann Durham, based at Grossmont College, directs the HWI program in behalf of nine community colleges serving San Diego and Imperial counties.

Further information can be obtained by contacting Gail Patterson at (619) 644-7206 or administrative assistant Samantha Cardenas at (619) 644-7059.

Sunday, April 13, 2014

Kaiser Permanente pharmacists consider going on strike

See also Kaiser often denies care to paying patients, but then doles out a bit of free care to get publicity and tax write-offs.

Kaiser Permanente pharmacists consider going on strike
Fontana Herald News
April 13, 2014

Kaiser Permanente pharmacists, including those in the Fontana medical center, voted on April 4 to authorize the Guild for Professional Pharmacists committee to call a strike, if necessary, after negotiations reached no agreement.

According to the GFPP, which represents more than 1,400 pharmacists in Southern California, the employees "overwhelmingly" authorized the committee to call a strike after Kaiser’s bargaining team did not offer better health coverage plans and retirement plans for employees who work for less than full time.

“Kaiser has, so far, steadfastly refused to do so and, instead, has sought benefits cuts that would give pharmacists even lesser benefits both wile actively employed by Kaiser and after retirement," said Robin Borden, president of GFPP. “This is outrageous and our members won’t stand for it. While I know no one wants to strike -- least all of our members, for whom patients come first -- our members will not stand by and let Kaiser undermine our economic security, including our security after retirement."

Borden added that if the strike were to be called, it could involve all or some of the following Kaiser medical centers: Panorama City, Woodland Hills, Sunset, West Los Angeles, Baldwin Park, Bellflower, Harbor South Bay, Anaheim, Irvine, Ontario, Riverside, San Diego and Fontana.

Kaiser Permanente released a statement through Jennifer Resch-Silvestri, senior director of public affairs and brand communications in the San Bernardino County area, saying that the company's first priority is “always the safety and care of our members and patients” and that pharmacists are “valued members of our professional health care team."

“It is important to note that all Kaiser Permanente health services are open and operating as usual to serve our members who should continue to come to our facilities for their appointments, lab tests, scheduled procedures, and to see their doctors," said the statement. “With the good faith involvement of all concerned, we are optimistic that we will continue to make

progress toward a contract agreement."

Kaiser often denies care to paying patients, but then doles out a bit of free care to get publicity

See what Kaiser does to paying patients at Garfield Specialty Center.

The fourth paragraph of the following article is shockingly deceptive, not giving even a clue that 20 non-Kaiser Permanente hospitals are involved in Project Access.

30 Get Free Treatment on ‘Super Saturday Surgery Day’ at Kaiser
by Chris Jennewein (former San Diego Union-Tribune administrator)
Times of San Diego
April 12, 2014

Nearly 30 San Diegans with debilitating medical conditions are scheduled to receive free treatment Saturday at a “Super Saturday Surgery Day” conducted by the San Diego County Medical Society Foundation and Kaiser Permanente.

About 150 physicians and staff will volunteer time and expertise to provide medical care to the patients. Kaiser Permanente Garfield Specialty Center in San Diego.

For 13 of them, treatments will include hernia repairs, gallbladder removals, head and neck therapy, and vascular surgery. Another 16 patients will receive diagnostic gastrointestinal procedures to prevent colorectal cancer.

Barbara Mandel, Executive Director of the San Diego County Medical Society Foundation, said that since the Project Access San Diego program started in December of 2008, more than 2,400 patients have received free specialty care, including both inpatient and outpatient surgeries and procedures.

[Maura Larkins' comment: Journalist Chris Jennewein fails to mention that all this care DID NOT COME FROM KAISER PERMANENTE. Only some of it came from Kaiser. Here's a list of hospitals involved in the program:

Alvarado Hospital
Carlsbad Surgery Center
Coast Surgery Center
The Endoscopy Center
Endoscopy Center of Chula Vista
Escondido Surgery Center
Euclid Endoscopy Center
Kaiser Permanente
La Jolla Endoscopy Center
Northcoast Surgery Center
Orthopaedic Surgery Center of La Jolla
Otay Lakes Surgery Center
Palomar Pomerado Health
Paradise Valley Hospital
Parkway Endoscopy Center
Poway Surgery Center
San Diego Outpatient Ambulatory Surgical Center
Scripps Health
Surgical Center of San Diego
Tri-City Medical Center
University of California San Diego Medical Center]

Kaiser says it has held a dozen Super Saturdays, providing more than $2.4 million in services.

[Maura Larkins' comment: Who came up with that number? Perhaps Kaiser values its own services very highly? I expect Southern California Permanente Medical Group will use this as a tax write-off, so it would be expedient to exaggerate the value of the service.]

To qualify for Project Access San Diego’s Saturday Surgery Day an individual must live in San Diego County, be low-income, ineligible for public health programs, and be referred by their primary care physician.

— City News Service

Wednesday, April 9, 2014

This 32-Year-Old Florida Woman Is Dead Because Her State Refused To Expand Medicai

Charlene Dill died because Florida Republicans refused to expand Medicaid that would have paid for her heart health care CREDIT: GoFundMe

This 32-Year-Old Florida Woman Is Dead Because Her State Refused To Expand Medicaid
By Tara Culp-Ressler
Think Progress
April 9, 2014

Charlene Dill, a 32-year-old mother of three, collapsed and died on a stranger’s floor at the end of March. She was at an appointment to try to sell a vacuum cleaner, one of the three part-time jobs that she worked to try to make ends meet for her family. Her death was a result of a documented heart condition — and it could have been prevented.

Dill was uninsured, and she went years without the care she needed to address her chronic conditions because she couldn’t afford it.

Under the health reform law, which seeks to expand coverage to millions of low-income Americans, Dill wasn’t supposed to lack insurance. She was supposed to have access to a public health plan through the law’s expansion of the Medicaid program. But Dill, a Florida resident, is one of the millions of Americans living in a state that has refused to accept Obamacare’s Medicaid expansion after the Supreme Court ruled this provision to be optional. Those low-income people have been left in a coverage gap, making too much income to qualify for a public Medicaid plan but too little income to qualify for the federal subsidies to buy a plan on Obamacare’s private exchanges.

Florida has one of the highest uninsurance rates in the nation, and is home to a disproportionately large number of residents who struggle to afford health services. Nonetheless, lawmakers have continued to resist accepting generous federal funds to expand Medicaid to an estimated 750,000 low-income Floridians like Dill.

Although Florida Gov. Rick Scott (R) initially indicated that he was in favor of accepting the funds for expansion, he’s since walked back that position. Meanwhile, Republicans in the legislature don’t even plan to schedule a vote to address Medicaid expansion during their current session, suggesting that the federal government won’t actually come through with the funding to support the policy.

Dill made about $9,000 annually by babysitting, cleaning houses, and selling vacuum cleaners. As the Orlando Weekly reports, she was optimistic about her coverage options under President Obama’s administration. She tried to sign up for Obamacare using the online calculator on, but quickly found out she fell within the coverage gap.

In the absence of health coverage, Dill’s best friend, Kathleen Voss Woolrich, occasionally turned to crowdfunding sites on the internet to raise the money Dill needed to pay for her heart medication. Last month, Woolrich crowdfunded to pay for Dill’s funeral.

In an emotional blog post published on the site Women on the Move at the end of last month, Woolrich blamed Florida politicians for her friend’s early death.

“You see the main argument Republicans use is that it’s some lazy person who needs Medicaid expansion. That those of us living without healthcare or dental care are lazy. But my friend, a single beautiful mother, worked three jobs,” Woolrich wrote. “I am burying my best friend because of the policies of the Republican Party. I am burying my best friend because had Medicaid expanded, her needs would have been met.”

And Dill won’t be the only one. A recent study conducted by Harvard researchers estimated that as many as 17,000 people will die directly as a result of their states refusing to expand Medicaid. In Florida, that translates to about six deaths like Dill’s every single day. This issue is exacerbated by the fact that the low-income residents in states that have resisted Medicaid expansion tend to have more health problems than the residents in other states.

Democratic officials in Florida have responded strongly to Woolrich’s story. Rep. Alan Grayson (D) — who told the Orlando Weekly that his colleaugues’ resistance to Medicaid expansion “has put the GOP’s appalling disregard for human life on full display” — entered Woolrich’s blog post into the Congressional record.

“I memorialized Charlene’s life and death in the Congressional Record, because the Republicans want to pretend that none of this is happening. That Charlene didn’t die as a result of their callous neglect — that no Floridians will die as a result of their willful refusal to expand Medicaid at no cost,” Grayson explained. “But I’m not going to let them forget. I’m not going to let them pretend. This is not a game; this is very real. This is life and death.”

Tuesday, April 8, 2014

Did a dead woman beat herself up--or did her doctor wrongly pronounce her as dead?

Arroyo v. Plosay (Cal. Ct. App. - April 2, 2014)
California Appellate Report
Thoughts on recent Ninth Circuit and California appellate cases from Professor Shaun Martin at the University of San Diego School of Law.
April 02, 2014

Maria Arroyo dies, and when the mortuary comes to pick up her body, her face is all bashed in, which the mortuary can't fix. Since Arroyo simply died of a heart attack -- not something that usually bashes a face -- everyone assumes that someone in the hospital must have futzed with (or mutilated) the body. So in 2011, Arroyo's survivors sue the hospital for disfiguring the body, which is indeed a tort.

But plaintiffs end up dismissing the case without prejudice after the trial court grants various summary judgment motions. Oh well. That's the way the cookie crumbles sometimes.

But then Arroyo's survivors figure out what really went down. How did Maria's face get bashed in? Well, after she was pronounced dead by the medical staff at the hospital, she was taken to the morgue and put in a compartment in the hospital's freezer. Presumably one of those drawer-like things that you see on television.

But when the mortuary workers found her, Arroyo was face down. With her nose broken and with lacerations and contusions all over her face.

How'd she get that way? You guessed it. The survivors' expert says that Maria was still alive when the hospital declared her dead and put her in the freezer. And that, later, she woke up, bashed her face and head against the compartment in a vain attempt to escape, and ultimately just froze to death.


There's a whole big statute of limitations problem. Which, as the Court of Appeal holds, is more fatal to one cause of action than some of the others.

But boy. I would not want to be defending this one. Because unless you've got a good way to explain to a jury how Maria ended up face down with her nose broken, the alternative -- that she was put in the morgue alive only to freeze to death -- is . . . well, chilling. To say the least...

The decision states, "The separate judgments
of dismissal are reversed as to the causes of
action for medical negligence and wrongful
death against the Hospital and Dr. Plosay
, and affirmed as to the cause of action for
The parties shall
bear their own costs on appeal.

Monday, April 7, 2014

I No Longer Have Much Faith in the Staff At This Hospital

by irishwitch
Daily Kos
Jan 28, 2014

...SInce I was up that early, I called Faye and told her I needed to get to the hospital today. I didn't tell her I had a really, really bad feeling about it. When we got there, Ben was upbeat (they put him on Zoloft and I want him off as soon as possible because the side effects are dreadful) because he thought he'd be going home today.

Our hopes were dashed. Very badly dashed and I am frankly thinking LAWSUIT because some of the stuff I am finally hearing indicates a level of incompetence that to me is just unbelievable. He is still on oxygen. His oxygen saturation isn't good enough to go home. Her boss and the cardiologist were fine discharging him, but the O2 levels when he walks go way down. So she decided he might have a blood clot in his luings, which apparently the oh-so-brilliant top 5 cardio hospitals in the country completely missed comp;etely.

I am the edn of my rope. I got very aggressive with the PA. I asked her why, when I asked the nurse about Deep Vein Thrombosis, said it was DVT, just a small superficial clot, othing to worry about. Nicole the PA said all clots are DVT, w=hich the AMerican Heart Association website (and several others that were not designed for civilians but for medical people) say is not true.

So they did a CAT scan, and NOW he had DVT behind his knee and a clot in his lung.

WHY THE FRIGGIN' HELL did they not do that CAT Scan when they discovered the one in his knee AND they knew he was having real problems breathing (turns out it was pneumonia which nobody bothered to tell us)? This sounds to me like GROSS incompetence. If there is a step beyond gross incompetence.

I was very aggressive in my questioning of Nicole, and MiL was mortified by aggressiveness and stopped out, leaving me unsure if she was leaving me there. I embarrassed her because I wanted to know the damned truth and was willing to have a knock-down dragout fight to get the facts. Because what I have gotten so far is at best half truths. And I am not passive aggressive. I WILL go to them at to learn the complete whole truth (which goes over with Nicole like a lead balloon and makes Ben unhappy with me). But so far they have made what seemed to me to have made so many mistakes which could have cost him his life, that I honestly have lost all faith in ANYONE at that hospital.ANd I wish I were ip North where family is respected and they actually the time to tell you the truth and generally don't make errors like not checking for a second clot in the lungs when his breathing isn't improving.

I'd also be thrilled to have nurses who speak something resembling the English language. His nurse today had a Southern accent so thick as to be unintelligible--and I can understand broad Yorkshire, thick Glaswegian, and very heavy Northern Irish brogues (reviews on Netflix always whine that they can't understand Irish accents)

I finally called Ben to get the info (since calling the damned nurses seems to be utterly useless), and heard about the blood clot. I have been crying non-stop and I no longer have any faith in this hospital or its staff. They've either been too incompetent to answer or they give me half truths. I don't trust any of them...

Wal-Mart shoppers: Kaiser Permanente will see you now

Wal-Mart shoppers: The doctor will see you now
Bakersfield Californian
Apr 05 2014

Shortly after the Kaiser Permanente Care Corner clinic opened for the day in a southwest Bakersfield Wal-Mart one recent Friday, licensed vocational nurse Irene Ethridge decided to drum up some business.

[Maura Larkins' comment: Irene decided? Or she was instructed to do so?}

"Hi there. Are you a Kaiser Permanente member?" she asked a woman strolling through the store's adjacent pharmacy.

"Yes," replied Kim Klaas warily.

Ethridge brightened and explained that as such, Klaas was eligible to use the telemedicine services at the clinic, a two-year pilot project of Kaiser -- which has about 102,000 members in Kern County -- and the nation's largest retailer.

The Bakersfield telemedicine clinic is one of two that Kaiser opened in October. The other one is in Palmdale.

Kaiser members and Wal-Mart employees can walk in, no appointment necessary, and have minor ailments assessed by a health care provider via a high-resolution webcam in a private room. A registered nurse in San Diego does an initial screening, followed by an urgent care doctor in Bakersfield.

The clinic is open from noon to 8 p.m. Thursdays through Mondays. About 125 people have had exams there so far.

Klaas, 39, was feeling well on Friday, but she was intrigued. "I love the hours," said the mother of two children, ages 5 and 6. "Kids always seem to get sick at night when the doctor's office is closed, and a little ear ache isn't the kind of thing you want to go to a hospital for." Retailers have been operating clinics inside stores for years, but until recently telemedicine has largely been confined to traditional clinical settings, usually for consultations between far apart medical colleagues. Because it's efficient and convenient, telemedicine is likely to expand into all sorts of nontraditional settings, but there should be standards to ensure patients are getting good care, said Mike Harris, a principal with Harris Consulting, a Los Angeles-based healthcare consulting firm. "Of course we have to make sure we closely monitor it to be certain we're not putting patients at risk," he said. The exam at Kaiser's Wal-Mart clinic is much more than just talking to a computer screen, Kaiser notes. With a specialized stethoscope placed on the patient by the nurse at the clinic, remote doctors can actually listen to the patient's breathing and heartbeat, just as they would in a face-to-face exam. An otoscope with a camera on it also allows doctors to look deep into a patient's ears and eyes. Similarly, a special dermatoscope can transmit extremely detailed, magnified images of skin lesions. Patients with sore throats open wide for yet another camera. For routine ailments, doctors can transmit an electronic prescription that patients can fill immediately at Wal-Mart, or at another pharmacy if they choose to wait. If the condition appears to warrant an in-person exam, patients are referred to Kaiser's urgent care clinic on Stockdale Highway, where they will likely see the same doctor who was on the other end of the webcam. The partnership between Kaiser and Wal-Mart is part of an ongoing strategy Kaiser is pursuing to make health care generally more accessible. It's trying out a traditional clinic at Paramount Farms for employees of the agriculture company, and a mobile clinic that travels to outlying areas of the county six days a week. There's also a mobile phone app for making appointments and communicating with doctors. "We want to take health care beyond the traditional setting to the places where people shop and work," said Kaiser chief administrative officer Sharon Peters. If visiting the doctor is convenient, the thinking goes, patients will come in sooner and possibly avoid the health consequences and expense of more severe problems down the road.

Going to a doctor's office in the middle of the day isn't convenient for most people, but swinging through a clinic while shopping isn't too much trouble.

"This really fits in with the needs of our patients," said Kaiser medical director Dr. Julia Bae. "Millennials and the younger population, especially, don't value the traditional one-on-one office visit. They want care to fit into their busy schedules." Wal-Mart says the experiment is one more way to better serve its customers.

"We are always testing new products and services to provide our customers with affordable ways to stay healthy," said spokeswoman Danit Marquardt. "This is an example of one of those pilot programs." Customers who are not Kaiser members or Wal-Mart employees can't take advantage of the telemedicine exams, but they can use self-service options such as health research or checking their weight or blood pressure. Linda Urias, 65, doesn't belong to Kaiser but stops in at the clinic whenever she's in the store picking up groceries. On the recent Friday, she checked her blood pressure. "A little low today, but at least it wasn't high," she said. Urias also stepped on a scale to make sure her diet is still on track. She recently lost about 20 pounds, and is trying to keep it off. "I've changed the whole way I eat," Urias said proudly. It's those types of health conscious consumers retailers hope to appeal to with in-store clinics.

The partnership between Kaiser and Wal-Mart has a lot to offer both sides, said healthcare consultant MaryKate Scott of Hartland, Maine-based Scott & Co., which has had Wal-Mart as a client in the past.

The obvious benefit to Wal-Mart is the potential to sell prescription and over-the-counter medicine, but that's only part of the story, Scott said.

There are about 2,500 retail clinics in the United States. Stores like them because they generate foot traffic at a time when a growing number of consumers are shopping online.

"They want customers walking through the store with their shopping carts making impulse purchases," Scott said. Plus, health care costs are a major concern for Wal-Mart as the employer of some 1.4 million employees. If it can keep those workers healthy, that's a huge savings, Scott said. And if health care costs worry an enormously successful international retailer, how much more so for its customers, typically working-class people for whom insurance is a major expense. "If I'm Wal-Mart, I'm thinking, 'Health care is a big deal for my customers. And if it's a big deal for my customers, it better be a big deal for me,'" Scott said.