Thank heaven for insurance companies

200 San Diego Kaiser Workers Strike for Fourth Time

2012-01-31T11:24:00.000-08:00

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

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

Over 200 Kaiser workers went on strike Tuesday.

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

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

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

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

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

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

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

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

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

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

$1.2 million Judgment Against Southern California Permanente Medical Group

2012-01-28T11:57:00.000-08:00

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

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

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

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

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

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

2012-01-24T12:44:00.001-08:00

WELCOME KAISER PERMANENTE SAN DIEGO EMPLOYEES

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

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

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

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

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

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

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

US to Force Drug Firms to Report Money Paid to Doctors

2012-01-17T10:24:00.000-08:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2012-01-11T15:45:00.000-08:00

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

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

This is what Sandy Santiago apparently wanted me to hear:

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

January 12, 2012 UPDATE

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

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

To:
“Leeanne”
Sandy Santiago
Sandy Santiago’s superior at CalPERS

From:
Maura Larkins

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

Here is what happened today:

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

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

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

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

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

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

“But I already did that.”

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

“Around December 22.”

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

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

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

“Verbage?” I asked.

“Yes, verbage,” she said.

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

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

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

“I want to speak to your supervisor.”

“Not a problem,” she said.

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

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

2012-01-07T13:59:00.000-08:00

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

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

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

The California Medical Board records noted:

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

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

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

2012-01-07T13:53:00.000-08:00

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

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

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

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

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

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

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

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

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

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

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

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

Child custody expert linked to lewd Web photos

2012-01-07T13:43:00.000-08:00

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

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

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

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

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

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

Kenan's detractors have been particularly vehement.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Montebello doctor accused of molesting patient

2012-01-07T13:34:00.000-08:00

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

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

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

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

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

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

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

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

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

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

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

"He has no criminal history," Lopez said.

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

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

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

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

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

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

Hospitals Sue Kaiser Over Emergency Care

2012-01-06T14:38:00.000-08:00

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

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

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

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

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

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

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

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

2012-01-04T12:49:00.001-08:00

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

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

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

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

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

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

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

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

Changes Afoot for Everyone

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

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

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

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

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

What's Driving the New Partnerships

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

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

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

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

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

California at the Epicenter

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

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

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

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

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

Reaction and Reassessment

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

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

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

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

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

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

In the States

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

Challenges to Reform

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

Inside the Industry

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

Did the infant show signs of hypoglyarbitration and kaiser permanentecemia?

2011-12-27T11:22:00.000-08:00

I got a kick out of this webpage, afflicted with mistakes and misspellings:

Arbitration and Kaiser Permanente California

...Nursing staff at Kaiser Sacramento iled to follow proper protocols when the innt showed signs of hypoglyarbitration and kaiser permanentecemia.

...3-year-old boy afflicted with multiple neurological injuries as a result of negligent delivery at the Kaiser Foundation Hospital in Redwood City...

That page led me to this far-more-sophisticated page:

California Birth Injury, Cerebral Palsy and Brain Damage Attorneys
Walkup, Melodia, Kelly & Schoenberger

...Nurse Error

In a case involving cerebral palsy and cortical blindness, our birth injury attorneys represented a Sonoma County family in a claim seeking damages for their 5-year-old daughter's brain damage. The little girl was the first child for a 42-year-old mother who should have been treated as a high-risk pregnancy but was not. The defendant doctor was a family practitioner who should have referred the mother and babies care to a high risk OB program. During a prolonged labor the expectant mother failed to progress and the child's fetal monitor strip demonstrated worrisome heart rate decelerations after contractions but the attending nurses ignored these. Experts retained by Walkup birth injury attorneys analyzed the monitoring strips and identified multiple indications of fetal stress. Our nursing experts were prepared to testify that the attending nurses should have called an on call obstetrician to perform a prompt C-section under these circumstances In mediation, our lawyers negotiated one of the largest settlements in Sonoma County history, payable both in cash and monthly installments to take care of the child now and throughout her projected life expectancy. The settlement was crafted so that future payments will increase with inflation and will be sufficient to pay for therapy, attendant care, visual and verbal stimulation, and future lost wages. A special needs trust was also established to preserve the child's ability to receive public benefits in the future.

- Brain Damage

Our birth injury settlement attorneys obtained a mediated settlement in a major obstetrical injury case involving anoxic brain damage and hypoxic ischemic encephalopathy. The case was brought on behalf of a two-year-old Sonoma County boy who sustained global brain damage when fetal distress was neither noted nor responded to during his birth. The settlement also included resolution of his parent's claims for emotional distress and his potential future wrongful death. The parents recovery was limited to the unfair and discriminatory limit of $250,000 per claim imposed by California's outdated MICRA statute. A special needs trust was established with an initial corpus of more than $1,250,000 into which future annuity payments (commencing at $5,000 per month, increasing at 5% annually, for life, guaranteed 20 years) are to be deposited. A second, separate, annuity will begin paying an additional $4,000 per month, increasing at 4% per year, when the child reaches his 18th birthday. Because the child is eligible for both CCS and Regional Center benefits until he reaches the age of three, the past out of pocket expenditures made by the parents have been modest - as a result, the settlement was designed to be back-loaded (and guaranteed) to protect against the cost of custodial and attendant care in a home-based environment in the future. The settlement is believed to be among the largest ever negotiated on behalf of a North Bay plan member of this HMO.

- Anoxic Brain Damage

Our traumatic brain injury attorneys obtained a cash and annuity settlement having a present cash value of more than $5,000,000 on behalf of a 6-year-old girl who sustained irreparable brain damage during her birth process. The defendant in the case was a national health maintenance organization. The obstetricians employed by the health maintenance organization failed to correctly analyze or diagnose signs of fetal distress as shown on fetal monitoring tapes Our brain injury attorneys hired experts in obstetrics and perinatology to testify that a timely cesarean section, occurring 45 minutes or more before the actual birth, would have prevented the child from sustaining anoxic brain damage (brain cell death due to lack of oxygen). Attorneys for the defendant health care provider attempted to prove that the child's brain injuries were not the result of oxygen deprivation during the labor process, but rather were the result of an infection, which the mother experienced one month before her delivery. When combined with available benefits provided by private insurance and government programs, the guaranteed future monthly and annual payments to be made under the settlement should assure that the his medical and special needs will be met regardless of his life expectancy.

- Prolonged Labor Infant Death

Our obstetrical injury lawyers resolved this birth injury case, in the maximum amount permitted by California's Medical Malpractice statutes ( MICRA ) on behalf of the parents of a newborn infant who died after his mother's uterus ruptured. The mother was admitted to the hospital with contractions, but was sent home several hours later because the nurses felt she was not progressing. Once home, she began to experience severe abdominal pain. By the time the defendant doctors realized that the infant was outside the uterus in the abdominal cavity, an emergency cesarean section was unsuccessful in saving the childs life. Walkup Melodia birth injury attorneys, working with expert witnesses in the fields of perinatology and obstetrics, demonstrated that the mother should never have been sent home from the hospital, and that if she had been monitored properly, her uterine rupture would have been anticipated, avoided and a safe and timely cesarean section performed.

- Failure to Recognize Fetal Distress

Our birth injury attorneys negotiated a cash and annuity settlement with a present cash value in excess of five million dollars on behalf of an infant born with severe developmental delay, spastic quadriparesis, and permanent neurological injuries after Kaiser San Francisco doctors and nursing staff failed to monitor the mother and deliver the baby quickly when fetal heart monitors indicated severe distress. The 36-year-old mother's pregnancy and delivery seemed to be progressing normally when, 8 hours after being admitted to the hospital, she developed a high fever. The doctor on call administered antibiotics for suspected chorioamnionitis, (an inflammation of the amniotic membranes), and said he would check back in an hour. Nearly three hours later, the fetal heart rate monitors indicated that the baby's heart rate had dropped to 85 and 90, and remained there for about 10 minutes, prompting a frightened nurse to contact the doctor. Deceleration of the fetal heart rate is a common effect of chorioamnionitis. The infant was born a half hour later, by emergent vacuum extraction, with no heart rate, and appearing blue, floppy, and apneic. She was resuscitated through chest compressions and intubation. In the days following her birth, the infant exhibited general seizures with tremors in the lower and upper extremities. An MRI performed 8 days after her birth revealed that the infant had severe hypoxic ischemic encephalopathy. The child will remain fully dependant for all of her care needs for her entire life. She is not expected to develop beyond the level of a one-month-old infant. Liability was based upon failure to aggressively monitor the mother and fetus post administration of antibiotics and failure to deliver the baby when infection was first suspected.

- Failure to Diagnose Down Syndrome

Our Birth Injury Specialists obtained a wrongful birth settlement in the amount of $875,000 when a child was born with Down syndrome. The pregnancy was considered high risk because the mother was 34-years-old and pregnant with twins. In violation of its own policy regarding high-risk pregnancies, the medical center failed to offer the mother an opportunity to undergo amniocentesis and Chorionic Villus Sampling early in course of her pregnancy. Had the doctors detected Down Syndrome with these tests, the mother could have been offered "selective reduction" to terminate the fetus that was determined to be the one with a birth defect. The parents brought claims for emotional distress and economic damages resulting from the complications of Down syndrome through the child's minority. In addition, an economic damages claim was brought for the child himself, for the cost to treat complications in his majority.

- Failure To Perform Timely Cesarean Section

In another case involving cerebral palsy, our birth injury attorneys obtained a binding and final arbitration award against Kaiser, following a two week arbitration. That arbitration award had a present cash value of $4,100,000 and was secured on behalf of a 3-year-old boy afflicted with multiple neurological injuries as a result of negligent delivery. Our birth injury team of attorneys and physician experts were able to prove that the infant endured a period of oxygen deprivation when his mother's uterus ruptured. The uterine rupture was due to an attending midwife's failure to properly manage the mother while in labor. Walkup, Melodia, Kelly & Schoenberger attorneys also proved that obstetrical nurses left the mother unattended prior to the rupture of her uterus, and for that reason failed to appreciate ominous signs of the baby's distress as reported on a fetal heart monitor. Before the beginning of the arbitration, Kaiser had made no settlement offer.

- Delayed Admittance to Hospital (Cerebral Palsy)

Our birth injury trial team negotiated a pre-trial mediated settlement on behalf of a child who suffered profound injuries when her mother's uterus ruptured at the site of a previous myomectomy (surgery to remove a fibroid in the uterine wall). Two weeks prior to the baby's emergent delivery, the child's mother was hospitalized in pre-term labor. After being medicated and released, she was advised to observe strict bed rest and communicate with her OBGYN's office. At 10:00 p.m. the evening before delivery, the parents called to report painful contractions. Without determining the onset, frequency, characteristics or location of the pain suffered by the mother, an on-duty advice nurse told the mother to take an additional dose of her anti-contraction medication and call if her condition worsened. Eight hours later, the mother awoke in severe pain. Her husband called 911. She was taken to a local hospital where the child was delivered by emergency C-section at 32 weeks gestation. We proved that the doctors employees were employees were negligent in failing to order the mother to the hospital at the time of the phone call. The child was diagnosed with periventricular leukomalacia, and later developed infantile spasms and cerebral palsy. The settlement was composed of both an initial cash payment and guaranteed monthly future annuity payments to offset the cost of future medical, therapy, laboratory and attendant care.

- Failure to Recognize Neonatal Hypoglycemia

Our attorneys obtained a mediated settlement of $2,250,000 on behalf of a male infant who now suffers from blindness, developmental delay and cognitive deficits, and who also had his pancreas removed, after nursing staff failed to follow proper protocols when the infant showed signs of hypoglycemia. The infant was born weighing 10 pounds, 7-1/2 ounces, which should have triggered blood screening tests at one, two, four, six and eight hours of age. Any tests revealing low blood sugar levels required that a blood sample be drawn and sent for analysis. In this case, the infant's six-hour test was conducted at seven hours of age, and came back showing low blood sugar. However, the protocol requiring that blood be drawn and sent to the lab was not followed. The infant's parents were never told of the abnormal result or warned to look for signs of hypoglycemia. At 24 hours of age, the infant and his parents were discharged. On the second morning at home, his mother had a hard time rousing him, and he presented at Urgent Care lethargic, not nursing, and with purple feet. He then suffered several seizures and was admitted to the hospital. Tests revealed that he had nesidioblastosis, a disease of the pancreas, resulting in profound, unremitting hypoglycemia. An MRI revealed evidence of posterior cerebral artery infarction, consistent with the diagnosis of severe hypoglycemia. Ultimately, nearly all of the infant's pancreas had to be removed. The settlement in this case was structured to pay monthly guaranteed payments to help offset future costs of attendant and nursing care and to supplement health insurance coverage and public program benefits, plus $732,000 to be paid into a trust on the infant's behalf.

- Infant Death (Uterine Rupture)

Our medical malpractice obstetrical injury lawyers resolved this birth injury case, in a confidential amount, on behalf of the parents of a 2-day-old infant who died after his mother's uterus ruptured during labor. The mother was admitted to the hospital with contractions, but was sent home several hours later because the nurses felt she was not progressing. Once home, she began to experience severe abdominal pain. By the time doctors realized that the infant was outside the uterus in the abdominal cavity, an emergency cesarean section was unsuccessful in delivering the baby before it suffered severe compromise. The child died two days later. Our attorneys demonstrated that the mother should never have been sent home from the hospital, and that had she been monitored properly, her impending uterine rupture would have been recognized, and a timely cesarean section would have been performed. The claim of our clients sought damages for the wrongful death of their daughter as well as the mother's personal injuries.

Patient advocacy group funded by success of painkiller drugs, probe finds

2011-12-24T11:01:00.000-08:00

Patient advocacy group funded by success of painkiller drugs, probe finds
By Charles Ornstein and Tracy Weber
Washington Post
December 23, 2011

The news about narcotic painkillers is increasingly dire: Overdoses now kill nearly 15,000 people a year — more than heroin and cocaine combined. In some states, the painkiller death toll exceeds that of car crashes.

The head of the Centers for Disease Control and Prevention has declared the overdoses from opioid drugs like OxyContin an “epidemic.” And a growing group of experts doubts that they work for long-term pain.

But the pills continue to have an influential champion in the American Pain Foundation, which describes itself as the nation’s largest advocacy group for pain patients. Its message: The risk of addiction is overblown, and the drugs are underused.

What the nonprofit doesn’t highlight is the money behind that message.

The foundation collected nearly 90 percent of its $5 million funding last year from the drug and medical-device industry — and closely mirrors its positions, an examination by ProPublica found.

Although the foundation maintains it is sticking up for the needs of millions of suffering patients, records and interviews show that it favors those who want to preserve access to the drugs over those who worry about their risks.

Some of the foundation’s board members have extensive financial ties to drugmakers, ProPublica found, and the group has lobbied against federal and state proposals to limit opioid use. Painkiller sales have increased fourfold since 1999, but the foundation argues that pain remains widely undertreated.

The group says industry money has had no effect on its advocacy.

“I’m convinced with every shred of my body that our interest is improving the lives of people affected by pain,” said Will Rowe, the foundation’s chief executive, “and we want to do that the best way we can.”

The problem isn’t opioids, Rowe and other group leaders say. It’s poorly trained doctors who prescribe them too easily or in excess.

Yet, critics say the Baltimore-based foundation is making it harder to address a major public-health problem.

“If you were a drug company, wouldn’t it be smart to make it look like you had a patient-oriented group?” said Gary Franklin, a Washington state official who tussled with the foundation over new restrictions on high-dose painkillers.

Its funding makes the group “one and the same” with the pain industry, Franklin said.

ProPublica’s review found that the foundation’s guides for patients, journalists and policymakers play down the risks associated with opioids and exaggerate their benefits. Opioids, derived from the opium plant, reduce the perception of pain by attaching to opioid receptors in the brain, spinal cord and elsewhere in the body.

Some of the foundation’s materials on the drugs include statements that are misleading or based on scant or disputed research.

The group’s board includes some patients but also doctors who are paid to speak and consult for drug companies, a researcher whose clinic has relied on their funding for survival and a public-relations executive whose firm represents them.

Last year, one board member was the lead author of a study about a Cephalon drug. Cephalon sponsored the study, and its employees were co-authors. The study found that the drug, Fentora, was “generally safe and well-tolerated” in non-cancer patients even though it is only approved for severe cancer pain...

CalPERS Lack of Auditing of Kaiser Permanente Services

2011-12-21T14:45:00.000-08:00

Kaiser Permanent employees labor under a draconian contract which prevents any physician or nurse who witnesses abuse or abandonment from notifying anyone of the problem.

CalPERS Lack of Auditing of Kaiser Permanente Services
Resulting in Patient Abandonment, Violation of Elder Abuse Laws
Sacramento, California
12th of Jul, 2011 by User936345

In many ways, CalPERS does an excellent job for California State retirees. However, that description does not extend to the monitoring of Kaiser Permanente, and the many systems Kaiser has in place to frustrate the reporting of retiree abuse, and abandonment. Obviously, CalPERS wants to hear good stories about Kaiser. After all, they are providing service to tens of thousands of State and local retirees. How horrible would it be for CalPERS to discover that the lack of complaints is due to the clever methods Kaiser Permanente has established for sheltering CalPERS from what they "don't need to know."

So what are these mechanisms that prevent nary a complaint from ever reaching CalPERS? They are many, including:

-A Member Services "complaint" system that can often take several weeks, a system that serves to defuse patient anger, but never results in a decision favorable to a retiree. So-called "resolutions" are simply word for word transcriptions of rationales supplied by offending physicians. There is never a meeting with a supervisor. Never a contact from the physician. The "case worker" analyzing the complaint has no medical training because she does not need any, since the finding is a foregone conclusion.

-An appeals process for Member Services "resolutions" to a nameless committee in either the San Francisco Bay Area or Los Angeles. These committees meet in secret, and the names of the attendees are never divulged to patients or their medical representatives. Again, a case worker without medical training is in charge of the paperwork, and, again, the result is a foregone conclusion. (CalPERS could well paper their offices with the stacks of denials resulting from these secret meetings.)

-RISK MANAGEMENT units: These groups are composed primarily of attorneys who are organized for one purpose only. That is, to reduce the risk to Kaiser Permanente from any patient who has been abused or abandoned. In Northern California, one may find this unit at Kaiser Plaza in Oakland. At the local level, a physician is normally assigned to a so-called MedLegal to refer patient "complaints" to RISK MANAGEMENT for burial.

-Ombudsmen: On each Kaiser campus there exists an Ombudsman. These individuals are typically either non-medical personnel or RN's who are very charming, but will tell patients immediately that they have no power to correct problems relative to medical care. Ombudsmen on Kaiser campuses are not respected by medical personnel. At best, an Ombudsman might serve as a traffic cop. However, if a patient has been abandoned, he or she will stay abandoned. If a patient has been referred to RISK MANAGEMENT, he or she will stay referred to RISK MANAGEMENT.

-THE CONTRACT: Kaiser Permanent employees labor under a draconian contract which prevents any physician or nurse who witnesses abuse or abandonment from notifying anyone of the problem. HIPAA rules and regulations having to do with medical information confidentiality are used by Kaiser in the same way as "national security" is sometimes used by the government, that is, to frustrate the ability of witnesses to have their information considered by proper authorities. In such an environment, it is unlikely that CalPERS will ever hear from all but the most persistent patients. (Illness, discomfort and other factors also play into the inability of retirees to be heard by CalPERS.)

Requesting a more aggressive CalPERS relative to Kaiser Permanente is the first purpose of this complaint. The additional purpose of this complaint is to notify CalPERS that its own systems for receiving and taking action relative to medical malfeasance are deficient. A much more immediate and less impersonal system needs to be designed. A five to ten day turnaround time for all complaints is simply inadequate. Routine surprise audits also need to be conducted by CalPERS of all Kaiser Permanente facilities. Further, the rating systems associated with CalPERS relative to Kaiser Permanente are out of date, and serve only to mislead both active and retired personnel into choosing a service that, as it is currently structured, is dollars vs patient oriented. CalPERS actions taken as a result of this NOTICE will be appreciated by all patient advocates, as well as Kaiser employees who are in positions to witness, but not to openly challenge, a system established for other than patient well being. Kaiser Permanente is not a hopeless organization. However, CalPERS, which siphons millions of dollars into Kaiser coffers every year, must be more diligent in making certain that the intentions of CalPERS and the delivery systems hired to fulfill those intentions are congruous.

Jerry Sandusky vows "fight to the death" against boys he abused

2011-12-13T09:59:00.000-08:00

Jerry Sandusky's attitude toward his victims is sadly common among human beings. Sandusky sees his victims as abusers because they made accusations against him. He feels they should leave him alone.

This attitude is actually startlingly common. Many people feel no remorse when they are called out for wrongdoing; instead, they attack their victims once again. They hire a lawyer that cares only about winning. Sadly, many insurance companies do this to the people that pay them for health insurance. I'm experiencing this same attitude from Kaiser Permanente. It's especially creepy when your doctor and your insurance company are one and the same, as in Kaiser Permanente. Then you end up with your doctor working to harm your health! At least with fee for service insurers, it isn't your doctor who's denying necessary care.

Vowing 'fight to the death,' Sandusky waives hearing in child sex-abuse case
Sandusky waives hearing, vows to fight charges
By MARK SCOLFORO and MARYCLAIRE DALE
Associated Press
Dec. 13, 2011

Former Penn State assistant football coach Jerry Sandusky opted against forcing his accusers to make their claims of child sex abuse in a packed courtroom Tuesday but then took his case to the courthouse steps as his lawyer assailed the credibility of the alleged victims and witnesses.

"There will be no plea negotiations," defense lawyer Joseph Amendola said. "This is a fight to the death."

Waiving such a preliminary hearing is not unusual but it was unexpected in this case: Amendola repeatedly had said his client was looking forward to facing his accusers. Afterward, he called the cancellation a "tactical decision" to prevent the men from reiterating the same claims they made to the grand jury.

Lawyers for the alleged victims said some were relieved they would not have to make their claims in public before a trial, but others said they had steeled themselves to face Sandusky and were left disappointed.

"It would have been apparent from watching those boys and their demeanor that they were telling the truth," said Howard Janet, a lawyer for a boy whose mother contacted police in 1998 after her son allegedly showered with Sandusky.

Sandusky has denied the allegations, which led to the departures of longtime Penn State football coach Joe Paterno and the university president. He is charged with more than 50 counts that accuse him of sexually abusing 10 boys over the span of 12 years...

Kaiser Permanente's Robert Pearl runs a two-tiered system regarding patient access to test results

2011-12-10T19:37:00.000-08:00

Robert Pearl runs a two-tiered system at Kaiser Permanente: some patients get their test results right away, but other patients might never see their test results--and their doctors might not ever see the results, either.

Here's an example of unavailable--and falsified!--X-ray results. Why would Kaiser do this? Perhaps to cover-up mistakes.

One remark of Dr. Pearl is certainly true: he really does work hard to "keep patients out of the hospital." Unfortunately, this sometimes causes the deaths of Kaiser patients.

See Kaiser executives.

Permanente boss warns of two-tiered health system
December 07, 2011
by Brendon Nafziger , DOTmed News Associate Editor
Travelers to South America can access their bank account from any humble ATM in the airport, but patients admitted to the emergency room with chest pain over the weekend often can't get their hands on electrocardiogram readings taken previously at a doctors office until the following Monday, thus raising health care costs.

Dr. Robert Pearl, the outspoken CEO of the Permanente Medical Group, a division of Kaiser Permanente, used this example to show why health care was lagging behind other industries when it comes to using information technology.

"Why do we provide so much less to our patients than banks do?" he asked attendees at the 8th Annual American Health Care Conference in Anaheim, Calif. on Tuesday.

Pearl said implementing the information technology retail and banking sectors take for granted was one of the only hopes to redeem the American medical system before it devolves into a two-tiered system, with one style of health care for the rich and one for everyone else.

"American health care most closely resembles a 19th century cottage industry," he said, adding that it was a fragmented system, mostly paper-based, with little leadership structure.

While the poor today don't have the same level of health care provision in the United States, he thinks it could get much worse. "I'm talking about a system where the middle class gets less and less, higher and higher deductibles, till there's rationing as the solution to the American health care crisis. Once that happens, we'll never go back. Today is the last great hope, I believe, for American medicine," he said.

Video games

Pearl thinks better integrating technology and employing preventive services is the best shot at boosting efficiency and reining in costs. He noted that the Kaiser Permanente system, the country's largest non-profit health plan, has been pioneering ways to help doctors share information and keep patients out of the hospital.

For instance, in a claim Pearl has made before, he said if every American received the same level of preventive services that Kaiser provides, there would be 200,000 fewer heart attacks and strokes. It's an extrapolation from a New England Journal of Medicine article from June 2010 that found the number of heart attacks at Kaiser fell about a quarter from 1999 to 2008, a drop credited in part to preventive strategies, such as giving patients beta-blockers or statins, and coordinated by Kaiser's complete electronic medical record system.

The technologies Pearl envisions to help are not even terribly cutting-edge. He sees a lot of mileage out of video and e-mail .

"I think video will be a major part of how health care is delivered in the future, if we're successful," he said.

For instance, he said in his system teenagers receiving Accutane acne treatments have tele-dermatology conferences so doctors can make sure the treatment is working and the patient isn't getting depressed, a known side effect of the drug. The conference only takes a few minutes, and doesn't require scheduling weeks in advance.

E-mail has similar productivity-boosting benefits. Pearl estimates the average Kaiser patient sends 5-6 secure e-mails to the health system a year. He thinks if this became widespread, it could lead to billions of dollars in savings. Of course, the trouble is figuring out a way doctors can get reimbursed for these services.

But it wont happen, unless we're able to change the structure, change the financing, and put in place leadership structure to make it happen," he said.

[Maura Larkins comment: Kaiser needs a new leadership structure in place to end the practice of cutting corners to make profits. Kaiser should follow basic medical standards for all patients.]

Is there a cover-up of serious errors at Kaiser hospitals?

2011-12-10T11:49:00.000-08:00

(< < < Click on image to enlarge.)

"Since 2007, hospitals have been required to report any errors from a list of 28 “adverse events” that put patients in immediate jeopardy of injury or death."

But if the hospitals don't report the events, then they don't get penalized!

The San Diego Union-Tribune reports (see story below) that Scripps La Jolla is "among most penalized."

But the numbers just don't add up. Kaiser Medical Center in San Diego has a much higher death rate than Scripps Memorial Hospital, but Scripps receives more penalites. Scripps, the nationally-ranked UCSF in San Francisco and Southwest Healthcare in Riverside have received the most penalties from the California Department of Public Health.

How could this happen? Probably because Kaiser is covering up mistakes by falsifying medical records. Kaiser mental health workers recently reported that they were forced to falsify medical records. It's time for other Kaiser workers to tell the truth, too. Kaiser patients would be safer if Kaiser received appropriate administrative penalties.

I have personal experience that Kaiser Permanente in San Diego has falsified medical records. On July 7, 2011 I was sent home from the Emergency Room on Zion because I insisted that doctors look at my X-rays taken on June 15, 2011. The doctors refused to do so. My doctor said she didn't want to "tie up" her "resources", and ordered me to be sent home.

As I was leaving, a nurse stopped me and asked me to sign a form, but she had her hand covering the text on the form. I asked to see what the form said. It said I was leaving against medical advice! I was quite surprised.

I asked the nurse, "I can stay if I want to?"

She said, "No."

I took the form with me when I left, and I heard the nurse tell another worker, "She took it with her!"

"Get another one," her friend said.

Sure enough, when I later obtained my medical records, I found that the nurse had indeed acquired another form, and she and the doctor both signed it! The doctor also wrote in the record that I had left of my own volition. I have attached the signed form to this post, but I covered up the doctor's and nurse's names because I believe that most Kaiser doctors would have done exactly the same thing. I believe they understand that they must work as a "team" with the "Kaiser family." The doctors increase their profits by not "tying up resources."

When I filed a complaint with Member Services, my complaint simply disappeared. I filed a complaint about the disappearance, and that complaint disappeared, too! Finally Kaiser processed another complaint. The "resolution letter" stated, the "issue you have raised will be addressed." I suspect it was addressed and delivered to the trash.

State fines Scripps Memorial for surgery error
Janet Lavelle
SDUT
Dec. 9, 2011

Scripps Memorial Hospital La Jolla was among 14 California hospitals issued administrative penalties Thursday for errors that caused or could cause serious injury or death to patients, state health officials said.

This is the sixth penalty Scripps Memorial has received since the California Department of Public Health began issuing them in 2007 — more than any other hospital in the county.

Statewide, UC San Francisco Medical Center is the only other hospital to get six penalties, exceeded only by Southwest Healthcare System in Riverside County, which has been hit with seven since 2007, state records show.

Scripps La Jolla was fined $100,000 after a one-inch pin was mistakenly left inside a patient’s neck during spinal surgery in October 2010.

The pin was found and removed in a second surgery more than 12 hours later, after the patient complained of pain, and trouble swallowing and breathing throughout the day. Three X-rays were done that day, but the problem wasn’t identified until the surgeon returned to the hospital late that night and spotted the pin on the last X-ray.

Scripps La Jolla was the only San Diego County hospital cited among the 14 on Thursday.

In a phone interview with reporters, Pam Dickfoss, acting deputy director of the state health department’s Center for Health Care Quality, said the penalties are part of a larger effort to make hospitals safer.

“Our goal is to improve the quality of health care in all California hospitals,” Dickfoss said.

Since 2007, hospitals have been required to report any errors from a list of 28 “adverse events” that put patients in immediate jeopardy of injury or death. So far, 214 penalties have been issued to 123 hospitals with assessed fines of more than $7.8 million, Dickfoss said...

Here's the list of local hospitals that reported errors. Isn't it a bit suspicious that Kaiser hasn't reported a single error, when it has higher death rates than Scripps, UCSD, and Sharp?

Hospital Administrative Penalties for San Diego County
Penalties Issued in 2011

Scripps Memorial HospitalNew Window
9888 Genesee Avenue, La Jolla, 92037, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its surgical policies and procedures. This resulted in a patient having to undergo a second surgery to remove a retained foreign object. The penalty is $100,000.

Palomar Medical CenterNew Window
555 E. Valley Parkway, Escondido, 92025, San Diego County - The hospital failed to ensure the health and safety of a patient when it did not implement its established policies and procedures for the safe distribution and administration of medication. This is the second administrative penalty issued to the hospital. The penalty is $75,000.

Pomerado HospitalNew Window
15615 Pomerado Road, Poway, 92064, San Diego County - The hospital failed to ensure the health and safety of a patient when it did not follow its policies and procedures for fall prevention. This is the third administrative penalty issued to the hospital. The penalty is $75,000.

Scripps Memorial HospitalNew Window
354 Santa Fe Drive, Encinitas, 92024, San Diego County - The hospital failed to ensure the health and safety of a patient when it did not follow its surgical policies and procedures. This is the first administrative penalty issued to the hospital. The penalty is $50,000.

Scripps Memorial HospitalNew Window
9888 Genesee Avenue, La Jolla, 92037, San Diego County - The hospital failed to ensure the health and safety of a patient when a patient was not adequately supervised during a surgical procedure. This is the second administrative penalty issued to the hospital. The penalty is $75,000.

Sharp Memorial HospitalNew Window
7901 Frost Street, San Diego, 92123, San Diego County - The hospital failed to ensure the health and safety of a patient when it failed to accurately administer a prescribed medication. The penalty is $25,000.
Penalties Issued in 2010

Palomar Medical Center (PDF)New Window
555 E. Valley Parkway, Escondino, CA 820211, San Diego County - The hospital failed to ensure the health and safety of a patient when it did not follow its patient care policies and procedures. This is the first administrative penalty issued to this hospital. The penalty is assessed at $50,000. - Administrative penalty issued based on finding during survey completed on 01/25/2010.

Grossmont Hospital (PDF)New Window
5555 Grossmont Center Dr., La Mesa 91942, San Diego County - The hospital staff failed to follow the policies and procedures for surgical and invasive procedures. Administrative penalty issued based on findings during a survey completed 04/03/2009.

Pomerado Hospital (PDF)New Window
15615 Pomerado Rd., Poway 92064, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its policies and procedures for fall prevention. Administrative penalty issued based on findings during a survey completed 09/02/2009.

Rady Children’s Hospital (PDF)New Window
3020 Children's Way, San Diego 92123, San Diego County - The hospital failed to implement its established policies and procedures for the safe and effective administration of medication. Administrative penalty issued based on findings during a survey completed 05/14/2009.

Scripps Green Hospital (PDF)New Window
10666 North Torrey Pines Rd., La Jolla 92037, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its surgical policies and procedures for equipment cleaning. Administrative penalty issued based on finding during survey completed on 10/15/09.

Scripps Green Hospital (PDF)New Window
10666 North Torrey Pines Rd., La Jolla 92037, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its surgical policies and procedures. Administrative penalty issued based on finding during survey completed on 05/21/09.

Scripps Mercy Hospital (PDF)New Window
4077 Fifth Ave., San Diego 92103, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its surgical policies and procedures. Administrative penalty issued based on finding during survey completed on 07/02/09.

Scripps Memorial Hospital La Jolla (PDF)New Window
9888 Genesee Avenue, La Jolla 92037, San Diego County - The hospital failed to ensure the health and safety of its patients when it failed to follow its surgical policies and procedures. This is the fourth administrative penalty issued to this hospital. The penalty is assessed at $50,000. Administrative Penalty issued based on finding during survey completed on 07/24/2009.

Sharp Memorial Hospital (PDF)New Window
7901 Frost St., San Diego 92123, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its surgical policy and procedure. This resulted in a patient having to undergo a second surgery to remove a retained foreign object. Administrative penalty issued based on findings during a survey completed on 04/06/2009.

Tri-City Medical Center (PDF)New Window
4002 Vista Way, Oceanside 92055, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its surgical policies and procedures. Administrative penalty issued based on finding during survey completed on 10/15/09.

University of California San Diego Medical Center (PDF)New Window
200 West Arbor Dr., San Diego 92109, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its surgical policy and procedure. This resulted in a patient having to undergo a second surgery to remove a retained foreign object. Administrative penalty issued based on findings during a survey completed on 02/24/2009.
Penalties Issued in 2009

Scripps Mercy Hospital (PDF)New Window
4077 Fifth Avenue, San Diego 92103, San Diego County - Administrative penalty issued based on finding during a survey completed on 09/10/2008.

Scripps Mercy Hospital (PDF)New Window
4077 Fifth Avenue, San Diego 92103, San Diego County - The hospital failed to have a safe, effective and timely system for dispensing and administering medications. Administrative penalty issued based on finding during a survey completed on 4/8/2008.

Sharp Chula Vista Medical Center (PDF)New Window
751 Medical Center Ct., Chula Vista 91911, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its surgical policy and procedure. This resulted in a patient having to undergo a second surgery to remove a retained foreign object. Administrative penalty issued based on findings during a survey completed on 01/22/2009.

Sharp Mesa Vista Hospital
7850 Vista Hill Avenue, San Diego 92123, San Diego County - Administrative penalty issued based on findings during survey completed on 12/02/2008. Information specific to the incident resulting in the issuance of this Administrative Penalty can not be released pursuant to Section 5328.15 of the Welfare and Institutions Code.

Tri-City Medical Center (PDF)New Window
4002 Vista Way, Oceanside 92056, San Diego County - The hospital failed to ensure the health and safety of a patient when the hospital did not follow its policies and procedures for fall prevention. Administrative penalty issued based on findings during a survey completed on 03/03/2009.

University of California San Diego Medical Center (PDF)New Window
200 West Arbor Drive, San Diego 92103-8976, San Diego County - Administrative penalty issued based on finding during a survey completed 11/26/2008.
Penalties Issued in 2008

Grossmont Hospital (PDF)New Window
5555 Grossmont Center Drive, La Mesa 91942, San Diego County - The hospital failed to ensure the health and safety of a patient when they failed to activate a stationary ventilator during a transfer of the patient from a transport ventilator resulting in the patient’s death. Administrative penalty issued based on finding during a survey completed on 4/4/2008.

Palomar Pomerado Health System (PDF)New Window
15615 Pomerado Road, Poway 92064, San Diego County - The hospital failed to maintain its anesthesia equipment in proper functioning order. As a result three patients experienced surgical awareness during surgical procedures. Administrative penalty issued based on finding during a survey completed on 4/3/2008.

Promise Hospital of San Diego (PDF)New Window
5550 University Avenue, San Diego 92105, San Diego County - The hospital failed to ensure the health and safety of its patients by allowing an unlicensed staff person to function as a licensed nurse. Administrative penalty issued based on finding during a survey completed on 5/15/2008.

Scripps Green Hospital (PDF)New Window
10666 North Torrey Pines Road, La Jolla 92037, San Diego County - The hospital failed to ensure the patient safety in the surgical department when a patient fell off an operating table during surgery. Administrative penalty issued based on finding during a survey completed on 4/8/2008.

Scripps Green Hospital (PDF)New Window
10666 North Torrey Pines Road, La Jolla 92037, San Diego County - The hospital failed to implement policies and procedures to provide for effective surgical service infection control. Administrative penalty issued based on finding during a survey completed on 11/27/2007.

Scripps Memorial Hospital (PDF)New Window
9888 Genesee Avenue, La Jolla 92037, San Diego County - The hospital failed to implement policies and procedures related to the safe and accurate use of medications in emergent situations. Administrative penalty issued based on finding during a survey completed 11/27/2007.

Scripps Memorial Hospital (PDF)New Window
9888 Genesee Avenue, La Jolla 92037, San Diego County - The hospital failed to develop and implement policies a procedures to protect patient safety related to the use of controlled substances. Administrative penalty issued based on finding during a survey completed 11/27/2007.

Scripps Memorial Hospital (PDF)New Window
9888 Genesee Avenue, La Jolla 92037, San Diego County - The hospital failed to protect a patient's right to considerate and respectful care. Administrative penalty issued based on finding during a survey completed on 8/30/2007.

University of California, San Diego Medical Center (PDF)New Window
200 West Arbor Drive, San Diego 92103-8976, San Diego County - The hospital failed to develop and implement policies and procedures to protect patient safety by failing to ensure the safe administration of medications. Administrative penalty issued based on finding during a survey completed on 9/18/2007.

New Study Finds California Pacific Medical Center (San Francisco) Profits Not Matched by Charity Care

2011-12-10T11:00:00.001-08:00

CPMC (California Pacific Medical Center) spent about four times LESS on charity care than St. Francis Memorial Hospital, which is about one-third of CPMC's size.

California Hospital News Roundup for the Week of December 9, 2011
California Healthline
December 09, 2011

California Pacific Medical Center [San Francisco] spends significantly less on care for low-income residents than other private not-for-profit hospitals in San Francisco, according to a report by UC Hastings College of the Law, the San Francisco Chronicle reports.

For example, the report found that CPMC spent about four times less on charity care than St. Francis Memorial Hospital, which is about one-third of CPMC's size.

CPMC and its St. Luke's campus had an average annual net income of about $149 million between 2006 and 2010, nearly 12 times the combined annual profit of the other facilities, according to the report.

CPMC spokesperson Kevin McCormack said that last year, the hospital provided more than $15.3 million in charity care -- nearly threefold what it spent in 2007.

According to McCormack, the report is biased because it was prepared at the request of community organizations that have criticized the hospital (Colliver, San Francisco Chronicle, 12/9).

New Study Finds CPMC Profits Not Matched by Charity Care
by Jonathan Nathan
Beyond Chron
Dec. 09‚ 2011

Members of the Community Economic Development Clinic of the University of Hastings College of the Law released a study on the profitability and charitable care efforts of San Francisco's nonprofit private hospitals on Thursday in a press conference, with representatives of various community organizations on hand to discuss the implications of the study and, specifically, the potential impacts of the proposed rebuild of Sutter Health's California Pacific Medical Center (CPMC).

The study detailed the financial capacity and performance of the major nonprofit hospitals in San Francisco, as well as their various levels of compliance with municipal guidelines on charitable care, based on a review of data gathered by the Department of Public Health, the Office of Statewide Health Planning and Development, the IRS, and publicly available documents.

The study concluded that CPMC, comprised of four campuses around San Francisco, has a significantly greater financial capacity than any of the other private nonprofit hospitals in the city, but spends a disproportionately lower amount on charitable care, Medi-Cal patient care, and Healthy San Francisco patient care. Medi-Cal and Healthy San Francisco are, respectively, the statewide and citywide programs for low- and middle-income consumers in the city. The St. Luke's campus, for example, is Sutter Health's most profitable hospital in California, and has accounted for over a quarter of Sutter's total profits over the last five years. St. Luke's had a net income of $743.9 million between 2006 and 2010 for an average annual profit of $149 million, roughly 12 times the average of all other area nonprofit hospitals combined. Yet the ratio of charitable care to net patient revenue at St. Luke's was lower than that at St. Francis, a hospital which had a net profit in the negatives over the past five years, and CPMC as a whole performed worse as a charitable institution than any other in the city, nearly five percentage points lower than the 6% guideline laid out by the Board of Supervisors.

Further, the study presents evidence that the chasm between CPMC's charitable performance and that of other area nonprofit hospitals would only worsen if CPMC's current rebuild plan were put into action, as the rebuild proposes cutting the number of beds at the St. Luke's campus, in the Mission, from over 200 beds to 80. As the St. Luke's campus is by far the best-performing of CPMC's hospital locations in terms of charitable care, the implications for CPMC's ability to fulfill its obligations to the community, as set forth by the Board of Supervisors, are dire. While CPMC spent nearly 4% of its revenue on charitable care, the other three campuses in the system spent less than 1%. With CPMC, the city's largest provider of Medi-Cal health care by far, currently slated to cut its capacity by more than two thirds, there is a clear threat to publicly funded health care for low- and middle-income consumers, and several of the assembled speakers at the press conference warned that the move would cause overcrowding at all of San Francisco's hospitals, particularly San Francisco General.

Emily Jie-Ming Lee, Lead Organizer for the Chinese Progressive Association, discussed the CPMC situation by framing it in terms of the Occupy movement, and called attention to the fact that health care is now the prime barrier to a middle-class lifestyle. She briefly spoke of one woman who had to remortgage her home to pay for cancer treatments, and eventually had to default and lost her home. Lee noted that City residents rely on public insurance in greater numbers than the national average, a trend which only increase as federal health care reform measures take hold in the coming years. Lee called on CPMC to increase its share of charitable care in the City, and to equalize the burden among its campuses. With St. Luke's seeing four times more charitable care cases than the other three campuses combined, “it does not speak well to equal access to care,” Lee said.

Paul Kumar, a spokesperson for the National Union of Healthcare Workers, called out CPMC for double-charging San Francisco taxpayers, in the sense that the system reaps the benefits of municipal tax relief while forcing customers to pay more out-of-pocket for services. Kumar made it clear, in no uncertain terms, that CPMC's refusal “to do anything like its appropriate share of charity care” has the same effect on everyday taxpayer's pocketbooks as would an actual tax increase, due to the stress it places on City finances. Given that CPMC is part of one of the most profitable health care systems in the state, Kumar argued, “claims of financial incapacity are laughable. If other hospitals, making far less money than CPMC, are able to do their share of charity care, why is it so unsustainable for CPMC?”

The various speakers made it clear that they were not against CPMC's rebuild proposals in principle, but that they wanted to make sure that whatever steps were taken would keep workforce development, local communities, low-income consumers, affordable housing, and charitable care as priorities. Said Lee, “We want to see this project built and we want a good project.”

NLRB Judge Throws Out Kaiser Elections

2011-12-09T15:27:00.000-08:00

NLRB Judge Throws Out Kaiser Elections
New Vote for 43,000 California Workers
by Cal Winslow
Jul. 20‚ 2011
Beyond Chron

The National Labor Relations Board (NLRB) has just thrown out the results of the September/October 2010 representation election at Kaiser Permanente, the huge California based Health Maintenance Organization. The ruling, by an administrative law judge, has handed California healthcare workers a stunning victory. In that election, the Service Employees International Union (SEIU) defeated the National Union of Healthcare Workers (NUHW), the new union challenging SEIU in the healthcare industry. The 2010 election – involving 43,000 Kaiser service and tech workers - was marred by a SEIU campaign of lies, fear and intimidation. The election itself was estimated to have cost SEIU between $20 and $40 million dollars – more than $500 per vote.

NUHW appealed, charging SEIU and Kaiser with a host of unfair labor practices, above all with collusion in denying service and technical workers a free and fair choice election, relying, crucially, on Kaiser’s illegal decision in 2010 to withhold scheduled wage increases for new southern California NUHW members.

In her July 18, 2011 decision, Washington DC Judge Lana H. Parke ruled that SEIU had indeed “interfered with unit employee’s free and uncoerced choice in the election.” Underscoring the significance of her ruling, Judge Parke explained, “The Board does not lightly set aside representational elections…There is a strong presumption that ballots cast under specific NLRB procedural safeguards reflect the true desires of the employees.” She then ordered a new election so that workers will have “the right to cast their ballots as they see fit…in the exercise of this right free from interference…”

The vote, taken in September/October 2010 was the largest union election in the US in the last seven decades.

NUHW spokesman Leighton Akio Woodhouse hailed the decision as a “total victory for our members – SEIU’s whole campaign was dependent on Kaiser’s violation of the law.”

In early 2010, NUHW Southern California nurses and professionals successfully challenged SEIU in NLRB administered elections. Kaiser responded by unilaterally denying these workers scheduled contractual wage increases, increases guaranteed, according to labor law, even when a union is replaced by another

Judge Parke’s ruling drew attention to the conduct of Kaiser Permanente Regional President Ben Chu who reinforced SEIU’s illegal threats during a large employee town hall forum prior to the election. SEIU “was joined in its warnings by Kaiser’s President [Ben] Chu, who informed employees that only members of coalition unions were guaranteed PSP incentive bonuses. “

The ruling focuses on SEIU. The withholding of wages, subsequently found by the NLRB to be illegal (back wages increase were ordered to be paid) gave SEIU a key opening for a barrage of misinformation.

Here’s just one example from a SEIU campaign leaflet: “After Southern California RNs and pros voted to join NUHW, here’s what happened: They lost their 2% raise in April. That means a loss of more than $1600 a year for some pros and RNs… They are no longer eligible for up to $2000 a year in tuition reimbursement…” Parke noted “30 disseminations of this statement in as many facilities.” It was just one of many. It was a lie.

“We won,” says Jonathan Siegel, the Oakland lawyer who led NUHW’s appeal. “I don’t want to quibble, she didn’t go far enough.”

Siegel believes Parke erred in not finding Kaiser also at fault. “It is clear that Kaiser and SEIU worked together to have raises come due precisely at election time, while arguing a NUHW victory would negate them.”

“But we won, they lost! SEIU will no doubt appeal, that will take 6 to 12 months, we may cross-appeal, but I’m certain the ruling will stand, so we’re looking for a new election in 2012.”

This California conflict remains, I’ll argue, the most important issue in US labor today, not as spectacular as the February days in Madison, to be sure, but ongoing and stark in its implications –can workers stand up to corporate power? With unions? What kind?

The California healthcare union dispute stems from the 2009 trusteeship of SEIU’s California local, the 150,000 strong United Healthcare Workers- West (UHW), then a militant, progressive union, now a shambles.

The California healthcare workers took issue with SEIU’s corporate structures and strategies, above all its back-door wheeling and dealing with healthcare corporations and corrupt politicians – policies aimed at increasing members (read dues payers) at any cost, most often at the expense of the rights and standards of its own members, healthcare workers.

They objected as SEIU spent lavishly on politicians (Blagojevich in Illinois) signed ten year contracts (in Washington State) gave up the right to strike (in California nursing homes), abandoned organizing drives (in Santa Rosa), sabotaged healthcare reform (with Arnold Schwarzenegger), ignored staggering intern corruption (LA local 6434) – all with the justification that cultivating friendly employers and politicians was the road to grow and influence. They are still doing it.

Today the healthcare corporations - profit and not-for profit alike - are as voracious as any. There is no recession for them. Kaiser reported a net income of $921 million for the first quarter of 2011, with reserves of more than $12 billion. Still, last month it announced it would raise premiums for more than 300,000 Californians. Kaiser officials claimed this would amount a 10.7 increase, but consumer groups predicted increases of up to 17% for some subscribers.

At the same time, George Halvorson, the CEO for Kaiser Foundation Health Plan and Kaiser Foundation Hospitals received compensation of $6.7 million.

“What is their justification for causing economic hardship on 300,000 people?” asks Woodhouse. “They’re doing incredibly well financially (and) sitting on huge reserves.”

Still Kaiser wants concessions and SEIU is handing them out. Worse, while the nation’s second-largest union announces one sham national political campaign after another, it has virtually abandoned its UHW members. Roy Chaffee, a call center clerk at Kaiser’s Vallejo call center, reports that “SEIU has withdrawn staff, they’re not visible, we have to fend for ourselves, with Kaiser taking full advantage – the changes have been unprecedented and all detrimental.”

Angela Glasper, Kaiser Antioch, fired executive board member of pre-trusteeship UHW, says, “We have not seen them /SEIU/… we get no representation at all. And we have people getting fired, some with 20 years on the job. It’s a big thing.”

And NUHW? According to NUHW’s John Borsos, “We are already working for the new election – but we’re mostly doing what unions are supposed to do, fighting back against employers demanding concessions, fighting for better standards for our members. And organizing. I have to say -in contrast with far too many unions today – we’re not rolling over in the face of employer demands for concessions. We’re in the middle of contract negotiations for several thousand healthcare workers.”

And it’s not just about talk. On May 18, 2011, 2500 NUHW members struck Kaiser in Southern California: 1100 nurses and 100 professional (social workers, therapists, dieticians, medical technicians) and picketed Kaiser’s Los Angeles medical Center in Hollywood, rejecting concessions and demanding a decent contract in a powerful display of solidarity.

On June 21 In Salinas, 850 NUHW members struck the Salinas Valley Memorial Hospital. The day- long strike, the first ever in the hospital’s 58-year history was in response to stalled negotiations with hospital management workers. NUHW is fighting plans to cut more than 100 direct-care positions and trim pension and healthcare benefits for new hires.

It is important to note that in each strike, SEIU sent multiple mailers to the workers involved, urging them to cross picket lines.

At the same time, NUHW is joining with other workers, community and consumer groups to expose corporate greed. At Salinas Valley NUHW members revealed the fact that Samuel Downing, outgoing chief executive, was granted a retirement package that included $5 million in supplemental payments plus a $150,000 annual benefit.

These struggles are critical. NUHW is rebuilding at a time when the situation of workers is increasingly desperate; they come at a time when it ought to be self-evident that concessions don’t work; they come at a time when the political class, here in California, across the nation, internationally, is singing just one song: austerity!

There is, however, an alternative. The NLRB ruling on the Kaiser election will strengthen it. “It was a shot of hope,” reports Glasper. “ People are smiling today, we’re rejuvenated. We still are the union. They tell us we our voices don’t count. We remember, they do.”

“This ruling is a tremendous vindication for us,” says Chafee. “It is a vindication for thousands of honest healthcare workers, the victims of the SEIU – we are excited and hopeful, we can still regain our union, we can restore our economic security, we can regain our voice and do the job we want to do – take care of and defend the rights of our patients.”

Cal Winslow has written extensively on the subject of the SEIU and NUHW. He is the author of Labor’s Civil War in California, PM Press and an editor of Rebel Rank and File: Labor Militancy and Revolt From Below during the Long Seventies (Verso, 2010). He is a Fellow at UC Berkeley, Director of the Mendocino Institute and associated with the Bay Area collective, Retort. He can be reached at cwinslow@berkeley.edu

SEIU-UHW Field Rep Lisa Cox Shows True Colors by Teaming Up with Kaiser Permanente... Permanently

2011-12-09T15:23:00.000-08:00

SEIU-UHW Field Rep Lisa Cox Shows True Colors by Teaming Up with Kaiser Permanente... Permanently
Stern Burger with Fries
November 21, 2011

Ever wonder how deep the collusion is between SEIU and Kaiser Permanente? Well, would it surprise you that SEIU’s Field Reps are taking jobs as Kaiser supervisors… and are now responsible for disciplining SEIU-UHW’s own members?

That’s exactly what happened at Kaiser San Francisco Medical Center, where workers report that SEIU Field Rep Lisa Cox just became a manager of the hospital’s Environmental Services Department.

Cox is the SEIU-UHW Field Rep who recently teamed up with management to threaten and bully SEIU-UHW’s own members in advance of the giant strike on September 22. Here’s what one worker wrote about Cox:

After talking with co-workers about the strike during a break, I was called into my director's office and was told to stop telling people they have the right to honor NUHW's picket line. She and her managers were telling employees that if they respected the picket line, they’d be considered a "no-show" and would be disciplined. At that point, Lisa Cox (the SEIU Rep) came into her office and told me, in front of my director, that SEIU did not support the strike and would support management's decision to discipline. My manager then said if I was "caught" talking about the strike, she would suspend me.

And it gets worse.

As the Field Rep, Cox was responsible for all of the hospital workers’ grievances and knew all of the intimate details about each worker’s case. By flipping to management, Cox is committing the highly unethical act of basically handing all these confidential details to management so they can screw workers.

Sounds par for the course for SEIU. After all, what can you really expect from Field Reps who're trained by SEIU officials to systematically bully and deceive the union's own members... like they did during last year's Kaiser election and so many others.
Posted by SternBurger

Kaiser Permanente violated the law to help a public agency that buys employee health coverage; did it a nice return on the investment?

2011-12-06T17:58:00.000-08:00

In fact, Kaiser Permanente Medical Center in San Diego has lower survival rates than other hospitals in San Diego which did not get recognition from Leapfrog Group. Why would this be? Is it possible that Leapgfrog Group is looking to save money on health insurance for employees, not to ensure the survival of their employees?

Recently I sent a letter to Jeffrey Weisz, executive medical director of Southern California Permanente Medical Group, telling him that certain Kaiser doctors had inappropriate links with public agencies that buy employee health coverage. I can prove that Kaiser violated the law to help an employer who was being sued by a Kaiser patient. I told Dr. Weisz I'd hand over documentation if the San Diego head of SCPMG, James Malone, would meet with me. I received no response.

So I'm not surprised that "public agencies that buy employee health coverage" would vote for Kaiser. They are getting more from Kaiser than is readily apparent.

"A consortium of large corporations and public agencies that buy employee health coverage, The Leapfrog Group rates hospitals and publishes the annual list in its effort to encourage hospitals to improve safety, quality and affordability."

UCSD, Kaiser San Diego named national Top Hospitals
Janet Lavelle
SDUT
Dec. 6, 2011

UCSD Medical Center and Kaiser Permanente San Diego Medical Center were among 65 hospitals nationwide and the only ones in the county to be named a 2011 “Top Hospital” by the influential Leapfrog Group on Tuesday.

A consortium of large corporations and public agencies that buy employee health coverage, The Leapfrog Group rates hospitals and publishes the annual list in its effort to encourage hospitals to improve safety, quality and affordability.

Nearly 1,200 hospitals voluntarily submitted performance data and participated in Leapfrog’s annual survey, which uses nationally standardized measures so consumers can compare hospitals nationwide.

The survey focused on three areas: patient outcomes, resources used to care for patients, and management practices promoting safety and quality, according to Leapfrog. The organization looked at what hospitals do to prevent medical errors, reduce deaths in high-risk procedures like heart bypass surgery, and reduce hospital readmissions for conditions such as pneumonia and heart attack.

Locally, Alvarado, Paradise Valley and Pomerado hospitals did not participate. Among the 65 award winners nationwide, 21 were in California and 18 of those were Kaiser Permanente hospitals. For more information and to view The Leapfrog Group hospital ratings, visit www.leapfroggroup.org.

Other organizations also provide data for consumers to compare hospital safety and quality.

The U.S. Department of Health and Human Services has a nationwide "Hospital Compare" ratings website.

The nonprofit California HealthCare Foundation provides a "Cal Hospital Compare" ratings website just for California hospitals.

[Maura Larkins comment: Warning! The "Cal Hospital Compare" site only looks at how the hospital treats you, not how your doctor treats you. If the doctors are giving poor diagnosis and treatment, you won't see that reflected in this site. You'll only find out about infections and accidents in the hospital. The truth is that Kaiser is rated far lower than UCSD and many other San Diego hospitals as far as overall survival for patients. It is bizarre that Kaiser is given a position alongside UCSD by Leapfrog Group. The motive of Leapfrog Group does not seem to be to ensure the best healthcare for employees. Still don't believe that Kaiser is getting special handling from Leapfrog Group? Look at the list below.]

The Leapfrog Group’s Top Performing Hospitals of 2011
By Khoffman
healthcareerweb.com
December 6, 2011

Leapfrog Group Best Hospitals 2011

Its the end of 2011, which means that the best of 2011 list are coming out. The Leapfrog Group continued their eleven year tradition and have recognized 65 top performing hospitals of 2011.

“The Leapfrog Group survey focuses on three critical areas: (1) how patients fare, (2) resources used to care for patients, and (3) management practices that promote safety and quality. In each of the three areas, Leapfrog asks hospitals to report on nationally standardized measures so healthcare consumers can compare hospitals in their community and across the country.”

Leapfrog Group’s full list of the top performing hospitals of 2011:

2011 Leapfrog Top Hospitals

Kaiser Permanente Antioch Medical Center (CA)
Kaiser Permanente Fontana Medical Center (CA)
Kaiser Permanente Los Angeles Medical Center (CA)
Kaiser Permanente Oakland Medical Center (CA)
Kaiser Permanente Panorama City Medical Center (CA)
Kaiser Permanente Richmond Medical Center (CA)
Kaiser Permanente Riverside Medical Center (CA)
Kaiser Permanente Roseville Medical Center (CA)
Kaiser Permanente San Diego Medical Center (CA)
Kaiser Permanente San Francisco Medical Center (CA)
Kaiser Permanente San Jose Medical Center (CA)
Kaiser Permanente South Bay Medical Center (CA)
Kaiser Permanente South Sacramento Medical Center (CA)
Kaiser Permanente South San Francisco Medical Center (CA)
Kaiser Permanente Vacaville Medical Center (CA)
Kaiser Permanente Walnut Creek Medical Center
Kaiser Permanente West Los Angeles Medical Center (CA)
Kaiser Permanente Woodland Hills Medical Center (CA)
Mills-Peninsula Health Services (CA)
Stanford Hospital and Clinics (CA)
UC San Diego Health System, Hillcrest (CA)
Baptist Health South Florida Homestead Hospital (FL)
NorthShore University HealthSystem-Evanston Hospital (IL)
NorthShore University HealthSystem-Glenbrook Hospital (IL)
Northwestern Memorial Hospital (IL)
Rush University Medical Center (IL)
Baystate Medical Center (MA)
Beth Israel Deaconess Medical Center (MA)
Brigham and Women’s Hospital (MA)
Anne Arundel Medical Center (MD)
University of Maryland Medical Center (MD)
Detroit Receiving Hospital/University Health Center (MI)
Spectrum Health Blodgett Hospital (MI)
Spectrum Health Butterworth Hospital (MI)
St. Joseph Mercy Oakland (MI)
University of Michigan Health System (MI)
Regions Hospital (MN)
St. Mary’s Hospital of Rochester (MN)
University of North Carolina Hospitals (NC)
Hackensack University Medical Center (NJ)
The Valley Hospital of Ridgewood(NJ)
Presbyterian Hospital (NM)
Montefiore Medical Center, Weiler Division (NY)
Roswell Park Cancer Institute (NY)
The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OH)
The Christ Hospital of Cincinnati (OH)
University Hospitals Case Medical Center (OH)
Lehigh Valley Hospital (PA)
Bon Secours St. Francis Health System – Downtown (SC)
Vanderbilt University Hospital (TN)
Swedish Medical Center First Hill Campus (WA)
Virginia Mason Medical Center (WA)

Kaiser picks Kearny Mesa site for new hospital

2011-12-05T18:14:00.000-08:00

“The fact that we’re focused on health, not sickness, makes sense to people.”
--Rodger Dougherty, Kaiser spokesman

"Kaiser's focus on 'health' doesn't make quite so much sense when a patient happens to get sick. Some patients are actually quite surprised when Kaiser fails to properly diagnose and treat them. When they joined, they didn't realize that Kaiser's focus was quite as limited as it turned out to be."
--Maura Larkins, Kaiser patient

Kaiser picks Kearny Mesa site for new hospital
Janet Lavelle
SDUT
Dec. 1, 2011

Kaiser Permanente announced Thursday that it has ended months of study and picked the county operations property in Kearny Mesa as the site for its new hospital, rejecting an option to buy the Alliant University campus in Scripps Ranch.

The decision was met with disappointment by the university and relief by Scripps Ranch residents worried that a hospital would overwhelm the quiet leafy suburb with traffic.

The purchase price for the 19.5-acre County Operations Center Annex property on Ruffin Road is at least $30 million, but would run higher if Kaiser gets permits to build a hospital larger than 425,000 square feet. The sale is scheduled to close Dec. 31, 2013, according to county documents.

County Supervisor Ron Roberts said the site, now home to the Registrar of Voters and some other county offices, makes sense for a hospital.

“It’s served us well for many years but I think it’s a perfect site for Kaiser and it’s got great access from the freeway,” he said. “It would be very compatible with what’s planned in the Kearny Mesa area.”

The property sits at the busy corner of Ruffin Road and Clairemont Mesa Boulevard between Highway 163 and Interstate 15, in a mixed industrial and commercial area with a scattering of residential streets.

Kaiser intends to build and open a 350-bed hospital there by 2018, either replacing or augmenting its existing 392-bed hospital on Zion Avenue in Grantville. By 2030, that facility will no longer meet state earthquake standards and will either need to be torn down, rebuilt or undergo extensive retrofitting, Kaiser spokesman Rodger Dougherty said.

Kaiser officials have said they plan to build up to three hospitals around the county over the next two decades to keep pace with a steadily growing membership.

Dougherty said Kaiser has seen solid growth since 2008 as individuals and employers looked for affordable health care during the recession. Kaiser currently has 506,000 members in San Diego County, adding 14,000 this year, he said.

“We expect that trend to continue, given health care reform and our own model of care,” he said. “The fact that we’re focused on health, not sickness, makes sense to people.”

San Diego’s competitive health care market already is home to 19 hospitals, with a 20th due to open when Palomar Pomerado Health completes a $1 billion hospital in Escondido next year. Scripps Health, Sharp Healthcare and UCSD also are working on major expansions.

Kaiser’s announcement snuffs a pending deal between it and Alliant for the 60-acre campus, which faced stiff opposition from neighbors.

More than 300 people packed a Scripps Ranch Planning Group meeting in November and another 400 sent emails to oppose the Kaiser project over concerns about traffic, lights, noise, emergency evacuation routes and dozens of other issues, vice chairman Robert Ilko said.

Although it was too soon for the committee to take a position on the project, the community sentiment was obvious, Ilko said. “It was clearly no on Kaiser,” he said.

Alliant University president Geoffrey Cox said he was notified of the decision Thursday. “We’re very disappointed,” he said. “We thought it was a good project and fit well with the campus site.”

Cox said the university had decided to look for a new location before Kaiser approached it last spring. The sprawling campus, built 40 years ago for an undergraduate residential university, no longer fits a graduate-degree program with 1,500 day students, he said.

“We were in the very preliminary stages of looking for another site,” he said. “Now we’ll have to regroup and decide whether to continue that process right now.”

The Ruffin Road property has been part of a $460 million agreement between the county and Lowe Enterprises Real Estate Group. Under the agreement, Lowe is midway through redeveloping the 32-acre main County Operations Center on Overland Avenue and also has development rights on the Ruffin Road site.

In October, county supervisors voted to allow a transfer of development rights from Lowe to Kaiser for the Ruffin Road land, if Kaiser decided to proceed with a purchase. With that decision now made, the transfer of development rights should be completed within two weeks, said John Kross, deputy director of the county Department of General Services.

The closing date of December 2013 allows the county time to move departments at Ruffin Road over to new buildings at the main operations center.

The Lowe project envisioned a mixed residential and commercial development on Ruffin Road. Kearny Mesa Planning Group Chairman Buzz Gibbs said he thinks a hospital is more appropriate.

“Personally, I would much prefer a hospital there than residential,” he said. “Putting a couple of hundred units in an industrial area is a terrible idea.”

Computer medical records stolen from Kaiser and from Sutter Health

2011-12-05T17:31:00.000-08:00

After data theft, Sutter Health sued
By The Associated Press
Nov. 22, 2011

SACRAMENTO, Calif. — A group of patients are suing Sutter Health after more than 4 million patient records were stolen.

The Sacramento Bee reports ( http://bit.ly/sKNKT3 ) the class-action lawsuit was filed Monday in Sacramento Superior Court.

The suit alleges the health care provider was negligent in keeping patients' electronic data safe, and in notifying the patients within 30 days of the theft.

A computer containing the data was stolen in October from the Sutter Medical Foundation's headquarters in Natomas. The computer held descriptions of diagnoses, names and addresses.

Plaintiffs' attorney Robert Buccola says the company should have taken far more measures to keep the data safe.

Sutter "deeply regrets the theft," said spokesman Bill Gleeson. He defended the time it took to reach patients, saying Sutter had to figure out what data were stolen.

Computer medical records stolen from Kaiser
By The Associated Press
Jan. 12, 2010

SACRAMENTO, Calif. — Kaiser Permanente says a computer drive containing thousands of patient records was stolen from an employee's car.

Hospital officials said Tuesday the external drive stolen Dec. 1 held data on as many as 15,500 patients throughout Northern California, including the patient's name and Kaiser medical records number.

The records could have also included a patient's sex, birth date, phone number and other medical information.

All of the patients live in the Sacramento area, and Kaiser says they have notified those affected.

Hospital spokeswoman Kristin Chambers says the theft presents a "low risk to our patients."

[Maura Larkins' comment: That sounds just like what they tell people with conditions that are not properly diagnosed. Thousands of those people end up dead.]

The hospital has fired the employee, who was authorized to access the data as part of her work, and says it is unclear why she took the device home.

Information from: The Sacramento Bee, http://www.sacbee.com

Hospitals target pricey medical devices for savings

2011-11-30T17:28:00.000-08:00

Analysis: Hospitals target pricey medical devices for savings
By Susan Kelly
Nov 29, 2011

(Reuters) - When U.S. hospitals cut expenses as the economy slid into recession, they looked first to basic supplies like lightbulbs and bandages. Next on the list: artificial hips and knees.

Implantable devices make up a sizable chunk of typical hospital budgets, and administrators are devising new ways to limit that cost as they brace for cuts to government reimbursement and treat more patients who can't pay for care.

That means methodically working through each category of device, from heart valve replacements and stents to spinal products, to see where they can negotiate lower prices. It also means creating databases of shared information on pricing between hospitals.

"We are pressing very hard on device makers because it is a big piece of the supply puzzle," said Michael Rosenblatt, vice president of supply chain management for SSM Health Care, a St Louis-based system with 15 acute-care hospitals.

Heart and orthopedic device makers have already seen their pricing power erode as patients forgo expensive treatments in the struggling economy, and the new push by hospitals will only intensify that pressure.

"Things are getting worse from a pricing standpoint. The big area of focus is the high-priced cardiac and orthopedic stuff. It's bad, and it's getting worse for everyone," said Mizuho Securities analyst Michael Matson.

Further hampering device makers are product portfolios full of mature technologies that make it harder to justify premiums. Drug-eluting stents are the most extreme example, Matson said, with annual price declines of 10 percent worldwide.

Prices also are falling, though not as dramatically, on pacemakers and defibrillators sold by companies such as Medtronic Inc, Boston Scientific Corp and St Jude Medical Inc, and orthopedic implants made by Stryker Corp and others.

"It's beginning to shift to where manufacturers understand that a lot of these products are really becoming more like commodities," said Christopher Baskel, supply chain director at Spectrum Health Hospital Group, a chain of nine hospitals based in Grand Rapids, Michigan.

Spectrum has found ways to cut costs in major device categories one by one, beginning with stents, then pacemakers and defibrillators, and recently spine devices. "We just got done doing orthopedic spine. We're starting on hips and knees next, after the first of the year," Baskel said.

To gain an advantage in negotiations with device makers, Spectrum is participating in an information exchange set up through its group purchasing organization, Novation, that allows members to see what other hospitals are paying for products. Company names are blinded.

"There is very little price transparency on these high-end sophisticated devices," said Baskel. "We've been working hard to lift the price transparency veil. We are not going to be satisfied until it's like Amazon.com."

CORRECTIVE MEDICINE

Americans pay far more for healthcare than patients in other developed countries but die earlier, according to the 34-nation Organization for Economic Cooperation and Development. They are among the top consumers of costly procedures including hip and knee replacements, MRIs and CT scans. For a graphic, see: link.reuters.com/pyr35s

Such statistics have put greater scrutiny on the role of device makers in driving unsustainable healthcare costs. The U.S. healthcare overhaul also gives financial incentives to hospitals and doctors to collaborate on cost savings while improving the quality of care for patients enrolled in the government's Medicare plan for the elderly.

"If you look at the healthcare system, the pressures are going to flow to those who can absorb them, and these guys have a lot of profit," Mizuho's Matson said.

Closer on the horizon, device makers face a 2.3 percent tax on their product sales beginning in 2013 to help pay for health reform. Stryker earlier this month said it would cut 5 percent of its workforce to help offset the device tax.

David Nexon, senior executive vice president for the Advanced Medical Technology Association (Advamed), which represents device makers, said some of the emphasis on cost is short-sighted. Devices such as artificial knees keep people out of nursing homes while new minimally invasive surgical techniques reduce the length of hospital stays, he said.

An Advamed-sponsored study found that medical device spending has remained constant at about 6 percent of national health expenditures over a 20-year period through 2009.

"If you look at price data, it doesn't suggest that we are a driver of higher costs, but certainly we've been a driver of greater value," Nexon said.

On the other side of the ledger, hospitals are caring for more people who rely on government programs or have no insurance at all as unemployment remains high. That is straining emergency rooms, which are required by law to provide treatment regardless of ability to pay.

The burdens brought by the struggling economy are making hospitals even more vulnerable to government efforts to reduce the national deficit by cutting the reimbursements they receive.

Premier Inc, a purchasing alliance for more than 2,500 U.S. hospitals, estimates that healthcare providers can expect cuts in reimbursement payments to reach 15 percent to 20 percent of current levels by 2017. So when hospitals look for places to cut, medical devices make even more sense.

DOING THE MATH

Hospitals are already losing thousands of dollars each time they perform one of the top dozen device implant procedures on a Medicare patient, according to Premier, which maintains a large database of patient claims and consults with its members on ways to improve their finances and quality of care.

For example, hospitals in a recent Premier analysis lost almost $15,000 on average for each cardiac valve replacement procedure performed on a Medicare patient.

Hospital administrators compare that with the robust profit margins traditionally enjoyed by medical device makers.

Operating margins for large medical device makers typically range from 25 percent to 28 percent, compared with 7 percent to 10 percent for publicly traded hospital operators, according to Thomson Reuters data. The spread on gross margins is even greater, with device makers in the 70 percent to 80 percent range compared with 35 percent to 55 percent for hospitals, according to analysts...

Attorneys allowed to gather more evidence in Tri-City wrongful termination suit

2011-11-30T11:51:00.000-08:00

Attorneys allowed to gather more evidence in Tri-City wrongful termination suit
Nathan Scharn
Nov. 29, 2011

OCEANSIDE — A U.S. District Court judge issued an order Monday allowing attorneys to gather more evidence in wrongful termination suits between former Tri-City Healthcare District administrators and their former employer, including trustees of the public health care district.

Judge Thomas J. Whelan ruled that attorneys for the administrators would be able to take depositions from defendants involved in a meeting held at Coco’s Restaurant in Vista on Nov. 20, 2008 regarding the discussion at the restaurant. They were fired in 2009 in an overhaul by the elected board of Tri-City’s leadership.

Whelan concluded that the meeting, attended by an attorney and now Chairwoman Rosemarie Reno and trustees Kathleen Sterling, George Coulter and Charlene Anderson, violated the state open government law called the Brown Act.

The law requires public notice of discussions of public business by a majority of elected officials on a board. At the time, only Sterling, who has since been dropped from the case, and Reno were on the board. Coulter and Anderson had been elected, but had not yet assumed office, which constituted a future majority, Whelan said in the ruling.

“The Brown Act also prevents future majorities from gathering privately to make collective commitments affecting the future of the local agency without public input,” Whelan wrote.

The get-together at Coco’s is not related to another controversial dinner meeting, held at West Steak and Seafood in Carlsbad in May 2010 and attended by Reno, Sterling and Coulter, though that meeting has been a factor in several lawsuits, including criminal hearings.

Much of the Coco’s meeting has been kept secret under Magistrate Judge Bernard G. Skomal’s July 18, 2011 discovery order, which held that the discussion at the meeting fell under attorney client privilege. Whelan reversed that, saying the meeting violated the law “in furtherance of a present criminal act,” the ruling said, and was thus exempt from the privilege.

The depositions could provide significant facts in the wrongful termination suit between the former administrators and the health care district.

Trustees fired nine employees after placing them on paid administrative leave. Then-Chief Executive Arthur Gonzalez received a severance package in 2009 worth as much as $1 million. Seven others sought damages in excess of $100,000.

Earlier this year, former vice president of strategic services Allen Coleman received $385,000 and former vice president of performance improvement William “Terry” Howell received $390,000 in settlements, their attorney Ray Artiano and Tri-City officials have confirmed. The other five employees are still pursuing the lawsuit.

The other employees fired were Suellyn Ellerbe, chief operating officer and chief nurse executive; Robert Wardwell, chief financial officer; Doreen Sanderson, vice president of human resources; Daniel Groszkruger, director of information systems; and Ondrea Labella, director of patient business services.

Whelan denied part of the ex-administrators’ contention that Skomal had erred as a matter of law.

Public Tri-City Healthcare District serves residents in Carlsbad, Oceanside and Vista.

Kaiser Permanente whistle-blower Emily Ryan from Roseville, California

2011-11-30T09:28:00.000-08:00

My name is Emily Ryan. I'm a Courage Campaign member and psychiatric social worker for Kaiser Permanente in Roseville, California. Recently I came forward, along with several colleagues, to blow the whistle on Kaiser's illegal and morally inexcusable mental health policies.

We've risked our careers to contribute to “Care Delayed, Care Denied” a report by the National Union of Healthcare Workers, which was featured in USA Today¹ and The Huffington Post.² Now, Kaiser will use its army of lobbyists and PR flacks to try to stop an investigation. This "non-profit" corporation has made more than $5.4 billion in the last three years and pays its CEO a salary of $9 million a year. Unless Governor Brown's Department of Managed Health Care pursues an investigation, Kaiser's billion dollar spin machine will succeed in silencing our voices.

We need your help. Please click here to demand Governor Brown start an investigation.

If you or anyone in your family suffers from mental illness or acute emotional pain, you know how damaging it can be. If they have Kaiser, they're likely to have an experience like Timm Sinclair, who told us,

My mother, a Kaiser member of 20 years, is 77 years old and has Parkinson's. She also suffers from chronic recurrent depression and severe anxiety disorder. The difficulties in getting her psychological and psychiatric needs met at Kaiser have been distressing for her and for me. Along with a revolving cast of doctors and therapists we have encountered lengthy delays of up to three months. I find it inconceivable that an organization that is supposedly dedicated to ensuring that their members 'Thrive' would allow this to happen.

Join us to demand Governor Brown direct the Department of Managed Health Care to investigate Kaiser!

Kaiser puts profits before patients. This year, they raised rates an average of 9.5% and are planning another hike -- their second in six months -- this January, but they refuse to hire enough staff to serve their patients adequately. Our report -- based a survey of over 300 Kaiser mental health professionals practicing at 57 Kaiser facilities in Northern and Southern California -- revealed the following:

• 90% report there is insufficient staffing at their clinic;

• patients, including those suffering from major depression and thoughts of suicide, are frequently forced to wait four weeks or longer for return appointments, despite California law requiring they be seen within ten business days;

• Kaiser falsifies patient scheduling records to conceal these delays from state regulators;

• and Kaiser often funnels patients into group therapy even when clinicians believe that individual therapy would be more effective.
Please ask the Governor to stand up for Timm, his mother, and the thousands of patients who rely on the country's largest HMO for their mental health services.

Emily Ryan
Kaiser Permanente psychiatric social worker and Courage Campaign member

1. USA Today
2. Huffington Post

Lack of record access drives up costs at L.A. hospitals for poor

2011-11-26T12:35:00.000-08:00

Lack of record access drives up costs at L.A. hospitals for poor
L.A.'s safety-net hospitals are scrambling to match others nationally that use electronic records and integrated systems to manage care for low-income patients and cut costly hospitalizations.
By Noam N. Levey
Los Angeles Times
November 25, 2011

The emergency room at White Memorial Medical Center on Los Angeles' Eastside was buzzing when paramedics arrived on a Friday night with an elderly man slurring his words and complaining of aching bones.

The nurse in the receiving bay immediately ran through standard triage questions: "Are you diabetic? Do you have high blood pressure? Are you allergic to any medications?" Each drew the same response: "I don't know."

The hospital and doctors had no record of the man or his medical history. And with their only guide a piece of crumpled paper they found tucked into the man's pants that seemed to indicate he might have had cancer, doctors had to order a full diagnostic work-up, including blood tests and an EKG to check his heart.

It was another night of high-priced detective work at one of America's urban hospitals.

"We're mostly flying blind here," said Dr. Brian Johnston, the senior emergency room physician at White Memorial, shaking his head at the high costs generated by the lack of records and unnecessary testing.

Waste bedevils much of America's fragmented healthcare system, driving up already skyrocketing costs. As health spending overwhelms government budgets, the stakes are especially high for safety-net institutions like White Memorial that serve the country's poorest patients, largely at taxpayer expense.

The best safety-net systems — in Denver, Dallas, New York and elsewhere — have found ways to practice medicine more efficiently, using electronic records and integrated systems to manage care for low-income patients and cut costly hospitalizations.

In Los Angeles, Chicago and many other cities, local healthcare officials are now scrambling to catch up.

"There is really no system of care here," said Allen Miller, a Los Angeles consultant who is working with private hospitals, clinics and physicians on a potentially trailblazing initiative to link together medical providers that care for some of Los Angeles County's neediest patients...

Consumer advocate Harvey Rosenfield takes on health insurers

2011-11-26T12:13:00.000-08:00

Here's a biography of Harvey Rosenfield.

Consumer advocate Harvey Rosenfield takes on health insurers
Rosenfield, who used California's initiative process to regulate auto insurance rates more than two decades ago, is preparing a new initiative that would force health insurers to get state approval before they could raise premiums.
By Marc Lifsher
Los Angeles Times
November 26, 2011

The former "Nader's Raider" who used California's initiative process to regulate auto insurance rates is headed back to the ballot. This time he's spoiling to take on health insurers.

Harvey Rosenfield, the combative attorney and consumer advocate who wrote California's landmark Proposition 103 more than two decades ago, is preparing a ballot initiative that would force health insurers to get state government approval before they could raise premiums.

Stricter controls are needed to put some restraints on a industry that's reaping fat returns for shareholders and multimillion-dollar salaries for executives while consumers struggle to pay for coverage, Rosenfield said. In California, average premiums for family coverage rose 7.5% in 2010, according to the California HealthCare Foundation. They increased by 3% nationally for the same period. About 1 in 5 Californians, or 7.2 million, have no health insurance.

"Everybody knows the horror stories," said Rosenfield, founder of the advocacy group Consumer Watchdog. "Premiums are going through the roof. A lot of people can't get health insurance at any price. Benefits are going down. Company CEOs are getting rich."

Consumer Watchdog submitted a draft of its initiative to state authorities this month, a first step toward placing the measure on the November 2012 ballot. Getting it there won't be cheap. The Santa Monica group would need to gather signatures from at least 505,000 registered voters, a process that could cost around $3 million, according to election experts.

If approved by voters, the measure would give California the country's most stringent regulation of the 35 states that have some form of health insurance oversight.

Health insurers denounce the initiative as big-government meddling that could lead to higher rates and less coverage for everyone.

"Giving a politician the power to set prices does not address the real reason healthcare costs are increasing and could threaten patients' access to medical care," said Charles Bacchi, executive vice president of the California Assn. of Health Plans.

The industry could spend more than $100 million trying to defeat Consumer Watchdog's proposed initiative, said Michael Mattoch, a former insurance committee staffer in the state Legislature and current executive at auto insurer USAA.

But Rosenfield and Jamie Court, Consumer Watchdog's president, say they like their chances. Private focus groups and polling show 80% of voters queried would support reining in health insurers, they said.

Some independent analysts share their assessment.

"I imagine this would be quite popular going into a [national] election. Insurance companies are not exactly the most favorite institutions," said Larry Levitt, a senior vice president at the Kaiser Family Foundation, a national healthcare think tank not related to the Kaiser Permanente health maintenance organization.

Rosenfield is no stranger to David versus Goliath battles.

Helped by his mentor, consumer activist Ralph Nader, Rosenfield in 1988 persuaded California voters to pass Proposition 103. That landmark ballot initiative slashed car insurance rates and forced auto insurers to get approval from state regulators for future premium hikes. The law also applies to rates for homeowners' and most other lines of property and casualty insurance.

Outspent by the opposition $120 million to $3 million, Rosenfield's tiny operation prevailed by tapping into the frustration of California motorists fed up with skyrocketing premiums. Despite dire predictions that carriers would flee the state, California's auto insurance market remains competitive. Premiums have declined by about 30%, saving Golden State motorists billions, according to the Consumer Federation of America.

Rosenfield said he's again resorting to a ballot initiative to allow California voters to do what the Legislature hasn't been able to do — rein in soaring health insurance premiums. Bills to give the state more authority to regulate rates have been bottled up in Sacramento for years; health companies and insurers have contributed millions to lawmakers to keep it that way, Rosenfield said.

Health insurance "fits perfectly with 103," Rosenfield said.

Insurance industry opponents counter that Rosenfield and his colleagues have other reasons for wanting to expand Proposition 103. Over the last two decades, they've reaped millions in legal fees and settlements from insurance companies while declaring themselves champions of the little guy.

Bacchi of the California Assn. of Health Plans criticized Consumer Watchdog as "a self-anointed consumer advocate," pursuing "yet another deeply flawed policy proposal that is ultimately designed to line their pockets with cash from expensive lawsuits."

Rosenfield, who has shaved his mustache, buffed up his physique and upgraded his wardrobe since his Nader's Raiders days in the 1970s and 1980s, said he welcomes insurer insults. That's "how I know we're doing our job," he said.

But the proposed health insurance initiative promises to earn Rosenfield more adversaries than usual.

Carefully inserted in the measure is a one-sentence "poison pill" that could nullify a proposed auto insurance initiative that's also aimed for the November 2012 ballot. The crafty tactic was aimed straight at Rosenfield's old nemesis: George Joseph, the chairman of Los Angeles-based Mercury General Corp., who is helping to bankroll the auto insurance measure.

That initiative, which would offer certain discounts to longtime insured motorists, would weaken Proposition 103, Rosenfield said, by effectively raising rates for drivers who were previously uninsured. Last year voters defeated a similar ballot measure, with the losing campaign costing Mercury $16 million. Undeterred, Joseph already has pumped $8 million into the new effort, which officially is sponsored by the American Agents Alliance, a trade group.

Rosenfield said his wording would restate and expand a controversial provision of Proposition 103 that previously uninsured drivers should not be penalized with higher insurance rates. It would take effect if both Rosenfield's and Joseph's measures were approved but Rosenfield's gets more votes.

The poison pill, insurers argue, is unconstitutional and is likely to be challenged in court on the grounds that initiatives by law can deal with only one subject.

Rosenfield contends that his measure would withstand such a challenge from insurers.

"We fight just as hard as we can for consumers," he said.

Kaiser Permanente's Charlie David Morgan, Ph.D. angry because SEIU Threatens To Dissolve CKPU

2011-11-24T11:50:00.000-08:00

SEIU Threatens To Dissolve CKPU
Adios Andy
December 8, 2009

The Coalition of Kaiser Permanente Unions is the group of unions that, along with KP management, make up the Labor-Management Partnership which was so instrumental in bringing KP up out of the ashes of the strikes in the late 1980's. SEIU is evidently so afraid of losing its monopoly position within KP that they are threatening to sunder the entire coalition, rather than to admit NUHW as a member in that coalition...One of the members of the SoCal KP units wrote a letter to the Executive Director of the CKPU regarding SEIU's threat...

Mr. August,

I am a Kaiser employee, Clinical Psychologist, and currently a UHW member. I have been very involved in LMP as a UBT member both locally and regionally, LMP co-lead, and trained LMP facilitator, and highly value the LMP process. I received your statement today from the CKPU regarding membership to CKPU and participation in LMP.

Firstly let me say that I have always respected your work with Kaiser and LMP. You have done wonderful things in the past to bring employees and managers together to discuss ways to make Kaiser the best place it can be for our health plan members and for employees.

Today however I am very disappointed with your statement and decision. I certainly do understand that Andy Stern is the head of CKPU and you are under his employ, and as such are in a difficult position to follow his demands or lose your job.

You should know that we as members ARE supporting NUHW and WILL win our decertification vote because we have been very disappointed with the direction Andy Stern and the UHW trustees have taken our union and do not agree with their policies, corporate unionism, and back-door deals with management.

I am very disturbed that you do not support our members' right to determine which union we want to represent us. You are threatening that if we choose NUHW through a federal legal process, exercising our rights, that you will not allow us to be part of CKPU or LMP.

Is not a union made up of it members and members voices? Is not unionism a democratic process where we as members have a right to take their union in the direction we feel is best for us and for those we serve? Does not LMP consist of union members (no matter which union) working together with management for the good of all?

I just don't understand how banning NUHW from participation does anyone any good. It does not benefit CKPU, LMP, Kaiser, or any of the other unions in the coalition. It is simply one more of Mr. Stern's scare tactics to not lose his union members.

As of today I have lost all respect for you and see now that you are simply a puppet in Mr. Stern's hands to manipulate and carry out his agenda within Kaiser. I don't think you understand that you are dealing with intelligent, highly educated professionals within these three professional bargaining units, who are not going to be fooled by SEIU (and now CKPU) propaganda and will not fall to your threats.

Charlie Morgan, Ph.D.
Clinical Psychologist
Kaiser Permanente San Diego

Stutz Artiano Shinoff & Holtz loses in Nevada pharmacy case (Walgreens)

2011-11-24T08:50:00.000-08:00

See Stutz Artiano Shinoff & Holtz on San Diego Education Report.
See blog posts re Stutz law firm.

KLASCH v. WALGREEN CO.
Leagle.com
November 23, 2011

DENNIS KLASCH, INDIVIDUALLY;
MARILYN LIND, INDIVIDUALLY;
AND DENNIS KLASCH, MARILYN LIND, AND REVA S. ARCHER,
AS CO-SPECIAL ADMINISTRATORS
FOR THE ESTATE OF HELEN KLASCH, Appellants,

v.

WALGREEN CO., AN ILLINOIS CORPORATION
D/B/A WALGREENS, Respondent.
No. 54805.
Supreme Court of Nevada.

Bradley Drendel & Jeanney and Bill Bradley, Reno, for Appellants.
Stutz, Artiano, Shinoff & Holtz and James F. Holtz, Las Vegas, for Respondent.
BEFORE THE COURT EN BANC.

OPINION
By the Court, PARRAGUIRRE, J.:
In this appeal, we consider the duty of care that a pharmacist owes his or her customers. Specifically, we are asked to clarify whether a pharmacist's only duty is to fill a customer's prescription with the correct medication and dosage or if, under certain circumstances, a pharmacist may have a duty to do more. We conclude that when a pharmacist has knowledge of a customer-specific risk with respect to a prescribed medication, the pharmacist has a duty to exercise reasonable care in warning the customer or notifying the prescribing doctor of this risk. Having determined that the pharmacist in this case had knowledge of a customer-specific risk, we conclude that the summary judgment record before the district court was inadequate to conclude, as a matter of law, that no genuine issues of fact remain as to breach of duty and causation of injury. Accordingly, we reverse the district court's summary judgment in favor of respondent and remand this case to the district court.

FACTS

In December 2005, Helen Klasch visited Dr. Fredrick Tanenggee, M.D., for the first time. While filling out paperwork concerning her medical history, Klasch indicated that she might have a sulfa allergy. People with sulfa allergies generally experience minor skin rashes when exposed to sulfa, but in a small number of cases, the sulfa exposure may cause a toxic reaction in the person's skin, potentially leading to death.

Although still largely unpredictable, people who have experienced a past allergic reaction to sulfa are at a heightened risk for suffering this toxic reaction in the event of future sulfa exposure. After some further discussion with Dr. Tanenggee's assistant, this possible sulfa allergy was recorded on Klasch's medical chart with a question mark ("Sulfa?").

In July 2006, Klasch returned to Dr. Tanenggee's office, complaining of "abdominal fullness." After performing routine tests, Dr. Tanenggee diagnosed her with a urinary tract infection. Dr. Tanenggee told Klasch that under normal circumstances, her infection could be treated most effectively with Bactrim, a sulfa-based antibiotic. Given the notation in her chart, however, Dr. Tanenggee asked Klasch to clarify how certain she was of her sulfa allergy. After some further discussion, Klasch downplayed the previous notation and asked Dr. Tanenggee to write her a prescription for Bactrim. Dr. Tanenggee complied, and Klasch dropped off the prescription at Walgreens Pharmacy on her way home from Dr. Tanenggee's office.

Later that same day, Klasch's caretaker returned to Walgreens to pick up the prescription. Upon asking a pharmacy employee to release the prescription, the employee told the caretaker that Klasch's prescription had been "flagged" by Walgreens' computer system while it was being filled. Walgreens maintains a "patient profile" for each of its customers, which its pharmacists use to identify any potential allergic reactions, harmful interactions with other medications, or adverse side effects that a customer may have to a particular medication. The employee told Klasch's caretaker that the prescription had been flagged because Klasch's patient profile indicated that she was allergic to sulfa-based drugs. The caretaker then asked the employee to call Klasch and to speak with her directly...

Kaiser doctors sue their nurses over CNA strike

2011-11-19T13:08:00.000-08:00

I'm glad someone at Kaiser is standing up to unethical bosses.

Kaiser, docs sue nurses over walkout
San Francisco Business Times
by Chris Rauber, Reporter
November 18, 2011

UPDATE: Chuck Idelson, a spokesman for the Oakland-based California Nurses Association , didn't directly respond to the substance of Kaiser Permanente 's lawsuit in U.S. District Court. But he told the San Francisco Business Times late Friday that Kaiser allegedly is taking the step as part of plans for an East Coast expansion move, to New York, New Jersey and the Washington, D.C., area (where it already has a regional unit). "Kaiser has dreams of empire," Idelson said, and wants to fund its expansion on the backs of workers. He said that is CNA's only statement on the suit.

Kaiser Permanente’s Northern California hospital unit and medical group filed a federal lawsuit Thursday that would require the California Nurses Association to go to arbitration over its recent decision “to violate its contract by calling a strike," the health care system said Friday.

Kaiser is asking the U.S. District Court for Northern California to order the CNA into arbitration over what it called a “serious breach” of the union’s contract by a one-day, Northern California-wide strike against the nonprofit system Sept. 22 to 23.

Kaiser said the union’s contract, which went into effect Sept. 1, includes a “mutually agreed upon provision that prohibits work stoppages and strikes for the life of the three-year contract.”

The Oakland-based health care giant said it filed a grievance against the nurses’ union on Oct. 18, “using the dispute resolution process spelled out in the contract,” but that the union rejected the request Nov. 7, claiming the no-strike provision didn’t apply, because only CNA has a right to file a grievance. CNA said at the time it went out in sympathy with a short strike by the National Union of Health Care Workers, which walked out at a number of Kaiser and Sutter Health facilities.

Roughly one-third of the 17,000 CNA-represented RNs who work at Kaiser facilities in Northern California crossed picket lines and showed up at work during the late September work stoppage, according to Kaiser's Nov. 18 statement.

Kaiser sues California Nurses Association over strike
November 18, 2011
Kathy Robertson
Sacramento Business Journal

Kaiser Permanente has filed a lawsuit in federal court alleging the California Nurses Association violated a no-strike clause in its collective bargaining agreement when it called a statewide strike by Kaiser nurses in September.

Billed as the largest nurses’ strike in state history, CNA called a massive walkout Sept. 22-23 by as many as 22,700 nurses, including 17,000 at Kaiser, 5,000 at Sutter Health and 700 at Children’s Hospital in Oakland. Other workers at other unions joined the walkout, too.

CNA’s current contract with Kaiser — which went into effect Sept. 1 — includes a mutually agreed upon provision that prohibits work stoppages and strikes for the life of the three-year contract, Kaiser alleges in the lawsuit. The strike required Kaiser to hire hundreds of temporary nurses and additional staff, limit elective medical procedures and transfer critical care through special teams, all at considerable expense.

Kaiser filed a grievance against the union Oct. 18, requesting a discussion to address the issue using the dispute resolution process spelled out in the contract.

CNA rejected the request Nov. 7, claiming the no-strike provision does not apply to sympathy strikes and that only the union has the right to file a grievance under the contract, court documents allege.

Kaiser seeks a court order compelling the union to arbitrate Kaiser’s grievance.

CNA spokesman Chuck Idelson said the union has a strong history — known to Kaiser — of providing support for other unions.

Tri-City Hospital board member Charlene Anderson's nursing license: revoked/stayed/probation

2011-11-19T09:28:00.000-08:00

John Graham:
While I agree with her probation and stayed revocation for what she did, I don't think Charlene Anderson should be a member of the Board until she has successfully completed her probation. Nurses are held to a very high standard and members of the State Board of Registered Nursing should be even more squeaky clean. It is not fair to the thousands of of other nurses who somehow find the time to get their charting properly done even when they are busy or understaffed. If she is as wonderful a nurse as many have commented, then she needs to do the right thing and resign from the Board in order avoid the appearance of corruption and double standard for members of the governing Board in her profession. I have seen many fine nurses in this state fired or had their licenses revoked for much less.

"...The state nursing board voted Thursday to accept the recommendation of an administrative judge to revoke her license, then stay the revocation and place her on probation... The board hands down stayed revocations to about 100 of the state’s 390,000 registered nurses each year.

"Anderson’s “failure to document the disposition of narcotics is a very serious matter,” Walker wrote. “'If she did not administer the medications to patients, she created a potential for harm by depriving them of prescribed medications. If she did administer the medications to patients, she created a potential for harm by creating a risk for over-medication.'”

Tri-City official gets probation as nurse
Three-year penalty stems from undocumented drugs
Aaron Burgin
SDUT
Nov. 18, 2011

The state Board of Registered Nursing has put Tri-City Healthcare District board member Charlene Anderson on three years probation for failing to account for prescription painkillers while she worked at Scripps Memorial Hospital in Encinitas in 2006.

Anderson, who was elected to the Tri-City board in 2008, was accused of failure to account for 23 Percocet tablets, seven Vicodin tablets and three tablets of Tylenol with codeine removed from a hospital dispensing machine from May to August of that year. Scripps fired Anderson a month later.

Anderson, 61, expressed regret for the incident in a prepared statement and said she would not step down from the board.

“I regret my apparent lack of complete documentation five years ago at Scripps when after correctly removing medications ... and correctly administering them to the patients, I apparently did not complete documentations on the chart in some cases,” she said. “My patients were not and have not ever been harmed and my nursing practice has been enhanced by this negative experience.

“Am I going to resign? Absolutely not. I did nothing wrong that affects my tenure on the Tri-City board,” she said.

The state nursing board voted Thursday to accept the recommendation of an administrative judge to revoke her license, then stay the revocation and place her on probation.

That action is one step short of outright revocation, said a spokesman with the state Department of Consumer Affairs, which oversees the nursing board. The board hands down stayed revocations to about 100 of the state’s 390,000 registered nurses each year.

The judge in the proceeding, Robert Walker, said that while Anderson’s actions were very serious, there was no evidence that patients were harmed by her actions. He noted that she had a nearly complaint-free record in her 20 years as a registered nurse.

Walker also noted that Anderson was not accused of taking the drugs or failing to give them to patients — just not properly charting them. [Maura Larkins comment: It would be next to impossible to find out what happened to those pills. The state didn't find Anderson innocent of consuming the drugs; it just couldn't prove anything, so it didn't charge her. “If she did not administer the medications to patients, she created a potential for harm by depriving them of prescribed medications. If she did administer the medications to patients, she created a potential for harm by creating a risk for over-medication...On the other hand, there is no evidence that (Anderson) actually harmed any patient,” Walker wrote.]

Anderson’s “failure to document the disposition of narcotics is a very serious matter,” Walker wrote. “If she did not administer the medications to patients, she created a potential for harm by depriving them of prescribed medications. If she did administer the medications to patients, she created a potential for harm by creating a risk for over-medication.”

“On the other hand, there is no evidence that (Anderson) actually harmed any patient,” Walker wrote. [Maura Larkins comment: Whew! Both Charlene and her patients were lucky that no harm occurred.]

Walker denied the state’s request to recover $46,456 from Anderson as restitution for investigation costs. The judge said the state did not properly substantiate its costs.

The State Attorney General’s office filed the administrative complaint against Anderson in January 2010, four years after the incidents occurred.

A four-day administrative hearing akin to a criminal trial was held in July. Anderson’s attorney argued that she wasn’t able to chart the medication because the hospital’s postpartum unit, where Anderson worked, was too busy and understaffed.

State authorities alleged that understaffing was not an excuse.

As part of her probation, Anderson must submit to mental health and psychiatric testing after Walker expressed concern that Anderson knew the rules and still failed to abide by them.

“Is there a medical problem that caused her to forget to do things she intended to do?” Walker wrote. “Because the evidence suggests these concerns, protection of the public requires that there be a professional assessment of the respondent’s ability to practice safely.”..

When doctors rely on attorneys who lie: Tri-City Healthcare attorney contradicts her own witness

2011-11-18T09:22:00.000-08:00

The tale of the out-of-control Andersons (CEO Larry and board member Charlene--no relation) and their odd little co-conspirators continues at Tri-City Hospital.

Paralegal says Tri-City report is wrong
She balks at hospital's version of events involving board member Kathleen Sterling
Aaron Burgin
San Diego Union-Tribune
Nov. 17, 2011

Oceanside — In making their case that elected Tri-City Healthcare District board member Kathleen Sterling should remain excluded from closed session meetings for the rest of her term, administrators cited what they considered traitorous activity.

At a meeting last month, Tri-City attorney Allison Borkenheim offered a sworn affidavit saying that paralegal Linda Elsner informed district officials that Sterling in 2003 or 2004 divulged confidential information to her law office, which was suing the district.

In response to the report, the public hospital board voted 5-1 to keep excluding Sterling from closed session, where issues such as CEO Larry Anderson’s performance and the strategic direction of the hospital are discussed.

The Watchdog contacted Elsner to verify Tri-City’s statements. Elsner said Tri-City officials misrepresented what she said — that she specifically told them Sterling shared only public information.

“How can they get away with this?” Elsner said. “How can they say I said these things and put them out as fact when I didn’t say them?”

Tri-City officials declined to be interviewed and issued a statement that they stand by Borkenheim’s affidavit and the belief that Sterling divulged confidential information to Elsner.

“The accounting set forth information provided by Linda Elsner, which she reported to at least four individuals in separate conversations, that Kathleen Sterling actively provided assistance to parties directly involved in legal matters against Tri-City Medical Center,” the statement said.

“Kathleen Sterling received information, some of which was confidential, while she was a member of the board. Under the state’s Ralph M. Brown Act, information deemed to be confidential is expected to remain confidential, and not arbitrarily made public at any point, unless the board authorizes its release. Ms. Sterling used that information to aid parties in litigation against the hospital.”

Elsner worked for personal injury lawyer Jennifer Lynch, who was pressing an ultimately unsuccessful lawsuit against Tri-City on behalf of patient Thomas Corelis over a surgery.

Elsner said she met Sterling while working on the Corelis case at the Vista courthouse. Sterling approached her and asked her if she was doing work on a lawsuit against Tri-City. When Elsner said yes, Sterling said she could give her information that could help.

Sterling later met with the attorney and pointed her in the direction of a report by the Joint Commission, an accreditation agency, on Tri-City.

Reached Thursday, Sterling confirmed that she gave public information to the plaintiff’s legal team at the time — when she was not a board member — in the hopes it would improve care at the hospital.

“I never gave them anything confidential,” she said.

Elsner said that this year, a former intern at her law firm mentioned the encounter to Charles Perez, the president of Tri-City business partner Medical Acquisition Co.

For months, Elsner said, Perez and Tri-City officials sought her cooperation in their ongoing probe of Sterling for alleged disloyalty to the hospital.

On April 25, Elsner said, she received a call from the former intern, again asking for information. Elsner said she told her that it was not a good time to contact her because she was going through personal and financial issues, including a car that needed the engine replaced, which would cost $3,000.

“She said, ‘Charlie could help you out, right?’” Elsner said. “And then Charles said, ‘Of course. All we need you to do is talk to these people and tell them what you know about Sterling.’”

Elsner said she did not accept any money. She said she told her story to District Attorney’s investigators, who took no action on a Tri-City complaint against Sterling regarding the incident. The DA’s office declined to comment.

Perez told The Watchdog, “My company had a professional relationship to Ms. Elsner for a couple of years and appreciated her law firm business referrals. I have never offered Ms. Elsner any money to break attorney-client privileges. My only involvement at the meeting was to introduce Ms. Elsner to Tri-City.”

Elsner said that on May 3, she met with Anderson, Borkenheim and Perez — the meeting Borkenheim described in her affidavit. Lynch, Elsner’s boss, attended by speaker phone.

Contacted for this story, Lynch corroborated Elsner’s account that Tri-City officials were told Sterling divulged no confidential information to them.

Borkenheim’s affidavit says she strongly believes that Sterling helped Elsner with other cases against Tri-City.

“I believe this because Ms. Elsner, when recounting discussions with Ms. Sterling to me said ‘in the first case...’ leading me to believe that there were other cases or matters in which Ms. Sterling sought to give or gave assistance,” the affidavit says.

Elsner told The Watchdog that’s not so. According to Elsner and a records search by The Watchdog, her law office had no other cases against Tri-City.

Kaiser Permanente has processes "when issues related to quality of care arise"

2011-11-17T14:33:00.000-08:00

"Every Kaiser Permanente physician is subject to review and evaluation to ensure the quality of care they provide. Like all health plans and hospitals in California, Kaiser Foundation Hospital Fresno has processes in place to monitor and evaluate the quality of care. And when issues related to quality of care arise, we have processes to take appropriate action."

In my case, Kaiser instituted a quality review on August 9, 2011. Then it cancelled the review on August 16, 2011.

Sure, Kaiser has processes. That statement is true. But Kaiser Permanente does not use those processes in a reasonable manner. It does not take appropriate action; that implication in the article below is false.

Our Point of View
Kaiser Permanente
October 16, 2007
Response to Los Angeles Times' Article About Fresno Medical Center

A recent story in the Los Angeles Times raised concerns about patient care involving a perinatologist on the professional staff at Kaiser Foundation Hospital Fresno. We take these issues very seriously. In regard to the Fresno Hospital matter, we took action more than two years ago to significantly limit the practice of the perinatologist and to monitor the care he delivers, and reported him to the state medical board.

Kaiser Permanente has more than 11,000 highly qualified physicians and specialists serving the needs of more than 6 million members in California. We expect each of them to provide the highest levels of quality care and believe in their clinical excellence.

Every Kaiser Permanente physician is subject to review and evaluation to ensure the quality of care they provide. Like all health plans and hospitals in California, Kaiser Foundation Hospital Fresno has processes in place to monitor and evaluate the quality of care. And when issues related to quality of care arise, we have processes to take appropriate action...

Kaiser fired Dr. Moran for complaining about Hamid Safari, the doctor who killed two babies

2011-11-17T12:38:00.001-08:00

Kaiser retaliation for patient advocacy

Kaiser fired the Chief of the OB/GYN Department for complaining about a doctor who has since become notorious for killing babies. At the same time, Kaiser offered $2 million to the baby-killing doctor to resign.

Dr. Gilbert Kenneth Moran's lawsuit says he was fired for complaining about "Dr. X," whose negligence resulted in three deaths at Kaiser in Fresno, which is where Dr. Hamid Safari worked when his notorious misbehavior occurred.

The lawsuit states:

...Between 2002 and 2004, while he was Chief of the OB/GYN department and oversaw the quality of care committee, petitioner complained to hospital officials about substandard patient care given by a doctor identified as Dr. X. The physician-in-chief told petitioner to stop complaining, and dismantled the quality of care committee; he demoted and otherwise disciplined petitioner as a result of the complaints. Dr. X's negligence resulted in the death of three patients.

Petitioner was told he could work harassment-free at Kaiser-Bakersfield if he resigned his partnership, returned to employee status, and accepted a reduction in pay and job security; he was told he would likely be promoted to partnership again after one year, rather than the usual three years. Petitioner agreed to this. His first day of work for SCPMG in Bakersfield was January 8, 2007. He subsequently filed a lawsuit alleging retaliation for patient advocacy; that suit was resolved on June 29, 2009. Petitioner was later told he would not be promoted to partner at Kaiser-Bakersfield; he was terminated effective February 22, 2010...

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

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

From the Fresno Bee:
Kaiser doctor rejected a deal
Hospital offered beleaguered Safari $2 million to resign.
By Tracy Correa

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prime Healthcare Files Antitrust Lawsuit Against Kaiser, SEIU

2011-11-16T15:48:00.000-08:00

November 16, 2011
Prime Healthcare Files Antitrust Lawsuit Against Kaiser, SEIU
California Healthline

On Tuesday, Prime Healthcare Services filed a lawsuit alleging that Kaiser Permanente and the Service Employees International Union have violated the Sherman Antitrust Act by colluding to drive Prime out of the Southern California marketplace, the Inland Valley Daily Bulletin reports (Edwards, Inland Valley Daily Bulletin, 11/15).

The lawsuit was filed in federal court in San Diego and names Kaiser Foundation Health Plan and its subsidiaries, and SEIU-United Healthcare Workers West as defendants (De Atley, Riverside Press-Enterprise, 11/15).

Background

The lawsuit is the latest in a series of allegations between the parties (Inland Valley Daily Bulletin, 11/15).

Kaiser previously has sued Prime, claiming that Prime facilities "trap patients" and "submit false and inflated bills" (Shimura, Victorville Daily Press, 11/15).

Details of Prime's Lawsuit

Prime's lawsuit alleges that SEIU, in exchange for wage concessions, has aided Kaiser's efforts to diminish Prime's market viability.

According to Prime, SEIU promoted false media stories about problems at its hospitals, including reports of high rates of blood infections. The lawsuit says SEIU also campaigned against the health system's efforts to acquire Victorville-based Victor Valley Community Hospital (Inland Valley Daily Bulletin, 11/15).

In addition, Prime's lawsuit claims Kaiser has withheld more than $100 million in reimbursements for care delivered to Kaiser members who received treatment at Prime facilities (Victorville Daily Press, 11/15).

The lawsuit is seeking injunctive relief to prevent activities that Prime alleges SEIU and Kaiser participated in, including disrupting Prime's business and "coercing or threatening patients" not to seek care at Prime hospitals. The lawsuit also seeks unspecified monetary damages (Inland Valley Daily Bulletin, 11/15).

Prime Implicates Lawmaker, News Organization

Meanwhile, Prime alleges that a "California State Legislator" who urged officials to look into high blood infection and malnutrition rates at its facilities had a "financial interest" in Kaiser and SEIU. The lawmaker implicated is Sen. Ed Hernandez (D-West Covina), the Pasadena Star-News reports. Rob Charles, a spokesperson for Hernandez, dismissed any suggestion that Hernandez helped facilitate a "conspiracy" between Kaiser and SEIU.

Prime also alleges that the news organization California Watch has served as a publicity arm of SEIU and published stories unfavorable to Prime (Luciano-Adams, Pasadena Star-News, 11/15). Mark Katches, editorial director of California Watch, said the organization has operated independently and has used state data and court documents to produce "a series of revelatory and groundbreaking stories" about Prime (Jewett, California Watch, 11/16).

Kaiser, SEIU Respond

Kaiser responded in a statement by saying it found the lawsuit "deeply puzzling."

Kaiser said, "At first glance, Prime's allegations appear to be that Kaiser Permanente's model of ... care, coupled with our ... labor management partnership, are somehow conspiracies designed to illegally compete with Prime Healthcare" (Victorville Daily Press, 11/15).

SEIU in a statement called Prime's lawsuit "frivolous" (Inland Valley Daily Bulletin, 11/15). David Tokaji, an SEIU-UHW spokesperson, added that the lawsuit is an attempt by Prime to deflect attention from allegations and investigations against the system (Victorville Daily Press, 11/15).

Survey Reveals Problems With Mental Health Care At Kaiser Permanente

2011-11-14T17:24:00.000-08:00

Who sits on the boards of those "independent rating agencies" and State of California offices that "recognize the quality" of Kaiser Permanente's mental health services? And who sits on the boards of "independent" agencies who rate other aspects of Kaiser's medicalcare? Kaiser doctors and administrators!

Survey Reveals Problems With Mental Health Care At Kaiser Permanente
November 14, 2011
By Kenny Goldberg
KPBS

SAN DIEGO — A union-backed survey of providers at Kaiser Permanente shows widespread dissatisfaction with the HMOs' mental health services. The union representing mental health professionals has been negotiating a new contract.

The National Union of Healthcare Workers surveyed more than 300 mental-health providers at Kaiser facilities in California. Many said they're not given enough time to evaluate patients, and they're not able to schedule return appointments in a timely way.

Jim Clifford has been a therapist at Kaiser's outpatient clinic in Otay Mesa for 10 years. He said mental-health care has gotten short shrift.

"We're trained to know what adequate care is and to provide it," he said. "And it's very troubling ethically to be in a position due to poor staffing not to be able to provide that. And it's been a chronic situation at Kaiser."

Clifford said Kaiser has refused to beef up staffing so that mental-health patients can get better care.

In a written statement, Kaiser officials said the quality of their mental health services has been recognized by independent rating agencies, and the state of California. The HMO said the NUHW survey was inaccurate and biased.

Long Wait Times The Norm At Kaiser Mental Health, Study Finds
Says company posting record profits while patients being denied the care they need.
Suisun City Patch
By Karina Ioffee
Nov. 15, 2011

Patients who seek mental health services at Kaiser Permanente have to wait for weeks for appointments, are routed into group therapy even when they need individual attention and are not given proper initial evaluations, according to a new report by the National Union of Healthcare Workers, that represents some 2,500 mental health clinicians.

The study is based on a survey of over 300 Kaiser mental health professionals practicing at 57 Kaiser facilities in Northern and Southern California, along with dozens of open-ended interviews with clinicians and patients.

Among its findings:

Kaiser mental health clinics are insufficiently staffed, with patients often forced to wait four weeks or longer for return appointments. That’s despite the fact that California state regulations require that patients be seen within ten business days,

Staff conduct accelerated initial patient evaluations that fall short of recommended clinical standards, which are then miscoded incorrectly in order to avoid penalties,

Patients that are funneled into group therapy even when their diagnoses call for individual therapy,

Falsified patient scheduling records that conceal appointment delays from state regulators, through practices such as "shadow" paper records and deliberately canceling and rescheduling patients' appointments while falsely attributing the cancellation to the patient.

Clinicians interviewed for the study describe a pattern of “deceptive practices by Kaiser administrators that routinely compromise the health and safety of thousands of patients suffering from emotional pain and distress in order to save the company money,” according to the report, titled “Care Delayed, Care Denied.”

Kaiser has more than 6.6 million members and is California's largest HMO. Since 2009, it has reported profits of $5.7 million and last year paid its Chief Executive Officer George Halvorson $6.7 million.

“It’s clear to us that decisions are being made from an accounting standpoint, that Kaiser’s approach to treatment is about making money for Kaiser and basically denying patients the treatment they deserve,” said Jim Clifford, a therapist for Kaiser in San Diego.

Click here to listen to interviews with Kaiser mental healthcare providers and patients

In an issued statement, Kaiser said the findings of the study were inconsistent with its patient and provider survey data and that the HMO regularly performs better than the standards set by the state of California.

“We are disappointed that the NUHW is going to such effort to attempt to discredit the great work performed every day by our clinicians and mental health therapists,” the company said. “They (therapists) provide timely, high-quality mental health care services to our patients, day in and day out, and whenever emergencies arise.”

The company went on to say that it offers Urgent Services where patients in crisis can get same-day or next-day appointments along with consultations for patients who have been admitted to a hospital or those who arrive in the emergency room. In addition, Kaiser says it offers a mix of individual and group therapy and defends the latter as a proven and effective method for mental health treatment.

Now, NUHW is demanding an investigation by the California Department of Managed Health Care, that regulates Kaiser's HMO plans and the Department of Insurance, which regulates the company's fee-for-service offerings.

They also want the Attorney General's office to look into potential unfair business practices at Kaiser mental health.

Kaiser Permanente found to be "cooking the books" regarding mental health care

2011-11-14T11:45:00.000-08:00

Dr. Robert Schannon and Linda Thornton are in charge of Kaiser Permanente's Behavioral Health Department in San Diego.

Study: Calif. mental patients force to wait past limit
By Kelly Kennedy
USA TODAY
Nov. 13, 2011

WASHINGTON – Mental health patients in California are often forced to wait for care beyond the 10-day limit required by state law, which is a troubling sign for the 2010 federal health care law's requirement to treat mental health patients in the same way as those suffering from other ailments, a survey of providers shows.

A survey of 305 mental health providers at 57 California Kaiser Permanente facilities found that mental health patients do not receive needed care in a timely manner, that managers ask employees to "cook the books" so it appears they meet a California law for an initial appointment within 10 days, that patients are funneled into group therapy because there are not enough clinicians for one-on-one care and that clinicians do not have time to perform basic assessments.

The survey was conducted by the National Union of Healthcare Workers.

The California findings are troubling for the nation because the federal health law requires insurers to pay for mental health issues as they would for any standard health issue, often referred to as parity.

Staffing has "always been a problem," but recent parity laws have made it worse, said Clement Papazian, a Kaiser Permanente licensed clinical social worker out of Oakland, where the organization is based.

That doesn't surprise Patrick Gauthier, director of AHP Healthcare Solutions, a research group that looks at behavioral health. He said that the problem is growing across the nation and that it will continue to grow until "parity" is better defined: what treatments should be covered and who can — or should — provide them. Even so, he said, until mental health care is integrated into the health system — rather than appearing as an extra service — it will be easier for plans to cut costs there.

According to the California survey, more than half of clinicians said their next available appointment was more than 10 business days away, and more than 65% said return appointments took longer than 10 days.

The California Psychological Association released a statement saying its members were "deeply troubled" because "if true, the care of the patient is being compromised."

Don Mordecai, the regional director of mental health and chemical dependency services for Kaiser Permanente in Northern California said his clinicians "provide timely access to high-quality mental health care for our members."

"The survey information described to us does not align in any way with our own data, nor with independent evaluations of our services," he said.

$2 Trillion US Health Care Sector Featuring Giants such as Kaiser Permanente, HCA Ascension and Tenet Healthcare

2011-11-13T03:03:00.000-08:00

Research and Markets: 2011 Report on the $2 Trillion US Health Care Sector Featuring Giants such as Kaiser Permanente, HCA Ascension and Tenet Healthcare
Press Release
Posted on 11/10/11
Benzinga Staff
DUBLIN--(BUSINESS WIRE)

Research and Markets (http://www.researchandmarkets.com/research/cc72d8/health_care_sector) has announced the addition of the "Health Care Sector" report to their offering.

The US health care sector includes more than 780,000 hospitals, doctor offices, emergency care units, nursing homes, and social services providers with combined annual revenue of more than $2 trillion. Major companies include Kaiser Permanente, HCA, Ascension Health, and Tenet Healthcare. The sector is highly fragmented: the top 50 organizations generate just 15 percent of revenue. Hospitals are the least fragmented industry: the top 50 hospitals account for 30 percent of total hospital revenue.

The sector includes about 6,500 general hospitals; 75,000 nursing homes and residential care facilities; 13,000 diagnostic labs; 30,000 outpatient clinics; 140,000 dentist offices; 220,000 doctor offices; and 150,000 family and social services providers.

Worldwide, health care expenditures total about $5 trillion annually, according to Swiss Re. Total health spending (both public and private) as a portion of GDP ranges from about 7 percent in countries such as Estonia to 17 percent in the US, according to the Organisation for Economic Co-Operation and Development.

COMPETITIVE LANDSCAPE

Demand for health care services is driven by demographics and advances in medical care and technology. The profitability of individual companies depends on efficient operations and, in the case of many nonprofit health care providers, obtaining grants and federal funds. Large companies have advantages in accessing the latest medical research, buying supplies, offering a wide range of services, and negotiating contracts with health insurers.

Key Topics Covered:

Industry Overview

Quarterly Industry Update

Business Challenges

Business Trends

Industry Opportunities

Call Preparation Questions

Financial Information

Industry Forecast

Web Links and Acronyms

For more information visit http://www.researchandmarkets.com/research/cc72d8/health_care_sector

Source: First Research

Research and Markets
Laura Wood, Senior Manager
press@researchandmarkets.com
U.S. Fax: 646-607-1907
Fax (outside U.S.): +353-1-481-1716

How is Kaiser Permanente in San Diego? Lawsuits and investigations

2011-11-08T16:06:00.000-08:00

City-Data.com
11-06-2011
thepinksquid Moderator
Join Date: Jun 2007
Location: San Diego, California
How is Kaiser Permanente in San Diego?

Hello my knowledgeable City-Data friends...

How is Kaiser Permanente care in San Diego? I'm considering changing my health insurance to Kaiser Permanente next year, but I have to admit I'm a little apprehensive as I've never had anything like KP before.

The Kaiser plan I could get through my employer is extremely inexpensive and offers a health reimbursement account, so I'd essentially have no out of pocket costs other than my paycheck deduction (which is very low). Right now I have a Health Net HMO... and it's fine, but unfortunately my doctor is retiring so I have to choose a new one anyhow. I'd love a PPO but the one my employer offers is super $$$. I'm fortunate to not have any major medical issues and my yearly costs are pretty low.

Any thoughts? Are some San Diego Kaiser facilities better than other ones? I live close to the Zion and Vandever hospitals, but would gladly go further for better care. It seems some people LOVE Kaiser, and others love to complain about it.

Is there a reason it's so cheap? Is it better to spend the extra money not go with Kaiser? Thanks!

__________________
Moderator of San Diego, San Jose & San Francisco sub-forums. =]

11-06-2011
AADAD
Senior Member

Join Date: Oct 2008
Location: Eagle River, Alaska & San Diego, CA

Yes there is a reason. It is at times inferior health care. Kaiser is built on a platform of efficiency first not care. Hats off to the hard working people there but I have had several friends have recent horror stories this year.

As a clinician I would advise you to stay away. As a consumer I can say you get what you pay for.

...I hear this quite a bit also. If you are in good health, KP may be better for you. If you are sick, really ill or really injured in that event KP is last on my list. In addition, they traditionally have much poorer scores for acute inpatient care. The nice(ities) fall off when you are hospitalized. In addition, your access to key clinical doctors is limited by their system. As I said, I have had two friends this year alone who were misdiagnosed (one who did not have stage 4 lung cancer but instead an infection she got while caving hystoplasmosis) after months of telling people she was dying she finally saw another specialist outside the KP system. I also had good experiences with pediatrics for my children. If you get sick, really sick KP is the last place one wants to be IMHO.

Maura Larkins
To find out how Kaiser compares, go to US News and World Report hospital ranking:
http://health.usnews.com/best-hospitals

I agree with AADAD that Kaiser is fine when you're healthy or when you have typical, though serious symptoms. You won't find Dr. House at Kaiser. They don't have the time to deal with any symptoms that aren't on their list of things to look for. They have a tendency to miss cancer diagnoses (both my friend and my mother were never seen by a Kaiser oncologist before their deaths from cancer). Most Kaiser facilities have outdated technology. (I see in the rankings in US News (see above) that the Medical Center on Sunset in Los Angeles is an exception.)

Kaiser Permanente Member Services is a joke. They cover-up serious problems. I recently complained that my X-rays taken on June 15, 2011 at the brand-new Garfield Specialty Center in Kearny Mesa were unavailable to my doctors. Member Services told me that the X-rays had not been saved electronically, but that the technician had saved a few X-rays on thermal paper and sent me some blurry photo-copied pages. Yet their advertising says all X-rays at Garfield Specialty Center are digitized! Are they lying to me or are they lying to everybody else???? I put my documents and X-rays on this webpage:
http://mauralarkins.com/kaiserurology.html

I complained to Member Services that the medical report about the X-rays was compromised. Kaiser's story was that the report had not been written by the urologist who had been present on June 15, 2011 and had seen the large series of X-rays as they were being taken, and spoken to me and examined me, but rather that the official report was written 5 days later by a non-urologist who had seen only 5 images on thermal paper! Also, the report had the wrong date of the procedure, the wrong referring doctor, and it was signed three days BEFORE it was supposedly written.

What did Member Services do with my complaint about tampering? They tampered with it! They changed it to say I was unhappy about not getting an anti-fungal medication--from a urologist! I did not want or need an anti-fungal medication; also, it is gynecologists or primary care doctors, not urologists, who deal with yeast infections. Kaiser can't even come up with a clever cover story.

Perhaps not surprisingly, the urology department in San Diego had lower than expected survival rates last year and average survival this year. About half of all hospitals have "better" or "much better" than expected survival rates.

Maura Larkins
Junior Member
Join Date: Nov 2011
Location: San Diego

They're playing the percentages. They take care of the simple cases.

Quote:
(Originally Posted by earlyretirement)
Definitely I think you will find people that are happy with Kaiser and probably will find people that will complain as well. One thing I'll say is that for all of our visits with our doctors, someone from Kaiser followed up with a phone call the next day to see how everything went and even asked if we had any complaints. I've never had an health care insurance provider do something like that before. So definitely I do think they care about customer service and satisfaction.

They're playing the percentages. They take care of the simple cases--and almost all cases are simple. They want to please the majority of their patients. But they make a lot of profit, and they do it by cutting corners and denying care strategically. When they get taken to court, they say that the case was unusual, and they couldn't be expected to know what to do.

AADAD
Making people happy does not make them healthy.

That pleasing the consumer is the trend now in health care to satisfy the consumer irrespective of solving the complex medical problems that they arrive with (on their own). From Scripps to Kaiser and Sharp to UCSD patient satisfaction scores are the goal. To make it worse, Medicare is linking payments to how well patients were "pleased" and satisfied. Nothing in my experience could be more undoing to the goal of sustaining a healthy person.

The steps to take now are to educate yourself and ask questions. Doctors and nurses are trained to solve problems related to our human bodies. We do better when we have a person who tells us about themselves. I cannot even begin to tell you the number of times the patient feeling satisfied gets directly in the way of helping them to be healthy down the road.

Kaiser is known for pleasing it's customer and in serious illness they would rather do that than solve the more complex problems. I concur on the cancer dx issues related in the post above. Kaiser puts it footmark on prevention. Once you are really sick, you would be better off in another hospital system. Stay alert to your bodies changes take notes do research and ask questions because in 5 years the nurse at your bedside will not be interested in asking key questions which would potentially save your life, they will be asking you how you want your coffee.

11-14-2011
tonyinsd

Not to resurrect a dead topic, but here's something that Huffington Post wrote about Kaiser's mental health services.

Kaiser Permanente Makes Billions In Profits While Overburdening Staff: Report

Maura Larkins
Location: San Diego

Why would this be a dead topic? This is fascinating, and seems to reveal that Kaiser is unrepentant about practices in the San Diego Psychiatry Department that led to a lawsuit and investigation in 2000:

Kaiser's Prescribing Policy Leads To Lawsuit, Ethics Concerns
Psychiatric News
May 5, 2000

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

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

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

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

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

Jury Orders UC-Davis To Pay $7.6M to Paraplegic Woman

2011-11-08T14:54:00.000-08:00

November 01, 2011
Jury Orders UC-Davis To Pay $7.6M to Paraplegic Woman
California Healthline

On Friday, a Sacramento Superior Court jury awarded $7.6 million to an Elk Grove woman after determining that UC-Davis Medical Center employees misread an MRI exam and that resulting complications caused her to become paralyzed. A UC spokesperson said in statement that an internal review of the case showed that "the medical care provided ... was appropriate." The jury awarded the woman $6.4 million to cover lost wages and the cost of lifetime medical and attendant care, as well as $1.2 million for pain and suffering. However, California's medical malpractice law caps damages for pain and suffering at $250,000. If the jury's verdict stands, the plaintiff would receive $6.67 million.

"Sacramento Jury Tells UC Davis To Pay $7.6 Million to Paraplegic Woman" (Furillo, Sacramento Bee, 11/1).
"Elk Grove Woman Wins $7.6M in UC Davis Malpractice Suit" (Robertson, Sacramento Business Journal, 10/31).

Kaiser Permanente and Sutter challenge medical peer review process

2011-11-08T14:21:00.000-08:00

I think these are bad doctors with a good cause. Peer review usually results in doctors and nurses covering for their friends and allies who make mistakes. The only doctors who are targeted are those who are unpopular, which often has nothing to do with competence. In fact, sometimes doctors are unpopular simply because they don't go along with group goals that put the interests of doctors ahead of those of patients.

Dr. Mark Fahlen sounds like he lost the confidence of nurses, and I believe that nurses are sometimes right and doctors are sometimes wrong. I saw a nurse save a patient's life when an Emergency Room doctor ordered the patient released, and the nurse intervened and said they should wait for test results. The test results revealed that the patient had a deadly condition, malignant hyperthermia. Nerve damage had already begun. She ended up fine after about nine days in the hospital. Thank you, dear nurse!

Also, Dr. Fahlen seems to be imperious and arrogant. If he had the patients' interests at heart, he would have explained to the nurses why his orders needed to be followed.

And of course, Dr. Hamid Safari has outrageously bad judgment. Like Fahlen, he failed to communicate and lost his temper. Those two babies should not have died. He yanked a baby who was in no distress at all out of his mother's uterus, killing it. Instead, he should have patiently explained to the mother why a Caesarian section was needed.

Nov. 07, 2011
Doctor files suit against Modesto hospital
He's challenging procedures used for complaints
By Ken Carlson
Modesto Bee

A Modesto physician is one of two plaintiffs in a federal lawsuit filed Monday, which challenges a process used by California hospitals to review complaints against doctors.

Attorneys filed the lawsuit in U.S. District Court in San Francisco on behalf of Dr. Mark Fahlen, a Modesto kidney specialist who saw patients at Memorial Medical Center, and Dr. Hamid Safari, a perinatologist who worked for Kaiser Permanente's Fresno hospital.

The lawsuit charges that California's peer review process violates federal due process laws and constitutes a violation of physicians' civil rights.

Named as defendants in the lawsuit are Sutter Central Valley Hospitals, which manages Memorial, and Oakland-based Kaiser Permanente.

The lawsuit charges that Sutter terminated Fahlen's privileges in January without proper cause. The physician said he is unable to see his patients who are taken to Memorial in emergencies or because of their insurance coverage, his attorney said.

Some of those patients are in advanced stages of kidney failure, he said.

The lawsuit seeks to reinstate Fahlen at Memorial.

Stephen Schear, an attorney for the two physicians, said the state has delegated peer review authority to health care corporations, giving them power to destroy doctors' careers without due process of law.

"California's peer review system for physicians is the only legal system in the United States where a powerful corporation is permitted to target an individual's career and then pick the judge and jury who decide the matter," Schear said in a press release.

From 2003 to 2008, Fahlen brought numerous complaints to Memorial administration regarding his allegations of nursing errors and insubordination.

He alleged that nurses ignored or disobeyed his patient care orders and changed orders without his consent.

Confrontational complaints

Nurses, in turn, complained to administrators that Fahlen was confrontational with staff and that his conduct interfered with patient care.

A hospital executive committee recommended in August 2008 that Fahlen's privileges should be terminated. He exercised his right to have a hospital-appointed judicial review panel hear testimony and evidence.

Even though the review panel recommended that Fahlen keep his privileges, Sutter followed through with his termination in January, the lawsuit says. Fahlen is now chairman of the department of medicine at Doctors Medical Center in Modesto.

A spokesman for Sutter's Central Valley region said the group had not seen the lawsuit and would not comment.

The California Medical Board in 2007 accused Safari of gross negligence in the deaths of two newborns in Fresno.

But a state administrative law judge found in 2009 that Safari complied with standards of care and was not at fault.

Despite that decision, Kaiser has not allowed Safari to practice medicine at its hospitals, the lawsuit alleges.

Federal regulators also investigated complaints by Kaiser medical staff and nurses who had raised questions about the Fresno physician's competence.

Officials issued a critical report in 2008 suggesting that the deaths could have been prevented if Kaiser had more closely monitored Safari.

National Toothache: U.S.’s Fifth World Health Care

2011-11-06T11:13:00.000-08:00

National Toothache: U.S.’s Fifth World Health Care
by Grady Miller
Canyon News
Nov 6, 2011

HOLLYWOOD—According to a recent Kaiser Family Foundation poll, fully one-third of Americans are skipping dental care because of the high cost. As the Times reported this week, doctors are seeing people who haven’t visited a dentist since Clinton was president, and they are enduring toothaches for years.

I know the dental neglect score, because I toughed out a painful abscessed molar for much of a decade. When the good Dr. Fundaminsky extracted it, I felt sudden relief and also learned about the grave dangers posed by infected teeth: it’s not just the pain. Because all the blood flows through the gums on its voyage throughout the body, infected teeth can lead to organ damage and even death, when left untreated.

Hearing of those poor who have deprived themselves of medical care, I recall my own long healing process when my eyes slowly opened and I overcame a deeply ingrained aversion to seeking the proper care — an insane aversion reinforced by the grin-and-bear-it brand of American stoicism, a usually admirable trait that is in the medical context deplorable. In fact, as someone who suffered M.A.S. (Medical Avoidance Syndrome - my coinage), I believe it poses a major public health problem.

From 1992 to 2001, I resided in a Third World country and during that time I discovered how deprived I had been, handicapped by my American notions of health care and a peculiarly American dread of going to the doctor. While in my new country of residence, Mexico, I was insured by I.M.S.S. (the Mexican Social Security Institute), even as a foreigner. As an American, I didn’t have the foggiest concept of what this meant or know how to take advantage of this benefit until it was too late for my molar, so indoctrinated had I been by the United States’ dysfunctional health care system.

In Mexico, the government-run system of health care and hospitals, established in 1943 under President Avila Camacho, is open to most Mexican workers and other individuals who pay a yearly fee (around $100) based on a full-time minimum wage. A good six years passed before I knew enough to get some antibiotics from I.M.S.S. to alleviate an ear infection.

For me, the real mind-opener was simply living for the first time in a country where medical care is widely available without costing an arm and two legs, a country where the dictates of common medical sense reigned. I lived in a country where alarmed friends and co-workers would urge a visit to the doctor when symptoms of a dermatological malady had conspicuously crossed the line of my stoic American tolerance for an ailment without seeing a doctor. (It turned out to be shingles.) In Mexico, my whole fearful outlook toward medicine changed: if I had a complaint or just plain curiosity about a change observed in my body, for $20 or $30, I could do something about it. At the end of such visits, I would usually be granted a generous dose of the great cure-all, the peace of mind that comes from knowledge.

An underclass of many, far too many, Americans have been infected with the pernicious idea of monetized health care. The land of plenty has spawned a destructive culture of self-sacrifice. We shun the dentist because it may be costly and the toothache will eventually subside. Likewise, a host of other medical issues and routine check-ups are postponed for a payday that never comes for the unemployed and the working poor. An embarrassing number of Americans steel themselves to ignore the body’s warning signs and deny themselves necessary care. With the recession, the trend is even more prevalent. Another Kaiser Family Foundation survey last year revealed that one in three Americans reported problems in paying medical bills, and almost half reported somebody in their family skipping pills and postponing medical treatment because of the cost. Hey, you wouldn’t put off an oil change on your car, would you? It is a pathetic commentary on our culture that we take better care of our cars than our bodies.

As for my infected molar, let me be truthful. I avoided the dentist for years in both Mexico and California. In addition to having the Scottish allergy to untoward expenses, I share the common human trait of dreading and hating the dentist. My dumb.

The Doctors Who Killed a President

2011-11-06T06:52:00.000-08:00

The Doctors Who Killed a President
By KEVIN BAKER
September 30, 2011

For 11 weeks Garfield endured unsterilized probings, large doses of quinine and a vermin-infested sickroom.

DESTINY OF THE REPUBLIC
A Tale of Madness, Medicine,and the Murder of a President
By Candice Millard

A near drowning while he labored on the Erie and Ohio Canal convinced him that God “had saved me for my mother and for something greater and better than canalling,” he wrote. For the next few years, he worked his way up through local schools and Williams College; at the Western Reserve Eclectic Institute (now Hiram College), a preparatory school, he mastered his studies so thoroughly that he was promoted from janitor to assistant professor. Returning there to teach, he became the school’s president at 26. In his spare time, he passed the Ohio bar.

Excelling both in combat and as a top staff officer, he rose to the rank of major general during the Civil War but was sickened by the carnage of battle. “Garfield would later tell a friend,” Millard writes, “that ‘something went out of him . . . that never came back; the sense of the sacredness of life and the impossibility of destroying it.’ ”

Elected to Congress in 1862, Garfield fought for black rights and liberty, writing in his pocket diary, “Servitium esto damnatum”— “slavery be damned.” Modest to a fault, he toiled diligently in the legislative vineyards for 17 years...

Had Garfield been left where he lay, he might well have survived; the bullet failed to hit his spine or penetrate any vital organs. Instead, he was given over to the care of doctors, who basically tortured him to death over the next 11 weeks. Two of them repeatedly probed his wound with their unsterilized fingers and instruments before having him carted back to the White House on a hay-and-horsehair mattress.

There, control of the president was seized by a quack with the incredible name of Dr. Doctor Willard Bliss. Dr. Doctor Bliss insisted on stuffing Garfield with heavy meals and alcohol, which brought on protracted waves of vomiting. He and his assistants went on probing the wound several times a day, causing infections that burrowed enormous tunnels of pus throughout the president’s body.

Garfield’s medical “care” is one of the most fascinating, if appalling, parts of Millard’s narrative. Joseph Lister had been demonstrating for years how his theories on the prevention of infection could save lives and limbs, but American doctors largely ignored his advice, not wanting to “go to all the trouble” of washing hands and instruments, Millard writes, enamored of the macho trappings of their profession, the pus and blood and what they referred to fondly as the “good old surgical stink” of the operating room.

Further undermining the president’s recovery was his sickroom in the White House — then a rotting, vermin-ridden structure with broken sewage pipes. Outside, Washington was a pestilential stink hole; besides the first lady, four White House servants and Guiteau himself had contracted malaria. Hoping to save Garfield from the same, Bliss fed him large doses of quinine, causing more intestinal cramping...

GlaxoSmithKline to pay $3B to settle charges over marketing practices

2011-11-03T10:01:00.000-07:00

GlaxoSmithKline to pay $3B to settle charges over marketing practices

GlaxoSmithKline agreed to pay $3 billion to resolve U.S. criminal and civil investigations into whether the U.K. company marketed drugs for unapproved uses and other matters, its biggest legal settlement.

Negotiations over the terms are ongoing and will be completed next year, the London-based company said in a statement today. The cost is covered by existing legal provisions and will be paid from the company’s cash resources, Glaxo said.

The Glaxo settlement would trump the $2.3 billion Pfizer paid in 2009 over the marketing of its Bextra painkiller and other drugs and the $1.4 billion Eli Lilly paid the same year over sales of its Zyprexa anti-psychotic medicine. The Bextra accord had been the largest pharmaceutical marketing settlement in U.S. history.

Glaxo to pay $3B to settle U.S. sales, Avandia cases
By Phil Serafino and Makiko Kitamura
November 3, 2011
Bloomberg

GlaxoSmithKline Plc agreed to pay $3 billion to resolve U.S. criminal and civil investigations into whether the U.K. company marketed drugs for unapproved uses and other matters, its biggest legal settlement.

Negotiations over the terms are ongoing and will be completed next year, the London-based company said in a statement today. The cost is covered by existing legal provisions and will be paid from the company’s cash resources, Glaxo said.

The potential settlement brings Glaxo closer to putting years of legal probes behind it. The company set aside 2.2 billion pounds ($3.5 billion) in the fourth quarter last year in anticipation of reaching an agreement on the cases. Glaxo said it will have about 1 billion pounds of its 2.9 billion pounds in total legal provisions remaining after today’s settlement is completed, and it hasn’t decided what to do with the money.

“This news essentially draws a line under a 10-year legal saga,” Gbola Amusa, an analyst at UBS AG in London who recommends buying Glaxo shares, said in an e-mail. “This removes significant uncertainty on ongoing legal issues.”

Glaxo were unchanged at 1,355.5 pence at 10:14 a.m. London time.

Pfizer Settlement

The Glaxo settlement would trump the $2.3 billion Pfizer Inc. paid in 2009 over the marketing of its Bextra painkiller and other drugs and the $1.4 billion Eli Lilly & Co. paid the same year over sales of its Zyprexa anti-psychotic medicine. The Bextra accord had been the largest pharmaceutical marketing settlement in U.S. history.

Abbott Laboratories agreed to pay at least $1.3 billion to settle claims by the U.S. government and 24 states alleging the company illegally marketed its Depakote epilepsy drug, people familiar with the accords said last month.

“Litigation is an ever-present business risk in the pharmaceuticals industry,” Mark Purcell, a Barclays Capital analyst, wrote in a note to investors today. Barclays expects Glaxo will incur legal charges of 150 million pounds a year, Purcell said.

Federal prosecutors began an investigation in Colorado in 2004, later taken over by the U.S. attorney in Massachusetts, into whether Glaxo promoted drugs for unapproved uses, and into ways Glaxo potentially influenced doctors. The probe concerns nine of the company’s best-selling products from 1997 to 2004, including the Advair lung treatment, Glaxo said in its annual report.

Medicaid Rebates

Today’s settlement also covers a U.S. Justice Department probe of Glaxo and a Medicaid rebate program, and a Justice Department investigation into the development and marketing of the Avandia diabetes drug, the company said.

Drugmakers are required to give rebates to Medicaid, the government health insurance program for the poor. The investigation examined how Glaxo reported prices charged to other payers, which are used in calculating the Medicaid rebates.

Regulators said last year that Avandia would be withdrawn from the market in Europe and sales would be limited in the U.S. because of an increased risk of heart attacks.

“This is a significant step toward resolving difficult, longstanding matters which do not reflect the company that we are today,” Chief Executive Officer Andrew Witty said in the statement. “In recent years, we have fundamentally changed our procedures for compliance, marketing and selling in the U.S. to ensure that we operate with high standards of integrity.”

Compensation Changes

Earlier this year, Glaxo changed incentive compensation programs for U.S. sales representatives. The company has eliminated the link between sales goals and bonuses, which are now based on selling competency, customer evaluations and overall performance of the representative’s business unit.

Glaxo still faces probes involving the United Nations oil- for-food program, and HIV product sales and marketing in the U.S., JPMorgan Chase & Co. analysts wrote in a note to investors today.

The legal provision, announced in January, led to a loss for Glaxo in the fourth quarter of 2010. Less than three weeks after the provision was disclosed, the company said it would begin a share repurchase for the first time since 2008 to enhance investor returns.

Kaiser waited a year and a half before doing biopsy; first oncology appointment scheduled a year after that

2011-11-02T17:58:00.000-07:00

My friend Sandy Wiltgen went to the San Diego Kaiser emergency room because
she'd been bleeding vaginally for months. She was so anemic they gave her a
transfusion.

After she'd been bleeding heavily for another six months, she went back.

They didn't give her a biopsy. They just gave her another transfusion and sent her
home.

After a year-and-a-half of bleeding, they finally gave her a biopsy. She had
uterine cancer.

But gynecology didn't want to refer her to an oncologist. (I think Kaiser Permanente doctors get bonuses if they don't make referrals to specialists.) But they finally gave in and referred her.

Sandy was unable to go to her first appointment with the
oncologist because she died of uterine cancer two weeks before the scheduled date.

I, too, have had some strange experiences with Kaiser. They told me my X-rays would be available to any Kaiser doctor within hours of my procedure. But apparently the X-rays proved that I was right and the doctor was wrong, so they didn't upload the X-rays. They also altered the report about the X-ray results.

Health Net punished for lying about contract cancellation bonuses

2011-11-02T16:45:00.000-07:00

"If they can mislead the Department of Managed Health Care, can you imagine how misleading they can be to their policyholders?"...State regulators fined WellPoint Inc., the parent of Blue Cross of California, $1.2 million and Kaiser Permanente $325,000 for improperly canceling policies. Investigations continue for Kaiser, Health Net, PacifiCare and Blue Shield of California.

Health Net punished for lying about contract cancellation bonuses
Victoria Colliver
San Francisco Chronicle Staff Writer
November 16, 2007

State health regulators fined Health Net Inc. $1 million Thursday for lying to investigators about paying employees bonuses based on the number of contracts they canceled after those policyholders got sick.

The penalty was the first levied on a health insurer for withholding information about incentives given to its employees.

Health Net, along with other major health insurers, is being investigated for combing through applications of members after they have filed claims to find mistakes or omissions that would justify revoking policies. Insurers say they resort to rescinding policies only when members lie about their health histories, but consumers say the questionnaires often are vague and misleading.

As part of the investigation, state regulators asked Health Net officials on two separate occasions whether the company gave financial bonuses to its employees for rescinding policies. State law prohibits tying compensation to claims decisions. Both times, plan officials denied doing so.

"The health plans say they have to rely on applicants being truthful and fully disclosing their medical conditions. And if they aren't truthful, there are very hard consequences," said Cindy Ehnes, head of the state Department of Managed Health Care. "As a regulator, I have to rely on that same truthfulness and full disclosure by the companies we regulate."

The company's practices came to light last week when a Southern California judge allowed documents to be made public that showed a Health Net analyst received more than $21,000 in bonuses from 2000 to 2006, based at least partly on meeting or exceeding the company's rescission goals. Health Net claimed to have saved $35.5 million in "unnecessary" care for rescinding more than 1,000 policies during that time frame, documents showed.

Health Net executives apologized Thursday for "any misunderstanding" with the state regulators. The company, based in Woodland Hills (Los Angeles County), accepted a consent agreement and promised to stop compensation practices linked to rescission.

The documents were submitted in an arbitration hearing involving Patsy Bates, a 51-year-old hairdresser from Gardena (Los Angeles County), who is suing Health Net for $6 million plus punitive damages for canceling her policy after she was diagnosed with breast cancer. The company said she lied about her weight and failed to disclose a heart condition.

Claremont attorney William Shernoff, who is representing Bates, called the fine appropriate.

"If they can mislead the Department of Managed Health Care, can you imagine how misleading they can be to their policyholders?" Shernoff said. The hearing in Rancho Cucamonga (San Bernardino County) is expected to conclude Friday.

State regulators fined WellPoint Inc., the parent of Blue Cross of California, $1.2 million and Kaiser Permanente $325,000 for improperly canceling policies. Investigations continue for Kaiser, Health Net, PacifiCare and Blue Shield of California.

Bayer pays $242 million for knowingly misreporting its "best price" to HCFA and underpaying its Medicaid rebates for private labels for Kaiser

2011-11-02T16:07:00.000-07:00

Bayer has agreed to pay $242,126,570 in damages and penalties to the federal and state governments for knowingly misreporting its "best price" to HCFA and underpaying its Medicaid rebates for Cipro and Adalat CC that was private labeled for Kaiser and PacifiCare from its determination of "best price.

CURRAN ANNOUNCES OVER $300 MILLION NATIONAL
SETTLEMENT WITH DRUG MANUFACTURERS
Maryland to Receive Approximately $2 Million
Maryland Attorney General
April 16, 2003

Attorney General J. Joseph Curran, Jr. announced today that his Medicaid Fraud Control Unit is among 48 Units nationally to reach settlements, in principle, with GlaxoSmithKline GSK and Bayer Corporation for violating the federal Medicaid drug rebate statute by failing to report "best price" information and their resulting failure to pay sufficient rebates to the state Medicaid programs in connection with their private labeling of certain drugs for health maintenance organizations.

In addition to the civil settlement, amounting to $87,600,922 in damages and penalties to the federal government and the states, GSK will enter into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services, Office of Inspector General. At the insistence of the National Association of Medicaid Fraud Control Units, GSK will be required to certify its "best price" methodology. This will add a new responsibility for the manufacturer and will enhance future state enforcement.

Bayer has agreed to pay $242,126,570 in damages and penalties to the federal and state governments for knowingly misreporting its "best price" to HCFA and underpaying its Medicaid rebates for Cipro and Adalat CC that was private labeled for Kaiser and PacifiCare from its determination of "best price." Bayer will plead guilty to a charge of violating the Food, Drug and Cosmetics Act in federal district court in Boston. The government will recommend that Bayer pay a fine of $5,590,800. An addendum with new obligations will be added to Bayer’s current Corporate Integrity Agreement with the U.S. Department of Health and Human Services, Office of Inspector General. At the insistence of the National Association of Medicaid Fraud Control Units, the CIA will require Bayer to certify its "best price" methodology. This new responsibility will enhance future state enforcement.

The National Association of Medicaid Fraud Control Units represents the 48 federally certified Medicaid Fraud Control Units that investigate and prosecute Medicaid provider fraud.

These settlements, which include 49 states and the District of Columbia, together with two major drug manufacturers represent the largest national Medicaid fraud settlements ever.

Both Bayer and GlaxoSmithKline sold products to HMOs at deeply discounted prices, and then concealed and avoided their obligation to pay additional rebates to the Medicaid programs. This was accomplished by re-labeling or re-packaging these drugs under the HMO’s private label. This fraud scheme is referred to as "lick and stick."

The federal Medicaid drug rebate statute is designed to return money to the Medicaid program in the form of rebates from drug manufacturers. Under the statute, in order to have the pharmaceuticals eligible for Medicaid payment, all pharmaceutical manufacturers must provide "best price" information to the Centers for Medicare and Medicaid Services (formerly HCFA). "Best price" is the lowest price that a manufacturer offers its products for sale to commercial purchasers. CMS uses this "best price" information to calculate rebates payable to the state Medicaid programs under the statute.

GlaxoSmithKline

The U.S. Attorney’s Office for the District of Massachusetts conducted an investigation into alleged improprieties relating to the reported "best price" for Flonase, a nasal spray, and Paxil, an anti-depressant. Flonase was manufactured and sold by Glaxo Wellcome and Paxil was manufactured and sold by SmithKline Beecham. These two companies merged and became GlaxoSmithKline in December 2001.

Through a private labeling agreement with Kaiser Permanente, an HMO in California, Glaxo Wellcome manufactured, packaged and shipped Flonase to Kaiser, but substituted the Kaiser unique identifying number for the Glaxo Wellcome unique identifying number on the label. The purpose of the private labeling arrangement was to provide Kaiser additional price discounts on Flonase without having to report the discounted price as Glaxo Wellcome’s "best price", thereby avoiding the obligation to pay additional rebates to Medicaid under the Medicaid rebate program. Similarly, SmithKline began private labeling Paxil for Kaiser. Paxil was manufactured, packaged and shipped by SmithKline to Kaiser, but SmithKline substituted Kaiser’s unique identifying number for SmithKline’s unique identifying number on the label. SmithKline provided Kaiser additional price discounts on Paxil without reporting the newly discounted price to the Medicaid rebate program, thereby avoiding payment of additional rebates.

Kaiser Foundation Health Plan Inc. penalized $1.9 million for improper Medicare claims

2011-11-02T16:03:00.000-07:00

Kaiser penalized $1.9 million
Pacific Business News
April 15, 2005

The U.S. and state attorneys general have penalized Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospitals and the Hawaii Permanente Medical Group $1.9 million for making improper Medicare and Medicaid claims.

Kaiser was penalized $1 million for submitting false federal Medicare claims and $900,000 for improper state Medicaid claims.

A Kaiser employee claimed that an employee in the dermatology department had treated patients without a required state license between May 1984 and December 2001, which was confirmed by the Medicaid Fraud Control Unit, state Attorney General Mark Bennett announced Thursday.

The state said the employee who provided the treatment wasn't a licensed physician's assistant although Kaiser billed the state Medicaid program for the services provided.

The state also found that Kaiser failed to properly supervise the treatments, although the investigation didn't reveal any evidence of improper care, substandard treatment or injury to Kaiser patients.

"We take regulatory compliance very seriously at Kaiser Permanente and we regret the mistake," said Jan Head, Kaiser president.

Kaiser says the inaccurate billings to Medicare and Medicaid occurred after the state created a certification requirement for physician assistants and that the dermatology assistant practiced at Kaiser prior to the change and failed to obtain a license after the requirement went into effect.

The whistle-blowing employee filed suit in federal court under the federal and state false claims act and will receive $225,000 of the $900,000 for informing the state.

The Medicaid program will receive $115,379 for claims made based on service provided by the unlicensed service provider and the Medicaid Investigations Recovery Fund will receive $559,621 that will be used to pay for future investigations.

Filing a complaint with Kaiser Permanente Member Services

2011-11-02T11:20:00.000-07:00

1 800 464 4000 Member Services Call Center

(* See below if your Kaiser email isn't working.)

Kaiser Permanente makes it hard to get through, but it's actually easy to file a complaint once you get to talk to a human being. You simply have to ignore all the little tricks they use to get you to hang up.

(Actually, sometimes you get an unhelpful person on the line. In that case, just call back and get a different person. One employee flat-out refused to take my complaint. I asked to talk to her supervisor, who was very helpful. One woman told me she would only take complaints going back three months. Usually they say six months. But if it's a continuing problem, you should describe recent events, then you would probably need to go back and explain the beginning of the problem.)

(Also, you can always fill out a grievance form. )

When I called Kaiser Permanente Member Services call center today, the recording said there were "extemely high volumes and wait times." Not true!

The truth was, I waited less than a minute to talk to someone once I had gone through all the menus.

Also, don't pay any attention when the recording tells you that you have punched in an incorrect Medical Record Number and 4-digit birthdate (month and year). Just ignore it. They are trying to get you to hang up and go away.

After you punch in your Medical Record Number and birthdate, there will be another menu to listen to. Making a complaint with Member Services won't be one of the options, but stay on the line. There will be a pause in the recorded menu making you think there are no more options. But if you keep holding, you will be told to press "0" to talk to someone to make your complaint.

The toll-free number is 1 800 464 4000.

KAISER PERMANENTE EMAIL NOT WORKING?

When I called Member Services to report that my Kaiser email wasn't working, Kaiser got me to hang up by means of a recorded message that suggested that the problem could be solved by clicking on a certain button. Not so. I believe that the message was just a trick to get people to go away.

I called back and reported the problem, and lo and behold, my email was working again within a few hours. Complaining can be very effective!

Board member balks over Tri-City treatment

2011-11-01T21:52:00.000-07:00

Board member balks over Tri-City treatment
SDUT
Randy Horton
Oct. 28, 2011

On Thursday, six months after secretly barring me from closed session attendance, Tri-City Healthcare District board members openly restored me on one condition: They reserved the right to exclude me from any and all future closed session agenda items by vote.

Tri-City voters, after electing their representatives, are free to recall them at any time for any reason. Federal and California courts also have legal authority to remove elected officials from office.

Although our state has not vested special district elected representatives with this power, the hospital is working hard to create legal rights by simply declaring that they now exist. Who died and made our board members kings and queens?

I was recently excluded from a day-long strategic plan retreat, a core board duty. How many other politically embarrassing open session items are now routinely buried in closed session?

“Opaqueness,” declares Tri-City, “thy name is now transparency!”

--Randy Horton
Board member

Tri-City reinstates Horton but not Sterling

2011-10-28T12:57:00.000-07:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Horton has been censured once.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2011-10-25T16:56:00.000-07:00

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

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

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

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

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

Employers to continue raising rates, shifting cost to workers

2011-10-23T12:59:00.000-07:00

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

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

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

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

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

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

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

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

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

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

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

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

2011-10-19T14:03:00.000-07:00

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

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

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

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

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

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

And he made on average $200 a day.

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

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

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

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

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

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

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

The illness started in about 2000 or 2001...

What were the symptoms?

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

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

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

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

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

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

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

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

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

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

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

“But he didn’t pay. He couldn’t pay.”

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

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

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

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

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

“His birthday was April 30.”

“My birthday is May 11.”

“He was 53 that year. I was 18.”

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

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

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

Did he say how he was going to do it?

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

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

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

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

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

That was April 2003.

Did he say anything after that date?

“Never. He never brought it up again.”

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

How did he kill himself?

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

Did he leave a note for you?

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

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

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

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

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

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

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

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

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

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

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

2011-10-18T15:27:00.000-07:00

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

Here's the June 2011 complaint against Charlene Anderson.

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

Why Are Customers of This Health Insurer So Happy?

2011-10-18T14:48:00.000-07:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Health-Insurance Plan Rankings from the NCQA Consumer Reports

Let board members in, attorney tells Tri-City

2011-10-18T09:01:00.000-07:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

As Kaiser Workers Face Cuts, Execs Have Enjoyed Lavish Benefits

2011-10-15T19:24:00.000-07:00

See Kaiser executives.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2011-10-15T13:05:00.000-07:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2011-10-15T12:56:00.000-07:00

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

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

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

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

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

His spinal cord had been severed.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2011-10-15T09:19:00.001-07:00

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

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

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

(Click on image to enlarge.)

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

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

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

Here's the Kaiser article:

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

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

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

(Click on image to enlarge.)

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

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

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

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

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

Absolute greed: Michael Moore supports Kaiser workers in Los Angeles

2011-10-13T10:05:00.001-07:00

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

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

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

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

We had good reason to strike against Kaiser.

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

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

Greed.

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

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

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

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

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

2011-10-12T19:48:00.000-07:00

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

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

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

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

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

Selected Kaiser Employees Will Strike for 24 Hours Starting Wednesday

2011-10-12T14:32:00.000-07:00

Selected Kaiser Employees Will Strike for 24 Hours Starting Wednesday

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

By Ken Stone
May 17, 2011

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

She argued that Kaiser can no longer claim financial hardship.

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

COMMENT

Ken Stone

4:39pm on Wednesday, May 18, 2011

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

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

2011-10-10T16:40:00.000-07:00

See Kaiser Permanente administrators in San Diego.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2011-10-07T14:10:00.000-07:00

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

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

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

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

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

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

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

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

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

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

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

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

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

Insurers Banking their Cash

2011-10-07T11:23:00.000-07:00

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

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

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

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

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

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

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

- Rhonda Swan,

for The Palm Beach Post Editorial Board

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

2011-10-06T11:07:00.000-07:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Facing Government Scrutiny, Kaiser Backs Off Rate Increases

2011-10-05T20:05:00.000-07:00

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

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

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

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

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

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

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

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

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

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

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

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

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

2011-10-02T20:38:00.000-07:00

Courage Campaign
October 2, 2011

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

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

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

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

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

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

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

Rick, Domingo, Eddie and the Courage team