Kaiser Cost a Man His Penis, He Claims

Kaiser Cost a Man His Penis, He Claims By BARBARA WALLACE  Courthouse News Jan. 21, 2015      NAPA, Calif. (CN) - An elderly patient's penis eroded because Kaiser would not let care providers remove his catheter, he claims in Napa County Superior Court.      Rupert Collins sued Kaiser Foundation Health Plan, Inc. for elder abuse, negligence and unfair business practices.      In his lawsuit, Collins says he was a patient at nonparty Napa Valley Care Center when he developed problems with his catheterized penis.      On July 21, 2013, a nurse sent a fax to Collins' insurer, Kaiser, according to the complaint.      "The fax stated that Rupert's penis was red and swollen with what was described as a cut. Rupert had a Foley catheter inserted into his penis. Monica's fax said: 'May we have a trial of no Foley to give the area a rest.' Despite this request, Kaiser denied the request to remove the Foley. Despite the fact that Kaiser was notified that Rupert's penis was red and swollen and cut, there is no documentation to show that any physician from Kaiser ever bothered to personally examine Rupert's penis," the complaint states.      "As a direct result of this reckless neglect by Kaiser, the Foley was left in Rupert's red and swollen and cut penis, and his penis began to erode further and further each day," it continues.      Two days later, there was a care conference about Rupert Collins' care, but no Kaiser representative showed up, according to the complaint.      "As a direct result of Kaiser's failure to participate, there was no meaningful communication or ongoing assessment and the dire need to remove the catheter from Rupert's eroding penis continued to be ignored," the complaint states.      On July 30, another nurse sent another fax to Kaiser requesting permission to remove the catheter, but the request was again denied, according to the complaint.      The next day, Collins' daughter had a look, according to the complaint.      "When Diana examined Rupert's penis, she was horrified at what she saw. Rupert's penis was split completely in half from the tip of his penis all the way down to the scrotum sac," the complaint states.      Collins' daughter had a third nurse contact Kaiser, but Kaiser told the nurse, "The penis erosion is normal and will heal on its own," the complaint states.      Collins' daughter pressed the issue and got him seen by a Kaiser urologist on Aug. 2. The doctor "stated that if Rupert had been treated earlier, the penis could have been saved but that the penile erosion was now complete, Rupert's penis would never heal and that reconstructive surgery was not a viable option," the complaint states.      "Rupert's penis and urethra is permanently eroded away and Rupert has suffered permanent genital mutilation," it continues.      Collins blames Kaiser's business practices for his injuries.      "The conduct of defendants is part of a general business practice at Kaiser conceived and implemented by Kaiser and Does 1-10, inclusive. This practice exists in part because defendants unreasonably expect few adverse consequences will flow from their mistreatment of their elderly, demented, disabled and vulnerable clientele, and said defendants made a considered decision to promote profit at the expense of their moral, legal and ethical obligations to their resident-patients," the complaint states.      Rupert Collins seeks general and special damages, treble damages, attorneys' fees and costs, restitution of all funds paid to Kaiser on his behalf and injunctive relief. He is represented by Rebecca J. Freeman of Freeman & Freeman in Santa Rosa.

Kaiser Settles Lawsuit of Social Worker fired for reporting a death threat

Kaiser Settles Fired Social Worker's Lawsuit
By BARBARA WALLACE
Courthouse News
March 19, 2014

SAN FRANCISCO (CN) - A social worker who claimed that Kaiser fired her for reporting a death threat has settled her civil suit, a federal judge's ruling shows.

Robin Love, a licensed clinical social worker and certified alcohol and drug counselor, sued the Permanente Medical Group, Kaiser Foundation Hospitals and Kaiser Foundation Health Plan in U.S. District Court for the Northern District of California.

The November 2012 complaint alleged that a fellow therapist had warned Love that one of her patients had said he wanted "to murder Robin Love."

"For many months, Ms. Love requested that defendants obtain a restraining order on her behalf to protect her from the threatening patient," the complaint stated.

"Defendants failed to protect Ms. Love. When Ms. Love complained to several of Kaiser's managers about the ongoing violations of workplace safety and Kaiser's failure to protect her, defendants retaliated against Ms. Love by bringing false disciplinary charges against her, subjecting her to unlawful corrective action, and then terminating her employment."

U.S. District Judge William Orrick dismissed Love's whistle-blower and contract claims this past December but left intact her claims for discrimination, wrongful termination, emotional distress and other issues.

On Friday, he dismissed the case with prejudice, noting that the parties had announced a settlement after a conference with U.S. Magistrate Judge Elizabeth Laporte.

The matter shall be restored to the calendar, however, if either party certifies within 60 days that the settlement did not occur.

Details of the settlement are unavailable. Love's attorney Jenny Huang declined to comment on the dismissal. A Kaiser spokesman noted that the voluntary settlement did not include "any admission of any wrongdoing by any of the defendants."

Kaiser takes seven months and four doctors to diagnose a broken ankle

Man claims Kaiser Permanente staff misdiagnosed his broken ankle for seven months, sues for $49,900
Aimee Green
OregonLive.com
June 16, 2014

A man who says he broke his ankle while playing soccer is suing Kaiser Permanente for nearly $50,000, claiming various medical staff repeatedly told him he only had a sprain -- and his fracture went undetected for seven painful months.
A Kaiser spokesman couldn’t offer an immediate comment Monday. But according to Andrew P. Newcomb’s lawsuit, Newcomb went to Kaiser’s Tualatin medical offices on Nov. 9, 2011, seeking treatment for an injury he suffered during an indoor soccer game. The next day, he was given an X-ray and physician assistant Jeffrey Myers told him his ankle was not broken, the suit states.
“...Myers diagnosed plaintiff Newcomb as having a ‘severe sprain,’ and recommended rest, ice, compression and elevation of the foot, and Advil, up to 500 mg twice a day with food,” states the suit, filed Friday in Multnomah County Circuit Court.
According to the suit:

• Two and a half months later, Newcomb’s ankle continued to bother him -- causing him to limp and use crutches. So he made another visit to the Tualatin medical offices. Dr. Louis H. Liu ordered an MRI and recommended physical therapy after diagnosing Newcomb with “arthralgia” -- commonly known as joint pain -- of Newcomb’s ankle or foot.

• Two months later, when his ankle had still not improved, Newcomb went in again and Dr. Christopher Jason Rae, an orthopedic specialist at Kaiser, diagnosed Newcomb with a sprain.

• More than one and a half months later, Newcomb’s ankle still ailed him. So he spoke to Rae, who ordered an MRI and again diagnosed Newcomb with joint pain.

• Less than two weeks after that, Newcomb’s ankle was still hurting so he saw Dr. Kimberly Workman, a Kaiser orthopedic specialist, who looked at Newcomb’s November 2011 x-ray and diagnosed him with a “closed fracture foot, talus." It was June 13, 2012, and more than seven months had passed since Newcomb had been injured.

Newcomb underwent surgery to repair his ankle and after some physical therapy, his ankle recovered, the suit states.
Newcomb seeks $3,500 for medical and care costs and $46,400 for months of “continuous physical pain and suffering, difficulty sleeping, anxiety, emotional distress and depression,” the suit states.
The suit was filed by Portland attorney Danna Fogarty.
-- Aimee Green

USC hospital sues Kaiser over nonpayment of bill; Kaiser also has contracts with UCLA

USC hospital sues Kaiser over nonpayment of bill
'It's usually the patient fighting to get transferred' from Kaiser, said attorney Scott Glovsky
USC says Kaiser didn't disclose that its patient had exhausted a $75,000 annual cap on insurance benefits
Stuart Pfeifer, Chad Terhune
Los Angeles Times
May 23, 2014

Two medical giants in Southern California are heading for a potentially bruising legal battle.

Keck Hospital of USC has sued Kaiser Permanente, accusing California's largest HMO of sending one of its patients to Keck for open-heart surgery and then refusing to pay the $544,000 hospital bill.

USC contends that Kaiser didn't disclose that its patient had already exhausted a $75,000 annual cap on insurance benefits when it asked Keck Hospital to perform the October 2013 surgery. Kaiser could have handled the procedure with its own surgeons but opted to transfer the patient to save money, Keck Hospital said in the lawsuit.

Kaiser declined to comment except to insist that USC knew about the limitations of the patient's insurance.

This legal battle between healthcare heavyweights highlights Kaiser's long-standing practice of using outside hospitals to see some patients who require more specialized care. It also provides a rare glimpse into the sometimes bitter disputes between health insurers and providers that are often handled behind closed doors.

Kaiser is both an insurer collecting premiums from customers and a medical provider treating them at Kaiser-run hospitals and physician offices. In some instances, Kaiser transfers patients to outside facilities for specialty care such as transplants, then covers the costs as any other insurer would.

In this case, Kaiser transferred the patient from the intensive care unit at its Los Angeles Medical Center to Keck Hospital knowing it would not cover the costs, USC said in the lawsuit, filed May 15 in Los Angeles County Superior Court.

The Kaiser representative who called Keck to arrange the surgery said the patient had active health coverage through Kaiser, the lawsuit said. With that assurance, USC authorized the surgery and treated the patient for 13 days at its hospital.

In December, Kaiser denied Keck Hospital's bill for the treatment, saying for the first time that the patient had exceeded the $75,000 cap on annual coverage, USC said. Those coverage limits were set by a state program Kaiser participates in for people who were denied coverage because of preexisting conditions.

Kaiser declined to discuss details of the lawsuit, but said in a statement, "We are confident that Keck's allegation that it was not informed about coverage limits is not accurate."

The lawsuit could tarnish a lengthy relationship between the healthcare giants. Keck, then known as USC University Hospital, and Kaiser first entered into an agreement in 1994 for the hospital to treat some Kaiser patients, with Kaiser paying the tab, USC said in the lawsuit.

Kaiser, a nonprofit based in Oakland, is California's largest HMO and one of the largest healthcare providers in the country. It reported $53.1 billion of operating revenue last year and $2.7 billion in net income.

Mark V. Pauly, a professor of healthcare management at the University of Pennsylvania's Wharton School, said a lack of communication about the patient's coverage appears to be at the center of the disagreement.

"It seems like somebody forgot to ask or somebody forgot to tell, which may be a sign of dysfunction in our healthcare system," Pauly said.

Scott Glovsky, a Pasadena attorney who represents other Kaiser patients suing the HMO over access to appropriate and timely care, said this latest hospital dispute is unusual in several ways.

Glovsky said Kaiser typically goes to extreme lengths to keep patients at its own facilities as part of its unique HMO model.

"It's usually the patient fighting to get transferred," he said. "If Kaiser authorized the treatment, they can't reverse course and later deny payment. It is not fair to a hospital to essentially dupe them into taking the patient."

Neither Kaiser nor USC would identify the patient, citing rules on medical privacy. Kaiser said the only coverage it offers with a $75,000 cap on annual benefits is part of California's high-risk pool, known as the Major Risk Medical Insurance Program.

For years, it has provided coverage to people with serious health problems who were previously rejected by insurers. There is a $750,000 cap on lifetime benefits in addition to the $75,000 annual limit.

New federal rules lifting most coverage limits don't apply to the state program.

Enrollment in the state high-risk pool has fallen by half to about 3,000 people since insurers are no longer permitted to reject applicants under the Affordable Care Act, according to Morgan Staines, chief counsel for the state program. The governor's latest budget proposal calls for closing the state program by the end of this year, Staines said.

For most consumers, the federal health law prevents insurers from setting lifetime coverage limits, and annual limits were phased out for most health plans starting this year. Health insurance policies in place before March 2010, when the health law was passed, are grandfathered and don't have to comply with rules on annual limits.

Keck Hospital is one of several medical centers with which Kaiser partners to supplement its care. For instance, it has sent patients to City of Hope for bone marrow transplants and used UCLA Medical Center for kidney transplants.