UCSD gives consent for sharing medical records without patient approval

I got an interesting letter from UCSD three days ago. It told me that I had consented to share my electronic medical records.

The trouble is--I had NOT given my consent. I never signed a consent form. I never clicked a box on the Internet agreeing to share my records.

And the letter from UCSD did NOT arrive in my home mailbox or even in my email. It was purely by chance that I found it on MyUCSDChart—NOT among the MyChart emails. If it had been among the MyChart emails, I would have received an alert about it in my regular email.

UCSD was definitely NOT trying to make sure that I found out about my “consent”.

Today, each time I have clicked on the link about sharing electronic medical records on MyUCSDChart, I found myself unceremoniously thrown back to the sign-in page. Automatically signed out. They really don't like it when I click on the link!

UCSD seems to be remarkably fond of both signing me in and signing me out--without my involvement--whenever it feels like it.

I found this page on the UCSD site about sharing electronic records. It seems that I am now part of two databases: The San Diego Beacon Health Information Exchange, and something called Care Everywhere.

It's not that I want to keep my records secret. In fact, I think sharing electronic records is basically a good idea. It's just that I've had problems with health providers hiding my own test results from me, so I'm sensitive about doctors violating the law regarding medical records.

Apparently the VA is also part of this system, but the VA has a more transparent consent process.

I've heard of falsified medical records, but this is the first time I heard of a falsified consent for release of medical records.



I found some interesting stuff about UCSD's informed consent process for patients in research projects:

iDASH Integrating Data for Analysis, Anonymization and SHaring

Informed Consent

Paper Consent versus Electronic Consent

Traditionally, paper-based consent has been the medium through which researchers and physicians conducted the informed consent process. The paper-based process consists of giving a hard copy consent form to a patient for him or her to review. Then a care provider answers any questions from the patient and in some cases assists the patient in reviewing the paper consent forms. The issues surrounding this procedure are that the paper-based consent form tends to be long and monotonous, and the retrieval of paper forms are often time consuming.

The new electronic consent forms use tablets or computers as the medium for communicating information and seeking consent from the patient...The iDASH team is also currently working on two systems, iCONS and iCONCUR, which are intended for such open source use in the future.

iDASH electronic informed consent management system

iCONS is a system currently being tested in a clinical trials environment at Moores Cancer Center Biorepository. The system supports informed consent electronically by enhancing the consent process for patients and researchers by acting as a consent broker and by adding multimedia aspects to the process. This consent process is opt-in, meaning no patient information is shared with researchers until the patient specifies what specific information he or she would like to share with researchers. The iCONS system creates a permission ontology to model the consent choices of the patient to assist in the process of releasing data and specimens to researchers for their consented uses.

iCONCUR is a pilot study within the University of California - San Diego Health System. This system transforms the sharing of electronic records from the opt-out system that is currently in place, meaning a patient’s record is automatically entered into the system unless the patient specifically requests to have their records taken out, to an opt-in system. The tool presents the patient with a taxonomy of his or her medical record allowing the patient to dictate what parts of the medical record to share and with whom it may be shared with.

HOSPITAL FAXED MEDICAL RECORDS TO PATIENT'S WORKPLACE

Tufts Medical Center sued for faxing patient records without consent
July 15, 2011
By Karen Cheung-Larivee
FierceHealthcare

Tufts Medical Center in Boston faces a lawsuit after a patient said the hospital faxed her medical records to her workplace without her consent, causing her embarrassment, reports The Boston Globe yesterday.

"I feel like I might have walked in (the office) naked," said patient Kimberly White.

White requested Tufts to send a form for a disability claim, but instead the hospital allegedly sent four pages of medical records about her hysterectomy to a shared fax machine at her workplace.

White filed a complaint in Plymouth County Superior Court. The hospital denies any wrongdoing, according to the article.

Tufts spokeswoman Julie Jette said, "In this matter, we complied with a patient's request to share information. We firmly believe we responded to the patient's request appropriately."

"I can't go back there," White said. "I am so embarrassed. ... I couldn't live with knowing what these people knew about me."

Earlier this year, another Boston hospital, Massachusetts General Hospital, faced accusations that an employee lost records of 192 patients on the subway. The hospital in February settled the federal case for $1 million, according to the article.

UCLA HIPAA VIOLATIONS

UCLA Health System pays $865G to settle HIPAA violation charges
July 8, 2011
FierceHealthIT
By Ken Terry

UCLA Health System has agreed to pay a fine of $865,000 and to develop a correction action plan to settle potential HIPAA privacy violations involving improper disclosures of medical records at its three hospitals, the federal Office of Civil Rights (OCR) reports.

OCR launched the investigation in 2009, following complaints by two unnamed celebrities that their medical records had been compromised. The government probe revealed that from 2005 to 2008, "unauthorized employees repeatedly looked at the electronic protected health information of numerous other UCLAHS patients," according to an OCR press release.

The Los Angeles Times reports that violations allegedly occurred at all three UCLAHS hospitals: Ronald Reagan UCLA Medical Center, Santa Monica UCLA Medical Center, and Orthopaedic Hospital and Resnick Neuropsychiatric Hospital, which are regarded as a single unit.

The hospital had disclosed in April 2008 that it had discovered that several employees had snooped into the patient records of dozens of celebrities, including Britney Spears, Tom Cruise and Maria Shriver.

When the alleged violations came to light in 2008, the California legislature passed a law that imposed escalating fines on hospitals for patient privacy breaches. The state fined UCLAHS $95,000 in 2009, reportedly in connection with the medical records of the late Michael Jackson.

The UCLAHS settlement with OCR is much smaller than previous HIPAA settlements, including those involving CVS Caremark ($2.25 million) and Rite Aid ($1 million).

As part of its settlement, UCLAHS agreed to institute new security and privacy policies, improve employee training, take action against employees who violate privacy rules, and designate an independent monitor to oversee compliance.

In a statement, UCLAHS said, "The UCLA Health System considers patient confidentiality a critical part of our mission of patient care, teaching and research. Over the past three years, we have worked diligently to strengthen our staff training, implement enhanced data security systems and increase our auditing capabilities."


MEDICAL ETHICS--RESEARCH ON MEDICAL RECORDS WITHOUT INFORMED CONSENT

J Law Med Ethics. 2008 Fall;36(3):560-6. doi: 10.1111/j.1748-720X.2008.304.x.
Research on medical records without informed consent.
Miller FG.

Observational research involving access to personally identifiable data in medical records has often been conducted without informed consent, owing to practical barriers to soliciting consent and concerns about selection bias. Nevertheless, medical records research without informed consent appears to conflict with basic ethical norms relating to clinical research and personal privacy. This article analyzes the scope of these norms and provides an ethical justification for research using personally identifiable medical information without consent.

PMID: 18840249 [PubMed - indexed for MEDLINE]

Napolitano’s newest headache: “Outright bullying” and “patient deaths”

Napolitano’s newest headache: “Outright bullying” and “patient deaths”
Josh Eidelson
Salon
Nov 20, 2013

Four months after former Obama Homeland Security head Janet Napolitano took the helm of the massive University of California system, unions representing 35,000 U.C. employees are staging a one-day strike over alleged illegal intimidation.

“She is the president, and she has the power to make change,” said Tim Thrush, a diagnostic stenographer and a vice president of the 21,000-member American Federation of State County and Municipal Employees Local 3299, which instigated the strike. “Ultimately it all comes back to her,” said Marco Rosales, a head steward in the 13,000-member United Auto Workers Local 2865, a student-worker union that is joining the strike.

At issue in today’s walkout is AFSCME’s allegation that U.C. management repeatedly violated state labor law in efforts to discourage the union’s members — patient care technical and service workers employed in medical centers – from mounting an unprecedented work stoppage last May. In charges filed with the government, AFSCME charges that administrators violated the state Higher Education Employer-Employee Relations Act through a battery of fear tactics: repeated statements by top officials promising or implying potential punishment for strikes; threatening postings and letters; and interrogations by individual managers.

“It’s a little disturbing that, you know, as we are fighting for patient safety in the workplace, and just being advocates for what’s right for the patients and their families, that management would act so aggressively to try to shut us up,” said AFSCME’s Thrush.

Thrush is among the AFSCME members who say they were personally intimidated by management in the lead-up to last May’s strike, before Napolitano took over for then-president Mark Yudof. He told Salon that his manager gave him a list of supplies to fetch from a supply room, and then “proceeded to pursue me” there, “blocking the door, and very aggressively began to interrogate me.” Thrush added, “Her hands were on her hips and she was roughly maybe two feet from my face, and was telling me that I was acting illegally, that I shouldn’t be doing what I’m doing, that I would be hurting patients and she didn’t think it was right that I told the other employees what their legal rights were when she was interrogating them.” He called the tactic “outright bullying,” and said he found it “pretty The evidence presented by AFSCME also includes a message from U.C. labor relations director Peter Chester stating that “Service Unit employees at any location who engage in an unlawful sympathy strike face the possibility of disciplinary action,” and notices posted throughout the U.C. Davis Medical Center warning that “If an employee fails to report to work on one or more days between May 20 and 23, their absence will be considered unauthorized, they will not be paid, and they may be subject to disciplinary action.” (The union alleges the university espoused specious arguments that strikes would be illegal as a way to intimidate workers out of participating, and then withdrew its legal charges to that effect because they were bogus.)

Asked about the allegations, the strike and Napolitano’s role, the university referred Salon to a series of recent statements, one of which charged that “even the threat of an AFSCME strike has already affected patients,” including the rescheduling of elective surgeries, and said that it had “proposed several packages that showed significant movement in response to the union’s concerns and offered multi-year wage increases, affordable healthcare and quality pension benefits, which AFSCME rejected.” AFSCME countered that as in May, certain critical employees would voluntarily stay on the job under the union’s Patient Protection Task Force. In another statement, U.C. vice president Dwaine Duckett said that the university “asked AFSCME-represented employees if they planned to come to work, as is our a normal procedure, so we could adjust staffing as needed and ensure we could still care for patients during the strike.” AFSCME contends that the university violated several legal limitations on such conversations.

AFSCME and U.C. administrators have been in negotiations for over a year and a half. The university has blamed the lack of an agreement on AFSCME’s resistance to pension changes, while AFSCME has blamed the university’s rejection of proposals it says would improve patient safety. “We have made major concessions on many of our proposals, including wages and retirement benefits, in hopes that they would respond to our safety proposals,” said Thrush. “And they have not.” He cited AFSCME proposals regarding training and staffing. Noting fines assessed by government agencies, he charged, “There’s been patient deaths as a result of staffing issues and neglect of the safety” of patients.

Thrush offered some praise for Napolitano’s record to date, saying, “We find her to be much more open and receptive to working with the unions and our right to advocate with patients” and “we would hope that she would carry that new attitude on to her management group and get them to actually give us a workplace that’s safe and free of the intimidation tactics that they apply to quiet our voice.” The UAW’s Rosales was less optimistic, charging Napolitano has tried to “take the wind out of our sails” by publicly committing to invest funds that are “actually the amount of money that we would get in raises each year,” and thus “trying to co-opt the pressure that is being put on the university.” Rosales added, “I don’t think she’s done a good job of responding to these issues in earnest. It seems not very genuine.” The striking AFSCME and UAW locals are both helmed by leaders who ran on reform platforms and ousted incumbent union officials in bitter 2011 contests...

U.S. veterans health probe confirms cover-up of care delays

U.S. veterans health probe confirms cover-up of care delays

By David Lawder, Roberta Rampton and Julia Edwards
May 29, 2014

(Reuters) - Calls for U.S. Veterans Affairs Secretary Eric Shinseki to resign grew louder on Wednesday as the agency's inspector general confirmed "systemic" and widespread VA scheduling abuses to cover up long wait times for veterans' healthcare.

The Department of Veterans Affairs' internal watchdog is probing manipulation of appointment data at 42 VA medical centers, up from 26 last week, it said in an interim report on allegations of secret waiting lists.

The office said it has confirmed that "inappropriate scheduling practices are systemic" throughout the Veterans Health Administration.

The report confirmed allegations that staff at VA medical facilities in Phoenix significantly understated months-long wait times for healthcare appointments for veterans. It linked these actions to performance appraisals, bonus awards and salary increases for VA executives. The findings prompted some Republicans and Democrats who had withheld judgment on Shinseki to call for his immediate resignation.

"If Secretary Shinseki does not step down voluntarily, then I call on the president of the United States to relieve him of his duties," Republican Senator John McCain of Arizona told a news conference in Phoenix.

The scolding continued during a House Veterans Affairs Committee hearing on Wednesday night where three VA officials were asked to testify on the alleged existence and destruction of a secret wait list identified by whistleblowers in Phoenix.

Dr. Thomas Lynch, the agency's assistant deputy under secretary for health for clinical operations, said the waiting list was in fact an “interim work product” meant to hold names of veterans whose appointments had been canceled. Lynch said that the list was properly destroyed after the patients were rescheduled to avoid keeping unnecessary information on patients.

His answer did not satisfy members of the committee, including Chairman Jeff Miller who has called for Shinseki's resignation and others who chastised the officials for being blind to the agency's problems.

“How you can stand in a mirror and look at yourself...and not throw up knowing that you’ve got people out there?” Congressman Phil Roe asked Lynch. “They’re desperate to get in.”

Shinseki, a retired four-star Army general, has headed the VA since early 2009. The inspector general said it has filed 18 reports on VA patient scheduling deficiencies since 2005.In Phoenix, the inspector general said it identified 1,700 veterans who were waiting for a primary care appointment but who did not appear on the agency's electronic waiting list.

The inspector general said a sample of 226 veterans waited on average 115 days for their first primary care appointment at Phoenix-area clinics, far longer than the 26-day average reported by the Phoenix VA and the department's 14-day goal.

But the Inspector General's Office said it needed more information to determine whether the appointment delays resulted in delayed diagnosis or treatment, or any deaths. VA doctors in Phoenix have said some 40 veterans had died while waiting for care.

FINDINGS "TROUBLING," "REPREHENSIBLE"

President Barack Obama "found the findings extremely troubling," White House spokeswoman Jessica Santillo said, adding that the VA must take immediate steps to contact veterans waiting for care. Last week Obama said Shinseki's job could be on the line depending on the investigation results.

Shinseki, in a statement, called the findings "reprehensible" and directed the Phoenix facility to "immediately triage" the veterans to get them care.

Shinseki is conducting his own review of scheduling practices at VA health care facilities nationwide, and was expected to deliver preliminary results from that effort to Obama this week.

(Additional reporting by Susan Heavey, Susan Cornwell and Patricia Zengerle in Washington, and David Schwartz in Phoenix; Editing by Matthew Lewis, Richard Chang and Ken Wills)

Kaiser Permanente hospital worker gave toddler whooping cough

Mom: Hospital worker gave toddler whooping cough
Thom Jensen
KXTV-TV
May 26, 2014

Jessica Chavez said it was just a normal trip to the hospital. Her 18-month-old daughter Adalena had come down with a mild virus, so she took her to Kaiser Permanente in south Sacramento in mid-to-late April.

But, when Adalena got sicker and sicker, Chavez said they went back to Kasier on May 12. Adalena was coughing uncontrollably and sometimes had difficulty breathing.

"I took her there to get better not to get worse," Chavez said.

Test results after that visit showed Adalena had Pertussis, also known as whooping cough. "It really scared me. I was at work when I found out," Chavez said. "I broke down crying. It terrified me to death."

Then Chavez discovered an employee at the hospital went to work with pertussis in April at the same time Adalena was there. She said she believes her little girl contracted the potentially deadly disease at the hospital.

"They should have more strict rules and regulations for how they allow their employees be at work," Chavez said.

Kaiser Permanente South Sacramento's Chief of Infectious Disease Dr. John Belko released the following statement:

Regarding recent media reports about the ongoing pertussis outbreak in Sacramento County, Kaiser Permanente South Sacramento did recently confirm that an employee, who was vaccinated against the disease [Maura Larkins’ comment: if the employee was not vaccinated, my personal experience indicates that Kaiser would most likely have hidden the truth and made up a false story], tested positive for pertussis. The employee left work as soon as symptoms appeared and was diagnosed.

As a precaution Kaiser Permanente is contacting members and employees who may have been exposed to the employee as much as three weeks prior to the diagnosis because those infected with pertussis can carry the disease for some time before symptoms appear. Out of an abundance of caution, we are contacting members who may have been exposed between April 22 and May 6. Due to patient privacy laws, we cannot discuss specific patient cases. Chavez said she's glad Kaiser is taking proactive steps to help stop the disease from spreading. As of last week, the Sacramento County Health Department had 69 confirmed cases of whooping cough. Last year, there were just 59 cases.

UCSD Medical Center says doctor who concealed six-figure pay from medical device company and used that company's products on his patient did nothing wrong; UCSD paid $1.75 million settlement

Dr. William Taylor, UCSD, implanted screws from a company that paid him a six-figure income and in which he owned hundreds of thousands of dollars in stock options

I don't believe that Dr. Taylor intentionally made this woman suffer. I think he was simply blinded by his financial interest. He couldn't believe the screws he had implanted (and heavily invested in) could be causing harm. He had hundreds of thousands of reasons not to believe it.

This does not explain, however, why Dr. Taylor kept his financial interests secret. I'll take a stab at explaining that. Perhaps he had confidence in his own ability not to be influenced by his large income from the medical device company and by the possibility that his investment in the company would pay off grandly if the screws proved to be successful in treating patients. He kept his financial dealings with the company secret because he didn't trust others to have confidence in him.

And why doesn't UCSD crack down on its doctors who violate law and university policy in this manner? Perhaps because the doctors who are tasked with enforcing the rules are getting just as much money from outside companies as Dr. Anderson is.

Dr. William Taylor got his medical degree from UCLA, whose medical school seems have particular problems with conflicts of interest.

"It took longer to uncover some critical details that Dr. William Taylor, the surgeon, had not told the retired special education teacher or the university: He owned stock options worth hundreds of thousands of dollars in the company selling the spinal devices and had also collected six-figure annual fees from the same firm, the lawsuit said. Disclosure of such corporate payments is required by state law and university policy.

"A lawyer for UCSD said Taylor did nothing wrong and denied that any patients were harmed. But the university last year paid Kitrosser $1.75 million to settle the case."

UC system struggles with professors' outside earnings
Failing to report compensation from other sources leads to concerns about conflicts.
BY MELODY PETERSEN
OC Register
May 25, 2014

Doctors eventually solved the mystery of why Brenda Kitrosser suffered from unrelenting pain after her back surgery at a University of California hospital in San Diego.

A UCSD surgeon had implanted experimental screws and other hardware into her back, promising this would relieve her pain. Instead the devices pressed on her nerves endlessly, according to a lawsuit she filed later.

It took longer to uncover some critical details that Dr. William Taylor, the surgeon, had not told the retired special education teacher or the university: He owned stock options worth hundreds of thousands of dollars in the company selling the spinal devices and had also collected six-figure annual fees from the same firm, the lawsuit said. Disclosure of such corporate payments is required by state law and university policy.

A lawyer for UCSD said Taylor did nothing wrong and denied that any patients were harmed. But the university last year paid Kitrosser $1.75 million to settle the case.

The controversy over Taylor’s undisclosed compensation is not an isolated case. The University of California has repeatedly failed to discipline medical professors who did not disclose payments from drugmakers and medical companies.

Last month, after UCLA paid $10 million to settle a lawsuit that centered on undisclosed corporate compensation, the non-profit group Consumer Watchdog called on state Attorney General Kamala Harris to investigate how widespread the unreported payments have become.

In a letter to Harris, the Santa Monica-based consumer group said that evidence presented in the case had shown that the university’s policies were “either inadequate or unenforced.”

“Patients in UC hospitals deserve the most reliable surgical devices and medication,” the group wrote, “and they shouldn’t be treated as subjects in expensive experiments.”

Officials at UCLA and UCI said they have recently increased efforts to make sure professors comply with the rules. UCLA doubled its compliance staff and hired a chief compliance officer. UCI’s chancellor directed all medical faculty to certify they were in compliance with reporting requirements and not engaging in unauthorized outside activities.

Those changes came after a series of undisclosed compensation cases involving professors from across the UC system. In each case, the professors who received the payments were involved in promoting or encouraging the use of a company’s product at the same time they were treating patients. In all the cases except one, it was people from outside the university who discovered the undisclosed payments.

• In a Los Angeles courtroom last month, Dr. Robert Pedowitz, the former chair of UCLA’s orthopedic surgery department, testified that administrators retaliated against him after he tried to get surgeons to report their corporate payments – including one doctor who said he had received $250,000 from a device maker for just 20 days of work. Just before closing arguments, UCLA agreed to pay Pedowitz $10 million to settle the case. The university said administrators did nothing wrong.


Dr. Thomas Ahlering
FILE PHOTO: MARK RIGHTMIRE, ORANGE COUNTY REGISTER

• At UC Irvine, Dr. Thomas Ahlering received more than $100,000 since 2002 from a company selling a surgical robot, but put most of that money in his nonprofit foundation without disclosing it, the Register reported last year. University officials say they have since required Ahlering to turn over $4,000 of that money to the school.

• An investigation by U.S. Sen. Charles Grassley in 2009 found that UCLA spinal surgeon Dr. Jeffrey Wang had failed to report almost a half million dollars in compensation he had received from several companies. UCLA officials say Wang was required to turn over an undisclosed portion of that to the university.

Although some of the professors were required to return a portion of their undisclosed pay to the university, it’s not clear whether the universities disciplined them in any other way.

In Oakland, UC administrators said they have an obligation to encourage faculty to work with companies to develop new medicines and medical devices that can help the public. And they pointed to the policies that the university has long had in place to require faculty to disclose payments.

“We also recognize that more can be done to increase transparency and oversight,” said Steve Montiel, a spokesperson at UC’s Office of the President, “and we are reviewing our policies to determine how best to achieve these goals.”

* * *

Under state law, UC faculty who are leading research must disclose publicly any payments or gifts they receive from the companies or other parties involved in those studies. They must also disclose how much stock or stock options they hold in that company.

According to university policy, all faculty also must disclose on internal annual reports how much time they are spending on outside activities, as well as how much they were paid for that work...

Last year, a civil jury in San Diego Superior Court issued a verdict against NuVasive, finding that the company and UCSD’s Taylor had conspired to intentionally mislead patients considering spine surgery.

The jury ordered the company to pay $3.1 million to Kitrosser. A judge later ruled that the $1.75 million that UCSD had agreed to pay could offset the verdict against NuVasive. The company was also ordered to pay court costs. NuVasive has appealed the verdict.

Neither Taylor nor a NuVasive spokesperson responded to phone calls or emails seeking comment. Thomas Lotz, a lawyer who represents UCSD, said Taylor never got the chance to fully tell his story in court. Taylor has not exercised the stock options that were revealed by the lawsuits, he said.

UCSD settled the case, Lotz said, to avoid a lengthy legal fight.

Robert Vaage, Kitrosser’s lawyer, said he had repeatedly informed UCSD about Taylor’s failure to report the payments from NuVasive. “They haven’t punished him at all,” he said. “In fact, they’ve promoted him.”

Carr, the UCSD spokesperson, disputed that, but said she could not explain further because personnel matters must be kept private.

After the state Fair Political Practices Commission fined Taylor $12,000 in 2011 for failing to report his compensation from NuVasive as required by state law, UCSD officials called it “an administrative error.” They said then that they planned no further action against him, according to a report in The Guardian, the campus newspaper.

Dr. James Doty, a clinical professor at Stanford, testified that Kitrosser should not have had the surgery that Taylor performed in 2008 because she suffered from a high-degree of scoliosis, an abnormal curvature of the spine. Doty said that Taylor had an ethical duty to tell her about his financial relationship with NuVasive.

“It’s a big problem,” Vaage said of the large payments received by Taylor and other surgeons. “It’s something the public needs to know about.”...Read more HERE.


UCSD surgeon fined over research payments
By Tanya Sierra
SDUT
Jan. 19, 2011

A University of California San Diego neurosurgeon and professor has been fined $12,000 by the state’s Fair Political Practices Commission for failing to report his economic ties to a company that was funding his research project.

Dr. William Taylor, a specialist in minimally invasive spinal surgery at the UCSD Medical Center, did not disclose that medical device company NuVasive Inc. was providing funding for his research projects.

Taylor could not be reached for comment Wednesday. To the FPPC, he indicated he did not intend to keep information from the public and did not deliberately omit his income from NuVasive on his state- mandated statements of economic interest. He later took corrective action including discontinuing his participation in two projects.

Taylor was the principal investigator on four medical research projects that were being funded by NuVasive. In one case the company, based in Sorrento Valley, was providing $16,821 for Taylor’s project. Three other projects received an undisclosed amount.

Taylor taught workshops on behalf of the company and provided services as a consultant regarding product development.

He was quoted in The San Diego Union-Tribune last year as a specialist talking about the advantages of the NuVasive system.

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.

YOU MUST FILE A TORT CLAIM AT UCLA MEDICAL CENTER RATHER THAN THE STATE OF CALIFORNIA

See below for recent lawsuits against UCLA.

YOU MUST FILE A TORT CLAIM AT UCLA MEDICAL CENTER RATHER THAN THE STATE OF CALIFORNIA

The University of California works hard to conceal the tort claim process.

You can't sue if you don't file a tort claim within 6 months, so the Regents try to prevent those who have been harmed from filing a tort claim.

At first I was duped by the following document published by the Regents of the University of California:

[Maura Larkins' warning: the following is deceptive, produced by the Regents to avoid tort claims.]

"The Office of The General Counsel of The Regents (“OGC”)... THE REGENTS IS NOT SUBJECT TO CLAIM-FILING PROVISIONS OF THE TORT CLAIMS ACT California Government Code section 905.6 exempts The Regents of the University of California from claim-filing provisions of the Tort Claims Act. A claimant who wishes to file suit against The Regents may serve OGC as specified in section 1 above."

But if you go to "section 1 above", you see an address in San Francisco. It's the wrong address for filing a tort claim. Clearly, the Regents want you to come to them for health care, but if they harm you, they don't want to repair the damage.

I did more research and deciphered the truth with much difficulty. You have to present a tort claim to the specific campus medical center that is involved.

Why is UCLA so afraid of tort claims?

Perhaps it has a lot to hide, as suggested by this story.