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

Kaiser sued for its common practice of releasing incorrect records

The medical records system at Kaiser is rather odd. It seems they often give the wrong records, or no records at all. I've received altered records from Kaiser, and a bizarre set of X-rays with many duplicates that Kaiser prepared in an apparent effort to hide the fact that most of my X-rays were missing from the set. Also, they gave Stutz, Artiano Shinoff & Holtz 20 years of my records illegally. It turned out that the woman at Kaiser who authorized the release was Facebook friends with Dan Shinoff's wife!

Man Claims Kaiser Screw-up Cost Him
By BARBARA WALLACE
Courthouse News Service
December 27, 2012

CLEVELAND (CN) - The Ohio National Guard rejected a man's application for Officer Candidate School because a Kaiser employee entered "intermittent explosive disorder" into a computer system, though he never had been diagnosed with that, the man claims in court.

Simon Montgomery sued Kaiser Foundation Health Plan of Ohio, Ohio Permanente Medical Group, and Constance Baker-Alden, who allegedly made the computer mistake, in Cuyahoga County Court. The National Guard is not a party to the complaint.

Montgomery claims he was diagnosed with "exercise-induced syncope" after he fainted after working out on a treadmill in February 2010. After this, his doctor had told him "that he was medically cleared for all activities and that the isolated incident should not be a cause for concern," according to the complaint.

Montgomery applied for Officer Candidate School in January 2010. To do so, he signed waivers allowing the National Guard to review his medical records.

The Guard rejected him, in a letter that said "his application for enlistment had been denied because of a permanent medical disqualification for Intermittent Explosive Disorder and exercise-induced syncope," the complaint states.

Montgomery says he appealed to the Guard, in a letter stating that the fainting episode happened just once and that the diagnosis of intermittent explosive disorder was incorrect.

He claims that Baker-Alden, "as an employee of Kaiser and/or Permanente," wrote a letter to him, which he immediately forwarded to the Guard.

"This letter explained that Baker-Alden had incorrectly entered the diagnosis of Intermittent Explosive Disorder on plaintiff's medical records," the complaint states.

The Guard rejected his appeal, "because his medical records were contradictory," Montgomery says.

As a result, he says, he applied to the Naval Reserves as an enlisted man, for monthly pay of $366 less than he would have earned as an officer in the National Guard.

He seeks punitive damages for more than $25,000 for negligence.

He is represented by Ann-Marie Ahern, with McCarthy, Lebit, Crystal & Liffman.

Meningitis warning for those who've had spinal injections of steroids since May 21, 2012

Doctors have been having problems recognizing fungal meningitis.

Doctors Are Off Balance as Patients Show Atypical Meningitis Reactions
By JENNIFER CORBETT DOOREN
Wall Street Journal
October 10, 2012

The rare fungal meningitis behind a deadly national outbreak is difficult to diagnose because it can cause strokes and other reactions unlike those typically seen with the more common type of the illness.

Meningitis, a swelling of the protective membranes of the brain and spinal cord, is typically caused by bacteria that can be treated with antibiotics, or by a virus, for which there is no treatment.

Fungal meningitis, on the other hand, needs to be treated with antifungal drugs. The length of treatment isn't known but the federal Centers for Disease Control and Prevention is telling doctors that patients may need treatment for months.

Bacterial meningitis tends to attack quickly with a fever, a headache that grows worse, a stiff neck and eventually a loss of consciousness.

However, some patients who contracted fungal meningitis in the current outbreak have had just a mild headache and no fever, and "for the most part symptoms occur in a more gradual fashion," said William Schaffner, an infectious disease expert and chairman of the department of preventive medicine at Vanderbilt University School of Medicine in Nashville, which has treated four patients with fungal meningitis.

Dr. Schaffner said fungal meningitis is invading blood vessels and causing strokes in some patients affected by the current outbreak. But doctors don't typically test for meningitis when patients go to the emergency room with signs of stroke, such as weakness or loss of movement on one side of their bodies, slurred speech or sudden vision changes.

"Nobody is totally sure what these patients look like," said Trish Perl, senior hospital epidemiologist at the Johns Hopkins Health System in Baltimore, who is advising doctors about patients who might have the disease.

Because the fungal-meningitis symptoms have been so varied among patients, federal health officials have urged doctors to set a low bar in deciding whether to test patients who received a steroid injection in their backs. The test requires a spinal tap, which involves a needle inserted in the spinal column to collect spinal fluid.

The CDC has said as many as 13,000 people in 23 states have been exposed to the potentially contaminated steroid injections made by the New England Compounding Center before the products were recalled Sept. 26. Compounding pharmacies create blends of medicines, including liquid forms of pills.

The agency said patients who have had an epidural steroid injection since May 21, 2012, and are experiencing symptoms such as headache, fever, sensitivity to light, slurred speech or numbness, should contact their doctors as soon as possible.

Officials are most concerned about spinal injections. Those given in other places, such as the knees or hips, are highly unlikely to cause meningitis, though there is the possibility of a local joint infection...

Woman self-diagnoses rare disease

I have known many people whose doctors failed to diagnose serious problems--particularly at Kaiser Permanente. It's wise to do some research oneself. Often doctors are too busy to think about unusual conditions. They rely on the sets of symptoms that they're familiar with. In fact, at Kaiser, doctors are expected to rely on fixed lists of symptoms, and to ignore everything else. This way, Kaiser is able to correctly treat a large percentage of people, while improperly diagnosing an unfortunate minority. It's medicine based on percentages, not the Hippocratic oath or professional standards.

Woman self-diagnoses rare disease
October 03, 2012
By RUTH MARVIN WEBSTER
For the North County Times

To look at Chondra Hungerford today, you would never think she had ever been anything but strikingly beautiful.

And yet, last year at this time, she was gaining a pound a week, thick hair had started to sprout on her back, her skin was broken out in adult acne, and a lump of fat had started to form between her shoulders at the base of her neck.

She endured a menstrual period every two weeks, her skin bruised at the slightest touch and people stopped to ask her whether she was pregnant.

After having been a fitness model and personal trainer all of her adult life, such a body transformation was torture for Hungerford, 28. "I was training really hard, eating only fish and vegetables and nothing was working," the mother of two from Vista recalled. "I was turning into a monster."

And though she saw doctors for these and other complaints since being diagnosed with hypertension at age 19, Hungerford's primary-care physician seemed unable to correctly diagnose her condition.

That was until one day early last year, after seeing photographs of her shockingly round face, Hungerford said, "It all came together for me ... I went in to the doctor (the next week) and told him that he needed to order a cortisol lab (test). I knew I had Cushing's."

Hungerford said her doctor remained skeptical that she had the rare endocrine disease, which strikes only two or three people in a million. "I tell him 'I have Cushing's disease,' and he says to me, ‘I hope you do, because everyone who comes in her swears they do and you'd be the very first one (who did).'"

Named for the American neurosurgeon Harvey Cushing, Cushing's disease is caused by a tumor of the pituitary gland, which is located at the base of the brain. People with the disease have too much adrenocorticotropic hormone or ACTH, which in turn stimulates the production and release of cortisol.

Cortisol, the body's fight-or-flight hormone, helps maintain blood pressure, reduces the immune system's response and controls the body's use of carbohydrates, protein and fats. But in excess, it can cause upper body obesity, a full or moon face, acne, unusual purple stretch marks called striae, bone pain, weak muscles and irregular menstrual cycles...

"Chondra is a remarkable young woman," said UC San Diego endocrinologist Joseph Witztum, who recommended Hungerford for surgery. "Being aware of what is going on with you, carefully noting all the changes and using the Web in an intelligent way allowed her to make the diagnosis of a rare disease. She essentially had her doctor collect the needed laboratory data and presented an endocrinologist with the diagnosis and the supporting data. I can only imagine how surprised he was!"

...In April 2012, UC San Diego neurosurgeon Hoi U performed Hungerford's hour-long surgery to remove a 1-millimeter tumor from her pituitary gland.

...Cortisol (like cortisone) has the effect of reducing pain. Having lived with such high cortisol levels and then going to almost none, she started feeling general pain sensations almost for the first time.

Dr. U said that after the tumor is removed, it takes some adjustment for the body to return to producing normal levels of cortisol. "It can be like cold turkey for the patient," he said. "You have to give the patient some cortisone at first to achieve a soft landing. But everybody's (pain threshold) is different as you taper it down," he said with a smile. "That is like being a Chinese chef ... too much soy sauce? Not enough?"

...Indeed, this month Hungerford gave a presentation to a combined medicine/endocrinology conference at UC San Diego at which she presented, in a half-hour "mystery" narrative, the story of her illness.

Many of the young doctors were not able to diagnose Hungerford's disease until the end, and her presentation did highlight some of the fragmentation of our current medical system, said Witztum, adding, "It was an amazing performance and I encouraged her to go into some type of medical-related profession, even consider going to medical school."

Kaiser waited a year and a half before doing biopsy; first oncology appointment scheduled a year after that

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.

Kaiser Permanente sues patient who didn't pay $10,000 for Kaiser's failure to diagnose

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.”...