Whistleblowers: United Healthcare Hid Complaints About Medicare Advantage

Whistleblowers: United Healthcare Hid Complaints About Medicare Advantage
By Fred Schulte
Kaiser Health News
July 28, 2017

United Healthcare Services Inc., which runs the nation’s largest private Medicare Advantage insurance plan, concealed hundreds of complaints of enrollment fraud and other misconduct from federal officials as part of a scheme to collect bonus payments it didn’t deserve, a newly unsealed whistleblower lawsuit alleges.

The suit, filed by United Healthcare sales agents in Wisconsin, accuses the giant insurer of keeping a “dual set of books” to hide serious complaints about its services and of being “intentionally ineffective” at investigating misconduct by its sales staff. A federal judge unsealed the lawsuit, first filed in October 2016, on Tuesday.

The company knew of accusations that at least one sales agent forged signatures on enrollment forms and had been the subject of dozens of other misconduct complaints, according to the suit. In another case, a sales agent allegedly engaged in a “brazen kickback scheme” in which she promised iPads to people who agreed to sign up and stay with the health plan for six months, according to the suit.

Though it fired the female sales agent, United Healthcare concluded the kickback allegations against her were “inconclusive” and did not report the incident to the Centers for Medicare & Medicaid Services, according to the suit.

Asked for comment on the allegations in the suit, United Healthcare spokesman Matt Burns said: “We reject them.”...

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This KHN story can be republished for free (details).

L.A. County Health Dept. Allegedly Falsified Nursing Home Records of Complaints

L.A. County Health Department Allegedly Falsified Nursing Home Probe Records

By Anna Gorman  
Kaiser Health News
November 10, 2014
 

The Los Angeles County Public Health Department falsified the dates it received complaints about nursing homes as pressure rose to meet state deadlines for launching investigations, according to two employees.
In a letter last month to county, state and federal officials,  inspector Kimberly Nguyen cited 11 cases in which she said the dates typed into the computer system were later than the dates the complaints were actually received. The cases mentioned in the letter involve alleged abuse, falls and pressure sores, she said.
“In my belief, falsification is a serious matter and unlawful and our department should know better to not manipulate paperwork to mislead others and the public,” Nguyen wrote in the Oct. 7 letter.

...Meanwhile, the state, which directly oversees nursing homes in every district except Los Angeles County, has had its own history of problems with timely investigations. A lawsuit by California Advocates for Nursing Home Reform, or CANHR, resulted in a 2006 order by a Superior Court judge instructing public health officials to follow the law regarding investigation timelines.
Geraneo noted that order in her e-mail to administrators, referring to a case involving a non-working generator in which the complaint year had allegedly been changed from 2013 to 2014. “We cannot change the initiation dates of these complaints because of the CANHR lawsuit!”
Geraneo declined to be interviewed.
Since Kaiser Health News began writing about the department’s health facilities inspection division in March, administrators have sent e-mails to staff telling them not to speak to the media and to forward all requests. Reached by phone, several inspectors have declined to talk, saying they feared retaliation.
Nguyen said  she has been she has been targeted for retaliation as a result of raising questions since July 2013 about the quality of nursing home oversight.
In May 2014, Nguyen was suspended for five days without pay because she allegedly failed to renew her nursing license. A department letter said her license expired on November 30, 2013 and that she worked for six days without a valid license.
But as the Board of Nursing later confirmed in writing, her license actually had been renewed promptly. The Board simply hadn’t entered the renewal on its website.

 

 

 

L.A. County Health Dept. Allegedly Falsified Nursing Home Records

California Health Line

November 10, 2014

Two Los Angeles County Public Health Department employees allege that the department falsified the dates it received nursing home complaints in order to meet state deadlines for launching investigations, Kaiser Health News reports.

Background

Under state law, investigations must be launched within 10 days of receiving a nursing home complaint -- or within 24 hours if the complaint involves the threat of death or serious harm.

The California Public Health Department requires inspectors to enter dates based on when the complaint was first received by phone, fax, email or letter.

Details of Falsified Records

In a letter sent last month to county, state and federal officials, Inspector Kimberly Nguyen cited 11 cases in which she found records with falsified dates.

The dates entered were much later -- as much as 79 days --than the dates the allegations actually had been submitted.

The cases involved complaints about:

• Abuse;
• Falls; and
• Pressure sores.

According to KHN, Nguyen said she believes the date manipulation was deliberate (Gorman, Kaiser Health News, 11/10).

Nguyen said her supervisor, Adewole Adegoke, has been aware of the record falsification since July but has made no effort to stop the practice (Nguyen Letter, 10/7). She wrote, "In my belief, falsification is a serious matter and unlawful, and our department should know better to not manipulate paperwork to mislead others and the public."

Meanwhile, Sharon Geraneo, an assistant supervisor at the department, sent a separate email in August about the department allegedly falsifying records.

Response to Allegations

The county Department of Public Health said it has "zero tolerance for intentional document falsification" and is not aware of any deliberate falsification.

Officials said that they had identified a data entry error by one individual that affected 35 cases but that "swift and appropriate corrective actions" were taken.

The California Department of Public Health said it is investigating the allegations (Kaiser Health News, 11/10).

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

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

UCLA'S $10 MILLION WHISTLE-BLOWER RETALIATION CASE:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Kaiser Whistleblower Case Steams Forward

Kaiser Whistleblower Case Steams Forward
By WILLIAM DOTINGA
Courthouse News Service
May 09, 2013

SAN FRANCISCO (CN) - The Permanente Medical Group must face a former employee's claim that she was fired after complaining about sub-standard care, a federal judge ruled.

Mirabel Ortiz claims that The Permanente Medical Group-a division of Kaiser Permanente-fired her after she raised concerns that the way managers handled the orthopedics department harmed patients. Kaiser claimed it terminated Ortiz for committing "personal improprieties," according to Ortiz's first amended complaint.

As a member of SIEU-UHW, Ortiz says collective bargaining agreements between Kaiser and the union mandate a progressive discipline process, which hospital officials failed to follow. She filed suit in San Mateo County court against TPMG and her manager, Cindy Lambdin, claiming wrongful termination, retaliation for whistleblowing and breach of employment contract as well as infliction of emotional distress.

Earlier this year, Kaiser successfully moved the action to federal court since many of Ortiz's claims involve breaches of a collective bargaining agreement. The healthcare giant then sought to dismiss the action for non-suit.

And while U.S. District Judge Susan Illston found that Ortiz failed to follow procedural grievance requirements under the collective bargaining agreement-by Ortiz's own admission-enough questions exist as to whether Kaiser retaliated for protesting unsafe conditions for the action to move forward.

"The first amended complaint alleges that plaintiff 'protested about the unsafe and unhealthy working conditions at her place of employment, including complaints that defendant Lambdin was running the orthopedics department in such a way as to be harmful to patients, among other things.'" Illston wrote. "The court concludes that plaintiff has alleged facts that add up to more than a sheer possibility that defendants discharged plaintiff in retaliation for making complaints."

Illston rejected Kaiser's claim that Ortiz failed to follow administrative procedure in pursuing her whistleblower action, namely by failing to file a grievance with the labor commissioner. She noted that the permissive legislative language of the statute and four examples in case law do not impose such restrictions on allegations of labor code violations.

Though Illston found Ortiz's claims of infliction of distress are tied to her failed contract claim, the wrongful discharge claim connects Kaiser's alleged whistleblower retaliation and should be tried.

Ortiz can amend her complaint to cure deficiencies in the contract action, Illston concluded.

Kaiser Employee Reported Illicit Patient Charges, Fired

Most Kaiser Permanente management employees, including doctors, understand what is required of them: they must go along with whatever is needed to increase profits. This woman didn't understand how Kaiser and other healthcare entities do business.

Woman: Reported Illicit Patient Charges, Fired
By TISH KRAFT
Courthouse News
November 29, 2012

PORTLAND (CN) - Kaiser fired its director of patient access business services for reporting what she believed was patient fraud, the director says in a complaint filed in Multnomah County Court.

Aimee Mansell sued Kaiser and her boss Lisa Morrison for wrongful termination and whistle blowing.

Mansell says in her complaint that she blew the whistle on Morrison, who had "devised a policy where Emergency Department employees, including Ms. Mansell, would collect an additional 'triage' charge from Emergency Department patients, or include the triage charge on that patient's invoice for services."

Because she believed the charges to be a violation of state and/or federal law, Mansell reported these violations to defendant's complaint hotline, the court complaint says.

"On numerous occasions Ms. Mansell complained to her supervisors, human resources department, and managers at Kaiser about what she believed in good faith were different work related violations which were being committed by defendant Ms. Morrison and other Kaiser employees," her court complaint continues.

"A substantial factor in Kaiser's decision to terminate Ms. Mansell's employment was due to her fulfilling the societal obligation of reporting what she believed in good faith was patient fraud, and by protesting these triage charges which defendant Ms. Morrison had imposed or planned to impose on patient accounts," Mansell says in her complaint.

A few months before she was fired, Mansell was presented an award "In recognition of many achievements and contributions throughout the year," signed by her direct supervisor and defendant Morrison, the Patient Access Business Services Director, according to the complaint.

Plaintiff is represented by Patrick D. Angel of Portland.

Did the FDA go rogue to protect X-ray equipment sales? FDA created enemies list and spied on scientists

In Vast Effort, F.D.A. Spied on E-Mails of Its Own Scientists
By ERIC LICHTBLAU and SCOTT SHANE
July 14, 2012

A wide-ranging surveillance operation by the Food and Drug Administration against a group of its own scientists used an enemies list of sorts as it secretly captured thousands of e-mails that the disgruntled scientists sent privately to members of Congress, lawyers, labor officials, journalists and even President Obama, previously undisclosed records show.

A list names three of the 21 people said to be collaborating in criticism of the F.D.A., including employees and outside contacts.

A memo reports that monitoring software had been placed on the laptop of an agency medical officer.

What began as a narrow investigation into the possible leaking of confidential agency information by five scientists quickly grew in mid-2010 into a much broader campaign to counter outside critics of the agency’s medical review process, according to the cache of more than 80,000 pages of computer documents generated by the surveillance effort.

Moving to quell what one memorandum called the “collaboration” of the F.D.A.’s opponents, the surveillance operation identified 21 agency employees, Congressional officials, outside medical researchers and journalists thought to be working together to put out negative and “defamatory” information about the agency.

F.D.A. officials defended the surveillance operation, saying that the computer monitoring was limited to the five scientists suspected of leaking confidential information about the safety and design of medical devices.

While they acknowledged that the surveillance tracked the communications that the scientists had with Congressional officials, journalists and others, they said it was never intended to impede those communications, but only to determine whether information was being improperly shared.

The agency, using so-called spy software designed to help employers monitor workers, captured screen images from the government laptops of the five scientists as they were being used at work or at home. The software tracked their keystrokes, intercepted their personal e-mails, copied the documents on their personal thumb drives and even followed their messages line by line as they were being drafted, the documents show.

The extraordinary surveillance effort grew out of a bitter dispute lasting years between the scientists and their bosses at the F.D.A. over the scientists’ claims that faulty review procedures at the agency had led to the approval of medical imaging devices for mammograms and colonoscopies that exposed patients to dangerous levels of radiation.

Inquiry into the spectacularly profitable HCA Hospital Chain cites unnecessary cardiac work

Hospital Chain Inquiry Cited Unnecessary Cardiac Work
By REED ABELSON and JULIE CRESWELL
New York Times
August 6, 2012

GRAPHIC: HCA’s Growing Profit

In the summer of 2010, a troubling letter reached the chief ethics officer of the hospital giant HCA, written by a former nurse at one of the company’s hospitals in Florida.

In a follow-up interview, the nurse said a doctor at the Lawnwood Regional Medical Center, in the small coastal city of Fort Pierce, had been performing heart procedures on patients who did not need them, putting their lives at risk.

“It bothered me,” the nurse, C. T. Tomlinson, said in a telephone interview. “I’m a registered nurse. I care about my patients.”

In less than two months, an internal investigation by HCA concluded the nurse was right.

“The allegations related to unnecessary procedures being performed in the cath lab are substantiated,” according to a confidential memo written by a company ethics officer, Stephen Johnson, and reviewed by The New York Times.

Mr. Tomlinson’s contract was not renewed, a move that Mr. Johnson said in the memo was in retaliation for his complaints.

But the nurse’s complaint was far from the only evidence that unnecessary — even dangerous — procedures were taking place at some HCA hospitals, driving up costs and increasing profits.

HCA, the largest for-profit hospital chain in the United States with 163 facilities, had uncovered evidence as far back as 2002 and as recently as late 2010 showing that some cardiologists at several of its hospitals in Florida were unable to justify many of the procedures they were performing. Those hospitals included the Cedars Medical Center in Miami, which the company no longer owns, and the Regional Medical Center Bayonet Point. In some cases, the doctors made misleading statements in medical records that made it appear the procedures were necessary, according to internal reports.

Questions about the necessity of medical procedures — especially in the realm of cardiology — are not uncommon. None of the internal documents reviewed calculate just how many such procedures there were or how many patients might have died or been injured as a result. But the documents suggest that the problems at HCA went beyond a rogue doctor or two.

At Lawnwood, where an invasive diagnostic test known as a cardiac catheterization is performed, about half the procedures, or 1,200, were determined to have been done on patients without significant heart disease, according to a confidential 2010 review. HCA countered recently with a different analysis, saying the percentage of patients without disease was much lower and in keeping with national averages.

At Bayonet Point, a 44-year-old man who arrived at the emergency room complaining of chest pain suffered a punctured blood vessel and a near-fatal irregular heartbeat after a doctor performed a procedure that an outside expert later suggested might have been unnecessary, documents show. The man had to be revived. “They shocked him twice and got him back,” according to the testimony of Dr. Aaron Kugelmass in a medical hearing on the case.

In another incident, an outside expert described how a woman with no significant heart disease went into cardiac arrest after a vessel was cut when a Bayonet Point cardiologist inserted a stent, a meshlike device that opens coronary arteries. She remained hospitalized for several days, according to a person who has reviewed internal reports...

In a recent statement, HCA declined to provide evidence that it had alerted Medicare, state Medicaid or private insurers of its findings, or reimbursed them for any of the procedures that the company later deemed unnecessary, as required by law...

Some doctors accused in the reviews of performing unnecessary procedures are still practicing at HCA hospitals...



A Giant Hospital Chain Is Blazing a Profit Trail
By JULIE CRESWELL and REED ABELSON
August 14, 2012

During the Great Recession, when many hospitals across the country were nearly brought to their knees by growing numbers of uninsured patients, one hospital system not only survived — it thrived.

In fact, profits at the health care industry giant HCA, which controls 163 hospitals from New Hampshire to California, have soared, far outpacing those of most of its competitors.

The big winners have been three private equity firms — including Bain Capital, co-founded by Mitt Romney, the Republican presidential candidate — that bought HCA in late 2006.

HCA’s robust profit growth has raised the value of the firms’ holdings to nearly three and a half times their initial investment in the $33 billion deal.

The financial performance has been so impressive that HCA has become a model for the industry. Its success inspired 35 buyouts of hospitals or chains of facilities in the last two and a half years by private equity firms eager to repeat that windfall.

HCA’s emergence as a powerful leader in the hospital industry is all the more remarkable because only a decade ago the company was badly shaken by a wide-ranging Medicare fraud investigation that it eventually settled for more than $1.7 billion.

Among the secrets to HCA’s success: It figured out how to get more revenue from private insurance companies, patients and Medicare by billing much more aggressively for its services than ever before; it found ways to reduce emergency room overcrowding and expenses; and it experimented with new ways to reduce the cost of its medical staff, a move that sometimes led to conflicts with doctors and nurses over concerns about patient care.

In late 2008, for instance, HCA changed the billing codes it assigned to sick and injured patients who came into the emergency rooms. Almost overnight, the numbers of patients who HCA said needed more care, which would be paid for at significantly higher levels by Medicare, surged.

HCA, which had lagged the industry for those high-paying categories, jumped ahead of its competitors and was reimbursed accordingly. The change, which HCA’s executives said better reflected the service being provided, increased operating earnings by nearly $100 million in the first quarter of 2009.

To some, HCA successfully pushed the envelope in its interpretation of existing Medicare rules. “If HCA can do it, why can’t we?” asked a hospital consulting firm, the Advisory Board Company, in a presentation to its clients.

In one instance, HCA executives said a private insurer, which it declined to name, questioned the new billing system, forcing it to return some of the money it had collected.

The hospital giant also adopted a policy meant to address an issue that bedevils hospitals nationwide — reducing costs and overcrowding in its emergency rooms. For years, the hospital emergency room has been used by the uninsured as a de facto doctor’s office — a place for even the most minor of ailments. But emergency care is expensive and has become increasingly burdensome to hospitals in the last decade because of the rising number of uninsured patients.

HCA decided not to treat patients who came in with nonurgent conditions, like a cold or the flu or even a sprained wrist, unless those patients paid in advance. In a recent statement, HCA said that of the six million patients treated in its emergency rooms last year, 80,000, or about 1.3 percent, “ chose to seek alternative care options.”

“Many E.R.’s in America, particularly in densely populated urban areas where most HCA-affiliated facilities are located, have adopted a variety of systems to determine whether a patient in fact needs emergency care,” the statement said. “About half our hospitals have done so. Typically, our affiliated hospitals have two caregivers — usually a triage nurse and a physician — make that determination. It should be noted that other non-HCA affiliated hospitals are using similar processes to address E.R. issues.”

As HCA’s profits and influence grew, strains arose with doctors and nurses over whether the chain’s pursuit of profit may have, at times, come at the expense of patient care.

HCA had put in place a flexible staffing system that allowed it to estimate the number of patients it would have each day in its hospitals and alter the number of nurses it needed accordingly.

Several nurses interviewed said they were concerned that the system sometimes had led to inadequate staffing in important areas like critical care. In one measure of adequate staffing — the prevalence of bedsores in patients bedridden for long periods of time — HCA clearly struggled. Some of its hospitals fended off lawsuits over the problem in recent years, and were admonished by regulators over staffing issues more than once.

‘Through the Roof’

Many doctors interviewed at various HCA facilities said they had felt increased pressure to focus on profits under the private equity ownership. “Their profits are going through the roof, but, unfortunately, it’s occurring at the expense of patients,” said Dr. Abraham Awwad, a kidney specialist in St. Petersburg, Fla., whose complaints over the safety of the dialysis programs at two HCA-owned hospitals prompted state investigations.

One facility was fined $8,000 in 2008 and $14,000 last year for delaying the start of dialysis in patients, not administering physician-prescribed drugs and not documenting whether ordered tests had been performed.

Claiming he provided poor care, the other hospital did not renew Dr. Awwad’s privileges. Dr. Awwad is suing to have them reinstated. HCA declined to comment. HCA says it stands by its procedures, billing practices and level of care...

Fired Worker Says Kaiser Backed Drug User

See UPDATE to this story.

"...Keefer, Burnett and two union representatives told her to sign a "last chance" agreement which included "false and inaccurate information" about those allegations. She says that when she refused to sign the agreement she was fired, on July 7, 2011. Grotz says Taylor was fired the same day."

Fired Worker Says Kaiser Backed Drug User
By MATT REYNOLDS
Courthouse News (CN)

Kaiser Hospital fired a longtime employee after she complained about her drug-using boss, whom the fired worker says she saw with a rolled-up bill in her nose, "snorting a white powdery substance" at work, the worker claims in a federal lawsuit.

Kristinna Grotz sued Kaiser Foundation Hospitals, the Permanente Medical Group, and SEIU-United Healthcare Workers West, which allegedly failed to stick up for her.

Grotz claims she worked in Kaiser's admitting department from 2002 until she was fired in the summer of 2011.

She says that from early 2008 department manager (nonparty) D. T. used drugs - "in all likelihood methamphetamine" - at work, and that D. T. retaliated against her for reporting it.

Grotz claims that in early 2010 she joined six other employees and wrote a letter complaining to Kaiser about D. T.'s alleged drug use and acts of retaliation and favoritism.

Kaiser then allegedly launched an investigation headed by Taylor's superior and friend Diane Keefer and human resources manager Alan Burnett, neither of whom are parties to the lawsuit.

Grotz say that though Kaiser told her and the other employees that they would be "immune" from retaliation, that "proved to be untrue."

"Thereafter, plaintiff and others were called in one at a time and were interviewed by Ms. Keefer and Mr. Burnett. During her interview, plaintiff informed Ms. Keefer and Mr. Burnett about Ms. Taylor's ongoing substance abuse problem in detail. She informed them that she had personally observed Ms. Taylor and another employee, Terry Caballero, an employee from another Kaiser department, in Ms. Taylor's office, with rolled up bills in their noses snorting a white powdery substance. Plaintiff also said she was aware that Ms. Taylor's apparent drug use had been observed by at least two other individuals who signed the October 15, 2010 letter... Plaintiff stated that she believed that Ms. Taylor received most of her drugs from other employees within the facility," the 14-page complaint states.

Kaiser's "investigation" was bogus, Grotz says, because Keefer helped Taylor cover up her drug use and dismissed the allegations for lack of evidence, despite "contrary eyewitness testimony of Ms. Taylor's drug use from plaintiff and other staff."

Grotz claims Kaiser then turned the matter over to an employee assistance counselor. She claims that during a meeting with that counselor, "Debbie Taylor looked plaintiff right in the eye while mouthing the words, 'You f---ing bitch.' The EAP counselor quickly closed the meeting. Only one meeting took place after this aborted meeting and only the admitting staff was in attendance, but not Ms. Taylor.

In fact, none was ever scheduled again with Debbie Taylor present. To plaintiffs' knowledge, employer did nothing further to remedy the hostile working environment or address the illegal use of drugs by Taylor and others in the workplace. Instead, plaintiff and the other employees remained in constant fear of retaliation by Ms. Taylor and Ms. Keefer, which did not take long to materialize."

Beginning in late 2010, Grotz was falsely accused of timecard fraud, threatening Taylor and acting unprofessionally, the complaint says.

Finally, Grotz claims, Keefer, Burnett and two union representatives told her to sign a "last chance" agreement which included "false and inaccurate information" about to those allegations. She says that when she refused to sign the agreement she was fired, on July 7, 2011.

Grotz says Taylor was fired the same day.

Grotz seeks a jury trial and damages for unlawful discharge and breach of the union's duty of fair representation, wrongful termination, intentional infliction of emotional distress, and negligent infliction of emotional distress.

She is represented by George Camerlengo with Camerlengo & Johnson of Redwood City.

Neither Kaiser nor SEIU-United Healthcare workers immediately responded to requests for comment.

Kaiser Permanente whistle-blower Emily Ryan from Roseville, California

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