"Horrific" consequences of Kaiser Permanente's failure to properly monitor bladder patient during and after surgery

See comparison of Kaiser urology department with other medical centers.

Patient Blames Kaiser for 'Horrific Events'
By BARBARA WALLACE
Courthouse News Service
May 08, 2013

DENVER (CN) - Two Kaiser doctors and a nurse practitioner overlooked an important lab test for a patient about to undergo bladder surgery, and both doctors made mistakes during the surgery, resulting in a "cascade of horrifying complications," the patient says in a complaint filed in Denver District Court.

Urologist Mina Shabnam Lee diagnosed 71-year-old Josephine Jansen with a mass in her bladder in April of 2011 and recommended a surgical procedure called a "bladder transurethral resection neoplasm," according to Jansen's complaint.

A nurse practitioner, Andrea Anderson, performed a pre-operative examination and Dr. Lee ordered lab work, the complaint states. Nonetheless, neither they nor the anesthesiologist, Thomas Arthur Gettelman, ordered a test of Jansen's sodium level, according to the complaint. "Either defendant Anderson or defendant Lee or defendant Gettelman could have easily ordered a simple blood test which would have included a panel of electrolytes such as sodium. The ordering of a sodium lab value is extremely easy, and non harmful to the patient, and would only take a matter of minutes to obtain. However, the priorities of each defendant were such as not to obtain this test. Moreover at least one of the drugs that the plaintiff was taking, Hydrochlorothiazide, (HCTZ) is a diuretic and has the effect of lowering some electrolyte lab values," Jansen says in her complaint.

"During the surgical procedure performed by defendant Lee, various and serious complications occurred," the complaint continues, including a ruptured bladder, and aspiration of stomach contents into Jansen's airway because Dr. Gettelman was "negligent in the performance of his duties as an anesthesiologist during the operative period," according to the complaint.

The complaint states that Dr. Lee, failed "to adequately consider the effects of fluid absorption as a result of the surgical misadventure."

"Defendant's superficial approach to this patient - particularly in having no understanding of her sodium prior to surgery - set into motion the cascade of horrifying complications which followed the surgery. And her operative and post operative mismanagement (especially in not ordering serum sodium immediately post surgery) caused further and increased harm to plaintiff," the complaint states.

"Following the surgery the plaintiff sustained severe and irreparable injury. She went into shock caused by abnormal and an almost deadly level of sodium, plaintiff's bladder was ruptured during the surgery and shortly following the surgery it was determined that plaintiff had developed severe hyponatremia which was complicated by acute cardiac decompression due to the stress induced cardiomyopathy, respiratory failure, renal failure requiring dialysis, prolonged ventilation, and significant neurological injuries. This cascade of horrific events including multi organ failure, were caused by the negligence of the defendants," Jansen's complaint says.

"Much of her damages are permanent in nature and her life has been forever changed," the complaint states. "The plaintiff has incurred substantial economic losses including the loss of her career."

Plaintiff is represented by John Astuno, Jr. of Denver.

Wells Fargo will pay $105m to settle OC fraud case regarding Medical Capital Holdings (MedCap)

Wells Fargo will pay $105m to settle OC fraud case
By The Associated Press
May 3, 2013

SANTA ANA, Calif. — Wells Fargo Bank will pay $105 million to settle a lawsuit that held it liable for an Orange County fraud scheme that cost investors as much as $1 billion.

The Orange County Register says the settlement was filed Tuesday.

Wells and Bank of New York Mellon were trustees of investor funds for Tustin-based Medical Capital Holdings. MedCap claimed to sell safe investments but authorities say it gambled on risky ventures such as unlicensed hospitals.

Regulators closed the firm in 2009. Its president pleaded guilty to wire fraud.

The investor lawsuit claimed Wells Fargo and Mellon ignored warning signs that MedCap was a fraud. The banks argued that they followed the terms of their contracts.

Mellon settled its case for $114 million.

Has Kaiser achieved its position through illegal tactics such as mislabeling employees to cut costs?

Kaiser avoided paying overtime wages and giving breaks by falsely labeling employees as managers, violating the California Labor Code.

Kaiser Uses Title Alone for Tax Status, Class Says
By PHILIP A. JANQUART
Courthouse News Service
May 07, 2013

SAN DIEGO, Calif. (CN) - Certain Kaiser Foundation Hospital Inc. employees were paid an exempt-status salary, but performed non-exempt tasks, according to a San Diego Superior Court class action lawsuit.

Lead plaintiff Adam Hardesty was employed at a San Diego County Kaiser hospital as a "project manager" from August 2012 to February 2013.

Hardesty states in his complaint that despite the title, employees had little to no authority, never served in a supervisory role and were otherwise "engaged in a type of work that required no exercise of independent judgment or discretion as to any matter of significance."

Instead, Kaiser project managers performed a "finite" set of non-exempt tasks that included transcribing written and electronic prescriptions, completing patient profile entries and notes, sending requests to doctors for medication refills and were even expected to troubleshoot the pharmacy computer system, all on top of "daily debriefing" conference calls.

"As a matter of company policy, practice and procedure, Kaiser unlawfully, unfairly and/or deceptively classified every project manager as exempt based on job title alone, failed to pay the required overtime compensation and otherwise failed to comply with all labor laws with respect to these project managers," the complaint states.

Hardesty alleges Kaiser operates the scheme to save money and be more competitive in the health care industry. "To successfully compete against the other health care service providers, Kaiser substantially reduced its labor costs by placing the burden of overtime work on a smaller number of salaried employees that Kaiser classified as exempt from overtime wages and other related benefits . . . the requirement to pay overtime wages extends beyond the benefits individual workers receive because overtime wages discourage employers from concentrating work in a few overburdened hands and encourages employers to instead hire additional employees," the complaint states.

In addition, the complaint alleges Kaiser did not provide the class compensation for missed meal and rest breaks, and did not provide accurate and itemized wage statements showing gross and net wages, hourly rates for regular and overtime hours or the corresponding hours worked at each hourly rate.

Hardesty is suing for violations of California's Unfair Competition Laws under California's Business and Professions code. He wants the court to enjoin Kaiser from continuing its practice of labeling employees as exempt by title only, to order Kaiser to correctly calculate and pay all wages due, and to disgorge "ill-gotten gains into a fluid fund for restitution" according to proof.

Norman B. Blumenthal, Kyle R. Nordrehaug and Aparajit Bhowmik, of La Jolla, Calif., represent the plaintiff.

Kaiser surgeon, or surgical resident, bungles colostomy closure, patient passes stool through vagina

Woman Blames Kaiser for Poop Through Vagina
By BARBARA WALLACE
Courthouse News
April 25, 2013

PORTLAND (CN) - A Kaiser surgeon, or a surgical resident practicing under a surgeon, bungled Vicki Lopez-Lunn's colostomy closure, puncturing her vagina with one or more staples and causing an abnormal opening between her colon and vagina, Lopez-Lunn claims in a malpractice lawsuit filed in Multnomah County Circuit Court. "As a result, Ms. Lopez-Lunn began passing stool through her vagina," according to the complaint.

James W. Dennis, M.D. and Emily Bubbers, M.D. are named as defendants.

"Vicki Lopez-Lunn was never informed of the increased risks associated with having a resident surgeon, [such as] Emily Bubbers, M.D. perform surgical procedures like the one performed on plaintiff," the complaint states. "Had Dr. Dennis and /or Dr. Bubbers informed Ms. Lopez-Lunn of the risks associated with this surgery, Ms. Lopez-Lunn would have elected not to proceed with the surgery."

"Defendant Dennis and/or Bubbers knew or in the exercise of reasonable care should have known that puncturing Ms. Lopez-Lunn's vaginal cuff with surgical staples would cause injury to Ms. Lopez-Lunn," the complaint asserts.

The plaintiff is seeking $1.7 million in damages and is represented by Clayton Morrison of Beaverton, Ore.

Kaiser: Guts Pulled Out through Cervix, Woman Claims

Kaiser: Guts Pulled Out Cervix, Woman Claims
By BARBARA WALLACE
Courthouse News
April 04, 2013

LOS ANGELES (CN) - During uterine surgery, a Kaiser surgeon perforated a woman's uterus and pulled part of her small intestine out through her cervix before realizing what it was, the woman claims in court.

According to the complaint, Dorothy Ho had uterine surgery performed by a Dr. Murray because of postmenopausal bleeding. "During the operation, as was later discovered, defendant Murray apparently, in attempts to remove a polyp during the course of the medical surgery, noted a protrusion of tan colored tissue, which defendant Murray then attempted to remove from plaintiff's cervix. As defendant Murray continued to pull on the tissue, it continued to elongate and when the tissue was sufficiently removed from the vaginal area, it was discovered that the tissue was not of gynecologic origin. Upon further consultation and confirmation with other medical staff, it was determined that defendant had perforated plaintiff's uterus and instead caused a small bowel injury to plaintiff's bowel due to a tear in her bowels caused by said surgery," according to the complaint.

"In this, defendant Murray failed in defendant's position as a trusted surgeon to perform the surgery with the level of skill, knowledge, and care that other reasonably careful surgeons would use in similar circumstances when confronted with a tissue of unknown origin attached to and protruding from an abnormal growth," the complaint states.

Next, defendant Murray, "immediately performed" a procedure, "during which a large portion, i.e. approximately 40 cm, of plaintiff's small bowel had to be removed," according to the complaint.

"After the operation, defendant Murray informed plaintiff Ho that despite the complication during the procedure, i.e. perforation and small bowel tear, that plaintiff would make a full recovery and would suffer no further, significant effects from the medical complications from the procedure," the complaint says. However, Dorothy Ho remained hospitalized for nine days, during which she "suffered from vomiting, abdominal cramping, bloating, and pain, which she was advised were normal complaints arising from such surgery," according to the complaint.

Dorothy Ho did not learn the full extent of her injuries for four months, during which time she continued to have abdominal pain and needed to take a leave of absence from her job as a Kaiser pharmacist, the complaint says.

Having lost 40 centimeters (about 15.6 inches) of her small bowel, Dorothy Ho's medical problems continue, including "inability to eat much, inability to eat greasy foods, inability to undertake hikes, [and] travel abroad," and "major depressive and anxiety disorders," requiring prescriptions for Xanax, Cymbalta and Ativan, according to the complaint.

Plaintiff is represented by David Lin of Pasadena.

Was Kaiser Permanente correct, or simply trying to save money, when it said Castleman's patient was "hopeless"?

One of Kaiser Permanente's tricks is to avoid testing patients, or to avoid releasing test results, so Kaiser won't have to pay for treatment.

I agree with Plaintiff's claim in the story below that "...a deliberate strategy and business practice on the part of defendants to systematically deny medically necessary care that Kaiser is unable to provide itself...Based on a consistent pattern and practice, defendants routinely deny medically necessary treatment requested by members' medical professionals on invalid and unjustified and unjustifiable grounds for the sole purpose of saving money and, ultimately, cause the premature death of members, thus relieving defendants of the continuing financial obligation to provide care and treatment to desperately ill people."

It will be interesting to find out exactly how Kaiser handled the following case. It is true that some cases are hopeless. But Kaiser's strategies intentionally make it difficult, if not impossible, to know the truth about a patient's condition.

Here's an update on this case.

Man Says Kaiser Business Model Includes Death
By PHILIP A. JANQUART
Courthouse News Service
March 14, 2013

LOS ANGELES (CN) - Kaiser Foundation Health Plan refuses to pay for care necessary to save a man's life, he claims in court.

Jalal Afshar, 58, suffers from Castleman's disease, a rare condition known as lymphoproliferative disorder. The disease is not cancer, according to the American Cancer Society, but often leads to lymphoma and is treated with chemotherapy or radiation. He also suffers from a rare blood disorder that appears along with Castleman's disease, called POEMS syndrome.

Diagnosed in 2005, Afshar says he developed a growth in his abdomen in January 2012 and sought advice from his Kaiser oncologist, Dr. Iman Abdalla, who told him, "I don't know what to do with you," and that she had "run out of ideas and options" for his treatment, the complaint says.

She attributed his difficulty in breathing, edema in his limbs and stomach, and the growth in his abdomen to "middle-age fat" and a "sedentary lifestyle."

He then sought out a second opinion, ultimately traveling to Arkansas where he was seen by Dr. Frits van Rhee at the University of Arkansas in Little Rock. Afshar began receiving chemotherapy on the advice of Dr. van Rhee who also planned to have stem cells collected for a future stem cell transplant. Kaiser, however, denied any coverage of the treatments, claiming Afshar could get the same treatments under the Kaiser plan.

Afshar twice appealed the decision over the phone because Dr. Abdalla had "already admitted that she did not know how to treat him, and given that all of the past treatment Kaiser had offered had been ineffective." Kaiser refused, causing Afshar to return to Los Angeles where doctors administered a 12-hour course of chemotherapy using a combination of drugs that were not the same as the ones used by Dr. van Rhee, according to the complaint.

By June 8, 2012 Afshar's legs were significantly swollen and his breathing had become more labored and difficult, according to the complaint. He developed a fever and his blood pressure dropped, leading to his admittance to the intensive care unit.

On June 13, Afshar's wife Maryam was told by doctors that his condition was "without hope" and that "there was nothing else they could do," according to the complaint.

A chaplain and a palliative care representative then visited Afshar in his room and told him they believed his case was hopeless, according to the complaint.

Afshar, however, refused to accept defeat, returning to Arkansas where he once again began receiving care from Dr. van Rhee. He has since amassed over $1.8 million in medical bills, which Kaiser refuses to pay.

Afshar has been under Dr. van Rhee's care since June 17, 2012.

"This action arises out of a deliberate strategy and business practice on the part of defendants to systematically deny medically necessary care that Kaiser is unable to provide itself," the complaint states. "Based on a consistent pattern and practice, defendants routinely deny medically necessary treatment requested by members' medical professionals on invalid and unjustified and unjustifiable grounds for the sole purpose of saving money and, ultimately, cause the premature death of members, thus relieving defendants of the continuing financial obligation to provide care and treatment to desperately ill people."

Afshar is suing for breach of contract, violations of California's Business and Professions Code and intentional and negligent infliction of emotional distress.

Scott C. Glovsky and Danae A. McElroy, of Pasadena, represent the plaintiff.

Kaiser Foundation Health Plan fails to pay medical bills, yet Kaiser's Rawlings Group goes after patient's settlement with restaurant where he was shot

The Rawlings Group corporate headquarters. The Rawlings Group does collections for Kaiser Foundation Health Plan.

"Defendants' conduct is particularly reprehensible because it was part of a repeated corporate practice and not an isolated occurrence."

See also, "The Rawlings Group plunders its own employees as it plunders Kaiser Permanente Patients"

Click on title of article to see Courthouse News story with link to case documents.

Kaiser Stiffs Hospital, Milks Man for $, He Says
By PHILIP A. JANQUART
Courthouse News
March 5, 2013

LOS ANGELES (CN) - Kaiser Permanente Health Plan failed to pay a man's medical expenses, and then attempted to get its hands on his settlement money, he claims in California Superior Court.

Jesse Cox was shot by a stray bullet while waiting in line at a restaurant drive-thru, leading to a five-day stay at Providence Holy Cross Medical Center in Mission Hills and a $300,000 medical bill that should have been paid by Kaiser, Cox says in his complaint.

Cox subsequently won a $300,000 settlement with the restaurant for failure to provide adequate safety measures for patrons, but alleges that Kaiser is illegally trying to get a big chunk of the dough.

"Not until the end of underlying litigation did defendant Kaiser, by and through its agent and joint venturer, defendant Rawlings, deceptively and unfairly claim a lien and subrogation rights to the proceeds of any settlement in the underlying personal injury action," the complaint states.

The Rawlings Group specializes in healthcare subrogation, or "recovery," services. Cox says Kaiser is using the company to obtain a portion of his settlement.

"Defendant Kaiser, by and through defendant Rawlings, has repeatedly asserted that they are entitled to $100,000 from the settlement proceeds, wholly ignoring the required reduction for costs and attorney fees, despite this being brought to their attention on multiple occasions," the complaint states.

Cox adds that Rawlings "has several times intentionally misled plaintiff's counsel into believing that they were in contact with defendant Kaiser on a regular basis and that their counsel was licensed in California," and that both Kaiser and Rawlings "knew that there was no basis for the claims they were asserting and have utterly failed to provide evidence pursuant to California Civil Code, that defendant Kaiser's lien claim is based upon the reasonable costs of medical services which were [not?] actually paid by any of the defendants herein."

Cox says he has received no proof that Kaiser has paid any of the bill. Under California law, "no lien asserted by a medical group, such as defendant Kaiser, may exceed the sum of the reasonable costs actually paid by the medical group," the complaint says.

Cox says "defendants refused to provide proof of payment actually made because in fact no payment for services was made by any of the defendants herein to any of plaintiff's underlying healthcare providers."

Cox is suing for breach of contract, breach of duty of good faith and fair dealings, fraud and for violation of California's Business & Professions Code. He seeks consequential, general, special, punitive and exemplary damages.

Philip J. Layfield and Jamie L. Keeton of El Segundo represent the plaintiff.