Another day another class action lawsuit:
Kaiser Permanente Insurance Co. was hit with a class action lawsuit in California on Tuesday, alleging the company of strong-arming the most disabled psychiatric patients into canceling their plans with the large insurance provider.
Plaintiffs Douglass Kerr and Matthew Szitzkar-Kerr allege in their class action lawsuit that psychiatric patients who are covered by Kaiser’s insurance plan are told by Kaiser that they will only receive care if they cancel their insurance. Then, allege the plaintiffs, psychiatric patients become uninsured and eligible for public assistance, including Medicare and California’s Medicaid program “Medi-Cal.”
The lawsuit was filed in September but KP is shamelessly continuing the practice, as evidenced by the following denial letter, dated October 18, 2014, which was posted to our Facebook Page by a family member of a patient unrelated to the lawsuit. You can read the entire letter by clicking on the images at the bottom of this post, but this is the meat of it:
We denied this request because it is not a covered benefit of her Plan with Kaiser Permanente. Our review determined that your daughter’s treatment team at the Kaiser Permanente Los Angeles Medical Center Hospital has considered transfer to an IMD facility for further management. However, the IMD is requiring that your daughter be disenrolled through her coverage with Kaiser Permanente so that the services will be covered by Medi-Cal as her primary coverage.
First of all, so much for KP’s old and tired claim that health care decisions are only made by doctors. The patient’s treatment team recommended transferring her case to a facility that provides services that KP cannot accommodate in-house (long term hospitalization). Health plans in California are required by law to provide mental health care coverage, but because it is more expensive outside of the Kaiser system, as they can’t pinch every penny at the expense of the patients, they are trying to intimidate members into dropping their Kaiser coverage so Medi-Cal (California’s version of Medicaid) will have to pay.
Of course, as always, they attempt to deflect responsibility as they have done here by claiming, “…the IMD is requiring that your daughter be disenrolled,” when it has done no such thing. A more honest way to word that would be, “..the IMD requires payment for services rendered, and because KP is refusing to pay, Medi-Cal is your only other option.” Another lie, because when the grievance was turned over to the California Department of Managed Health Care, Kaiser suddenly agreed to pay (within the last few days), but only AFTER subjecting the family to wasted time and multiple denials, apparently hoping they would just go away.
Do you suppose that miraculous change of heart had anything to do with recent sanctions and fines for similar shenanigans?
Received this press release yesterday, which we are reprinting in full below. NUHW is quickly becoming our favorite union. It is the same organization that crafted the complaint which recently resulted in a $4 million fine against KP for violating California mental health care laws. The link in the first paragraph takes you to a PDF of the lawsuit.
NUHW Sues California’s “Obamacare” Exchange to Protect Patients from Kaiser Permanente’s Substandard Care
SACRAMENTO, Calif. , Sept. 4, 2013 /PRNewswire-USNewswire/ — Today, the National Union of Healthcare Workers (NUHW) and five other plaintiffs filed suit in the Superior Court of Sacramento, California to block Kaiser Permanente from participating in California’s Health Benefit Exchange due to its substandard care that violates the Exchange’s rules.
In June, the California Department of Managed Health Care (DMHC) fined Kaiser $4 million for committing multiple and “serious” violations related to its mental health services, including failing to give patients’ access to care and violating California’s Mental Health Parity Act. The DMHC’s fine is the second largest in the agency’s history and stems from a complaint filed in November of 2011 by NUHW’s mental health clinicians on behalf of their patients.
According to state and federal law, the Health Benefits Exchange can only contract with HMOs that “are in good standing with their respective regulatory agencies,” which is further defined as “the absence of any material statutory or regulatory violations, including penalties, during the prior year…”
Nonetheless, last month California’s Health Benefits Exchange ignored state and federal law by signing a contract with Kaiser even after the Exchange had been fully apprised of Kaiser’s ineligibility to participate in California’s new health insurance market. Today’s lawsuit simply asks a judge to compel the Exchange to follow state and federal law, including the “good standing” requirement.
“Before Kaiser is allowed to enroll thousands more patients through the Exchange, it should first demonstrate that it can take care of the patients who already rely on Kaiser for their health care,” said Dr. Horace Beach, a psychologist who has worked at Kaiser Vallejo for many years. “It’s unfortunate that it takes going to court to protect California consumers. But the Exchange shouldn’t allow a plan like Kaiser to participate until it can demonstrate that it has corrected all of the serious violations documented by the DMHC and has paid the $4 million fine to the state.”
NUHW represents 10,000 frontline caregivers, including nearly 5,000 healthcare professionals employed by Kaiser Permanente, including registered nurses, psychologists, licensed social workers, opticians, and other professionals. In October 2011, NUHW released a 34-page paper entitled “Care Delayed, Care Denied: Kaiser Permanente’s Failure to Provide Timely and Appropriate Mental Health Services,” which first made public Kaiser’s substandard mental health care.
SOURCE National Union of Healthcare Workers
Highly recommended reading for everyone with an interest in how Kaiser’s rigged arbitration system works to keep its many misdeeds out of the public eye. It is rare for KP to lose in arbitration, but when they do, as in this case, “Kaiser offered to fund an annuity with the arbitration award, but only if the family agreed not to publicize the case.”
They will lie, cheat and steal to win, and on the rare occasion they don’t win, they will go to any lengths necessary to prevent these stories from getting out. Many thanks to the Palmer family and attorney Robert Vaage for refusing to take the bribe.
Kaiser Permanente loses $4.9 million in brain injury case – San Francisco Business Times
A San Diego man who allegedly suffered permanent brain injury in a Kaiser hospital two years ago has won a $4.9 million arbitration award in a rare instance of an arbitration loss by the Oakland-based health giant being made public.
The patient, then-17-year-old Raymond Palmer, was stabbed at a San Diego trolley stop in May 2011, taken to UCSD Medical Center and later transferred to Kaiser Zion hospital, also known as Kaiser Permanente San Diego Medical Center.
Shortly after the transfer, Palmer’s breathing tube allegedly became dislodged, resulting in a Code Blue, according to a statement by Palmer’s lawyer, San Diego personal injury attorney Robert Vaage.
17 years old. How differently would this young man’s life have turned out if only that transfer to Kaiser Zion had never taken place? Kaiser Thrives on ruining lives. Lies and denies.
This isn’t attorney Vaage’s first rodeo. In 2009 he won a large award against KP for a man with warning signs of an impending stroke that were repeatedly ignored until it was too late. We are frequently asked to recommend attorneys, and although we don’t make direct referrals, we do always suggest that you look for someone with a history of winning against KP. Lawyers without that experience often don’t have any idea what they are going to be up against. Kaiser doesn’t just play dirty; they wallow in the sewer. It’s where they live.
The adorable Andrew Arce, who is quite a bit older now
Great news! The Arce vs. Kaiser autism class action lawsuit has been settled, resulting in the creation of a $9 million fund to reimburse members who incurred out-of-pocket expenses due to having their treatment denied. Anything left over will go to autism research.
KP’s PR statement tells us that, “this settlement does not determine that Kaiser Permanente acted inappropriately,” but we know better, don’t we? Just once we would like to see something truthful come out of that BS factory. Such as, “This settlement determines that KP acted inappropriately, by denying treatment to members with autism. This often meant depriving them of the early intervention that virtually every autism expert in the world deems necessary for the best results. However, our agreement to establish a $9 million fund to reimburse our victims should in no way be construed as concern for the actual well being of the people we have harmed. It is merely a reflection of our realization that seeing the lawsuit through to the end would have cost us many times that amount, and of course our fear of the bad publicity that would have certainly resulted.”
There is nothing KP hates more than bad publicity, and now they get to pretend they did it out of the goodness of their black little hearts.
Below is a link to the article in Sacramento Business Journal, and the Autism Daily Newscast has also covered the story here:
Kaiser to pay $9M to settle autism therapy suit
Kaiser Permanente has agreed to pay up to $9 million to settle a class action that alleged the health plan illegally refused to provide behavioral therapy for autistic children before it was mandated by state law.
The lawsuit was filed in Southern California in April 2009 on behalf of Andrew Arce of Los Angeles and others like him. Andrew was 2 years old when Kaiser denied coverage for applied behavioral analysis even though its own doctors said it was medically necessary.
Did you get that last part? “Kaiser denied coverage for applied behavioral analysis even though its own doctors said it was medically necessary.” That’s right, when KP says in its advertisements that medical decisions are only made by doctors, they are flat out lying.
Our prior posts about this case are located here, and we have archived many of the court filings and other documents here.
In other news, we would like to remind everyone that while we haven’t been able to do as much updating of the website as we would like in recent months, we do regularly update our Facebook page with links to Kaiser related news, lawsuits and scandals. Please do not mistake our lack of posting here as an indication that KP has changed its ways. We do believe there have been some positive changes over the last few years, but not nearly enough. We are receiving fewer complaints about certain issues that were prevalent in the past, but we have a particular concern about KP’s treatment of the elderly, which only seems to be getting worse. Unfortunately, we can’t often post those stories because most of the victims are still under Kaiser care.
Now, to everyone we owe emails: we are backed up and trying to slowly work our way through them, but it will take some time. We do always read them as they come in, but haven’t been able to respond in a timely manner. If you are waiting for an answer, your best bet for a speedy reply is to contact us again, and we’ll get back to you as soon as possible. No need to retype everything you sent previously, just give us enough info to find your prior attempt.
Kaiser Permanente has been cited by the California Department of Managed Healthcare for multiple mental health care violations, including keeping two sets of records to hide lengthy appointment wait times from investigators. Definitely worth reading the entire article because it shows the deliberation with which Kaiser skimps on your care and then lies to cover it up. The sad part is that they are so rarely caught red-handed like this because the DMHC usually treats each complaint like an isolated incident, rather than evidence of the systemic fraud and malpractice that is obviously occurring. The complaints that spurred this particular investigation came from Kaiser’s own mental health practitioners, which is unusual, but it’s about time!
Government Cites Kaiser Permanente for Providing Inadequate Mental Health Care to California Patients
The California Department of Managed Health Care (DMHC) issued a report yesterday affirming the findings of an exhaustive complaint filed by Kaiser Permanente’s frontline mental health clinicians, who are represented by the National Union of Healthcare Workers (NUHW). The DMHC cited Kaiser for multiple violations that have now been referred to the agency’s Office of Enforcement, which is responsible for imposing legal and financial penalties on HMOs.
It then goes on to list some of the specific violations, and explores the serious impact Kaiser’s failure to meet state standards can have on patients.
The DMHC’s full final report is here; and the complaint from the clinicians – with the assistance of the National Union of Healthcare Workers – can be found here. This is a very well put together complaint, with all of the data to back it up.
How convenient for KP Southern California’s bank account that this man’s father was “accidentally” disconnected from his ventilator, only hours after his doctor failed to talk the man’s son into doing so on purpose! You have to ask yourself — is your Kaiser Permanente doctor a one man death panel?
By Dwight Smith
The Pulmonologist caring for my father pulled me aside and asked me to sign a slip giving Kaiser permission to disconnect my father from a ventilator. Horrified, I said, “Ask him yourself, he’s fully conscious.” Terrified, I asked my father to take a quiz: Write the first six letters of the alphabet, which I’d written at the top of a blank page. My dad did so in a shaky but readable hand. I then demanded that the charge nurse place the document into my father’s chart and handed it to her.
The next day when I arrived, my brothers were in a tragic huddle. During the night, transportation aides had taken my father for a CAT scan. During the process, the lanyard keeping his ventilator tube in place had been untied, and the entire two foot length of his air tube “accidentally” got pulled from his throat. In spite of the fact that he was to undergo x-radiation, no Doctor was present, and when one was finally summoned to re-insert his airway, so much time had elapsed that my father had suffered irreversible brain damage.
When a clumsy attempt to sample my father’s arterial blood gasses, which involved digging deep into his arm with a needle elicited no response at all, I realized the time had come to disconnect my father, just as the Pulmonologist had requested. The heavy lanyard securing his airline took some time to undo, and I held him as we pulled the tube from his lungs and watched him die. I realized at that moment that it required deliberate and intentional malice to accidentally “disconnect” a patients airway.
As I left to attend a meeting wherein the Pulmonologist persuaded my three brothers to argue me out of an autopsy, I looked at the bulletin board at the side of his bed. The quiz that proved he was alert and conscious, his last six letters, written in response to my written question, was posted as patient art.
Make no mistake about it – Kaiser doctors kill patients.
Below are ten more Kaiser Permanente scandals from the time period when we were not regularly updating this website. Most of this information comes to us in Google News and Blog Alerts, but recently the Big G has taken it upon itself to carry water for Kaiser, and has blocked most critical websites from the Alerts. We still find them, but it requires us to go actively looking, which is obviously more time consuming. For that reason, if you ever run across an article or blog post that we haven’t reported, or see something in the news, we’re requesting that you send us an email to let us know.
If you hate censorship, and find Google’s blatant effort to bury criticism on behalf of one of its biggest advertisers as appalling as we do, then please consider walking with your fingers and using a different search engine. Hit ‘em where it hurts — in the advertising revenue. You may have noticed that we removed our own Google Ads (we never made money from them, but they covered the costs of running the site), and now you know why. We recommend DuckDuckGo for offering its users real privacy, and Bing as the next best alternative.
- KP’s Oakland hospital was fined $50,000 for a medication error involving a 90 year old man.
- Non-profit Kaiser posted $2.1 billion in profits for the year 2009. That’s the money that was left over after your health care was provided and all operating expenses were taken into account. This when people are struggling to pay ridiculously high insurance premiums and 22% of California residents are uninsured. Appalling.
- Four patients at KP hospitals in Northern California were served chicken noodle soup with fragments of glass in it. Mm mm good!
KP surgeon, Dr. Michael Meehan, was arrested on a DUI charge after a head-on crash in Napa that injured 5 people. If you receive health care at the Vallejo Medical Center you had better hope he doesn’t operate on you while drunk, because he’s still working there and he looks a little toasted in his official KP
Kaiser Vallejo Surgeon Dr. Michael Meehan
mugshot portrait, at right.
- KP was sued by the family of a 69-year-old California woman who died after consuming food contaminated with salmonella, while recovering from surgery at the Hayward facility. We always like to remind people that it is the members who ultimately pay the cost for all of these lawsuits.
- A KP Manteca registered nurse, Gerado Cuevas, was sentenced to 12 years in prison for sexually molesting a 13 year old girl, along with another man who was also found guilty of the crime. According to an earlier article, the abuse happened more than once and was videotaped. Sickos.
- On track to exceed 2009 earnings, KP reported $706 million in net income in the first quarter of 2010 alone. And they are so proud of getting rich off of the sick and suffering that they send out a press release.
- A woman claims she was treated with such negligence in the KP emergency room that she developed ulcers the circumference of a man’s fist and lost all sensation and use of her body below her neck.
- In another outrageous breach of privacy and abuse of power, KP inserted itself into the middle of a family dispute between members. The site admins redacted the company name, but we are sure it was Kaiser because we saw it at the time.
- In a follow up to the case of Dr. Death Jayant Patel, Kaiser members ask the question, “Why wasn’t he stopped?”
More scandals to come…
Lawsuit alleges that a runner collapsed & died at the finish line of the Kaiser Permanente San Francisco Half Marathon & 5K Run, because the medical tent was staffed by chiropractors and chiropractic students rather than medical doctors & EMTs, and no defibrillator or ambulance was present.
That’s KP for ya – always trying to save a buck without regard for human life. And guess who gets to pay for the lawyers to defend the lawsuit? Kaiser members!
Read the legal complaint via Kaiser Bad News (PDF).
Could your private medical file be sitting in some guy’s garage in Indio? A small cataloging and storage company claims it has the records of hundreds of thousands of Kaiser patients that KP hired it to process, but refuses to pay the bill to return or destroy.
Kaiser Permanente stuck in odd struggle with tiny Indio vendor – San Francisco Business Times
Stephan Dean of Surefile Filing Systems
Giant Kaiser Permanente has found itself locked in a David-and-Goliath-scale struggle with a tiny Southern California record storage vendor over up to 1 million unencrypted Kaiser patient records the vendor claims remain on servers in his house and garage.
Former KP psychiatrist Dr. Stephen Melcher
Yesterday, Sacramento Business Journal
and CBS13 News
reported on the case of a Kaiser Permanente psychiatrist who has been convicted of a felony sexual act with a minor. Dr. Stephen Melcher was sentenced to one year in jail for a lewd and lascivious act against a child under 14 — in this case an 11-year-old boy.
The Medical Board of California says it is also pursuing disciplinary action. According to MBC records, the boy was molested after a dinner party at Dr. Melcher’s Sacramento area home on October 8, 2011.
Melcher was arrested the following December, but continued to practice at KP until March, when he finally resigned from his position there. In April he pleaded “no contest” to the charges, which lead to last week’s sentencing.
It’s not clear when Kaiser became aware of the allegations, but from the following statement it looks like they did know about the arrest, but chose to allow him to continue working until his resignation.
“Dr. Melcher is no longer with Kaiser Permanente. The charges against Dr. Melcher relate to an incident that occurred in a social situation outside of Kaiser Permanente and his medical practice.
“Kaiser Foundation Hospitals and Health Plan must take into account the legal and due process rights of employees and physicians while they await adjudication. Dr. Melcher’s practice involved only adults. We evaluated Dr. Melcher’s practice and confirmed that the charges against him related to an incident that occurred in a social situation outside of Kaiser Permanente and his medical practice. He resigned on March 19.”
Innocent until proven guilty, as they say, but given the sensitive nature of a psychiatric practice, it seems that at the very least a suspension with pay should have been in order until the case was decided. It creeps us out a lot to put ourselves in the shoes of his patients, trusting and sharing their innermost secrets and problems with an accused child molester, unbeknownst to them. I don’t know about you, but even if it is true that he only treated adults, I wouldn’t want even an alleged pervert for a psychiatrist.
The news articles can be accessed via the links above, and we will be posting any updates that come through to Facebook and Twitter.