Only the ethically challenged need apply (or How Kaiser Permanente made another enemy for life)

[editor: This email we received from a former Kaiser pathologist speaks for itself. We receive reports like this a few times a week from ex-employees who have been railroaded by Kaiser for not towing the line, but we're not always able to publish them. Those of you following the Elisa Cooper story will note the similarities.]

I am a pathologist with 17 years experience. For personal reasons (wanted to stay in the Sacramento area) I accepted a trial 3 month entry level pathologist position at Kaiser South Sacramento. I was told by hospital chief (KF) that the trial contract was to evaluate if there was appropriate “chemistry”. I verbally accepted the job offer which was very generous even at entry level. The Permanente Medical Group offered 20K in salary more than my previous position and excellent benefits, including a defined benefit pension plan which paid a percentage of salary at retirement, almost unheard of in today’s labor market. However, a week or so after I verbally accepted I was shown the trial 3 month contract and asked to sign it as soon as possible or else I could not get hospital privileges and start a the beginning of January 2005 when my last job contract expired (this was the end of October). The physician administrator stated the contract I was forced to sign was “non negotiable” and included termination for no cause and had this long clause agreeing to binding arbitration as follows “This agreement includes any claims of employment discrimination, and other unlawful conduct such as, but not limited to, claims arising under Title VII of the Civil Rights act the Americans with Disabilities Act, the Age and Medical Leave Act, the California Fair Employment and Housing Act, the California Constitution , the Family Rights Act as amended and any other federal, state, county or municipal law or regulation governing the relationship between employers and employees. The parties hereto expressly waive their rights if any to have such matters heard by a court or jury weather state or federal. I asked myself, why does the Permanente Medical Group need to have so much protection from legal action against them. Do they plan to mistreat me? I thought this was strange but I knew I was a good doctor and I had good work ethics. I had already turned down at least two other job opportunities by the time I saw this contract. My hands were tied so I signed. One needs to have trust ?.how could I be SO WRONG. Why should anyone be asked to sign away hard earned and carefully thought out rights and protections our government thinks we as citizens need? Such contracts need to be made illegal!

The practice in the department was backwards. I was very open about my areas of strength and weakness when I took the position, but i soon found out that my area of weakness, dermatopathology, had very poor support in the department. The performance of the two most senior pathologists in this area (RY and SB) was erratic and there was a large settlement pending for the under diagnosis of melanoma on a case evaluated by SB and the department, fueling these erratic diagnosis pattern. My questioning of non-standard diagnostic terms generated hostility from the chief (RY) and senior pathologist (SB), instead of standard proctoring feedback. The standard proctoring protocol was completed, but the chief (RY) stated that the cases reviewed were not difficult enough and i was showing too many cases for prospective review (I followed the rules in the department, which did result in a large number of cases to be reviewed. The senior pathologists (RY and SB) did not follow their own rules ). I experienced hostility (open refusal to review cases and slamming slides trays around) when trying to comply with the department rules and get the appropriate standard prospective reviews of cases I felt uncomfortable with. This included mocking and writing opinions upside down by one pathologist (SB) and open hostility by the chief (RY). Since I was on a trial contract, I limited the reviews as I felt intimidated and wanted to keep the chief and senior pathologist happy. After all, they had the final say on my job security. My fate was in their hands.

Three weeks before the end of my trial contract, there was a complete 100% retrospective review of my work. The senior pathologist (SB) was taken off service to perform this review and I was left with a larger proportion of work as one pathologist devoted 100% of several days to scrutinizing every detail of my work. SB found some diagnosis discrepancies most of which were insignificant, pretty typical for such reviews. Of note, retrospective reviews are not part of the standard quality control process in the department as they are in most departments of pathology in the local area. . This was only undertaken to provide some evidence for the non-renewal of my trial contract, as my questioning of what was non-standard practices became an irritant to the chief and the senior pathologist. For this reason, the pathologists had no idea of what they would find in such reviews and since they never review themselves, have no way to evaluate the finding. I could tell that retrospective reviews were not part of their quality process as their diagnoses were so erratic. The pathologists never communicated or did quality control on each other. For this reason, no standards could be applied. The chief (RY) told me that for my 16 years of experience she expected more and that I was sloppy. Of note, my position was at the entry level, with no compensation for experience. After being let go in this manner, I experienced great difficultly finding employment, leading to my relocation to the LA area for work. Many opportunities were interested until they checked references. Moreover, the Permanente Medical Group without the benefit of a hearing issued a report of employee termination to the Medical Board and the National Practitioners Databank, stating that they were obligated to do this by professional code standards. However, they stated they did not need to give a reason for the non-renewal of my contract. My contract was a trial contract. It expired. I was not terminated from a regular Kaiser Position.

I was not a good fit for the type of medicine that is practiced at Kaiser Permanente. The reports issued say there were concerns with my diagnostic skills and experience. I am in the process of undergoing an internal appeal of this report, after the fact and at my own personal expense. My demands for a outside review of my work were ignored and intimidation tactics are being used to discourage any appeal. No action was taken until I wrote to the CEO of Kaiser, Dr. Pearl. Now that I no longer live in Sacramento, I am obligated to return for this hearing. The hearing is being conducted, in a very odd fashion without allowing appropriate access to information needed to make my case of intimidation and harassment leading to limiting my consultations in the department.

My experience at Kaiser feels so wrong, in particular when contrasted to my current work place experience in which my chief openly encourages the pathologists to show as many cases as possible and is very supportive. It is the best for the patient to have as many eyes put on their material as possible and for everyone in the lab to be on the same page when it comes to diagnoses. My current employer did not require that I put aside all the work place protections. In fact, the lab has a zero tolerance policy for all workers who violate protections. Why does the Permanente Medical Group protect their management from any work code violations? This publication is intended to increase awareness of these types of practices at Kaiser and put a stop to the behavior exhibited by the physician chief, the CEO, the pathology chief and other pathologists at Kaiser South Sacramento. Moreover, my case brings up the aspect of using the California Professional Code to eliminate competing physicians. If a physician is not going to be a good fit for Kaiser, then they should not be able to practice in the community and Kaiser uses this code to eliminate the competition. No other doctors in the area, means more people will be obligated to sign up for Kaiser to get any health care at all. After all, my skills were good enough to be on the medical staff of such university medical centers as Emory, UCSF, UC-Davis and University of Louisville in addition to community medical centers such as San Joaquin General and Kern County Medical Center … just not Kaiser? I just asked too many questions. Now I have a black mark on my record and a feeling that patients need to be protected from the type of practice that occurs at Kaiser South Sacramento.