[kaiserthrive.org's editor's note: Is this vindication for Kaiser critics, who have been making these claims for years, only to be erroneously discredited, abused and marginalized by Kaiser management and its less than ethical PR and legal departments? Feels a little like vindication, but in our experience these people seem to regret their horrendous actions quite a bit less than they do being caught.
We received an email from a Kaiser employee a few days ago, asking us if we would be willing to post some tangible steps that Kaiser could take to improve itself, as well as a score card listing some of these steps and how Kaiser is doing with implementing them. Kaiser makes a point of pretending it doesn't respond to anything we do, which we know for a fact isn't true, but in the spirit of supporting what is best for Kaiser members we are more than willing to report on positive steps in the right direction. We're still hoping to find even one Kaiser member or employee who has been treated fairly in a dispute, and as soon as that happens it will be our pleasure to report it here.]
From the L.A. Times:
State fines Kaiser again
The HMO’s second such penalty in a year targets its handling of patient complaints at nine hospitals.
By Tracy Weber and Charles Ornstein, Times Staff Writers
Kaiser Permanente will be assessed a record fine today for its haphazard investigations of questionable care, physician performance and patient complaints at its California hospitals, according to state HMO regulators.
The California Department of Managed Health Care said it will levy a $3-million fine against Kaiser, the largest HMO in the state, with 29 medical centers and more than 6 million members. If Kaiser makes necessary improvements, agency director Cindy Ehnes said, she will forgive $1 million of that.
The penalty marks the second time in a year that Kaiser has been publicly rebuked and fined for glaring breakdowns in oversight.
The state’s latest inquiry grew out of its investigation into problems that forced the closure last year of Kaiser’s kidney transplant program in San Francisco. Hundreds of patients were endangered when Kaiser forced them to transfer to its own fledgling program from established transplant centers at outside hospitals.
Last August, the state fined Kaiser $2 million for the transplant debacle, and the HMO agreed to pay an additional $3 million to promote organ donation.
Even then, Ehnes said, the question remained: “How could it happen?”
To answer that question, the state focused on whether Kaiser was properly handling — or even knew about — allegations of subpar care at its hospitals statewide. Inspectors examined 246 files involving complaints, quality-of-care concerns and other issues from four hospitals in Kaiser’s Northern California region, and four in its Southern California region.
The investigation did not examine whether individual patients had been harmed, only on how well Kaiser monitored the quality of patient care.
“A patient has to be sure that if they have a problem — the health plan has their ears open to hear those complaints and their arms available to tackle any of the problems that have arisen,” Ehnes said in an interview. “That’s what our concern was, that those ears in particular seemed to be sometimes deaf.”
A top Kaiser official on Wednesday called the state’s 51-page inspection report “thorough and actually very constructive.”
The managed-care agency found that under the HMO’s massive umbrella, individual hospitals had their own rules: Some rigorously pursued potential medical mishaps; others did not.
The vast majority of the report focused on a system called “peer review,” a standard quality-assurance mechanism at hospitals in which doctors’ committees examine patient cases to determine if the care was appropriate.
Inspectors found large differences among hospitals in how often questionable cases were being referred for peer review. In Northern California, one hospital might refer as much as 20 times as many cases as another.
Even when peer review was performed appropriately, it did not always result in sufficient efforts to improve care, the report says. In a quarter of the 57 cases examined by the state in which peer review committees found a quality problem, follow-up was incomplete.
In one case, a peer review panel examining pediatric care determined that a doctor provided an “unacceptable standard of care,” but it doesn’t appear anyone alerted the hospital’s top doctors to the findings so they could act.
Regulators also found several instances in which doctors were in charge of investigating cases in which the treatment they provided was called into question.
Investigators said they stopped short of determining whether those reviews were handled appropriately.
“You can’t really move on from the taint of looking at your own case,” said Marcy Gallagher, the chief state surveyor on the Kaiser inquiry and the head of health-plan surveys at the managed-care agency.
Gallagher said inspectors identified at least three occasions on which committees at Kaiser hospitals inexplicably stopped their review of troubling cases before they were complete. Kaiser was asked to finish those reviews, she said.
Overall, the report found that the HMO “lacked the ability to verify consistent handling of complaints throughout its medical centers or to determine whether serious or chronic problems were being addressed.”
The nine Kaiser hospitals examined as part of the report are in Woodland Hills, Fontana, Baldwin Park, West Los Angeles, south Sacramento, San Rafael, South San Francisco, Fresno and San Francisco. The state did not identify which hospitals had the weakest systems.
Bernard Tyson, Kaiser’s executive vice president of health plan and hospital operations, stressed that the review did not take issue with the quality of care delivered. “The survey identified the areas in which there were shortcomings, and we have corrected those shortcomings or are well on the way to correcting those shortcomings,” Tyson said.
He added that the HMO is focused on shoring up the systems for handling member complaints and quality assurance at its hospitals — and not on the fine or the public relations fallout of two rebukes in as many years.
Unlike other HMOs, Kaiser is both a health plan and a hospital system. It works exclusively with an affiliated group of physicians called the Permanente Medical Group. Kaiser, a nonprofit organization, had nationwide revenue of $34.4 billion last year and net income of $1.3 billion.
Ehnes said Kaiser officials had been cooperative during the review process, “from the level of the national board on down.”
Although the report did not look at patient harm per se, Gallagher said the findings are troubling.
“You are creating incredible risk when you don’t have an oversight or a checks-and-balances system,” she said. “I hate to think that we have to wait for somebody to get harmed before we say, ‘Wait. Let’s make sure the safeguards are in place.’ ”
The report said Kaiser officials and board members received “extensive reports” on patient satisfaction scores and other quality indicators — such as cancer screenings and childhood immunizations — but no reports on trends or problems found at individual hospitals during confidential reviews.
Kaiser closed its Northern California kidney transplant program in May 2006 after The Times exposed how hundreds of patients were stuck in limbo for months — with little hope of receiving new kidneys — because the HMO had failed to properly handle paperwork transferring them to its new program in 2004.
In Kaiser’s program, twice as many patients died on the waiting list in 2005 as received kidneys, The Times found. The statewide pattern was the reverse: Twice as many patients received kidneys as died.
All the while, the Kaiser patients had to undergo prolonged dialysis, which removes impurities from the blood but can lead to fatal complications and reduce prospects for a successful transplant.
In the report to be released today, the state reiterated its contention that Kaiser knew only general information about the start-up of its kidney program, even though such a massive rollout had never been tried before. The HMO did not measure the effectiveness or adequacy of the start-up or monitor the timely access to transplant services for hundreds of its patients moved to Kaiser’s new program, the report says.
Under the managed-care agency’s oversight, about 2,000 Kaiser kidney patients were transferred to other programs.
“We have now, in many ways, done the concluding chapter to this whole kidney issue,” Ehnes said.
Actions promised
Kaiser Permanente has agreed to overhaul its quality oversight system to ensure that member complaints and concerns about questionable care are consistently reviewed at its 29 California hospitals. The HMO has agreed to:
* Pay $3-million fine, which will be reduced to $2 million if it corrects its problems quickly.
* Create a reporting system so HMO leaders can monitor how care is delivered and quality-of-care complaints addressed.
* Draft uniform set of standards for peer review — the process by which doctors’ committees examine patient cases to determine if the care was appropriate.
* Form a member concerns committee in Southern California to examine member grievances and complaints, similar to what is underway in Northern California.
* Audit physician peer review programs to ensure they are accurately evaluating — and correcting — potential quality issues.
* Reconfigure computer systems to better track quality reviews.
Kaiser Thrive Exposed would like to personally thank Dr. Geoff Galbraith - Kaiser Permanente Care Management Institute board member; and Vice President, Hawaii Permanente Medical Group, Quality Improvement Management - for inspiring us to create this website. Did we make it into the top 5?
Well, it’s about time somebody pays attention.
I’d love to be one of the first guinea pigs to ask them to make a specific change.
1. First, I would like them to give me an explanation of why this happened to me:
http://www.freewebs.com/mykaisernightmare/
2. Then, I will go back to that ER in Roseville and do everything the same, exact way I did before, and see if they still try to make me wait in the waiting room nude under my gown and use the public restroom in my gown, when the ER isn’t even busy at all!
3. I will report back here the results.
You should also report it to the DMHC, because as I stated above Kaiser makes a point of pretending it is unaware of what is being posted here, and elsewhere on the web.
Why didn’t the Department of Managed Health Care investigate any complaints from the 500,000+ patients in Kaiser Permanente’s San Diego Medical Center?
Visit http://www.hmohardball.com to learn why Cindy Ehnes’ protects Kaiser, not patients.
There is a lot the DMHC didn’t address, like the mutilation of medical records in dispute cases. They also left the individuals high and dry who have been cheated in the complaint process, like they always do.
I want to believe that this fine and the resultant media attention and (yet another) ding to Kaiser’s reputation will mean real changes, but the cynic in me feels that they are just being given another opportunity to learn how to better cover their tracks.
Although hospital operations are most critical since they concern life-and-death decisions, DMHC should also consider every day clinical operations such as DME and Physical Therapy. I have never received the DME items that were prescribed by my physician. In every case substitutions are made with inferior and sometimes unusable items. The physical and occupational therapists who are allowed by departmental administrators to treat lymphedema are not adequately trained in the specialty techniques required. They practice this hands-on medical protocol after a 22.5-hour weekend course in spite of the national certification requirement of 135 hours. Repeated complaints accompanied with clinical evidence are met with refusals to train the therapists without addressing the evidence. Complaints to DMHC are dismissed with statements that Medicare statutes pre-empt state regulations. (This is not true when it relates to licensing issues and medical staff qualifications.)
[...] demonstrated lapses in ethics and judgment by Kaiser Permanente executives doesn’t end there. Kaiser Thrive has the story of a $3 million fine being levied against Kaiser Permanente, one of the largest in the history of the Department of Managed Health Care, for Kaiser [...]
It’s too bad that the DMHC didn’t get off their collective duff until after a whistle blower (Dr. David Merlin, Kaiser Kidney Center SF)went public and they got bad press starting with the L.A. times.
Guess Ms. Eynes had to finally make the appearance of doing her job. Trouble is, its way too little - what’s $2-$3 million to a company that makes had nationwide revenue of $34.4 billion last year and net income of $1.3 billion. And way too late - where was the DMHC from 2004 to 2006, when many complaints were filed against the Kaiser Transplant Center alone.
Kaiser members keep complaining, getting harmed, and dieing. Ms. Eynes has “closed the chapter”…
The question I have, whould she have even openned the book if it wasn’t thrust in her face by the whistleblower going public?
When I worked at KP, I monitored the “peer review” process. In one case, a patient death that resulted from obvious negligence was noted as “an improvement opportunity” … because the physicians reviewing the case felt strongly that they would not want to receive a low “score” for *their* care and so would not give one to the doctor in question. It was ridiculous.
To Anonymous, I was given “rehab” at the Kaiser Facility in West Los Angeles after a head on car collision.
They saw me once every week (until I complained that this was below the standard of care for my injuries)…it was then increased to two.
Kaiser sent me a bill for my “treatment”….In the bill was a charge from a Therapist for ‘home rehab trainig techniques’ (wording paraphrased at this time since i do not have the bill directly in front of me currently). The reality is, is that this charge for ‘home rehab. technique training’ was actually for the therapist handing me a brochure stating I should perform these exercises at home (NEVER did they ever discuss these techiniques with me personally or go over any of them to show how they should be properly performed)….More lies and fraud……
When will the DHS step up and do something?……
Well, not until it is done to one of their high ranking officials….or….when the media attention is hot enough on their trail…..
*THEY* are just as culpable (as joint commission, the ama and the state medical boards) in allowing Kaiser (as well as their Physicians) to continue to practice substandard care!
Q.I. done on a case by the same Physician who provided the treatment, other Physicians at Kaiser not giving bad scoring to a Physician who committed medical negligence….surprising?
At Kaiser it is not……Seriously, just look at the Kaiser Physicians in Oregon who wrote recommendation letters for “Doctor Death” (jayant patel). His license was taken by the Oregon Board and New York Board to protect patients from him. Not being able to practice in the U.S. anymore, he went to Australia (along with his copies of recommendation letters by Kaiser Doctors).
He worked in Australia until he started maiming and murdering patients there too (seems the Australian review boards act much more quickly than the ones in the good old U.S. of A. to protect their citizens, and apparently their Physicians have ethics versus the strong desire to cover up medical negligence)…..
Surprising that Kaiser and their Physicians cover up for each other?……Please, those who hang out with dogs all carry fleas themselves.
[...] you need a kidney transplant, or have pneumonia, or cancer, or a past due pregnancy, or a consumer complaint, or need a prescription, or, or, [...]
I’m currently struggling with Kaiser about the billing. It’s been more than a year. DHMO didn’t help me at all. I’m thinking about lawsuit against them. Do you know any good lawyer to do that?
Wendy, there are some attorneys that specialize in Kaiser arbitrations. Try a Google search.
[...] been harmed when a mistake has been made. But actions speak louder than words, and the reality of how Kaiser treats everyone who complains certainly doesn’t include the kind of sympathy that involves willingly making restitution to [...]
Kaiser is facing a class action lawsuit regarding their “treatment” or lack thereof for Autism. The lawsuit was filed last week by a friend of mine who has a 2 year-old baby boy with autism and Kaiser has refused to treat him.
Kaiser has a pattern of dumping their own members diagnosed with Autism into the hands of government for treatment. Effectively shifting their financial obligation to treat this children onto taxpayers. Shameful!
I can tell you that DMHC is conducting a large scale investigation about the practice after someone I know personally filed more than a dozen complaints with agency. According to the agency, the investigation is huge! Let’s see how are they going to weasel out of that one.
Kaiser is required to treat Autism by statutory and contractual obligation, but on the other hand they claim not to cover any of the treatments for Autism in violation of the law. Their contract specifically provides for the treatment of Autism. However, the “treatment” that Kaiser offered the baby was two OT sessions a month, one visit with the Psychiatrist (no follow ups), and an assessment every three months. I wonder-what are they going to assess if there are no treatments offered?
[...] one reader explained in this comment on another post: Kaiser is required to treat Autism by statutory and contractual obligation, but on [...]
was there anyone else that had to miss work due to the TB Scare at the SF Kaiser? The nurse in the maternity ward that took care of my newborn and myself had TB and we were exposed. Luckily, our tests came back negative but Kaiser will not reimburse me for my loss of wages due to an error on their part. What do I do from here? I already was denied twice by the Review Board and now am getting the run around from their employees.
Kasier emergency doctor did not listen to me on September 26. I was assaulted by two men. One was obviously intoxicated. The Kaiser doctor accused me of drinking and askede me what the date was.
I do not drink and I knew what the date was.
He then tricked me into seeing a man who would help with “transportation issues” The man ended up sending me to a mental hospital against my will. For at least eight hours no one knew where I was. I was denied access to the phone or phone numbers in the emergency room. I fell at the hospital and there does not appear to be an incident report. I have been extremely depress and want to dump Kaiser. Filed a complaint and found false information on my medical records. Scared to death of Kaiser now. Please advide. Filing complaint with state because of frustration with complaint process. Also personal property was stolen and I fear identity theft. No one helps.
please advise.
I edited your comment to remove your personal information and location for privacy purposes. Kaiser also monitors this site.
This kind of thing is standard operating procedure at Kaiser and you can expect them to use the trumped up mental health charges against you during the complaint process. There is literally no limit to how low they will go.
I’m not saying don’t complain, but consider it carefully because you’re in for the dirtiest fight of your life. You can file complaints with the Department of Managed Health Care and the Medical Board of California, and hopefully someone will help you. You can also write to your state legislators and the governor. It’s hard to win because Kaiser controls all of the evidence and is not above fabricating its case.
The best thing you can do for yourself is to change health plans as soon as possible.
my dad was kill by dr.payant and it was coveryup this happen in 1991 and we can not find anyone to help us get any closure he cut our dad’s liver while working on him
I WOULD LIKE TO FILE A COMPLAINT ON KAISER EMERGENCY DEPARTMENT THIS PAST WEEK IVE BEEN TO THE HOSPITAL 3 TIMES 2 HOSPITAL TESTED ME POSITIVE FOR SWINE FLU BUT WHEN I GO TO KAISER SENDS ME HOME SAYS NOTHING IS WRONG YOUR HEALTHY BUT IVE LOST MY VOICE, I HAD FEVER AT 104, IVE BEN VOMMITING , DIREAH CAN NOT KEEP FOOD OR LIQUID DOWN, SEVERE HEADACHE, BODY ACHE, SORE THROAT COFFING, 2 HOSPITAL TESTED ME POSITIVE BUT KAISER SAIS NO YOUR FAKING IT, SECCOND OF ALL SOMOENE BROUGHT ME INTO MEREGENCY WITHOUT MY CONSENT OR PERMISSION STARTED GIVING OUT ALL MY INFORMATION TO THIS INDIVIDUAL I THOUGHT THEY HAD A STRICT RULE ABOUT CONFIDELAITY BUT THEY DONT. MY OTHER CONCERN IS I WENT TO THE EMERGENCY WHILE BACK WAS TOLD I HAVE COLD IT TOOK ME 3 EMERGENCY TRIP IN ONE DAY FOR THEM TO DETERMEIN I HAD PHEUMONIA NOT A COLD. THE SECCOND TIME OH YOUR ASTHMA JUST ACTING UP AGAIN SEVERAL TRIP OH YOU HAVE BRONCHITAS. NOW THIS TIME 2 HOSPITAL TEST M EPOSITIVE BUT KAISER SO LAZY HARD HEADED THEY DONT WANT TO DO ANYTHING WHAT DO I DO.