| Kaiser Permanente Risk Management - Oakland |
| Patient Abandonment, Violation of Elder Abuse Laws of the United States |
| 11th of Jul, 2011 by sarabert |
There is a time and place for doctoral degrees, PhD's of law and philosophy, and a time for common sense alone
Let me share with you a situation where common sense was been thrown to the wind with tragic results.
When a simple problem that cries out for mercy and charity presents itself, and instead of running to scripture, we run to our law books, those books which have in America attempted to replace the ten commandments (with over 20,000 new laws per year, and ten times as many regulations) we are expressing the very hardness, the coldness that is reflected in this story..
The following is a tale of a former football player with a single, simple problem, a problem that begged for a common sense solution.
Instead what we as a society delivered was abandonment, and even cruelty, as Kaiser Permanente's famed Risk Management, Oakland attempted decide not how to reduce risk for an elderly patient, but rather to reduce risk to the millions of dollars that comes into that behemoth every month in the form of premiums, premiums that are then used to discover ways and methods to deprive Kaiser members of the most inexpensive services.
THE STORY.
Approximately three months ago, an elderly man (69 yr old former football player) who had been treated for a deteriorating skeletal condition for ten years, was assigned a temporary replacement
Permanente physician, Dr. Susan Scholey, while his permanent physician, Dr. Gary Rinzler, took a few weeks to rest.
Dr. Scholey decided that, even though X-rays and ten years of ongoing evidence of success with this patient were present, they were insufficient.
Dr. Scholey therefore, placed an assessment requirement before the patient which was not part of the agreement the patient had with his permanent doctor, an assessment that Dr. Scholey could not defend in terms of either science or medical necessity.
Since Dr. Scholey was theoretically in charge in Dr. Rinzler's absence, and since her recommendations to interrupt the ongoing treatment were not overturned by her immediate supervisors, Dr. Scholey terminated care of this elderly patient, including all medications.
Upon the return of Dr. Rinzler to the scene, he attempted to simply take back the patient and resume care. However, Drs Scholey, Midgley, Isaacs and Pearl evidently had decided that the independent assessment was necessary.
That being the case, the patient found the time resources to comply, since the assessment was now being recommended by Dr. Rinzler, if only so that he could resume care. The patient therefore underwent the assessment with Permanente physician, Dr. Kegang Hu.
As the patient knew he would, Dr. Hu agreed wholeheartedly with Dr. Rinzler that the treatments being provided to the patient for ten years were appropriate.
However, when the patient then asked to be returned to Dr. Rinzler's care as agreed, Dr. Scholey advised everyone that the matter had been referred to Permanente RISK MANAGEMENT, in Oakland, CA.
So, now we have a patient paying $5,000 in premiums, still only wanting to resume his decade long medical regimen, having complied with an unnecessary assessment, still being denied the only medical services Kaiser Permanente was providing to him for this premiums.
Actions taken by the patient's Medical Representative thus far:
Medical Licenses of Drs. Scholey, Midgley, Isaacs and Pearl have been reported to the Medical Board of California. The Charge: Violation of the Elder Abuse Laws and Patient Abandonment.
Kaiser Permanent has been reported to the California Department of Managed Health Care for the same violations of law.
The patient himself has repeated constantly that the only thing he requires is a return to the regimen that several physicians prior to Dr. Scholey felt was perfectly appropriate.
It is amazing all the staff time expended and agony generated when the resolution of this issue has always been so simple: Return the patient to the regimen that was in place prior to Dr. Susan Scholey deciding for non-medical, non-scientific reasons that an interruption was appropriate.
The patient has unilaterally indicated to anyone who will listen that he has backed away from a consideration of litigation, and simply and humbly continues to request that the simple treatment for his deteriorating skeletal condition be resumed under the direction of Dr. Gary Rinzler.
Not that it is particularly relevant, but to follow up on the football comment above. The condition was the result of a violent illegal back block during a football game that caused the compromised spinal condition initially. At that time, those kinds of hits were legal.
AGAIN THE SOLUTION IS SIMPLE: A RETURN TO WHAT WAS THREE MONTHS AGO BEFORE DR. SUSAN SCHOLEY decided an elderly man didn't deserve to have his suffering ameliorated.
That the Permanente Medical Group has chosen to ignore this patient's pain and legitimate need in the face of several evaluations which support the patient's long term regimen is testimony that, when an organization loses contact with the human aspects of medicine, all sorts of abuses are possible.
As of this writing, this elderly man, 69 years of age, is without medical services of any kind. He is currently paying Kaiser Permanente $5,000 in premiums for absolutely nothing.
Isn't there a word for that someone in America? |
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We can take a great lesson from this story. We really need to as a society back off from our coldness, and simply resolve things easily.
This one was a no brainer to solve well, but we had to begin splitting infinitives.
Folks, JUST DO THE RIGHT THING. FORGET FOR A MOMENT THAT SOMEONE GAVE YOU A LAW DEGREE. |
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It is amazing to me that these people are still making a living ruining the lives of patients. I was looking at the ratings for Kaiser Permanente the other day by a well known public advocate. And, they rate Kaiser very high.
The REASON is the effectiveness of thirty attorneys at the Oakland and Los Angeles Risk Management centers.
These people are pros at shutting patients up. They in effect turn patients premiums back on them.
When an entity gets big enough, they can charge their clients for actually abusing them.
Such was obviously the case here, and it was the case with my daughter as well.
When a local medical facility makes a mistake, and there is any risk of that information costing Kaiser Permanente, instead of looking to do the right thing, as with the case of the famous Susan Scholey who doesn't understand the word "right, " matters are turned over to risk management, and they will continue, albeit more cleverly than those at the local level, NOT to solve the problem; NOT to provide the patient with relief.
In this case, the solution would have cost Kaiser ZERO dollars. All the patient asked was to continue his modest services which amounted to about 20% in value of what he was paying in premiums.
But do you think these guys in Oakland with their fancy law degrees could recognize a just cause or a fair request.
In the face of three rights and ten wrongs, do you think these legal experts could find a charitable bone in their collective bodies...of course not.
They will continue to collect their paychecks which, of course, comes from patient premiums, and continue to deny services to those who pay their salaries. Why? Well you see they are lawyers, and lawyers don't look for solutions in America. They look for maximum conflict, and they look to remain standing when they have destroyed everyone and everything around them.
In this case, it should be easy. Here we have a 70 year old battered professional football player who really can't fight for himself any more.
All this fellow asked was for a way to take care of the pain resulting from becoming old after providing us with great entertainment. But, you know, these people who are lawyers generally wouldn't face up to this footballer on his best day. They could only beat him with their papers and depositions.
What a lovely Country we have become. The Japanese with one lawyer for every 10, 000 citizens and us with one lawyer for every 265 persons. The Japanese believe we are the meanest least honorable country in the world...and they would be right. Of course, we have the most bombs.
And, who do we have in Congress and the White House making us less free every month. Of course 700 lawyers. |
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I had contributed an article to the RipOff Report about this same provider, citing the same patient experience, since Dr. Bernard is the favorite of everyone who knows him.
Here is a former semi-pro football player, almost 70 years of age, bearing up in a manly way under his crushed spine, and the rich medical community in the form of a spoiled girl doctor who has never known anything like the hardship Dr. Bernard has suffered, acting out like a child. Her organization, just as spoiled, going along with her for Affirmative Action reasons compounds the tragedy.
The whole story is horrible. This is the new type of hell we have brought upon ourselves in the United States. We are so sophisticated drowning in lawyers, that we have turned our Country into a party for paper barbarians.
I wrote the following story for the RipOff Report. Hopefully, it will help Kaiser Permanente clean up its act.
But, more importantly it's important for PERS to wake up and realize they have a real problem provider on their hands.
THE STORY:
It's our of my hands!"
"Sorry, no medical services today."
"I know you are suffering badly, but our hands are tied!"
"We apologize, but, we can't give you a name to call!"
"The patient has no services, and we can't do anything about it!"
"We know the patient is suffering, but he has been referred to RISK MANAGEMENT, and it's out of our hands. CHECK WITH THEM."
You might think that such statements are coming from a clinic in the middle of the African Savanna, a place where a few doctors every year volunteer their efforts to bring some semblance of health care to people who, for the remainder of the year, suffer the worst survival rates on the planet.
But, you would be wrong.
What you are hearing are physicians working on local Northern California Kaiser Permanente medical campuses describing why patients fully insured under the Kaiser plans are being abandoned to their pain and suffering in favor of having their cases determined by a cadre of anonymous lawyers in Oakland, California, known at the local level, with a wink, as Kaiser's Legal Beagles.
The beauty of so-called RISK MANAGEMENT, Kaiser style, is that the patient and his medical representatives are never given a name(s) with whom to speak. Risk Management, Oakland is not there to lower patient suffering or risk, as the name might mislead the public to believe.
Risk Management is there for ONE reason, and one reason alone, to find ways of lowering Kaiser Permanente's legal responsibility in the face of local area mistakes, misjudgments and simply bad medicine.
Patients continue to pay handsomely for health insurance while Risk Management deliberates in secret. And, the process has no announced time limit. A patient can suffer for years while the lawyers muddle through their paperwork. Sometimes the longer the better.
Bottom line here, once referred to Risk Management, all offices at the local level, offices the patient has been depending upon for critical services, are closed to him or her.
So can I give you an example of a patient thus treated. Of course! That's one of the reasons for this Report.
Enter Dr. Ronald Bernard, a former semi-professional football player, a player whose only crime was his lack of discretion on the football field, that is, a failure to move quickly enough to avoid a crunching tackle to the kidney area by a charging linebacker.
Dr. Bernard's (mathematics) didn't perhaps judge the angle of attack in a way favorable to his continued health and ended up with a crushed spine. (This was at a time when hits to the kidney area (from behind) were not as severely punished as they are today. In truth, Dr. Bernard never saw the linebacker coming.)
At any rate, that hit ended Dr. Bernard's playing career.
Enter Kaiser Permanente. For 30 years Kaiser attempted to diagnose exactly what was the problem of Dr. Bernard's crushed spine area. And for thirty years, they failed. The consequences of that failure were a severely compromised ability for Dr. Bernard to enjoy a pain free life.
However, ten years ago, a Kaiser physician diagnosed and then treated Dr. Bernard with a medication that hadn't been used before in Dr. Bernard's case.
Lo and behold, the new regimen worked, and for the first time in 30 years, Dr. Bernard was pain free. And, so long as the regimen was continued, the pain free status would continue.
Without the regimen, though, as one would expect, the severe pain would return, along with severe depression. (It is interesting to note that the very same "nerves" that are responsible for the registering of pain, are the nerves that serve to carry messages of depression.)
The regimen was carried forward for ten years with great success, until one physician, Dr. Susan Scholey, a replacement physician not trained to understand pain/depression relationships, decided to interrupt the successful regimen, simply, and evidently, because someone gave her the power to do so.
And, so, assessments were ordered threatening years of success.
Place yourself in Dr. Bernard's position. You had suffered for 30 years with a debilitating condition, and then, a decade ago, a treatment (an inexpensive treatment that uses about 20% of the premiums Dr. Bernard pays to Kaiser every year) is discovered. After ten years of success, an inexperienced physician now threatens the regimen, placing various assessment requirements in your path, said assessments introducing the idea that, once again, pain and suffering are on your horizon.
Well, if it were me, I would be upset that any question regarding the regimen is being raised in the first place. Of course, Dr. Bernard objected, and asked the new physician for reasons of medical necessity, scientific reasons for her placing his regimen in danger.
Since Dr. Scholey was unable to argue from science, she argued from bias, and the argument was rejected by Dr. Bernard's Medical Representative, the patient himself, and the physician who was taking sick leave (Dr. Bernard's ongoing physician, Dr. Gary Rinzler.)
Upon Dr. Rinzler's return, Dr. Bernard was told by Dr. Rinzler that, without the assessment, Kaiser planned to cancel the patient's regimen. Therefore, Dr. Bernard, trusting Dr. Rinzler, agreed to the assessment. A Dr. Kegang Hu conducted the assessment and came to the only medical conclusion possible, that is, an interruption of the regimen would have tragic consequences.
One would have thought that that would be the end of the story. A happy ending. However, think again.
At that point, RISK MANAGEMENT - Oakland had the case transferred to them.
So what happens to the patient?
Well, his medical regimen has been cancelled, no one at the Kaiser campus administration can or will speak with the patient, and Dr. Scholey, who has been promoted to the position of Chief, Department of Physical Medicine at the South Sacramento Kaiser facility, has been allowed to discharge Dr. Bernard from the "spine clinic" patient roster, a serious problem, since Dr. Bernard's physician, Dr. Rinzler, works at that clinic.
Again, one would think, "Well, this isn't the African Savanna. Surely the Physician in Chief, Dr. Richard Isaacs, would intervene. Surely Dr. Bernard's regimen would continue while Risk Management is conducting a review. THINK AGAIN. Dr. Isaacs office simply says, when they say anything. "Sorry, it's out of our hands. Speak to Risk Management."
Approaching MedLegal at the South Sacramento campus. That is Dr. Robert Midgley and Ellen Wilson, the word there is, "Sorry, it is out of our hands."
When the Medical Representative asks Ellen Wilson for a name or names to contact at Risk Management, no names are given, no contacts. No response at all.
Needless to say, Kaiser continues to charge PERS $5, 000 per year for zero services as of this writing.
Dr. Bernard's Kaiser card is not honored at the only clinic where he needs services, and RISK MANAGEMENT, a group of attorneys, attempts to figure out how to rid itself of a problem, how to continue to collect premiums in order to pay their salaries, and how to maintain its five star rating with the State of California.
Somehow RISK MANAGEMENT has always managed all three.
The Medical Board of California and the California Department of Managed Health Care have been contacted, but their processes are deathly slow, and they are wary of finding for patients without hard core proof of several deaths.
In the meantime, what happens to the patient?
Dr. Bernard has been abandoned. Plenty of pain in store, and the Elder Abuse Laws, passed by Congress to prevent this very kind of suffering, remain ineffectual.
Welcome to the African Savanna. |
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The former semi-pro football player spoken of here, Dr. Ronald Bernard (mathematics), is also a retired State employee who was very special to the people of California during his career.
For example, when the earthquakes hit San Francisco and Los Angeles in the 1980's, he was the fellow who, working 96 hour straight shifts, designed the computer systems (under tremendous pressure) that tracked the recovery of family property owners in both places. Without him, both FEMA's and the Department of Social Services' efforts to come to the aid of tens of thousands of rubble haunted California families would have ground to a halt.
I mention this because, sometimes, Californians forget that there are many retired State employees who have more than earned their salaries during their careers, in effect, true heroes. (Perhaps Dr. Bernard developed his ability to work well under pressure playing football. Who knows...)
Which brings us to PERS and their blind spot relative to Kaiser Permanente. Somehow PERS fails to see how Kaiser fails, often in spectacular ways, to serve many State retirees when their stars begin to fade in old age.
A quick survey of the PERS rating systems have Kaiser Permanente ranked as a five star insurer and medical provider.
If this weren't such a bad joke, it would actually be laughable.
Kaiser Permanente's recent denial of Dr. Bernard's access to the spinal clinic, over the vociferous objections of his physician, Dr. Gary Rinzler, is just one of hundreds of cases of this kind every year that are hushed up using every possible technique, from a Member Services complaint process which hasn't issued a patient favorable decision in over ten years, to a Risk Management system that provides no personal interface opportunities, meets in secret, and, using a combination of shallow paper arbitration tactics and empty promises, delays Medical Representatives until, after eighteen months, and more denials, the patient is left with what he or she started with, i.e. nothing. Top that off with an Ombudsman who will tell the patient in the first five minutes that she has no power at all, and you have, in effect, an ingenius system which is set up to "contain" patient unhappiness rather than address problems.
Has anyone out there attempted to fight healthy lawyers while suffering extreme pain? Fighting lawyers is not a pleasant prospect at any time. However, just think about fighting 30 healthy lawyers while suffering as Dr. Bernard does, from a crushed spine, all the while approaching the age of 70.
How does this kind of thing happen anyway?
Well, promote a physician over more qualified individuals to a position of Chief of the Department of Physical Medicine, a person willing to use her power to settle scores with individuals who were former colleagues.
Combine such an appointment with an all male chain of command too weak to oppose the appointee when she makes terrible mistakes, and a perfect storm of elder abuse and patient abandonment ensues.
Doctors are not built for conflict, and when a physician, especially a female physician with female strengths, happens to come upon the scene, she can inflict tremendous hurt on others. And, Dr. Susan Scholey, the new Chief of the Department of Physical Medicine, is doing just that.
The specialist who was treating Dr. Bernard, Dr. Gary Rinzler, an eminently qualified doctor, and specialist regarding the very kind of conditions from which Dr. Bernard suffers, has been placed out of reach to Dr. Bernard by Dr. Scholey. (Dr. Rinzler is a target of Dr. Scholey, that is, one of those colleagues mentioned above who had the temerity to disagree with Susan when her power was not absolute.)
Pass by Dr. Rinzler's office any day he is on duty, and Dr. Scholey has arranged to have signs announcing that Dr. Rinzler is WAAAY behind schedule posted for all the patients to see. Dr. Rinzler is behind schedule because of the booking schedule Dr. Scholey has demanded. Try to find any other office on that floor, which is extensive, embarrassing physicians in that manner, and you will fail. From this advocate's position, that is out and out harassment. Isn't anyone watching?
The bottom line though for this informational addition is: While Dr. Scholey makes working conditions impossible for Dr. Rinzler, Dr. Bernard is being barred from the spinal clinic. He has no spinal services. (Incidentally, Dr. Rinzler is not the source of our information. There are persons working in and around that office who currently do not wish to be identified, but who are upset with what they are seeing happen to patients and physicians alike working in that atmosphere. To identify themselves would endanger their employment status, one other way that Kaiser makes certain PERS is never made aware of problems.)
Back to the point of this addition: So here we have PERS publicly rating Kaiser as a five star insurer and health provider, and, just ten miles away, one of their star retirees is being denied services that are critical to the maintenance of any semblance of comfort in his retirement.
HOW CAN PERS FAIL SO BADLY?
Well, PERS loves good stories, not bad, about the programs they offer retirees, especially star retirees.
Kaiser Risk Management in Oakland and Los Angeles try their darnedest to shut stories like this one down, and, before the RipOff Report and Scam Informer were available, that was easy to do.
After all, with all the money Kaiser has, you can imagine the pressure they can bring to bear.
We patient advocates are attempting to get the book opened on Kaiser absurdities like the out sized power of a Dr. Susan Scholey to run a mean private kingdom within the South Sacramento Kaiser campus.
Until Dr. Bernard is returned to Dr. Rinzler, a physician uniquely qualified to monitor Dr. Bernard's set of medical conditions, both Kaiser and PERS ARE FAILING BADLY IN THEIR RESPONSIBILITIES. |
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