In many ways, CalPERS does an excellent job for California State retirees.
However, that description does not extend to the monitoring of Kaiser Permanente, and the many systems Kaiser has in place to frustrate the reporting of retiree abuse, and abandonment.
Obviously, CalPERS wants to hear good stories about Kaiser. After all, they are providing service to tens of thousands of State and local retirees.
How horrible would it be for CalPERS to discover that the lack of complaints is due to the clever methods Kaiser Permanente has established for sheltering CalPERS from what they "don't need to know."
So what are these mechanisms that prevent nary a complaint from ever reaching CalPERS?
They are many, including:
-A Member Services "complaint" system that can often take several weeks, a system that serves to defuse patient anger, but never results in a decision favorable to a retiree. [continued below]....
..... So-called "resolutions" are simply word for word transcriptions of rationales supplied by offending physicians.
There is never a meeting with a supervisor. Never a contact from the physician. The "case worker" analyzing the complaint has no medical training because she does not need any, since the finding is a foregone conclusion.
-An appeals process for Member Services "resolutions" to a nameless committee in either the San Francisco Bay Area or Los Angeles. These committees meet in secret, and the names of the attendees are never divulged to patients or their medical representatives. Again, a case worker without medical training is in charge of the paperwork, and, again, the result is a foregone conclusion. (CalPERS could well paper their offices with the stacks of denials resulting from these secret meetings.)
-RISK MANAGEMENT units: These groups are composed primarily of attorneys who are organized for one purpose only. That is, to reduce the risk to Kaiser Permanente from any patient who has been abused or abandoned.
In Northern California, one may find this unit at Kaiser Plaza in Oakland. At the local level, a physician is normally assigned to a so-called MedLegal to refer patient "complaints" to RISK MANAGEMENT for burial.
-Ombudsmen: On each Kaiser campus there exists an Ombudsman. These individuals are typically either non-medical personnel or RN's who are very charming, but will tell patients immediately that they have no power to correct problems relative to medical care. Ombudsmen on Kaiser campuses are not respected by medical personnel. At best, an Ombudsman might serve as a traffic cop. However, if a patient has been abandoned, he or she will stay abandoned. If a patient has been referred to RISK MANAGEMENT, he or she will stay referred to RISK MANAGEMENT.
-THE CONTRACT: Kaiser Permanent employees labor under a draconian contract which prevents any physician or nurse who witnesses abuse or abandonment from notifying anyone of the problem. HIPAA rules and regulations having to do with medical information confidentiality are used by Kaiser in the same way as "national security" is sometimes used by the government, that is, to frustrate the ability of witnesses to have their information considered by proper authorities.
In such an environment, it is unlikely that CalPERS will ever hear from all but the most persistent patients. (Illness, discomfort and other factors also play into the inability of retirees to be heard by CalPERS.)
Requesting a more aggressive CalPERS relative to Kaiser Permanente is the first purpose of this complaint.
The additional purpose of this complaint is to notify CalPERS that its own systems for receiving and taking action relative to medical malfeasance are deficient. A much more immediate and less impersonal system needs to be designed. A five to ten day turnaround time for all complaints is simply inadequate. Routine surprise audits also need to be conducted by CalPERS of all Kaiser Permanente facilities.
Further, the rating systems associated with CalPERS relative to Kaiser Permanente are out of date, and serve only to mislead both active and retired personnel into choosing a service that, as it is currently structured, is dollars vs patient oriented.
CalPERS actions taken as a result of this NOTICE will be appreciated by all patient advocates, as well as Kaiser employees who are in positions to witness, but not to openly challenge, a system established for other than patient well being.
Kaiser Permanente is not a hopeless organization. However, CalPERS, which siphons millions of dollars into Kaiser coffers every year, must be more diligent in making certain that the intentions of CalPERS and the delivery systems hired to fulfill those intentions are congruous.