"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. [continued below]....
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.