• Report: #751572

Complaint Review: Kaiser Permanente Risk Management - Oakland

  • Submitted: Mon, July 11, 2011
  • Updated: Wed, July 13, 2011

  • Reported By: Dr. Robert moore — Sacramento California U.S.A.
Kaiser Permanente Risk Management - Oakland
1 Kaiser Plaza Oakland, California United States of America

Kaiser Permanente Risk Management - Oakland Patient Abandonment, Violation of Federal and State Elder Abuse Laws, Fraud Oakland, California

*Consumer Comment: Why the Silence from Kaiser Permanente

*Consumer Comment: PERS Needs to Investigate Kaiser Retiree Abuses

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"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.

This report was posted on Ripoff Report on 07/11/2011 03:56 PM and is a permanent record located here: http://www.ripoffreport.com/r/Kaiser-Permanente-Risk-Management-Oakland/Oakland-California-94612/Kaiser-Permanente-Risk-Management-Oakland-Patient-Abandonment-Violation-of-Federal-and-751572. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.

Ripoff Report has an exclusive license to this report. It may not be copied without the written permission of Ripoff Report.

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#1 Consumer Comment

Why the Silence from Kaiser Permanente

AUTHOR: Gaston56 - (United States of America)

Everyone here has to keep in mind why, when a patient's services are interrupted, especially when everything was going so well for the patient, the reaction up and down the chain of command at Kaiser Permanente is not to attempt to correct the situation.

First, with someone like Dr. Susan Scholey, should her decisions (bad as they are in this case) were to be challenged, she can cause lots of problems for Kaiser Permanente.

Second, anyone who takes on the responsibility of attempting to serve a patient in jeopardy, the entire weight of proof falls on his or her shoulders. With this one, even though it is cut and dried,  and the only reasonable thing to do here with this non-litigious patient is to grant his request, the entire system Kaiser has to deal with these kinds of situations is adversarial and, therefore, inappropriate.  In other words, Kaiser expects patients in this kind of situation will be belligerent, which Dr. Bernard is NOT.

That is, Kaiser just can't or won't believe that they are dealing with a sweetheart of a patient like Dr. Bernard, who doesn't want his pound of flesh, but simply wants to be returned to his doctor in one piece.

When an organization doesn't get too many people who are willing to simply let a problem die, by sheer habit  that organization doesn't know how to deal with that peaceful personality. It just seems too simple to say, "Sure, we'll get you back into the Spinal Clinic, since you do have a deteriorating spinal condition as verified by X-ray."

As has been said before, dozens of people could have corrected this problem, and saved everyone, especially the patient, lots of grief. But, no one has done that.

Dr. Evan Bloom's reaction is probably the most honest. He just didn't want any of this on his doorstep. Who can blame him? However, since every single person with the power to advocate for this patient has passed, except Dr. Rinzler himself, and Dr. Kegang Hu, it just becomes too heavy a burden for anyone to step in and be a champion.

Three years ago when this patient went through something similar, there was one physician who did step in and simply solve the problem. That was Dr. Robert Midgley.

This time though, Dr. Midgley felt the price was too high to do what would in effect be the right thing, so he passed on helping the patient.

Therefore, Risk Management has taken over responsibility.

I'm sure there was a sigh of relief throughout the South Sacramento facility when all the administrators could now say honestly that the situation was out of their hands.

Since they passed it along in silence, of course, eventually the case HAD to be out of their hands. That's the way life works.

Let's all hope against hope that Dr. Bernard will eventually be returned to Dr. Rinzler. That is all he has ever asked. I've met the man, and he is the nicest fellow you'd ever want to have in your home.

If Kaiser can find fault with Dr. Bernard, most of the rest of us are really in trouble.
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#2 Consumer Comment

PERS Needs to Investigate Kaiser Retiree Abuses

AUTHOR: bethcharette - (United States of America)

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.

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 this 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, 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?

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.)

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 man 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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