May 15, 2006 News







Kaiser Permanente, the organization that advertises they want you to thrive is actually making their patients die.  Their HMO thinking has stopped paying for transplants at outside hospitals and only will be done at Kaiser San Francisco.  This is reasonable if the physicians would have done the transplants and not worried about their stats.  They only did 56 transplants in 2005 but more than twice that number died awaiting their turn.  This is the opposite of the established centers.  The Kaiser program has had problems in deciding who should be transplanted and 10 of the 22 permanent employees have either quit or been fired.  Kaiser, as usual, refused to acknowledge the problems until the Los Angeles Times has started their investigation.  The move to change centers for the transplants made many of the potential recipients go down on a transplant list potentially causing their demise.  One potential donee had the wait for a kidney change from three to six years.  There are over a hundred patients of Kaiser on the donee waiting list at UCSF.  UCSF has attempted many times to contact Kaiser about these patients but have been stonewalled, as are the patients.  Those lucky few who did get the transplants at Kaiser are doing well one year post surgery.  However, Kaiser only accepted 17% of the offered kidneys.  This is not dissimilar to the fiasco in Southern California where the hospital that did the same thing is under federal investigation.  The major difference is the patients in Southern California were private and could go to another center without loss of the time spent waiting.  Kaiser patients are captives.  The transplant program has lost two administrators, several surgeons and the head of the entire program has now been relieved of her administrative duties.  She is the only transplant surgeon left in the program which does not say much for the program or the health of the Kaiser members who are stuck.  Kaiser deserves to be investigated and have their transplant abilities pulled.  The old saying is still true, You get what you pay for.

The next day, another article on the "Thrive" organization by the LA Times detailed the refusal of Kaiser to transplant perfectly matched kidneys in 25 patients last year.  The problem was the patients were not in either program due to Kaiser's foul up.  UCSF asked Kaiser if they could use the kidneys to transplant into the Kaiser patients since Kaiser was not ready.  The answer came back via the pocketbook, no.  Kaiser denies this until the whistle was blown on them by one of their own surgeons who is no longer there.  This is typical of this organization.  They will stonewall as long as they believe they will not get caught.  They will not research prior to the denial.  The California Transplant Donor Network should be investigating the program and possibly shutting it down.  

In the third day of the Kaiser expose, the LA Times noted that Kaiser did not notify any regulators about safety transfers of 1500 on the wait lists.  This is usual for the haughty program that believes laws do not apply to them. The United Network for Organ Sharing was not notified until after the program had opened.  Kaiser's paperwork in the massive transfer was full of inaccuracies and mistakes.  Kaiser also "forgot" to tell patients that their paperwork was not in process, so the patients had no inkling that they were on no list. United has to accept some of the blame.  They did not put a stop to Kaiser nor do any investigation of potential or actual patient harm. 

The San Francisco Chronicle had a story regarding the California Department of Managed Health starting an investigation of Kaiser's transplant program.  The Kaiser spokesperson is attempting a stonewall with statements such as people die while waiting transplants and Kaiser had less die than other programs.  There was no data to back up the statements.  The criticality of the patients were not mentioned.  Kaiser is now hiring an outside firm to investigate the program.  Remember who is paying the outside firm. 

The Government has raided Kaiser to inspect their transplant program.  With no warning the government started interview, chart reviews and internal document review.

Kaiser has now bowed to pressure and agreed to continue to pay their negotiated price of $60,000 per transplant to UC Davis and UC San Francisco.  It takes alot of pressure to make this happen and kudos go out to the Department of Managed Health Care and the LA Times for applying that pressure.  Those people that want to return to the better programs may and should providing Kaiser does not again screw up the paperwork.  

In something almost unheard of, Kaiser has issued an apology for the transplant screw-up.  Mary Ann Theode did the back face apology by stating she did not know about the problems and she has had many letters from patients happy with the care.  She did not speak about the numerous letters criticizing the lack of care. She did not speak about the organization that may have hid all from her.  She did not mention the lack of follow-up on problems reported to the organization.  She either is a liar or does not have a good organization. Neither speaks well of her or Kaiser. 

Although a legal issue, it should be noted that the lawsuits maybe up to 1000 against Kaiser are starting.  The problem is the patients signed arbitration agreements and so can not sue.  The attorneys will attempt to get around the arbitration requirement by suing for a breach of the implied covenant of good faith and fair dealing with bad faith in their handling of the transplants. 

At the end Kaiser gave up and discontinued its transplant program.

Kaiser will reduce their rates in 2007 since they were unable to tell what the charges per patient were for.  Now that the organization has electronic data entry, diagnosis cqn be obtained more easily.  This may mean lower premiums for the healthy young and higher premiums for the employers with older workers.  This will give more information to employers who can determine if the price has value.

Tenet Hospital loves their physicians.  They are paying for the public to be able to access information about them from HealthGrades Physician Quality Reports.  The information is board certification, and disciplinary actions.  The physicians will be able to post their education, plans accepted and office hours.

Speaking of Tenet, the feds have apparently decided not to retry Alvarado Hospital on fraud but instead just drop them from the Medicare program.  

The Oregon Medical Society voted to make health care for all the people of the state "the" health care priority.  The symbolic vote would be non binding and since the OMA only has 1/2 of the state's physicians is fairly meaningless.  The healthcare for all would be based on the present Medicaid system of prioritization of medical illness and where the money could do the most good for the most people.  The rest would need to suffer.

A new report by the feds shows Medicare will go broke two years earlier than expected.  The new date is 2018.  This is not because of Part D.  It is because of accelerated hospital costs.  The Executive Branch has been warning about the crisis but the Congressional Democrats refuse to do anything. 

Medicare Part D has prior to its May 15 deadline enrolled over 30 million people, its goal for the time allotted.  There are about 42 million people eligible to go to Part D.  Many, like me, have done the math and have found that my own Medigap coverage is cheaper and has more flexibility. There are millions of others who have insurance via their employers that is as good or better than Part D.  Some are just procrastinators.   

California has an increasing number of uninsured.  They also have an increasing number of insured that are refusing their employer's health insurance.  The decline is because of the money they are required to pay for the insurance.  Some of those take their spouse's insurance.  This shifting of costs to the workers may be a direct result of the Democratic laws that state if a company doe not offer insurance they will need to pay an amount to a state's fund.  They do offer the insurance and the employee just doesn't take it.

A study has shown that white American males over the age of 55 are less healthy than their British counterparts.  The last sentence or the article states the probable reason.  The Americans are under much more stress than the Brits.  

What a difference time makes.  Several years ago the elderly were lined up for the flu shots.  Now, there are millions of flu shots unused.  Of course even in that strange year there were still four million more shots than were used.        Top


The ED physicians are stating it is becoming more difficult to obtain specialty coverage.  this is specially true in neurosurgery where there are not enough, plastic surgeons who do not use the hospital and orthopedics who are using the hospital less and less.  The ED physicians also state that there are patients being "boarded" in the ED due to lack of hospital beds.

This is no longer true in Stuart, Florida, Martin Hospital, a non profit, has hired their two neurosurgeons at $1 million each plus paying for their malpractice insurance to work at the hospital and care for the ED patients.  The two neurosurgeons have worked at the hospital for over 10 years.  The two physicians do over 350 cases a year at an gross income of over $$20 million (before insurance discounts).  The hospital is part of a combine that sends it neurosurgical patients to wherever a neurosurgeon is working that day.  There are only three days a month that the hospitals are uncovered for the specialty.

The American Academy of Pediatrics has stated that it wants its members to monitor the active lifestyles of the children.  There is no penalty if they don't but the idea is to get them to focus more on the preventative advantages of an active lifestyle.

In Ohio, there is a marked increase in physician investors in new facilities.  This includes cancer centers and urgent care centers as well as office buildings.  The physicians have seen the light and it is real estate.  The physicians also have seen the inefficiency of hospitals that they can't control and the excellent patient care and efficiency in surgical centers.  The problem to date has been the low pay for the same procedure in the center as opposed to the hospital by the insurer. 

A large Eastern Consulting firm that works exclusively for hospitals and not physicians has a new Tips for creating a disruptive behavior policy. They, working for the hospital, believe that the physicians should be nice placid people and not make any waves.  If they see areas that are wrong they should keep their mouths shut.  They believe and recommend that physicians who undermine the reputation of the institution should be punished.  This is not only vague but goes against free speech and whistleblowing. They would also label a physician disruptive if he/she refused to sit on committees.  I guess slavery did not go out with the end of the Civil War.  I don't understand why medical staffs let themselves be suckered into going to conferences put on by this organization.  

The same organization states that it may be a good idea to allow non physicians into the peer review discussions.  This would depend on only allowing the physicians to vote, the medical staff allowing the people on the committee if they keep the confidentiality and the number of non physicians should be limited.  The argument for this is to not allow the physicians to white wash a problem.  The flip side is to stifle discussion in the meeting.

An article in the New York Times discusses the increasing numbers of physicians that do not participate in managed care.  This, they state, may lead to higher costs and less access.  There are now 11.5% of physicians who do not participate, up from 9.2% the year prior.  The reason for the defections are simple, paperwork and money.  Since managed care organizations exclude some small practices and those not board certified, they can increase the number of physicians in their program if they wished.  They do not wish.  A smaller number may be bad for patients but it makes it easier to have control over the physicians that remain.  The larges amount of physicians without plans are those with experience (over 20 years in practice) and OBs who shun the paper.        

Physicians are getting more peeved at Pharma for asking them how many of a prescription medication that they prescribe.  They feel the data collection is an intrusion.  The same is not true of the hypocritical AMA.  They have a data mining business going that sells data to Pharma.  The organization wants physicians to make the decision whether or not to give the information and have have state legislation forbidding it, since that would affect the hypocrites.  The California Medical Association has started its own collection base as a pilot project.  I wonder how much that trade organization like its larger trade organization will collect from Pharma. The American College of Physicians is against the collection of the data by any organization. 

The OIG has reported on the use of physical therapy bill by physicians in the first six months of 2002.  They found 91% of the billing was erroneous due to inadequate documentation and referral aberrances.  They believe this service is vulnerable to abuse and that only licensed people should be doing the service.  The recommended that the CMS should consider revising the incident to rule to only allow licensed therapists to give physical therapy.  They also recommended the therapist should meet recognized standards of care.  

The physicians in Maryland can learn from their brethren in New York.  As those in Maryland are spineless (see new Legislation), those in New York are standing up to hospitals and insurers.  In the latest a 60 person medical group in Rock Hill have given up their privileges in Catskill Regional Medical Center.  They did this to protest poor patient care.  For some reason the hospital did not respond to questions. 

The Federation of State Medical Boards reported that serious disciplinary actions against physicians dropped in 2005.  The Federation and the State Boards both say that a slight drop in part of the normal variation.  However, the stalwart guardians with no knowledge, Public Citizen believed that were potential problems.  They took the same survey and massaged he numbers so they would come out to their likening.    Top  


See above for Alvarado Hospital and the CMS removal.

In Oregon, those who utilize digital radiographs were in for a rude awakening.  a computer crash at St. Anthony's Hospital in Pendleton, Oregon, lost over 5000 x-rays on about 100 patients.  The radiographs can not be retrieved.  There is no mention if there were backups and what happened to them.

At Scripps Hospital in La Jolla, California has Aspergilla in its pipes again.  This happened five years ago and due to two managers not following directives they have the problem back.  The managers were fired.  

St. Michael Hospital of Milwaukee, Wisconsin, is shutting its ED and inpatient areas.  The psych patients will be transferred to another of the parent's hospitals and they will keep open outpatient surgery, pain center, and imaging areas.  They are losing money on Medicare and Medicaid patients.  Imagine that.  It is or was a 121 bed hospital with declining volumes.

The recent GAO report shows that specialty hospitals have no effect on community hospitals, positively or negatively. The survey showed that community hospitals did not change their programs or efficiency to combat the specialty hospitals or imaging centers. (See Recent Legislation)   

At Muskogee Regional Hospital the CEO has banned a reporter for a piece she wrote in the local paper about the removal of an anesthesiologist because he would not sign a contract.  The anesthesiologists were made to sign contracts since there were surgical delays and the administration was convinced the delays were caused by the anesthesia department.  The hospital let the anesthesiologist go since they believed without any proof that he was the cause of a leak to the paper.  The law suit should be interesting.   Top   


Pennsylvania has good news.  The number of malpractice filings has decreased.  Also there was a decrease in the big verdicts.  The major cities saw the biggest decreases in case numbers as the smaller counties saw a rise. 

A study published in the New England Journal of Medicine by the Harvard School of Public Health showed that almost 40% of med mal suits filed in the US are groundless.  The attorneys lose money, as they should, on most of those cases.  However, the toll on the physicians sued can not be imagined. It is had to believe but about 15% of the groundless suits are settled with some payout.           Top


In a slap in the face to the over zealous California Nurses Assn. a report by the California Institute for Nursing and Health Care states there are not enough nurses in the state for the ill thought out nursing patient ratio law.  In a study of 24 metropolitan areas half got a D or an F in nurse to population ratios.  There was one B in the state in Redding and no As.  With not enough nurses one of two things must occur.  The hospitals must hire travel nurses who do not know the hospital routine and cost significantly more than local nurses or they must shut down services to meet the artificial state mandated demands.  There also continues to be a major shortage of nurses to teach nurses.  There are others out in the community who could teach the nurses but who not allowed because of the bad rules that only nurses can teach nurses.          Top


DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.