Wednesday, July 29, 2015

Kaiser Does It Again

I've written before about the problems of having Kaiser Permanente as your HMO, and I'll be writing about it again in the future, I'm sure. That's just because it is fraught, fraught, I say, with so many problems and pitfalls for patients.

The worst one I've heard in a long time happened to a teenager whose Kaiser physicians --- read, gate-keepers and bean-counters --- declined to perform a diagnostic MRI for her severe back pain. Instead, they referred her to an acupuncturist (yes, an acupuncturist) and a nutritionist to lose "extra belly weight" --- even though the five-foot-four girl weighed 125 pounds, which makes me think she had no "extra belly weight."

Problem was, the girl had a tumor which could have been treated early if detected by an MRI. But, because it wasn't detected early, when it was finally treated, she had to have her right leg, half of her pelvis, and part of her spine removed.

The L.A. Times reports, "Attorneys for 23-year-old Anna Rahm of Chatsworth argued that a cancerous tumor in her pelvis grew during the three months she and her mother tried to persuade Kaiser doctors to authorize an MRI. By the time the test was finally approved, doctors were forced to amputate Rahm's right leg, half of her pelvis and part of her spine."

A couple of months ago, a Los Angeles jury righted this wrong --- as much as it could be righted --- by ordering Kaiser to pay the young woman $28 million.

Kaiser, of course, is probably going to appeal. Because, they say, according to the L.A. Times, even though "....the health and safety of our patients is paramount at all times, [some of their]  highly respected medical experts testified that the medical care provided was appropriate."

Of course they said that. Why am I so dang cynical, anyway?

Meanwhile,Ms. Rahm said, "I hope I taught the doctors who were working with me a lesson.” She's studying at Cal State Northridge "to work with children facing life-threatening illnesses." And she "uses crutches to get around campus because she does not want to use a wheelchair." Brave girl!

The L.A. Times article notes that Kaiser is "both an insurer and provider," which I think is at the root of the problem. Kaiser "care providers" are not really working for the "patients," but make "care" decisions based on potential cost to the Kaiser system than patients' actual needs.

For a supposed non-profit, Kaiser is doing pretty well, with $56.4 billion in revenue and $2.2 billion in revenue in 2014.

Why do I keep using Kaiser, you may ask (and probably have asked me). Because it's the only option available in my area that isn't even worse. Which says a lot about our national health-"care" system, doesn't it. 

Then why do I keep complaining about it? Because I can't really switch to another program, so I can only hope that publicizing the faults in the Kaiser system will eventually force these bean-counters to improve their system.

1 comment:

AskTheGeologist said...

The solution, of course, is to get past the Hypochondriac Filter, which if left unchecked would mean 10% of Kaiser patients consume 80% of the Kaiser resources. We've all known this type. Hence the need for a gate-keeper. Our own son makes it VERY clear that there is a hardened coven of people "shopping" for painkiller drugs that they have become addicted to. They use anger and litigation threats to eat into the resources of people like you and me. Gatekeepers are thus critically necessary.

This means we must be our own advocates. Instead of assuming an HMO will "care" for (or about) us, WE must assert ourselves. Instead of being passive, we must be active in our own behalf. It will be more like this in any fully nationalized health system (e.g., our daughters living in Canada and Australia). How to be our own advocates? THAT's the hard part. As the old saying has it, "Don't get angry, just get even." I would revise this to be "Don't get mad, just start thinking about what to do next. Where's the next door in the hallway?"