The only reason Kaiser has been getting away with the crap it gets away with is that the government, the media, and everyone else who could have put them under review chose to look the other way. The stars of justice must have finally aligned, though. As much as Kaiser's PR department scrambles to stuff the news channels with fluff articles, the serious journalists aren't being thrown off the trail.

First, the president of Kaiser Northwest resigned because first quarter profits dropped 88% - largely because of glitches with the EMR (Electronic Medical Record) billing system. The EMR, which was subsidized by hikes in member fees (including millions of dollars wasted on the write off of the previous system) was chosen expressly for the billing system. Kaiser rushed out the billing system first thing, and they probably would have been satisfied with just installing that. This is a failure of awe-inspiring proportions, and it should give people pause for thought before Kaiser manages to pawn it off on the Federal government as the Medicare EMR. Yep - the ultimate plan was for the taxpayer to foot the bill and line the pockets of Kaiser's "early EMR adopter" shareholders.

How interesting to learn from the same article that Kaiser suffered a 112% loss in underwriting (profit from insurance sales). Looks like consumers are finally starting to wise up. Perhaps one too many Kaiser doctors dismissed imminent heart failure as a "recommendation for diet and exercise". I've been told that Kaiser lowers its metrics for heart attacks by not counting anyone who dies before they reach the emergency room.

But that's not all! There's more revelations from the David Merlin lawsuit. Finally, investigative journalists are paying attention to the role played by Kaiser's profit-taking medical groups:

So far, however, no senior executives in the Permanente Medical Group, which ran the unit, have left or been reprimanded. And except for the first days after the issue came to light, TPMG executives have repeatedly deflected questions on the medical group’s role, leaving Mary Ann Thode, president of Kaiser’s Northern California hospital and health-plan units, to bear the brunt of public scrutiny....The medical group, unlike the rest of Kaiser, is a for-profit enterprise that splits profits among its physician partners. Critics say that gives an incentive for the group to bring services in-house for financial reasons, sometimes to the detriment of enrollees. In addition, critics say, Kaiser’s emphasis on “population health” — meaning providing cost-effective care for the greatest number of enrollees — carries within it some risk that the interests of individual patients could be compromised in an attempt to stretch health-care dollars across a broad spectrum of care.

That appears to have been one of the factors leading Kaiser executives to take steps that put some individual patients at risk, with the goal of ultimately benefiting the greater good, Given said. This “may at least partially explain TPMG’s unwillingness to respond to (patient and family) complaints in a timely manner — or apparently at all — if the media had not gotten involved.” ....Other sources, including some within Kaiser, say Kaiser’s corporate culture and the influence of its powerful medical group, contributed to a reluctance to address these issues directly and publicly....Critics say the powerful influence of Kaiser’s doctors within the organization is little known to the public or to regulators, and that financial incentives sometimes result in clinical decisions that can put some patients in jeopardy. A senior Kaiser source blamed the situation on internal power struggles and cultural change within what the source called “a doctor’s culture.”

Other highlights of this article include the whistleblower Merlin being told to "shut up", and Kaiser's notorious "issues management" consultant, making the snide comment: "we’re not to going to litigate or advance our litigation strategy in the media."

This remark has particular resonance for me this week because I've been talking to several people about the tactics Kaiser's lawyers use when judges were out of sight. I was personally threatened on two occasions by a Kaiser lawyer who said, and this is a quote, patients wanted to "come after me", and I would thus have to cooperate with Kaiser if I wanted them to protect me. Of course the only reason patients might want to "come after me" is that Kaiser called up 150+ patients to tell them that I had stolen their patient info when Kaiser itself had been posting the info on the Internet for around five years. It's my belief that Kaiser has only been able to get away with this sort of unethical bullying because people who are involved with lawsuits are all isolated. If there's anyone with access to Lexis-Nexis and an interest in legal research (Ph.D. student, perhaps?) who might be interested in researching patterns in the "hallway" part of Kaiser's "litigation strategy", please let me know.

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Last, but certainly not least, Kaiser has been posting patient info on the Internet yet again. The patient involved received this letter in March 2006, but the letter itself is undated. My theory is that Kaiser did this deliberately to create confusion if this letter was used in litigation. I haven't seen a word about this letter from either the press or the DMHC (remember the DMHC making a big deal about how they wanted to handle HIPAA violations even though all of Kaiser's training materials says to report violations to the Federal Dept. of Health and Human Services...?).

This is a stunning HIPAA violation. Remember Kaiser siccing their full lawyer power (as well the DMHC) on me just for calling attention to their publicly posted web site? (Note the EFF finally figured out the problem with persecuting the transmitter of public posted information in this case). So how on earth did Kaiser manage to quash it?

I challenge investigative journalists to follow up on and validate this letter. While I've redacted the patient's name on the document I posted, I'm sure the patient would be more than willing to cooperate.