Kaiser/Employer Alliance Against Injured Workers
In 1996 California's State Compensation Insurance Fund (SCIF = Worker's Comp) allied with Kaiser Permanente to reduce costs associated with injured workers. Kaiser is still SCIF's "preferred provider", though SCIF started to add a few Blue Cross physicians last year as a token alternative to the Kaiser monopoly. Since Kaiser is also in the business of selling insurance to employers, there's a patent conflict of interest: employers aren't going to buy insurance from a health care provider that takes the side of their employees and costs them money. And of course no one gets shafted worse than injured Kaiser workers in this situation.

Recently a woman contacted me about her Kaiser/Worker's Comp ordeal, and I hope that posting some of her experiences will raise awareness of how rotten the SCIF/Kaiser alliance is for workers. Since she wishes to remain anonymous, I will call her Jane Doe.

Once upon a time Jane Doe went to Kaiser, the health plan provided by her employer, to be evaluated for workplace-induced stress so she could establish the medical justification that would allow her to transfer to a different department. At Kaiser she was assigned to a "work clinic" therapy group - one of Kaiser's innovations to reduce the costs associated with Worker's Comp. Jane Doe participated in the clinic for approximately three months. (Note: Corrections in this paragraph made at Jane Doe's request - she did not apply for Worker's Comp).

One of the other injured workers assigned to the clinic notified the social worker in charge that he was planning to file a Workers Comp claim for emotional distress, and he asked the social worker to provide a copy of his records and testimony for his hearing. The social worker then informed the entire group, I will never testify for you. We do not go to court for you, do not expect us to. We do not testify in courts for employees - only for employers. And we do not record everything, we do not keep detailed records. We do not record our own conclusions - we only say that "this is what you told us."

The social worker also said that Kaiser used to provide a "service" of "evaluating" Workers Comp stress claims. Kaiser had to shut down this particular operation altogether after having been sued by a labor union for either dismissing or declaring "not work-related" virtually 100% of the claims they "evaluated". (Note: This is the testimonial of Jane Doe - I don't have any further information about this program or the union lawsuit.)

At first the social worker sounded sympathetic to Jane Doe, who was traumatized by her own situation, and the social worker agreed that Jane Doe should transfer to a different department. However, when Jane Doe mentioned that she had a well-documented paper trail of misconduct by her supervisor to support her request, the social worker turned around and recanted her previous support. She refused to cooperate with Jane Doe's attempt to transfer UNLESS she went through Kaiser's mandatory condition of undergoing THEIR "forensic testing" to diagnose her with "some sort of mental illness or personality disorder" (the social worker's words). The social worker continued: We need to diagnose you with something *psychiatric*, you'll have to take our written evaluation, answer some 500 questions or so, and you will have to talk to our doctor about some medications. You don't have to take medications if you don't want to, but we have to prescribe something for you.

Jane Doe realized immediately that this would destroy her legal standing, since the first thing every attorney and every "independent medical examiner" asks is about history of any "mental health treatment" and "having ever been prescribed psychiatric drugs". The social worker had already confirmed that any RX prescribed by Kaiser would NOT be used in Jane Doe's defense - only in her employer's!

Jane Doe reminded the social workers of her previous warning about Kaiser "not keeping detailed records", "not providing their conclusions" and "never testifying in court for employees." Instead, Jane Doe requested that if any testing was needed, it should be done by an independent provider who would be able to testify in court on EITHER side and DOES keep accurate records. The social worker's response was to kick Jane Doe out of the work clinic.

There is a happy ending for Jane Doe. She filed a lawsuit against her employer. During the discovery stage, she agreed to undergo an "independent medical evaluation" by an "expert" of her employer's choosing. That gave her the chance to take a glimpse at her Kaiser medical records. She found out that:

1) Kaiser had early on violated her written request NOT to communicate with her employer.

2) While Kaiser did not record her words (re: Kaiser's careful avoidance of anything that could be used as legal evidence on the employee's behalf, they INSERTED into her file things she'd never said! For instance, they claimed she had expressed "suicidal ideation". Jane Doe avers that she has never, ever contemplated, discussed, planned or made any attempts at taking her own life: the only thing she mentioned was that she wanted to transfer out of her toxic workplace. However, that little "suicidal" insert gave her employer the much-needed pretext to subject Jane Doe to a "fitness-for-duty exam". In the end, though, the bullying and corporate scheming came to naught. Jane Doe won the lawsuit.

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Personally I think Jane Doe also has a strong HIPAA complaint against Kaiser. In terms of Kaiser's propensity to "position" potential litigants as mentally ill - I know someone who filed a complaint with a State agency because some of her medical records disappeared when she needed to point to previous malpractice as a justification for corrective surgery. She only got her medical records after Kaiser reviewed them, and when she got them, a prescription for anti-depressants from years earlier had been put on top. She filed a HIPAA complaint about this TWO YEARS AGO, and the Office of Civil Rights still hasn't gotten to it.

Kaiser seems to be constantly scheming about how to disadvantage patients in case of any litigation. A Kaiser Physical Medicine Questionnaire obliges physicians to record whether the patient is involved in litigation:



What could impending litigation possibly have to do with diagnosing a medical problem?

Over a year ago I pointed out that Kaiser was coaching physicians on litigation-safe documentation. Kaiser told physicians that litigation is "not a search for truth", and thus physicians might as well get a head start constructing an edifice of untruth that will win in litigation. Another acquaintance of mine attempted to get the California Supreme Court to overturn a Kaiser arbitration decision that had been based on physician lies, to no avail.

In short, Kaiser and the physicians that contract with Kaiser have too many conflicts of interest to be allowed to control what happens to employees who apply for Worker's Comp. Injured employees must be allowed to obtain claims evaluation from unbiased physicians who would not benefit financially from suppressing the claim, declining to testify on behalf of employees, or tampering with medical records on behalf of employers or for the sake of "cost reduction".