Kaiser Permanente - Corporate Ethics

Kaiser Permanente, which covers millions of people in California, has been facing one crisis after another from the cover-up of their kidney dialysis unit to the firing of workers who stand up for proper heathcare and health and safety. This forum will have speakers from the trenches at Kaiser who have seen how it operates from the inside and how the system really operates inside and outside. Who is regulating Kaiser and where is Kaiser going?

Join with Kaiser workers, consumers and healthcare advocates:

Dina Padilla, for Kaiser SEIU 250 shop steward and Voices CA Chapter Pres. B.E.S.T.
Dr. Charles Philipps, Former Kaiser Doctor, author and critic Of managed care
Sharon Rushford, Fought a legal battle for her husband who was a patient of Kaiser
April Gottman, Ex SEIU 250 Kaiser employee and researcher

And...[drumroll]...ME as a Former Kaiser web worker and activist for Kaiser transparency.

Sponsored by VOICES CA, B.E.S.T.
California Coalition For Workers Memorial Day
Labor Video Project

I AGREE TO BE BOUND BY THE BYLAWS and RULES & REGULATIONS OF THE PROFESSIONAL STAFF for KAISER FOUNDATION HOSPITAL EAST BAY, OAKLAND/RICHMOND CAMPUSES AS NOW ADOPTED AND AS AMENDED IN THE FUTURE, and THE LAWS & REGULATIONS OF THE STATE OF CALIFORNIA

Dr. Min Su said he found it hard to believe when patients expressed frustrations in dealing with the health system for which he worked. This week, the Modestan found himself in those patients' shoes, battling the system after an insurance flap caused his premature twins to be split between two hospitals [Kaiser wanted the weaker of two twins to be moved to a Kaiser hospital]....The Kaiser health system did not literally "require" the transfer, but a case manager said the parents would have to pay for the charges [if one of the twins remained at an outside hospital]...

..."I heard a lot of patient complaints about Kaiser," Su said. "Now, I realize they provide good care for the healthy patients, but when the big one comes, they don't care. They just care about saving money."

...As a former physician for Kaiser, Su said, he was able to appeal to officials in Kaiser management to resolve the issue, something that is rarely possible for regular patients...."I got nowhere going through normal channels," he said. "I can see it is frustrating for people who are looking for help and don't know where to go."

If it turns out to be a complete con job, it's a darn good one: Not only did the writer capture PR-speak perfectly -- he/she also knows an awful lot about Kaiser. All of the names and titles check out. Korn/Ferry, the search firm listed, is the one Kaiser used last time its top job was open. The media contact number listed is the real one. And Kaiser frequently uses PR Newswire to pump out its actual news releases.

All of the pieces for members.kp.org, except physician messaging, are actually from the legacy systems. Lab results, appointment times, prescriptions, are all from the legacy apps (or in the case of prescriptions and refills, from the third-party pharmacy app they chose to integrated into the Epic suite). Epic is doing some work on helping KP integrate some of those parts into a more seamless "EpicWeb experience," but I don't think Epic can yet take credit for the KP member portal features. Last I heard, that's sometime into 2008 right now for most of the regions (other than California, which might be 2009 at this point).

Appellant [the Kaiser employee] was barred from referencing her termination at trial, and the trial was limited to the claim that certain pre-termination counseling and discipline had been discriminatory or retaliatory...Appellant contends she was denied a fair trial because of respondent's continuous claims that her errors could have killed a patient. Appellant cites to this court's unpublished decision noting that all appellant's errors could be characterized as "simply errors in record-keeping" and to respondent's post-remand admissions that none of the incidents which it relied on in terminating her employment resulted in any adverse consequences to a patient...Appellant contends she was prejudiced by the court's restriction on her right to cross-examine respondent's supervisors and expert witness on the comparability of her errors and those of her non-terminated peers.

...for the most part, appellant's briefs consist of descriptions of alleged errors without any nexus between the alleged error and legal authority or supporting argument. "This court is not required to discuss or consider points which are not argued or which are not supported by citation to authorities or the record."

...once discussing defined contribution, Halvorson pointed out why handing over the purse strings to consumers can't motivate all of them to shop for price: "Anyone who has just been diagnosed with cancer is in no position to go out for bids." (Source)

...Go STRAIGHT to the CA Att'y General or OIG. Build your case with solid evidence and facts...don't let ANYONE on to your game WITHIN KAISER.

Avoid KP Compliance Hotline like your life depended on avoiding it. If you already called, hold your breath, cross your fingers and wait for the repercussion (or don't hold your breath, depending how you look at it).

Don't trust upper management fools with a title that has the words DIRECTOR, NATIONAL, COMPLIANCE, and/or INVESTIGATOR in it. Don't trust that they have your best interest, your department's best interest, or even that they are interested in doing the right thing. Oh sure they may have great concern at first and may personally WANT to see things change for the better and pursue your complaints/concerns, until THEIR superiors yank their chain and threaten their jobs. Basically upper management is concerned about protecting the party line (i.e. the KP "Party"), saving their own individual necks and their jobs in the process. They're willing to pretend to listen to you, while looking the other way, like a therapist nodding his head at the patient while doodling and drawing stick figures in his pad, pretending to listen and look completely concerned. Kaiser's internal investigative wing is NOT (I repeat, NOT) interested in seeing the right thing done. They're interested in protecting the image of the organization as a whole.

More advice...watch for KPIT spyware...if you notice your station unexpectedly slowing down for extended periods of time, CTRL+ALT+DEL then go to task manager, look under tab "Processes" and scroll down until you see something like RGTMS.EXE or RTGMS.EXE (you get the idea) which is a particularly stubborn & nasty KP spyware, allows them to "shadow" your workstation remotely IN REAL TIME, copying your emails, taking screenshots of your computer activity and monitoring your web page visits, etc. At this point it's just simply too late for you, just hope that you haven't done much NON-KAISER with the KP workstation/computer while connected to Corona. There's nothing you can do, and there's no way to fight it. After all, KP can monitor whomever, whenever, for whatever reason. Your employment requires you to sign something to that effect coming in, so...too bad I guess.

BOTTOM LINE - KP MANAGERS WILL DO ANYTHING TO PRESERVE THE IMAGE AND PRESTIGE OF THE ORGANIATION IN THE PUBLIC EYE, AND DO ANYTHING TO NOT LOSE MEMBERSHIP. They'll resort to playing both sides, lying, cheating, leading you on...possibilities and permutations are endless.

...OR...you can be like every other chicken-s**t 20-something plus year veteran of Kaiser, stick your fingers in your ears, shake your head side to side while loudly humming a tune, eyes closed, keep your d**ned mouth shut, and say nothing...exactly the model employee that KP wants to see. You don't even have to be anything but marginally competent at your job. You can be a mindless, unimaginative and uncreative Yahoo (with a literary nod to Swift, not Filo & Yang). 1800 Harrison and 1 Kaiser Plaza prove that every f****ng day of the week.

It's your choice, just go into battle knowing what the result that you want to see, then charge full steam ahead. Ahoy matey and happy sailing!

People in the field are frustrated, and the people in IT are just as frustrated because this was a solution forced upon us and was not an IT solution...

[The plaintiff had been]...raising patient care issues regarding mishandling and loss of patients charts, medical records, including orders[,] failure to provide equipment and supplies to the patient timely, breach of patient confidentiality, alteration of patient records. The jury also found [the plaintiff] had proven, by clear and convincing evidence that...[her manager] had acted with malice, fraud or oppression.

[Kaiser contended that]...[the plaintiff] had failed to prove her common law cause of action because [the plaintiff] had failed to articulate the constitutional, statutory, or regulatory basis for the cause of action and failed to provide a nexus between the termination and Kaiser’s violation of any constitutional, statutory, or regulatory provision. Labor Code section 1102.5, the whistleblower protection statute, precludes employers from retaliating against an employee who communicates with governmental or law enforcement agencies where the employee has reasonable cause to believe that the information discloses a violation of state or federal statute, or a violation or noncompliance with a state or federal rule or regulation."

During the hearing on [the plaintiff]’s motion for attorney fees and costs, the trial court stated it did not “think . . . that the primary purpose of bringing this case was to benefit the public, it was for [the plaintiff] to get damages and/or get some kind of compensation for what happened to her.”

As the trial court found, the jury verdict in favor of [the plaintiff] did not confer a significant benefit upon the general public. Rather, it was a suit primarily brought to compensate [the plaintiff] for her losses, including lost wages. (See e.g., Flannery v. California Highway Patrol, supra, 61 Cal.App.4th at p. 635 [fees under section 1021.5 rejected because plaintiff’s primary purpose was vindication of her own personal right and economic interest]; Weeks v. Baker & McKenzie (1998) 63 Cal.App.4th 1128, 1170-1171 [sexual harassment case brought to vindicate plaintiff’s personal rights and economic interests]; compare with Edgerton v. State Personnel Bd. (2000) 83 Cal.App.4th 1350, 1362 [action helped preserve a significant public benefit].) Thus, the trial court did not abuse its discretion in denying the motion for attorney fees pursuant to Code of Civil Procedure section 1021.5.

...Health and Safety Code section 1432 prohibited long-term health care facilities from discriminating or retaliating against patients or employees of those facilities who complained or cooperated with governmental agencies relating to the case, services, or conditions at these facilities. Neither the current version of Health and Safety Code section 1432, nor the version in effect in 1999 had an attorney fee provision.

...Pursuant to Section 1278.5..."An employee who has been discriminated against in employment pursuant to this section shall be entitled to reinstatement, reimbursement for lost wages and work benefits caused by the acts of the employer, and the legal costs associated with pursuing the case."

...In her initial complaint and in her subsequently filed amended complaint [the plaintiff] did not include a cause of action based upon Section 1278.5, a statute specifically designed to expand the protections provided by other statutes (Note: Section 1278.5 was enacted in 1999, and became effective January 1, 2000 ~ CorpHQ). [The plaintiff] only sued on a common law cause of action for wrongful termination in violation of public policy and as to that cause of action, [the plaintiff] did not seek attorney fees. It does not appear that [the plaintiff] ever sought to add a statutory cause of action for wrongful termination. It does not appear that [the plaintiff] sought to amend her complaint to request attorney fees with regard to her common law wrongful termination cause of action. As we discussed in Case No. B167858, [the plaintiff] tethered her common law cause of action to Labor Code section 1102.5, and possibly to Title 22. Even though her complaint was filed seven months after the effective date of Section 1278.5, [the plaintiff] never suggested Kaiser violated Section 1278.5, or that her wrongful discharge cause of action was tethered to this Health and Safety Code section. [the plaintiff] raised Section 1278.5 only after trial, in her motion for attorney fees and costs.

Thus, [the plaintiff] never pursued a statutory cause of action for wrongful termination. [the plaintiff] did not pursue her wrongful termination case pursuant to Section 1278.5. (§ 1278.5, subd. (g) [stating that employee who was “discriminated against in employment pursuant to this section shall be entitled to...the legal costs associated with pursuing the case”]; cf. U. S. v. Stone Container Corp. (9th Cir. 1999) 196 F.3d 1066, 1068-1069 [party seeking attorney fees under particular statute must have brought claim “pursuant to” that statute, as the statute specified].) Rather, [the plaintiff] rested her wrongful discharge cause of action solely upon a common law cause of action in which she did not seek attorney fees. Having prevailed on that common law cause of action, [the plaintiff] is foreclosed from belatedly arguing (after a verdict is rendered) that she is entitled to attorney fees and costs based upon a statutory claim.

For reasons unbeknown to this court, [the plaintiff] never put before the jury the suggestion that Kaiser’s actions violated Section 1278.5, even though the statute was enacted prior to the complaint being filed and even though such an argument would parallel many of her Title 22 and Labor Code section 1102.5 arguments. We will not second guess this tactical decision. [the plaintiff] did not raise a statutory cause of action for wrongful termination. Thus, she cannot seek statutory remedies under that statute.

In light of our conclusion, we need not address [the plaintiff]’s argument that a retroactive application of subdivision (g) of Section 1278.5 enables her to obtain attorney fees and costs. For this proposition, [the plaintiff] cites to a number of cases including, Bradley v. Richmond School Board (1974) 416 U.S. 696, California Housing Finance Agency v. E.R. Fairway Associates I (1995) 37 Cal.App.4th 1508, Harbor View Hills Community Assn. v. Torley (1992) 5 Cal.App.4th 343, Kievlan v. Dahlberg Electronics, Inc. (1978) 78 Cal.App.3d 951, and Olson v. Hickman (1972) 25 Cal.App.3d 920. These cases and their discussion do not address the facts before us.

Thus, the trial court did not err in denying [the plaintiff]’s request for attorney fees and costs pursuant to Section 1278.5.

DISPOSITION
The order denying attorney fees and costs is affirmed. [The plaintiff] is to pay costs on appeal.

The Los Angeles city attorney's office filed false-imprisonment and dependent-care-endangerment charges against hospital giant Kaiser Permanente on Wednesday, the first criminal prosecution of a medical center accused of "dumping" patients on skid row...In addition to the criminal charges, the city attorney filed a civil lawsuit against Kaiser, using a state law on unfair business practices that city prosecutors usually implement against unscrupulous slumlords...

...meetings with Kaiser and hospitals failed to yield reform — and that was part of the reason for the court filings...

It is known within Kaiser that Garcia has initiated an HP-like information gathering program to identify employees releasing information to blogs.

Physician Workflow At Kaiser Permanente
In his paper (Sep/Oct 05), J.D. Kleinke incorrectly states that Kaiser Permanente controls the workflow of the physicians it employs. In fact, Kaiser Foundation Health Plan and Hospitals sells health insurance and operates hospitals. Permanente medical groups, owned and operated by physicians with independent boards of directors, provide medical care to health plan members, and it is they, therefore, that employ the physicians. The medical groups, rather than the health plan, control the physicians’ workflow. As a result, physicians designed, as well as put in place, a robust clinical health information technology (HIT) system. Although this distinction might seem a small one, it carries larger strategic and operational implications.

Both parts of Kaiser Permanente agree on the benefits of advanced HIT systems, but physicians are responsible for the metrics of physician workflow, and they are also accountable for quality, service, and access. As Kleinke points out, a prepaid, integrated medical care system is more capable of concerted economic action than the fragmented fee-forservice system that prevails in most parts of the country. In addition, eliminating an incentive for increased coding levels alters workflow design in potentially beneficial ways. Although such an approach need not necessarily improve quality or efficiency, it is at least one way to implement quality and service improvements in an IT-driven comprehensive health care system.
George K. York and Robert M. Pearl
The Permanente Medical Group Inc.
Oakland, California

Completion of this project would not have been possible without the willingness of Kaiser Permanente to provide their electronic-medical record projects as a testing ground for my ideas. In particular, I wish to thank Simon Cohn, John Mattison, Jeff Rose, and John Dewy. They have been my champions inside Kaiser Permanente, and it is through their efforts that my dissertation project was funded. The Kaiser Permanente modelers were patient subjects for my experiment.

I've been reviewing the PR financial statements at the Kaiser site for quarterly statements trying to find the $7 billion Justen referred to in his letter. The four year project, starting in 2002, was suppose to cost $3 billion so Kaiser must have spent at least the whole budget PLUS already and expecting two more years to finish the project. But reading the financial PR's, I can't find it! What a mess!! Not only can Kaiser not remember what they stated last year in their YOY references accurately (compare Q2 2004 and Q4 2004 PR's), the numbers don't add up YTD for what they do print. It is interesting what they choose to omit from time to time too. Kaiser started leaving off their operating income quote beginning Q4 2005. But doing the math - their operating revenue per member has gone from $2,402 to $4,012 = 40% increase when the membership base only increased by 3%. These increases in just the past FIVE years (2001 - 2006). Employers and patients are paying for this! Wake up! I doubt this is the 'bend the trend' Halverson wants changed though. Kaiser never reports operating expenses and this is where continued mis-perception and lies to the public regarding just how much HealthConnet is costing. All those other hospital execs go to California for a site visit and are so impressed (mislead) on the costs and 'happiness' of the clinicians. The ability to cope with HealthConnect is directly reflected in their evaluations and pay. 'Let's reward dishonesty with more money because they are cheerleaders to our business objectives and obligations to the Vendor. Tell the truth and you are fired.'(or put on administrative leave). Amazing so many healthcare providers are willing to choose dishonesty for their own gain. It is sad and it is also a direct reflection of what this corporate culture pays as reward.

In the financial PR's, Kaiser only claims capital, which would be hardware, to be later depreciated. I'm guessing their payments are due to EPIC in Q4 by the trend and fits with the expectation to be bleeding again this upcoming quarter prompting Halvorson's bend the trend letter. How in the world would Halvorson be concerned when the revenue per patient is so darn high and they are averaging 8.6 billion in revenue per quarter so far in 2006?! Just how much is this system really costing patients? Capital expenses usually exclude operational (human) expenses towards the project. What is the truth regarding the expenses of this project? NO ONE will ever know because there is no public accountability to the truth with EPIC or Kaiser.

I went to the EPIC website to see if they have any PR's related to finances - just how much is Kaiser really sending to EPIC? Nope, absolutely nothing there. They don't have to disclose because EPIC is a privately held company too. Kaiser and Epic compare themselves to the UK and Cerner all the time. You can't compare what you can't see. At least in the UK, complete financial statements exists on both sides of the curtain for their project. In the U.S., it is an employers choice though where to send your employees for healthcare services. Annual premium increases sent only to the pockets of Kaiser's profits is really a choice employers have to offer to their own bottomline. Since enrollment is up only 3% in five years, at least it looks like some employers have noticed the lack of quality and financial waste and taken their business elsewhere. Those deep pockets at Kaiser are fattened by patients and employers! Wake up!

From: Bruce Miller
To: (Kaiser Victim)
Date: Wed, 8 Nov 2006 18:36:19 -0800
Subject: RE: Declaration coming from Dr.Phillips
Dr. Philips makes a career out of acting as an expert against Kaiser, ever since his employment ended there. I am in the process of collecting documents about him from around the country, to submit as a reply.