[April 28, 2008: It was a little over two years ago that Beth Stover's daughter, Lehna Brewer, was stillborn at Kaiser Walnut Creek. We're spotlighting this post again this week to coincide with an article in USA Today about the alarming national trend of missing records in medical error cases, in which Beth's story is featured. Any new posts will appear below this one for the rest of the week.]

Update March 5, 2007: Lehna’s father speaks out about how deeply the death of his daughter has impacted the lives of her family — by former Kaiser HealthConnect employee, Andrew Brewer.

By Beth Stover

For a complete documentation of the events surrounding the death of My Baby at Kaiser Permanente, please read part one of my story.

Part Two:

One year ago today, March 4th 2006, My Beautiful Baby — Lehna Jordann Brewer — was stillborn at Kaiser Permanente in Walnut Creek, California. She didn’t have to die, but because Kaiser Permanente chose to withhold care and send me home, she died. This is a follow-up story documenting all of the challenges and roadblocks of the past year. It is not enough to be victimized only once at Kaiser. Kaiser chooses to continue victimizing by withholding critical medical information that the patient — EVERY PATIENT — has a right to as a U.S. Citizen. This is clearly stated in The Patient’s Bill of Rights.

ROADBLOCK Number 1: Destruction of Evidence

After Lehna died, apparently Kaiser felt that they had something hide. To date I have not been able to see the fetal heart monitor strip from the stress test done the morning before Lehna was stillborn. I have made several requests over the past year: in writing, and in person and by phone. According to Kaiser, the fetal heart monitor strip was “lost.” CONVENIENTLY LOST.

Only after I initiated an investigation by the California Department of Health, Licensing and Certification, did Kaiser begin to look for the missing fetal heart monitor strip. Ironically, the very same week that they were being investigated I received a phone call from the Kaiser ombudswoman telling me that they had found the missing strip in an envelope with my name on it. She told me, “Well, it doesn’t have a date or a time but we’re pretty sure it’s yours.” My response was, “Well, if it doesn’t have a date OR a time, OR a name OR a medical record number, then how can you be sure it’s mine?” And she replied, “We can’t.” She told me she would go ahead and put it in the mail. There is NOT ONE PIECE OF IDENTIFYING INFORMATION ON THIS STRIP THAT WOULD EVEN REMOTELY CONNECT IT TO ME. This is not even mine; it is a blatant attempt to commit fraud. This strip belongs to someone else and Kaiser knows it.

As a 40-year-old woman who has lost her Baby, most people would assume I would get some answers as to why my beloved Lehna died. This has been all but impossible with Kaiser. Instead of working with me to get some kind of closure or answer that makes any sense, they have withheld critical records and have put more effort into covering up the facts. At age 40 I was never classified as high-risk by Kaiser. I have educated myself since then and now I know that even 36-year-old women are normally considered high-risk outside of the Kaiser system. I have since learned that minimizing risks in general is standard operating procedure at this organization that proclaims that it is “setting the standard for health care delivery worldwide.” Be very afraid.

Never mind the fact that once I passed my due date of Feb. 23rd, a Kaiser doctor attempted to schedule me for an induction that would have put me at 15-days past my due date (not 13, as originally noted in Part One of my story). Does this seem like the standard of care that EVERY OB patient is entitled to? A 40-year-old woman, 15-days past her due date? I’m still trying to figure out how delaying necessary intervention equates with quality care. THIS, in and of itself, appears negligent.

ROADBLOCK Number 2: No Cause of Action for Spoliation of Evidence

This is ludicrous. Did you know that in California it is not against the law to “lose” important Medical records? How convenient for Kaiser. All they have to do is “lose” the medical records and they seem to be off the hook. This “No Cause of Action for Spoliation of Evidence” is in direct contradiction to the Patient Bill of Rights. It is AGAINST THE LAW to destroy a patient’s medical records, but if you conveniently “lose” them, then that seems to be OK. Just as in my case, I have heard that a lot of medical records get “lost” at Kaiser. Missing and/or tampered medical records make it very difficult to prove your case which works very well for Kaiser.

ROADBLOCK Number 3: California’s MICRA and Kaiser’s own version of MICRA (Medical Injury Compensation Reform Act)

This is a BIG ROADBLOCK and one that works very well for Kaiser and any other healthcare provider that has adopted the practice of providing negligent care, or should I say “withholding care”. MICRA is a law enacted back in 1975. Yes, 1975! This puts a $250,000 cap on non-economic damages in medical malpractice cases in California. My Baby’s life is not worth enough money in California for a lawyer to be interested. It’s not a good business decision financially for lawyers to take on malpractice cases UNLESS the Baby/patient will need a lifetime of care. This brings us back to the missing fetal heart monitor in my case. Kind of makes us wonder if my Baby was left to die after discovering possible brain damage had already taken place. It is MUCH cheaper to let the Baby die instead of getting stuck with the economic damages that might have applied if Lehna had lived. This should have been my decision, NOT a financial decision made by Kaiser. I would have chosen to let Lehna live.

Not only do you have MICRA to go up against in California, but Kaiser saw how well MICRA prevented lawyers from going after them for medical malpractice that they decided to enforce a double whammy and put a $250,000 cap on any future Kaiser Members everywhere, who experienced medical malpractice within Kaiser. MICRA and Kaiser’s $250,000 cap is a LICENSE TO NOT PRACTICE MEDICINE since it prevents Kaiser from being pursued in the all too common event that medical malpractice has taken place. There seems to be no recourse for many Kaiser members and Californians due to the fact that finding a lawyer who will take these cases is next to impossible. ALL Kaiser members, not just in California, need to read the fine print in their agreement with Kaiser.

“In the cold calculations of medical malpractice, a brain-damaged baby is worth more than a dead baby. The brain-damaged baby will need a lifetime of specialized care.”

“Arbitrary caps on “non-economic” compensation unfairly discriminate against the suffering of women — who typically sustain injuries due to medical negligence, such as laceration of the uterus or loss of a new born during child birth, that do not carry high “economic” price tags but involve significant loss. Injuries sustained by homemakers are also unvalued, because they have no “wage loss.” Caps not only deny women victimized by medical malpractice fair compensation and legal representation for their injuries, but subject women to repeat offenders and have been undeterred.”

Click here for more on MICRA.

ROADBLOCK Number 4: Kaiser’s Ability to tamper with medical records

Not only does Kaiser destroy medical records, but they change medical records at will. In the original notes from the delivery room when Lehna was born it was first reported that I had a fever of 103. Later on in notes, the Dr. had gone in and “amended” the original notes. She dropped my fever from 103 to 101. Now, would someone please tell me how she would know this sort of thing after the fact? A fever is a fever and no one could not have possibly known hours after the fact what my fever was unless it was documented at the time, which it was. It was documented at 103. PERIOD. Why the need to go back and change it hours later?

ROADBLOCK Number 5: Kaiser’s Ability to Deny, Deny, Deny.

During the investigation by the California Department of Health, Licensing and Certification, back in Dec. 2006, the nurses and doctors at Kaiser were interviewed/investigated regarding my account of how I was treated at Walnut Creek Labor and Delivery the evening before Lehna died. One nurse in particular, whose initials are J.V. (and she knows who she is), completely denied everything to investigators. Once again, Kaiser is off the hook since it is her word against mine. Why, I ask, would I have a need to make this sort of thing up? I remember it all like it was yesterday. This is not something you ever forget. I will also add that there was a deficiency notice given to Kaiser for their lack of documentation surrounding the Death of My Baby. This comes as no surprise.

ROADBLOCK Number 6: My Baby was a “Non-Event.”

California law says that since Lehna died before she was born that she is considered a “Non-Event.” Please take a look at the photos of My Baby. Does She look like a Non-Event? The Birth of Lehna was the biggest and most important event of my life (along with the birth of my first Daughter). With no disrespect to Laci and Connor Peterson, the manner of death should not be a factor in determining whether or not My Baby is considered a Human Being, an “event.” Lehna was most certainly an event to us. A MUCH-LOVED, FULL-TERM, BEAUTIFUL BABY GIRL.

I will continue to document the chain of events as I go along. But today, my oldest Daughter and I will eat cake and remember our Little Lehna who would have turned one today. It’s a very quiet day in our home.

Happy 1st Birthday My Dear Little Lehna.

Now this is funny. It’s rare that we post something that isn’t Kaiser related, but this extremely humorous political ad for Senator Ron Wyden’s Healthy Americans Act is about universal health care, which we strongly support.

While we would prefer a single-payer universal health care plan that cuts insurance company bureaucracy and greed out of the picture completely, we have our doubts that it is politically possible at this point in time. Wyden’s plan for guaranteed portable insurance coverage for all is a good start because it puts the “free” (as in freedom) back in free market. What universal health care opponents have long refused to acknowledge, is that there is no free market in health care when people are tied to jobs they hate just to keep their health coverage; or when they can’t change plans regardless of how poorly they are treated, because their employer only offers Kaiser.

Our sympathies go out to Kaiser employees everywhere, who not only have to work for a huge, uncaring corporate bureaucracy, but have to receive their health care there too.

For more information visit CareYouKeep.com

On 04/08/2008 a lawsuit was filed against Kaiser Permanente in Los Angeles Superior Court, on behalf of a two-year-old child that Kaiser has refused to treat for autism. The lawsuit accuses Kaiser of breach of contract, bad faith, unfair dealing, and is seeking class action status on the third complaint. As a result of the case, the DMHC is conducting a massive investigation into Kaiser’s practice of dumping all autistic children onto the government for care, and shifting its financial obligation onto taxpayers.

As one reader explained in this comment on another post:

Kaiser is required to treat Autism by statutory and contractual obligation, but on the other hand they claim not to cover any of the treatments for Autism in violation of the law. Their contract specifically provides for the treatment of Autism. However, the “treatment” that Kaiser offered the baby was two OT sessions a month, one visit with the Psychiatrist (no follow ups), and an assessment every three months. I wonder-what are they going to assess if there are no treatments offered?

All parents who feel Kaiser may have unfairly denied their child’s treatment for Autism are requested to contact attorney Scott Glovsky at sglovsky@arkinglovsky.com.

[Kaiser's PR statement about halfway through this article is interesting, as usual, because of what it doesn't say. They only stopped illegally rescinding policies in 2006 because they were caught and fined for it. The DMHC is now conducting a more in depth investigation that will reveal the illegal practice for what it is: standard operating procedure at KP and most other insurers.]

From the AP via San Jose Mercury News:

3 insurance companies to have dropped policies reviewed

By SHAYA TAYEFE MOHAJER Associated Press Writer

LOS ANGELES–Three of the state’s largest health insurance companies could be forced to reinstate thousands of dropped policies after a state regulatory agency on Thursday ordered an independent review.

The Department of Managed Health Care ordered the review of dropped policies the last four years by Kaiser Permanente, Anthem Blue Cross and Blue Shield of California.

A partial review of the three companies found that 26 people had been improperly dropped, said agency director Cindy Ehnes. Their policies were ordered reinstated immediately, and the insurance companies were also ordered to reimburse medical costs incurred after their insurance was dropped.

The cases were found in a random review of 286 cases and were “so clearly wrong that they needed to be reinstated right away,” Ehnes said.

Ten were Kaiser Permanente customers, eight from Anthem Blue Cross and eight from Blue Shield of California.

In a statement, Anthem Blue Cross said, “It is important to clarify that the survey found only a relatively small number of rescissions reviewed were improper.”

Kaiser Permanente issued a similar release, adding that the company had suspended the practice of rescissions since October 2006, and was “awaiting clear guidelines from the state.”

The California Association of Health Plans, a trade association representing 40 full-service health plans, issued a statement saying many insurers had made efforts in recent years to self-regulate.
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The trade association also noted that the threat of rescission is limited to the 2.6 million Californians who pay for their own coverage in individual plans, not those covered by their employers’ plans, Medicare, MediCal or other public programs.

Blue Shield declined further comment, saying they deferred to the trade association’s statement.

The regulatory agency’s announcement was applauded by Gov. Arnold Schwarzenegger, who pledged to work with legislators to “ensure this egregious practice is stopped.”

“It’s outrageous that innocent patients have to live in fear of losing their health care coverage,” said Schwarzenegger in a statement.

The order follows a Wednesday superior court filing by Los Angeles City Attorney Rocky Delgadillo, who said he would seek up to $1 billion in fines and restitution from Anthem Blue Cross for deceptive practices and unlawful termination of policies.

In recent months, the city attorney’s office sued another insurer, Health Net Inc., for allegedly canceling the policies of sick patients needing expensive treatment. As part of a separate suit, Health Net was ordered to pay $8.4 million in punitive damages to a woman whose policy was scrapped while she underwent treatment for breast cancer.

[How do you like that? Only at Kaiser can you kill two babies and endanger countless others, only to be handed $2 million of member money to quietly resign. The pattern should be glaringly obvious by now. Kaiser always tries to lie and buy its way out of a scandal, and only does the right thing when its malfeasance becomes a media event. Note that even after Safari turned down the settlement, Kaiser still would have declined to suspend him if only CMS hadn't rejected the first plan of correction (pdf).]

From the Fresno Bee:

Kaiser doctor rejected a deal

Hospital offered beleaguered Safari $2 million to resign.

By Tracy Correa

Three months before Kaiser Permanente suspended a Fresno physician at the center of a state investigation into the deaths of two babies, the hospital offered him $2 million to resign.

Dr. Hamid Safari, who treated high-risk pregnancies, said he refused the Nov. 28 offer because he wanted to continue working and believes he has done nothing wrong.

“I have spent my life to be a perinatologist and help patients, mothers and babies. The money was not my intention or my goal in life,” Safari said.

Kaiser officials acknowledged that they have discussed a settlement with Safari, but would not confirm the $2 million figure. The hospital suspended the doctor last week.

“We have considered many alternatives over time regarding Dr. Safari leaving the organization, including settlement, because we believed it was in everyone’s best interest,” Linda Monte, interim senior vice president and area manager for Kaiser’s Fresno hospital, said in a written statement.

The doctor and his lawyer, Stephen Schear, said Kaiser buckled under the pressure of bad publicity. They also criticized Kaiser for telling reporters about the suspension.

Schear said Safari was not interested in taking any amount of money in exchange for his career.

“Our counteroffer was to sit down and work things out so he could continue to treat patients at Kaiser Fresno,” he said.

Safari said a Kaiser representative showed up at his home about 5 p.m. on Feb. 29 and handed over a letter stating that he was suspended, effective immediately. He had been off that day for his deposition in a lawsuit filed by two Kaiser doctors who said they were retaliated against by hospital administration for questioning Safari’s competence.

The suspension followed months of criticism and public pressure on the doctor and Kaiser Permanente since details of the deaths — in 2004 and 2005 — became public late last year.

In September, the California Medical Board accused Safari of gross negligence — charges that could lead to loss of his California medical license. A hearing is pending.

In 2004, Safari waited more than three hours before performing a Caesarean section on a patient even though the baby was in distress, according to the accusation. The baby girl, who was deprived of oxygen, died 10 months later.

The other case occurred in 2005, when Safari allegedly severed the spinal cord of a baby boy, a twin, in what has been described by investigators in documents as a brutal delivery.

Medical staff and nurses have said they had raised questions about Safari’s competence but hospital administration failed to act.

Drs. Gilbert Moran and Robert Rusche are now suing Kaiser for retaliating against them after they complained about Safari.

Safari, in turn, accuses Moran — the former head of the OB/GYN department — and Rusche of complaining to the state medical board as part of a vendetta against him. He said they did so after he complained to superiors that one of the doctors was abusing his power on a quality review committee to go after doctors he didn’t like.

In January, federal health officials issued a critical 68-page report following an investigation into the situation. The report suggested that if Safari had been monitored more closely, the deaths might have been prevented.

Days later, Susan Ryan, the hospital’s then-top administrator, stepped down.

Schear said the bad publicity had become too much and Kaiser was determined to get rid of Safari. He also said that even though the doctor is suspended, he is collecting his Kaiser paycheck and is still entitled to due process, involving hearings and appeals, that can take months or years.

Schear said the $2 million settlement offer was an attempt to quickly disassociate the hospital from Safari and shortcut that process.

Schear provided The Bee a copy of a Nov. 28 letter from a Los Angeles law firm he said represented Kaiser. He blanked out all but one passage in the letter, which reads, “Kaiser will pay Dr. Safari $2 million, provided Dr. Safari complies with all conditions set forth herein.”

Schear said the letter also set forth conditions, including a confidentiality agreement and a pledge that Safari wouldn’t sue Kaiser.

“The essence was, you leave and we give you the money,” Schear said.

He said $2 million was a starting point and that the offer came “with indications they would pay him significantly more than that if he immediately resigned.”

Schear said he believes Kaiser moved to suspend Safari because it doesn’t think the medical board will end up revoking his license when all the facts come out.

“They just decided to throw him overboard,” Schear said.

Safari said he has performed well in recent months and that there have been no reports of any problems since 2005. He said his patient satisfaction rates are the highest they have ever been and only eight Kaiser patients have asked to be reassigned to another doctor.

“I think the action [suspension] was taken because he’s performing too well and building up a track record,” Schear said. “The longer he goes without problems, the harder it is to get rid of him.”

Safari now serves primarily as a consultant in high-risk births. Kaiser restricted Safari in July 2005 from performing vaginal deliveries and made the restrictions permanent in April 2007.

[Kaiser Permanente had no intention of suspending this murdering doctor, and did so only because CMS rejected Kaiser's initial plan of correction (pdf).]

From the LA Times:

Kaiser suspends accused doctor

Co-workers questioned the competency of Hamid Safari, who handled high-risk pregnancies at a Fresno hospital.

By Charles Ornstein and Tracy Weber, Los Angeles Times Staff Writers

Kaiser Permanente has suspended a physician who handled high-risk pregnancies at its Fresno hospital, more than four months after the Los Angeles Times reported that doctors and nurses there had repeatedly questioned his competence.

In a statement released late Friday, interim hospital Administrator Linda Monte said that, effective immediately, perinatologist Hamid Safari would not be able to provide care to any Kaiser member in a hospital or outpatient setting.

“Kaiser Permanente is committed to ensuring the safety of our patients, and we take this obligation to our members and patients seriously,” Monte said in the statement.

Safari allegedly botched at least two deliveries after staff members began raising concerns about his skills and demeanor, The Times reported in October. One baby died in the delivery room in April 2005; another died months after her January 2004 birth. Safari has been accused of gross negligence by the Medical Board of California.

His attorney, Stephen D. Schear, has said his client did nothing wrong. Neither Safari nor Schear could be reached Friday.

In January, federal inspectors criticized the way Kaiser responded to complaints about Safari and said that had the hospital kept a closer watch over its medical staff, the two babies might still be alive.

Days later, the hospital’s administrator stepped down.

In July 2005, three months after the second baby’s death, Kaiser imposed restrictions on Safari, barring him from performing vaginal deliveries and requiring him to be monitored by another physician or advanced-practice nurse. The restrictions became permanent last April, hospital officials said.

Since September, Safari has not performed any surgeries or caesarean sections and has served as a consultant at the hospital, they said.

Monte said the hospital decided it had to take further action “after detailed and comprehensive quality reviews during the last year.” It also was cooperating with the medical board’s investigation of Safari, she said.

Safari has the ability to appeal any discipline against him, and that process can take months. Monte said state law prevented her from “discussing publicly any peer review matters or inquiry into Dr. Safari’s quality of care.”

Kaiser still faces a lawsuit by two doctors who contend they were punished after raising concerns about Safari’s work.

[This update to the Hamid Safari case came out a few days ago. We're happy to see a resignation come from this situation, and we're hearing rumors that there might be another one that hasn't been announced yet. This is a change for Kaiser. Usually what we hear are a lot of denials, and some of the worst offenders in these scandals can end up being promoted, not fired -- especially the ones who have learned to keep their mouths shut, or are willing to perjure themselves to keep Kaiser out of trouble. We don't know if Kaiser is finally getting a clue, or if this is some kind of fluke that will never be repeated, but either way it's a good move where patients are concerned. The fact that the spokesliars didn't give the usual statement claiming the resignation was for unrelated family reasons, or that this person is "retiring" is also a good sign.]

From the LA Times:

Administrator at Kaiser’s Fresno hospital steps down

Susan Ryan’s resignation comes after a federal report faults the hospital for its slow response to complaints about a physician

By Charles Ornstein, Los Angeles Times Staff Writer

January 29, 2008

The administrator of Kaiser Permanente’s Fresno hospital stepped down Monday, days after the release of a federal report that criticized the way the medical center responded to complaints about a doctor who handled high-risk pregnancies.

In a written statement released late Monday, Kaiser said Fresno hospital administrator Susan Ryan had resigned, effective immediately.

Last week, the U.S. Centers for Medicare and Medicaid Services released a report suggesting that if Kaiser Fresno had kept a closer watch over its medical staff, two babies might still be alive.

The review was the latest in a series of critical assessments of the giant health maintenance organization, the nation’s largest with 6.5 million members in California.

The Medicare agency investigated the Fresno hospital after the Los Angeles Times reported in October that doctors and nurses had complained repeatedly to higher-ups about perinatologist Hamid Safari’s medical and interpersonal skills.

Rather than address their concerns, staffers told the newspaper, hospital leaders allowed Safari to continue handling high-risk pregnancies without restriction.

Safari allegedly botched at least two deliveries after staff members raised their concerns. One baby died in the delivery room in April 2005; another died months after her January 2004 birth. Safari has been accused of gross negligence by the state medical board; his attorney said he did nothing wrong.

Gregory A. Adams, associate regional president and chief operating officer of Kaiser Foundation Health Plan and Hospitals in Northern California, acknowledged in a written statement that the federal report was “highly critical of the Fresno hospital administration’s oversight.”

“We have reviewed the facts and taken action to address the leadership issues raised in this report,” he wrote.

Last week, in response to the federal report, Ryan defended the hospital’s quality oversight program and said officials had taken appropriate action after Safari’s alleged mishaps.

“When these events occurred, they were thoroughly investigated and corrective actions were taken,” she said in a written statement Friday. “This has led to significant improvements in our perinatal safety program.”

In July 2005, three months after the second baby’s death, Kaiser imposed restrictions on Safari, barring him from performing vaginal deliveries and requiring him to be monitored by another physician or advanced-practice nurse. The restrictions became permanent in April 2007, hospital officials said.

Since September, Safari has not performed any surgeries or C-sections and has served as a consultant at the hospital, Ryan said last week.

Ryan, who took over in August 2005, was not in charge at the time of the allegedly problematic deliveries by Safari. But a Kaiser spokesman said that “the hospital administrator has responsibility and accountability for the systems and processes in the hospital.”

Spokesman Mike Lassiter declined to say whether the hospital planned to take action against Dr. Varoujan Altebarmakian, the hospital’s physician in chief since 1999, who records show received numerous complaints about Safari.

Linda Monte, current chief operating officer of Kaiser’s South San Francisco hospital, has taken over as interim hospital administrator.

[It's late and I'm tired, so I'm posting this without commentary. I'll add more information as the news stories start trickling in tomorrow. But whew! 3.2 million.]

From the OC register:

Kaiser pays $3.2 million in birthing malpractice case

A now 14-year-old girl wasn’t breathing when she was born at the Anaheim hospital.

BY COURTNEY PERKES

A 14-year-old Lake Forest girl who suffered brain damage during her birth at Kaiser Permanente’s Anaheim hospital received a $3.2 million settlement this month.

Ariana Ehtemam wasn’t breathing when she was delivered by Caesarean section and now suffers from physical and behavioral problems, according to court documents.

The money from Kaiser has purchased an annuity worth $20 million over her lifetime. She will receive the first payment at 18.

Her parents, Ardie and Ela Ehtemam, declined to comment through their attorney, Frank Barbaro.

The settlement was reached after a binding arbitration decision in favor of the family.

“We were surprised by the verdict but want to extend our sympathy to the family,” Kaiser spokesman Jim Anderson said Tuesday.

According to court settlement papers filed Jan. 11, Ela Ehtemam’s C-section wasn’t performed in a timely matter. The baby had to be resuscitated and spent several weeks in the hospital. Ariana now suffers from hearing loss, poor impulse control and attention deficits.

The money will pay for future medical expenses, ongoing rehabilitation services and any residential supervision she may need.

“She is keeping up with her schooling,” Barbaro said. “She has to have a lot of accommodations. She has these wonderful parents who really do protect her and a school district responding to her need.”

In California, malpractice judgments are capped at $250,000 for pain and suffering. Additional monetary damages result from loss of wages and need for ongoing care. Some of Orange County’s largest medical malpractice judgments have exceeded $15 million.

Late last year, Kaiser paid $1.8 million to the family of a Huntington Beach man who suffered a brain aneurysm after his headache was misdiagnosed.

Contact the writer: 714-796-3686 or cperkes@ocregister.com

[Same old story: complaints were ignored, patients died, whistleblowers were retaliated against, and Kaiser denies any wrongdoing regardless of copious evidence to the contrary. It happens so often we would be bored if it wasn't so damned tragic. Scroll down to the bottom of the story for a link to the original report about this incident from last October.]

From the LA Times:

Report criticizes Kaiser for lack of action

Federal inspectors fault its Fresno hospital’s response to complaints about a doctor who allegedly fatally botched two deliveries.

By Tracy Weber and Charles Ornstein

If Kaiser Permanente’s Fresno hospital had acted on complaints and kept a closer watch over its medical staff, two babies might still be alive, federal health inspectors concluded in a report released this week.

The U.S. Centers for Medicare and Medicaid Services began investigating the hospital in October, two days after the Los Angeles Times reported that doctors and nurses had complained repeatedly to higher-ups about perinatologist Hamid Safari’s medical and interpersonal skills.

Rather than address their concerns, hospital leaders allowed Safari to continue treating high-risk pregnant women without restriction, staffers told the newspaper.

Safari allegedly botched at least two deliveries after staff members had raised concerns. One baby died in the delivery room; another, months after her birth.

In its report, the Medicare agency criticized the way Kaiser Fresno responded to those deliveries, both of which were detailed in The Times story. At least one staffer told inspectors that Kaiser had received complaints about Safari as far back as 1998.

In a written response to the report, Kaiser Fresno administrator Susan Ryan defended the hospital’s quality oversight program and said officials took appropriate action after Safari’s alleged mistakes.

In a statement to The Times on Friday, Ryan said, “These are difficult and emotional situations, and we empathize with all involved. When these events occurred, they were thoroughly investigated and corrective actions were taken. This has led to significant improvements in our perinatal safety program.”

In one of the two cases cited by inspectors, Safari waited more than three hours before he performed a caesarean section on a patient in 2004 — even though there was clear evidence that her baby was in distress, the report said. The baby was severely deprived of oxygen and died months later.

One Kaiser nurse told inspectors that she fruitlessly voiced concerns about the baby’s condition to Safari, and that after the delivery, the perinatologist “was hounding nurses” and telling them how to describe the incident in the medical records.

Another staffer told inspectors there was a “violation of common sense and standard of practice” during that delivery.

In the other case, in April 2005, Safari allegedly severed the spinal cord of a baby after repeatedly and vigorously attempting to draw him out with a vacuum extractor. When the baby finally emerged, he was “white as a sheet” and unresponsive, staffers told inspectors. He died.

A clinical summary documented that the baby “had a good fetal heart rate up to the time of delivery,” the Medicare report said.

One nurse told inspectors that after the baby was pronounced dead, Safari was “angry and yelled at everyone else saying it was their fault.” Safari then “harassed” staff members and told them what to write in the medical records, the nurse said.

In July 2005, three months after the second baby’s death, Kaiser imposed restrictions on Safari, barring him from performing vaginal deliveries and requiring him to be monitored by another physician or advanced-practice nurse. The restrictions became permanent last April, hospital officials said.

Since September, Safari has not performed any surgeries or c-sections and has served only as a consultant at the hospital, Ryan wrote Friday.

The federal report refers to additional guidelines that had been put in place for Safari, including a rule that he make his rounds with a high-risk nurse specialist. But nurses told inspectors that Safari did not follow those rules, and the hospital did nothing about it.

One perinatal nurse said Safari’s failure to comply “was a serious and significant problem with potential negative impact” on his patients. The federal report concluded that Kaiser’s failure to hold Safari accountable “placed patients at risk.”

In her statement to The Times, Ryan wrote that the hospital “will take further steps to ensure Dr. Safari is accompanied during rounds.”

The federal report is the latest in a series of critical assessments of Safari, Kaiser Fresno and the giant HMO itself, the nation’s largest, with 6.5 million members in California.

In September, the state medical board accused Safari of gross negligence, seeking to revoke or suspend his license. And Kaiser’s handling of the matter is the subject of a civil lawsuit filed by two doctors who claim they were punished for raising concerns about the April 2005 incident in which the baby died. Kaiser denies the allegations.

Safari’s lawyer, Stephen D. Schear, said he believes his client will be exonerated. He also speculated that the federal report was based on “bad information” from the same sources who talked to the medical board and perhaps The Times.

“This is all just a tragic smearing of a very excellent doctor by people who had motivation and the means to ruin his reputation without basis,” Schear said.

Previously:

Kaiser covers up for another negligent doctor, whistleblowers retaliated against — AGAIN

[One of the more disturbing patterns that has emerged over four years of tracking Kaiser's many misdeeds, is that patients with very real and serious medical problems are often misdiagnosed with mental health issues, leading to much unnecessary suffering, and sometimes death. A few recent examples are the cases of Jupirena Stein, Craig Pozzi, and a woman with West Nile Virus, who was repeatedly told her symptoms were all in her head even after a positive blood test confirmed the infection. For the reason behind this troublesome trend, one need look no further than Kaiser's clinical practice guidelines, where Kaiser doctors are instructed to label anyone with an undiagnosed illness as a psych case.

Update 12/9/07: We have added a scan of A Secret of Behavioral Health Integration: The Handoff from "The Collected Papers of Nicholas A. Cummings, Volume I: The Value of Psychological Treatment." In it he describes the process by which Kaiser members are manipulated into accepting mental health treatment for physical illnesses.

The money quote (because it's always about the money at Kaiser):

"Without this seemingly simple touch, patient compliance was not very good, but with this idea of the handoff, compliance jumped to 90 percent. And the saving in medical costs was tremendous."

Cummings developed the Kaiser Behavioral Health Division.]

From the OC Register:

Kaiser to pay $1.8 million in malpractice case

45-year-old man was not diagnosed with cerebral bleeding and later suffered permanent brain damage.

BY COURTNEY PERKES

Kaiser Permanente will pay $1.8 million to the family of a man who suffered a brain aneurysm after his headache was wrongly attributed to grief.

In 2005, 45-year-old Ted Blackwell visited a Kaiser clinic in Orange County with a headache and neck pain. According to the binding arbitration document, doctors attributed his symptoms to grief over the death of his brother eight days earlier.

He received an injection and was sent home.

Blackwell returned to the clinic two days later, still in pain. According to the document, his daughter requested a CT scan because of her father’s disorientation but doctors decided that wasn’t necessary.

Two days later, Blackwell collapsed and underwent surgery at Hoag Hospital for bleeding in his brain. He suffered permanent brain damage and is unable to work, according to his attorney James McElroy of Del Mar.

Jim Anderson, a spokesman for Kaiser, expressed sympathy to Blackwell, but added “we thought differently in this or we wouldn’t have taken it to arbitration.”

The award, decided by arbitrator Robert Devich, covers pain and suffering and lost wages, but the bulk is for around-the-clock supervision for the rest of Blackwell’s life.

In California, malpractice judgments are capped at $250,000 for pain and suffering. Additional monetary damages result from loss of wages and need for ongoing care.

Contact the writer: 714-796-3686 or cperkes@ocregister.com