Your HMO – Part 2
Aired: November 26, 1996
According to consumer surveys, 85 percent of Kaiser Permanente’s health plan members say they’re satisfied with their health care. This is one of the highest approval ratings in the HMO industry. But not everybody’s happy. And when some people complain about life and death issues, Kaiser may not be doing enough to solve their problems.
It has been ten months since Terry Preston’s mother died at Kaiser Permanente Hospital in Hayward. And for those ten months, Terry says she’s been trapped in Kaiser’s complaint system, “I don’t believe that Kaiser has a complaint system. If they do, they certainly keep it secret from the people that want to complain.
Terry is complaining about what happened to her mother last January 26. That morning, 74-year-old Margaret Utterback awakened with a sharp pain in her side. For several hours, she tried to reach her doctor at Kaiser Medical Clinic in Hayward. Margaret made six or seven calls describing her symptoms over and over, but she could never get through to a doctor or nurse. Finally, someone gave her a doctor’s appointment for 4:15pm.
Margaret’s other daughter, Barbara Winnie, gets emotional even today thinking about it, “I remember every day, you know, what the day was like trying to get her in.”
Arriving at the clinic early, daughter Barbara says they pleaded with the registration clerk three times to see the doctor, but still waited almost two hours. By that time it was too late. All day long the main artery in Margaret Utterback’s abdomen had been ballooning with blood. As she was finally being rushed to surgery, the balloon burst. She died two days later.
Barbara says tearfully, “It wasn’t good medicine. Nobody with that kind of pain and symptoms should be allowed to go through a whole day trying to get to see her doctor.” But Kaiser has a different story to tell. Katherine Alexander of Kaiser’s public relations office says, “I think that we truly believe that Mrs. Utterback received prompt attention. She was worked into the schedule. She was seen by the physician when he set up an appointment for her. I think he did a very good diagnosis. She was transported to the ER and operated on immediately.”
Kaiser Permanente says it did nothing wrong that day, and that Margaret Utterback made the mistake of waiting to see her doctor instead of going straight to the emergency room. For most families, that might have ended the matter. But in Margaret Utterback’s family, there are three nurses and a doctor. And they say that Kaiser made the mistakes that day.
“We began the complaint process a week after she died,” says Terry, who is not a medical person. The other family members are afraid of backlash from the medical community if they go on television.
The family wrote detailed letters to Kaiser pointing out what went wrong, and suggesting changes in how Kaiser should handle patients in the future, especially when they call for medical advice.
“We told them this wasn’t a lawsuit,” says Terry. “We just wanted things changed at Kaiser so this wouldn’t happen again.” She followed Kaiser’s complaint procedure, but hit a stone wall.
Dr. Wesley Lisker, Chief of Medical Quality at Kaiser-Hayward, says Kaiser tries to deal with complaints quickly and effectively. “We do not want to keep people in the dark about these things; it doesn’t serve any purpose. This has to be an open process.” He says if Terry goes to administration or member assistance and speaks to the staff, she will get answers. Terry says she did go to administration and to member assistance, but when she asked to see her complaint file nobody knew where it was. So, last June, Terry decided to go over Kaiser’s head. She filed a complaint with the California Department of Corporations (DOC), which oversees the HMO industry.
By coincidence, one week after Margaret Utterback’s death the DOC issued a report describing more than a dozen deficiencies in the Kaiser Health Care System, including problems with the patient call-in system. What’s more, the DOC called Kaiser’s complaint process “inadequate.”
The DOC ordered Kaiser to clean up its complaint system in order to fix any problems that might affect patients’ health. And the DOC told Kaiser to do a better job of responding to patients who file complaints.
Last month, Kaiser did respond to Terry’s DOC complaint with a letter, which Terry says is nothing more than a “cover-up” of Kaiser’s mistakes in her mother’s death. For example, the letter says that when Terry’s mother came to the medical clinic, “she was registered and seen within fifteen minutes of her scheduled (appointment).”
But, says Terry, “There’s a big gap in there about the part that she had to wait in the waiting room for two hours when the waiting room was essentially empty. When she went up to the desk three times pleading to be seen because she was in so much pain, that part they just skimmed over.”
We asked Dr. Lisker about the time discrepancy in Kaiser’s letter. “Well, she may have come in somewhat earlier asking to be seen,” he responds. “And uh, you know, I don’t know what to say about this right now.”
has been trying to call the woman who wrote Kaiser’s letter
from a department called Member Relations, but she’s having trouble
Member Relations. “There’s no number there; no telephone number at
says Terry, “not in her signature and not in the letterhead.” So Terry
keeps getting transferred or put on hold, left with the death of her
and no real answers. Terry
Preston did finally locate member relations, who referred her
to Dr. Lisker. Dr. Lisker says he’s sorry for any trouble with Terry
complaint and has offered to meet with her to clear things up. We
add that healthcare professionals we talked to outside of Kaiser say
is one of the most responsible of the HMOs, and that the “deficiencies”
exposed by the Department of Corporations could well be worse in other
managed care systems.