Tuesday, April 25, 2006

Memorable Kaiser Malpractices

Here are some of the more tragic instances of Kaiser's malpractices.

Monday, April 24, 2006

Having trouble getting your medical records?

For some reason, it can be difficult for patients to obtain health information about themselves. Here's one method for getting your records.

State action against bloggers violation of constitutional rights


This individual had Kaiser actually launch a disinformation attack against them.

Here's the whole story
... and a timeline

Patient denied health insurance because of Kaiser Permanente's faulty information

So more recently, I tried to leave Kaiser. That as well is a long complicated story, but I decided to try switching to a PPO. I was denied coverage because of a list of items, three of which were not even true. Two were both "guesses" on the part of the nurse practitioner who diagnosed me. A third was just a blatant lie. They claimed that I had not had a test done, and it had been done, and with a good outcome.

It was also interesting to me that when I received requests to access my health information from the PPO (they're required to get these because of HIPPA, I presume), the form was designed in such a way that it looked as if it was mandatory for you to reveal information such as psychiatric care and whether or not you have HIV. It is illegal for a health insurer to ask those questions of an applicant, but they were just trying to see if someone would sign it by accident, allowing them to check.

Kaiser chooses not to participate in patient satisfaction survey

Check it out here

Kaiser Permanente Thrive Exposed

Do you feel you've been thriving at Kaiser? Read more on this "be pro anti-HMO" site. It's a great site with lots of information about "Kaiser Permaprofit".
http://www.kaiserthrive.org/

Here are some Kaiser horror stories:
http://www.kaiserthrive.org/kaiser-permanente-horror-stories/#warehousing

http://corphq.livejournal.com/51385.html

Monday, April 03, 2006

Avoid using Monistat for recurrent yeast infections

Overuse of creams to treat vaginal itching.
I took Monistat 7, 3, etc., trying to get rid of my problems and Kaiser (my HMO) wasn't helping. Finally at some point I developed an allergy to it which I think may have been one of the reasons I had chronic yeast infections. I had burning and abdominal pain. A year later I took it because I couldn't afford a prescription medication at that point and had a repeat of the burning and abdominal pain. I suspect a lot of people are developing immunities to these types of medications.

I'm angry that women spend so much on a product to get their symptoms under control when they don't have a good alternative (for many people oral anti-fungals are not effective at some point).

If I wasn't laughing I'd be screaming: Trying to get treated at Kaiser Permanente

If I wasn’t laughing, I’d be Screaming (Part I)
or
The difficulties in trying to get treated as a patient at
Kaiser Permanente
Part I

READ Part II



The following story illustrates how difficult it is for a patient to be treated at Kaiser Permanente.

Synopsis:
Patient has a hip injury, is released from emergency care, and chaos ensues as patient tries to a) determine the cause of injury is and b) seek treatment.

January 2005. I injured my hip at a dance rehearsal. The director picked me up and carried me to his van, and drove me to the emergency room (I will call it Facility 1) an hour away. We would have gone to the nearest Kaiser, but another dancer advised, “Don’t go there. They’re so slow; one time I was there and bleeding for hours before I got seen.”

After finding an entrance around the construction near the emergency room, I was admitted, and got x-rays taken. While I waited, I was told that they had given the wrong x-rays to the doctor by mistake. I waited some more. When I saw the doctor (I will call him ER Doctor), he did a very cursory examination. The x-rays showed no broken bones or dislocations. He looked briefly at my hip, had me stand up and take a couple of steps. When I didn’t fall down, he must have decided I was fine, because he sent me home. I asked him when I’d be able to dance, and he said, “by next week”.

I was in a hospital wheelchair at the time, and it was extremely painful to put weight on that leg at all. I asked them if I could borrow crutches, and they checked with the doctor. “No, he says you’ll be fine. Just try to stay off of it.” I was driven home, and carried to bed, which I barely left the next couple days. I could barely walk to the bathroom. My Mom came and dropped off some crutches she had at her house. If she hadn’t, I don’t know how I would have eaten.

Two weeks went by. My chiropractor looked at my hip and said I might have strained a muscle, but it was possible I could have a labrum tear or have fractured something, and that I should get an MRI to be sure. I pay for chiropractic and acupuncture out of pocket because Kaiser generally doesn’t cover such things, even though I have sought them as an alternative to the healthcare system which isn’t working for me. “Oh right, like Kaiser would just give me an MRI,” I said. I called and left a message with my Primary Care Physician. She had been helpful in the past, and listened to me and paid more attention to my medical history than most doctors I encountered. I told her what my chiropractor had said and asked if she could get me an MRI. I even left my chiropractor’s phone number. Several phone calls and days later, she said she could get an appointment for me with orthopedics. My chiropractor later related that she had been rude to him on the phone but he mentioned the possibility of avascular necrosis, so she had to agree to order the test or be liable later.

Many phone calls and a week later, I had an orthopedics appointment for Friday February 18 (one and half weeks after requesting an MRI). I went to the nearby Kaiser orthopedics (Facility #2, the one I had been warned about), where I’d be referred to Dr.#2. They told me to come an hour and a half early. I soon found out why. This facility is probably the most inefficient Kaiser branch I have ever been to. Either that, or extremely ill-equipped and understaffed. I could see why the other dancer had recommended avoiding it. I had to walk over to get x-rays done myself, where I stood in line leaning on my crutches for ten minutes.
While in line, I wondered why I had to get more x-rays when I needed an MRI. From the waiting area, I could see into their back hallway, where patients lay in rolling carts or sat half-dressed in chairs lining the hallway, waiting for their x-rays. “How embarrassing,” I thought, feeling sorry for the patients. The woman in radiology was working the desk by herself during lunch break. “I document it,” she said, frustration evident in her voice.

When I was called in to be x-rayed, I was given a robe to change into and pointed toward a closet-like room. I changed and put clothes into my backpack. Good thing I had it with me, since they hadn’t supplied any bags or suggested a place for clothes. I sat on a chair in the hallway, feeling exposed to the waiting room and sharing horror stories with a woman next to me. “They nearly killed my husband,” she said.

In the x-ray room, I asked if they could cover the ovaries somehow since they were taking an x-ray of the pelvic area. The x-ray attendant couldn’t find anything to cover them with (they’re supposed to have that strangely shaped thing they place over your abdomen while they x-ray you). Finally she found one, though she pointed out that they needed x-rays of the other side. “Just try to make sure you’re ovulating on your right side when you get pregnant,” she joked. I understood it wasn’t too much of a concern since I wasn’t pregnant, but would have felt more comfortable if the equipment hadn’t looked very old.

Out in the hallway again, feeling half-naked. I was handed my x-rays and hobbled back to orthopedics. There I waited for more time until eventually I was called in to see Dr. #1. He asked me if I had any medical conditions. I asked him to define a medical condition. He listed heart disease, diabetes, etc. I told him I’d been having a lot of pain in my wrists. He said, “I’m not talking about minor aches and pains, I’m talking about medical conditions. I’ll put down no.” I wondered if tendonitis counted as a medical condition. Or how about a history of chronic yeast infections and overactive bladder? It was strange that he didn’t have access to my medical records.

He examined me for a while, and asked questions. Finally he said he thought I’d be fine from the incident. But he did want to tell me about some hip dysplasia he thought he’d found. He said the upper part of my acetabulum was not as curved as it should be, which prevented the femur from going in all the way, and could cause arthritis in “fifteen, twenty, thirty years”. He wanted to talk to an orthopedic surgeon about it. I asked if I could talk to him about my wrists because I’d been having a lot of pain in them recently. I’d had wrist pain for a year, which I had tried to seek help from Kaiser about, and had only ended up with a record of “tendonitis”, although the nurse practitioner admitted she wasn’t sure what it was. I had given up and was seeing an acupuncturist. Who knows what else is in my records that Kaiser never really was sure about. I suspect if I told them I had a deadly peanut allergy they would simply record it without testing, thereby worsening my health record, which prevents patients from receiving healthcare. (Patients who have “prior conditions” have great difficulty receiving individual coverage.)

Dr. #1 refused to look at my wrists, saying he didn’t have time. There were a lot of patients in the waiting room; I could attest to that. I also knew that if I tried to get an orthopedics appointment myself I would have to see my nurse practitioner first ($50 copay visit), then wait at least a week, then see him or another orthopedist (another $50 copay). I told him it was interfering with my work, and I told him it would cost me $100 to see him and that it was very difficult to get an appointment with a specialist at Kaiser. “No it’s not,” he said. “You got one today right after you called.” Actually it took me a week and a half, probably ten phone calls, and $50 to see an orthopedist. And the only reason I hadn’t had to see a nurse practitioner first is that she agreed to talk to my chiropractor and schedule an appointment without coming in.

The next morning, I got a call from Dr. #1. “Is this about my wrists?” I asked. No, but he had talked to the orthopedic surgeon, who agreed about the hip displaysia and thought I might have a labrum tear in my hip. “That’s what my chiropractor said,” I agreed. He wanted me to come in and get an MRI done, which is what I wanted in the first place. He asked me what time I could come in, and I suggested 2pm. He said he would see me any time that day, and would have someone call to set up a time. After I hung up, I realized that there would be fewer people in the morning, and decided to go in earlier. I called and left a message saying so. Then I got another call from Dr. #1. “Can you come in the morning?” I told him I was on my way.

I drove back to Kaiser Facility #2, my hip hurting intensely from walking around so much at Kaiser the previous day. I had to park again in the upper lot, very far from the entrance, since those spots are reserved for those with handicapped plates on their cars. By the time I got there, I was in a lot of pain. I asked the woman at orthopedics for a wheelchair. She called and said she couldn’t reach the appropriate department or they didn’t have one available, I don’t recall which. She was having trouble getting the credit card reader to take my card. Later I was told that Dr. #1 wouldn’t be charging for the visit since I’d been seen the previous day. I sat down next to a man with an artificial leg, caused by diabetes. He was very nice. “No use getting depressed about it,” he said.

I was shown into the exam room, and propped into the chair. After a long time, Dr. #1 came in and apologized. He told me the orthopedic surgeon was very busy, moved my leg around a little bit to test something, and left again. I think I was waiting at least half an hour. Finally Dr. #2 came in. He was very nice, and seemed to have more experience working with patients and more knowledge about orthopedics in general. He explained that I needed an MRI, but that they couldn’t do it there. I needed an arthrographic MRI (or MRA), which involved injecting dye into the area first. I wondered why I had been sent to an orthopedics department with the wrong type of MRI for my injury type.

He didn’t mention the hip dysplasia, but said he thought I might have a torn labrum. I said, “That’s what my chiropractor said.” Dr. #1 wondered if we should wait to get the MRI done “in case it gets better.” (Looking back at this from a later vantage point, I can’t believe he suggested that.) I was very relieved when Dr. #2 said no, that we wanted to get it done as soon as possible so we knew what was going on. Dr. #2 showed Dr. #1 a way of testing for this by pulling my leg far out to the side. When Dr.#1 tried it, he was almost yanking at my leg. Dr. #2 noticed and said, “You’re hurting her,” and I was glad that he was so in tune with how I was feeling.

Note: Three years after writing this, Dr. #2 has left Kaiser (big surprise, he was probably frustrated) and Dr. #1 has gotten reviews from other patients of being misdiagnosed and not being board certified in orthopedics. I’m not sure if that has changed.

Dr. #1 told me that I would get a call from orthopedics, and that we shouldn’t schedule physical therapy until after I’d had the MRI. I went to leave the hospital, and realized that after walking all that time and having my leg pulled this way and that, I was in a lot of pain. I didn’t think I’d be able to make it all the way out into the parking lot to my car.

I walked out into the hallway and went to the information desk to ask for a wheelchair. There was no one there. I think they were gone that day. I asked a passing man who looked like an attendant. He couldn’t help me. He indicated a security guard. I asked the security guard. He said he couldn’t help me get out to my car, that it wasn’t part of their job. I asked him if he could radio someone for a wheelchair. Finally I got him to radio his boss, and he couldn’t help me. He suggested I walk down the hallway to somewhere else. I walked further down and finally asked an attendant wheeling another woman if someone could wheel me out to my car. She suggested sitting down and said she would find someone.
I sat down and started crying, I was just in so much pain and so frustrated. People walked by and ignored me. I wondered how long a patient who was in pain could be ignored in a hospital if something were more serious. A couple minutes later she came back herself with a chair. It turned out she was a volunteer! She was really nice, and wheeled me out to my car, where I was able to drive home. As far as I could tell, there were no wheelchairs at Facility #2 hospital available for patient use, and since I didn’t have someone with me to wheel me around, no attendants were readily available to help with that.

A week went by, and no call from orthopedics. I decided to call them myself on Thursday, February 24. I documented the call, to illustrate the typical process in trying to accomplish something through the Kaiser phone system.

February 24
8:49am. It took 2 minutes to get through the initial part of the call, where an automated voice told me about allergies, flu, and other things which were not emergency-related. I could not press any buttons to bypass this message.

8:53am. I talked to a phone attendant (probably not a nurse). She said the system had me down as waiting for Facility #2 orthopedics. I wanted Facility #1. Facility #2 orthopedics had already told me they did not do arthrographic MRIs. I wondered what would have happened if I had not called.
She put me on hold to find out what was going on, and we got disconnected. I waited for her to call me back, but she did not.

9:05. After a couple minutes (yes I really did only accomplish that much in 12 minutes) I called again.
9:08. Still waiting, listening to Davis Kaiser’s depressing waiting phone music.
9:12. I got to talk to a call attendant.
I explained what had happened to her, and she said they weren’t allowed to call people back. She gave me the phone number for Facility #1 radiology and said she would transfer me.
9:14 I was on hold again.
9:17 The original person came back on the line and said she had gotten through to radiology and that they would pick up soon.
9:21 Radiology. The person I was talking to had been told nothing. I explained briefly what I wanted (an arthrographic MRI at Facility #1). She said she’d check if they did that type of MRI.
9:24 On hold again.
9:26 “The person you need to talk to is—“
“On vacation?”
She laughed, “No.”
“Sick?”
She laughed again. “No, they’ll be in the office in 5 minutes.”
I said, if it was only five minutes I’d like to wait. I’d already been on the phone for half an hour. What was another five minutes? She pointed out that there were people behind me in the phone queue. She transferred me, I left a message, and waited.

9:52am. I got a call back. While we waited for her slow computer, I explained what I wanted (an arthrographic MRI). She finally asked if I could come in the following Monday. I said, “Yes, and I’m available today.”
“How about 2:20?” I was excited. Finally the MRI appointment I’d dreamed about. “Great!” I hung up and called my partner to tell him the news. I’d gotten the appointment I wanted. Shortly through the call I had call waiting. I switched back to find the same person on the line. She told me that we couldn’t do the MRI. The person who did arthrographic MRIs was out of the office today. She would have to wait until Monday to schedule it, and these things often took two weeks. “Two weeks? That’s crazy. I’ve been waiting for two weeks already.” She apologized and said she would call me on Monday.


To be continued…


Unfortunately, this story and ones like it are not at all uncommon. This is just one of many incidences experienced by this patient in trying to get healthcare.
My goal by sharing this story is not to bash Kaiser doctors. I’ve had good doctors and bad doctors there, just like Dr. #1 (who misdiagnosed me, hurt me, and was rude) and Dr. #2 (who was caring and tried to get the necessary tests, and accurately diagnosed me). But the system which both doctors and patients must deal with does not work. And it’s time that patients’ experiences were recognized.


READ Part II