Kaiser Fined $1 Million in Patient’s Death

The state Department of Corporations, saying it discovered “systemic health care delivery problems” at Kaiser Permanente, has levied a $1-million fine against the giant HMO for allegedly delaying urgently needed care to a 74-year-old patient who later died.

The fine against Kaiser, the state’s largest health maintenance organization, is one of the biggest penalties ever for alleged lapses in patient care.

Consumer advocates say the penalty may signify a more rigorous approach to HMO regulation on the state’s part, just as oversight of HMOs is to be passed from the Department of Corporations to a newly created Department of Managed Care this summer. Critics have long contended that the corporations department’s approach to HMOs has been unfocused and lax.

The action stems from a 1996 case in which a Kaiser Permanente patient who was suffering from back and abdominal pain pleaded throughout the day to see a Hayward clinic doctor, according to Department of Corporations documents released Monday. When she finally was seen, she did not receive appropriate or prompt emergency treatment, the department contends.

Margaret Utterback suffered a ruptured aortic aneurysm minutes after arriving in the emergency room and died 1 1/2 days later, the department says.

In documents released Monday, the corporations department faulted Kaiser for what it described as systemic problems: failing to ensure that care be accessible to enrollees; failing to provide basic health care services, including preventive and emergency care, and failing to have medical records readily available.

Kaiser Permanente is entitled to a hearing on the matter. Although the HMO says it has already made some changes in response to the incident, a Kaiser official vowed on Monday to vigorously fight the penalty.

“We will be appealing the [Department of Corporations] allegations because we believe [the department] is essentially proposing a new and dangerous standard of oversight,” Kaiser spokesman Jim Anderson said.

HMOs should not be put in the position of intervening in the practice of medicine, Anderson said. “In effect,” he said, “we believe the [department] would have health plans tell physicians how to practice.”

Anderson said Kaiser extends its sympathies to Utterback’s family, which has “suffered a great loss.” However, he said that even the Medical Board of California, which he said had reviewed the case, came up with “no adverse findings” against the physician involved.

The department has issued at least one larger fine against an HMO--a $3-million fine against Western Dental Services in 1996, which was settled at $1.7 million, a spokeswoman said. But this fine against Kaiser far exceeds anything in the recent past against the state’s largest HMO and surpasses the total of fines levied against all health plans last year, the official said.

Peter Lee, executive director of the Center for Health Care Rights, a health care consumer group, called the announcement of the fine “good news and bad news.”

“It’s very important that the department be able to take strong enforcement actions when it’s appropriate,” Lee said.

But, he added, “it concerns me that the fine levied here relates to systemic problems [that allegedly existed] four years ago. . . . Systemic health problems could be affecting thousands and thousands of people. Those have to be stopped immediately.”

Lee and other critics said the four-year delay underscores the importance of Gov. Davis’s creation of the Department of Managed Care. Unlike the Department of Corporations, which has a variety of responsibilities, the new department will be devoted solely to health plan oversight and will be able to act far more promptly, consumer advocates say.

Terry Preston, Utterback’s daughter, said she was reasonably happy at the final resolution of the investigation into her mother’s case. But she contended that she had to write “letter after letter after letter” to prod the Department of Corporations into action.

In fact, she said, an initial investigation went nowhere. It was only after an assemblyman took up her cause that the department agreed to look further into the case last year, she said.

As for the fine, “I think it’s very small given that my mother lost her life,” she said.

According to documents prepared by the corporations department, Utterback, a Kaiser patient for 50 years, was in generally good health until the morning of Jan. 26, 1996, when she called Kaiser to report back and abdominal pain. She began calling her primary care physician at 8:30 a.m., but it took several calls and repeated explanations of her symptoms before she was scheduled for an appointment at 4:15 p.m.

She arrived at the Hayward clinic nearly two hours early, hoping that her doctor, Rod Perry, would see her early.

Though she asked to be seen early three times and “squirmed in her chair and held onto her side” in plain view of the reception desk, Utterback wasn’t seen by Perry until 4:30, the documents state.

One medical assistant who saw her in the waiting room reportedly said, “She doesn’t look that sick to me.”

“Mrs. Utterback was exhibiting classic symptoms of the life-threatening condition for which her medical history made her a likely candidate,” according to the corporations department’s news release. Yet for hours, “she was unable to speak with a doctor, a nurse or other medical professional.”

When Perry did see her, he immediately diagnosed her with a “dissecting abdominal aortic aneurysm,” according to the documents. If such an aneurysm ruptures, a patient can bleed to death. Yet the doctor failed to follow the most basic protocols in such a case, such as starting an IV or administering pain medication, the state documents say.

The documents also state that Perry failed to communicate the nature or urgency of the case to the Fire Department personnel who took Utterback to the hospital, saying only that she was complaining of lower back pain.

Utterback did not arrive at the emergency room until an hour after she had been diagnosed. Her aneurysm ruptured minutes later.

When Kaiser responded in an October 1996 letter to the concerns of family members about how Utterback’s case was handled, the letter contained “almost nothing but misstatements,” the state documents say.

“This investigation itself puts at issue Kaiser’s failure to thoroughly investigate this matter,” the state concluded.

In response to the case, Kaiser contends it has made some changes, including its method of evaluating patients in clinic waiting rooms.