Talk About Kaiser Chutzpah!

Talk About Kaiser Chutzpah (Nerve)
by Chuck Phillips, MD

Webmaster's note: This article first appeared as a post on the listserv of the Health Administration Responsibility Project website run and managed by H.S. Frey, Ph.D. M.D., Esq. It has been slightly modified read better here. The content has not been altered at all.

Webmaster's additional note: February 5, 2000 - Charles Phillips, M.D. is a former Kaiser physician. He left the system when he found his "shifts" suddenly cancelled causing him profound economic stresses. He believes that this is as a direct result of his very outspoken criticism of Kaiser and its policies.
[Dr. Phillips worked an average of 2/3s time in a Kaiser hospital emergency room over an 18-month period. While he is still on the Kaiser medical staff as confirmed this week in writing, his outspokenness on Kaiser and managed care in general has lead to the absence of any scheduled hours. In fact, Kaiser has suggested that if Dr. Phillips resubmitted hours, he would be put back on the schedule immediately.]
Dr. Phillips has written a number of pieces that appear on this web site. We are publishing them as a service to Dr. Phillips and to the general public. We at RHCD believe that the only way the public will be able to ever make informed choices about health care is with unfettered access to multiple sources of information about Managed Care as it exists today. We at RHCD and its sponsoring organizations and the individuals and organizations that are in support of and will participate in RHCD present this information as a service and in no way are responsible for the validity of the content of any of these pieces. This responsibility remains with the author.
[Dr. Phillips personally accepts full responsibility for every published comment he makes. He is a direct observer of medical care and represents no outside group. One of his nicknames is Hospital Cop. His opinions are those formulated over a 32 year career included such roles as publishing five medical textbooks, being president of a medical staff, serving perhaps 18 years as a medical director, being a state of California quality inspector, providing consultations to five paramedic systems, teaching trauma at the university, offering direct care as a Board Certified Emergency Physician, and being the proud the father of six children - five of whom have had to get their care through Kaiser.]

One reason of the many reasons Kaiser fails to diagnose some cancer early is that they also have the Chutzpah to change the generally medically accepted value for normal on test results so as NOT to find illness.

For example, Kaiser's definition of anemia is a lower hemoglobin than is accepted by every other source I have found. By expanding the definition of "normal," they reduce the amount of illness to be found. Missing early anemias often means missing early right colon cancer.

This is now the new year. Patients have switched plans. I just picked up a Kaiser patient where a right colon cancer was picked up only at the obstruction stage -- very late. Do you wonder why I am requesting the whole chart? Kaiser does not really worry about missing a cancer because they have developed a fast track into Hospice and are comfortable with the concept of Duty to Die.

I also just received a post Kaiser refugee that had a 90% narrowed coronary artery. The first angioplasty failed -- ? low bidding contractor. (What happened to try, try again?) So they gave up and forced him to accept medications only. His second MI occurred three months later. Now he is short of breath walking to the bathroom. I am hoping that we can rethink a new angiogram and recover some more cardiac muscle. Once we get the "whole chart," I'll go for the missing angiogram film across town.

Another Kaiser patient died suddenly after an almost but not "normal" stress test was deemed a sufficient workup. My patient is the grieving son hanging on to college. I had to explain to his interested attorney that the complete record was not sent to him despite his normal subpoena of all documents. The Kaiser cardiology department keeps its own separate records on stress tests. By redefining normal once again they can save on outside referrals.

I am really not after Kaiser alone. Perhaps they are even middle level players in mangled care. But being so big they are often the ones who run with the experimental mudball first. They started pill splitting unscored pills two years ago; (webmaster's note: If a pill is not scored it usually should not be split. To split an unscored pill can result in two nearly equal halves or variations, including two pieces differing as much as over 20% to low and to over 20% too high. Among some of the pills split by Kaiser like Paxil (for panic attacks) and Lisinopril (for high blood pressure) either too high a dose can be harmful or too low a dose non-effective. This is experimental medicine in the absence of any research committee authorization.) Now others are following. Sometimes the competition follows only because they cannot compete if they don't lower the playing field to the same subterranean level. As Kaiser bypasses 9-1-1 and let a Denver patient talk to a Milwaukee short-trained dispatcher (great story in USA Today), the others have to follow. And it all drags down the whole medical community managed and unmanaged.

I don't chase ambulances; they come through my front door. I am just a scribe. My favorite course was journalism in high school. Past Quill and Scroll member now scrolling through the Net. Luckily there are web sites like this to talk to. Rescue Health Day becomes more important every day.

Chuck Phillips, MD

Also by Dr. Phillips:

"Evidence Based Medicine" and "Best Practice" of Medicine -- The Dynamic Duo

Talk About Kaiser Chutzpah

Health Care Diary - 2/10/00

The Killing Fields

Inside Kaiser's ER

The Evolution of the Managed Care "Medical Director”