Texas Regulators Assail Kaiser on Physicians, Care
Kaiser Foundation Health Plan in Texas routinely refused to pay for emergency room care, even in some cases where Kaiser nurses advised patients to seek emergency treatment, according to a controversial state report released by Texas regulators.
The report, provided to The Times on Wednesday, also said Kaiser failed to act on complaints against its physicians, and it faulted the company for “an unacceptable disregard for quality-of-care issues.”
Kaiser executives blasted the report as shoddily done and based on inaccurate information.
Kaiser had gone to court in a failed attempt to block the public release of the report by the Texas Department of Insurance, sparking a bitter dispute between the HMO and state officials.
Last week, Kaiser agreed to pay a $1-million fine to settle state allegations concerning the Texas health plan’s quality of medical care and poor financial health. The state report had recommended a $3-million fine.
The Texas unit is part of Oakland-based Kaiser Permanente, which has faced similar allegations of inadequate patient care from the California Nurses Assn., a labor union involved in a contract dispute with the nation’s biggest HMO. Kaiser has more than 4.8 million members in California alone.
As part of the Texas settlement, the parent company agreed to provide $80 million in financial support to the money-losing Texas unit.
Similar complaints against HMOs generally have resulted in public anxiety over the shift to managed care and a wave of legislative reform efforts in California and elsewhere.
The Texas report cited one instance in which the parent of an 11-year-old child who was experiencing severe bleeding, dizziness and weakness sought emergency treatment. Kaiser denied payment for the claim, even though paramedics who responded to the 911 call wrote letters on behalf of the family supporting the need for emergency treatment, according to the report.
In another case, a child who injured a foot in a fall was told by a Kaiser “advice nurse” to go to the emergency room. Kaiser later denied payment, the report stated.
The report also said Kaiser failed to comply with state licensing requirements for quality assurance, peer review and physician credentialing. It failed to discipline one doctor who had as many as 80 complaints against him in two years, regulators said.
But Kaiser spokesman David O’Grady said the state’s conclusions were based on incorrect information. The child’s foot injury, for example, turned out to be a sprain rather than a fracture, and thus was not an emergency, he said.
Dr. William Gillespie, president of Kaiser’s Texas operations, denounced the allegations in the 19-page state report as “like a tabloid journalism story.” He said the allegations about specific patient complaints were “flawed and erroneous” and had been compiled by “unqualified and untrained” state reviewers.
Gillespie was critical of Texas Atty. Gen. Dan Morales, alleging that by making the report public he broke state laws relating to patient and physician confidentiality.
Texas Insurance Commissioner Elton Bomer released the report after a ruling from the attorney general--prompted by requests for copies of the report from the Los Angeles Times and the Dallas Morning News--that the report was a public document.
