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Quote from: When the Hospital Staff Isn't Enough
By Abigail Trafford Washington Post Staff Writer Sunday, January 7, 2001; Page A01
"You want your own advocate there all the time,"[in hospital] said David Lawrence, the head of Kaiser Permanente health plans and member of the IOM committee on medical quality. "If there is no family member, you can hire a care management nurse to be there with you. Or a minister. You need an adult who is not going to be intimidated by the place. "That will be necessary until we put in more systematic approaches that build in safety." For the entire article - https://kaiserpapers.com/howto/sunday.html
Link to:
How to get a Outside Second Opinion if you have an HMO
A big red flag should go up when:
1. When any hospital starts the guardianship process.
2. When a drug is or appears to be the cause of change of mental status or seems to cause pneumonia.
3. If you have any type of illness and you are advised to participate in the Kaiser and the For-Profit Behavioral Health Program.
4. If a person is suddenly just labeled nuts. I.E. - Call a guy crazy and you can get away with doing anything to him you want. And, if he complains, well, you know, he isn't all there to know what is really going on!
5. If after diagnosis or treatment of any long term illness Kaiser staff starts implying that you are depressed or insists that you are depressed! Not a casual comment or suggestion, but outright insistence of your depression, even if you are having a very happy day; be very concerned.
6. My all time favorite cause for concern is in the event that a person has been previously treated for any form of cancer twice, the statement from Kaiser staff that the third time they will no longer provide treatment and that means the patient will just die. You know that is just a bunch of balcony to get out of honoring their contract with you and do not need to put up with it.
7. The scariest red flag is if Kaiser staff tells you that you or a loved one has already used up their one chance for treatment and now nothing can be done. If you hear that, ask to see where it is stated in your contract.
8. If anyone within Kaiser tells you that there is no antibiotic for a person's infection that can be used because the patient has become immune to all of them it is a lie and tell them that fact. Do not let them get away with such an abusive statement.
9. Never, ever believe anyone that says they can't find your veins. If you are alive you have veins. You do not need medical credentials to inform the Kaiser staff member of that important fact.
Don't believe these things people if Kaiser staff pulls them on you. Kaiser staff may be doctors and nurses but they are also people just like we all are. They handle more people at one time than is generally reasonable and practical and a lot of mistakes happen because of that. Because they are overworked they also sometimes pick and choose who they will bother providing medical care for. It is human nature to pick the easy, quick fixes over the more complicated matters.
With Kaiser it is also the patients that cost the less to treat that actually get saved in many people's opinions. They can fix a broken bone because it is a quick fix. They may not want to treat a expensive medical condition over several years because it costs doctors by lowered return on their Permanente stock investments and costs some nurses their bonuses for providing as little care as possible.
To them it is just business. To you it could be your life.
Enforce Your Rights As A Patient
And remember that these are only quick fixes for each situation. As soon as you let your guard down expect another problem to crop up! Your best remedy is to get health care elsewhere.
1. If You Believe that Kaiser is Violating Your Patients Rights in a Kaiser clinic situation, then Immediately Contact Your Local Department Of Health. They Have Jurisdiction over Licensing. You do not have to be a victim! You can enforce your rights as a patient!
2. If You Feel that Kaiser is Abusing You while using their online chat line and you know that you are following their "Rules of the Road", don't waste your time on the site. It is just a promo site and we have received information from the public that some of their information is inaccurate.
3. If while at a Kaiser Clinic you find unsanitary conditions contact your local health department. Your life and safety are more important than any fear that Kaiser staff can try to inflict on you. Do not believe Kaiser staff if they try to pass off the seriousness of other people's body fluids, dirt, overcrowding of rooms or bugs, etc.
4. Use the Buddy System. Do not visit any Kaiser Permanente or Foundation facility of any type without someone with you. If you can't get a friend to go with you try to use a granny cam. If you can't do that then bring a tape recorder and then use it openly. Use it for apparent innocuous things such as a nurse talking to someone near you about your medical treatment. Let them know that you are taping them. The law says that you have to inform them in California if you are taping them before doing so. It may save your life. Be sure to have the date and time if possible on the tape recording as well as names of who is speaking. If the staff is conducting themselves properly then they will be proud of have this documentation. If they won't allow it then wonder what they have to hide and seek medical treatment elsewhere.
Further detailed legal information on taping can be found at: A Practical Guide to Taping Phone Calls in All 50 States http://www.rcfp.org/reporters-recording-guide
5. Tape record all telephone conversations with any and all people regarding Kaiser Permanente and make sure that they are aware of it. Do not sneak - If they are already openly taping, you can also tape. Check to see what the law says for your state. In California phone tape recording is a two person agreement state. That means that both parties have to approve of the taping. In most other states this is not the case. If Kaiser has a prerecorded message stating that you will be taped then it is all right for you to tape the conversation or you can just repeat the Kaiser disclaimer back to the staff. Just try very hard to get that prerecorded message on tape before you talk to anyone while taping if you are going to use that route. Otherwise, just be open and tell them up front that you are tape recording them. Do not hide the fact that you are taping any Kaiser personnel. To do that would be against the law. To get decent medical care as promised in Kaiser and the for-profit Permanente advertisements and your written contract you should not have to become a criminal. So make sure that you are following the law for your specific area.
6. Get your medical records for each and every visit. Do not delay. The longer you wait to do so the greater the chance that they will be altered, confused with another patient, or just plain made up. This includes all pharmaceutical records as well.
7. If in California, learn the DMHC (Department of Managed Health Care) phone number, web site, mailing address and do not hesitate to let Kaiser know that you will file a complaint with them if you do not receive needed medical treatment immediately.
8. When you can glance at your medical chart, check to see what if any colored sticker they have on your chart. Or if they have many stickers. Each color and shape labels you as a type of patient. Are you a trouble maker? Do you have a serious medical problem? Are you a psych patient? Most of these stickers are just labels that some Kaiser worker pasted on your chart for whatever reason they thought of at the time, but the doctor doesn't necessarily know if they are for a real medical or mental condition or is just the work of a malicious Kaiser worker. Ask them what the stickers mean if you notice them. Kaiser staff members have reported to us numerous variations on this sticker matter and some are even unfamiliar with it. Some provide great detail on their purpose. Directly asking questions is only to your advantage. It is your life and your body and you have a right to know what is taking place, what your diagnosis is and how your HMO has labeled you.
That doctor also isn't going to take the time to find out if any labeling is factual or not. So learn what Kaiser has labeled you. I am willing to bet that if you have a chronic long term medical condition you are going to be labeled as a mental patient. That way any doctor seeing that will automatically not bother treating you with anything other than cheap, 80% purity generic drugs. Prozac or something similar is probably the one for most all mental health labeling in the general Kaiser system. Paxil seems to be their second choice. Be prepared. Do not raise your voice if you discover this to be fact, you will only be proving to the doctor holding your chart that you have a problem and then he will have a valid excuse, least to himself) that the sticker is fact. Remember if there is a sticker to ask and remember that it probably at most will only mean that tests were run or they should be. This means they probably are not really that worrisome.
9. If you are making the mistake of having surgery at a Kaiser Permanente or Foundation facility be prepared to sign a statement that the surgeon will be working with an assistant. What this actually means though at Kaiser is that a surgeon will be present, often overseeing several surgeries at the same time, and a resident in training, (quite often a third year student) will have your life in his/her hands. This information comes directly from staff members of Kaiser within the operating room. Remember as per Kaiser data, they really do not have enough specialists on staff per self-reported patient population and do have to supplement their income by having trainees overseen by the few specialists they do have.
10. If you are having a serious, emergency medical event such as a heart attack and you go to a Kaiser hospital and they tell you to wait and you do for hours, or just an unreasonable length of time realize that you are placing your life in danger. This time frame is determined by you and not by Kaiser staff. - Get up and go to another emergency room, if you can't do that then just call 911 to be transferred by ambulance. Do not be embarrassed to save your own life! Your life will most likely be saved and in the end Kaiser will have to pay the bill. Don't put any threat from Kaiser staff or fear of a medical bill ahead of your life. If you do waste time you might not be around to even worry about the staff or bill.
11. For any medical diagnosis from Kaiser staff, learn everything about it. Study everything that you can about the disease or medical condition. Kaiser staff is far too busy in a lot of cases to verify their own diagnosis so you have to do a little bit of medical sleuthing yourself. Make sure that the Kaiser diagnosis is factual, especially if the prescribed treatment doesn't seem to be doing any good. Make sure that all prescribed medicines are compatible as well. It is very easy to just ask any pharmacist for their opinion without involving them into the actual case. Just ask if medicine A,B,C, etc., are compatible and see what they say. If the Kaiser pharmacist does not want to tell you anything or his statements you believe are questionable then just call up your local area pharmacy and ask them. You do not have to say that Kaiser is involved. You are only seeking information for your own well-being.
12. If, after your own personal research, you discover that there are apparent inconsistencies or inaccuracies in your diagnosis, plan of treatment, etc., speak to your Kaiser doctor about this and present him/her with all of your evidence. You might get lucky and they will address your questions. If they don't seek independent judgment and then again pleasantly, confront the Kaiser staff with an outside medical opinion. Always be pleasant or you will be labeled a troublemaker. If this doesn't get you anywhere then read the section on "How to get a second opinion outside the Kaiser system." https://kaiserpapers.com/howto/secondop.html
13. If you have a financial problem in obtaining an outside of Kaiser, independent opinion, go to one of the numerous low cost urgent care centers, or community clinics. If you cannot afford any of their tests, you can at least get a statement from them saying that you need to have your medical condition investigated further.
14. Currently, it is a felony for any person to deliberately advise or encourage another person to commit suicide. California Penal Code 401 - Mention that to Kaiser staff if they encourage you to forgo medical care or sign into their convoluted hospice program instead of getting decent, life saving medical care. Your primary concern is staying alive - Kaiser's primary concern is on not spending money on medical care for the patient.
Do You know someone that is trapped in a hospital against their will for imaginary/misdiagnosed physical illness? - CALIFORNIA CODES PENAL CODE SECTION 236-237. And don't listen to the HMO baloney that if the patient leaves they won't pay for it because it isn't true! Think of the patient's life over any threat that is made to you. Life has priority over any imagined bill. If the service was provided, the HMO will pay for it whether you leave or not.
15. False imprisonment is the unlawful violation of the personal liberty of another.
16. (a) False imprisonment is punishable by a fine not exceeding one thousand dollars ($1,000), or by imprisonment in the county jail for not more than one year, or by both that fine and imprisonment. If the false imprisonment be effected by violence, menace, fraud, or deceit, it shall be punishable by imprisonment in the state prison. (b) False imprisonment of an elder or dependent adult by use of violence, menace, fraud, or deceit shall be punishable as described in subdivision (f) of Section 368.
17. If You Believe that Kaiser is Violating Your Patients Rights Immediately Contact Your Local Department Of Health. They Have Jurisdiction over Licensing. You do not have to be a victim! You can enforce your rights as a patient!
18. If while at a Kaiser Clinic you find unsanitary conditions contact your local health department. Your life and safety are more important than any fear that Kaiser staff can try to inflict on you. If you have a camera with you then take pictures of the unsanitary conditions. Show the Department of Health the proof. Show the world the proof if you want to. Just don't put people in the pictures unless it is a consenting individual.
19. Avoid the Kaiser Home Health/Hospice Programs and then you can live out your life as long as you and God want you to.
20. With all Medicare Patients, there is a CAP, a limited amount of money that Medicare will pay for a person's medical care. Payments to hospice still have a CAP which is the reason they will eliminate patients after the cap is reached. For private insurance companies that do NOT get Medicare payments or Medicaid payments, the cap is simply that they will pay for six months and then don't pay ANYTHING unless they go through the reapplication process, so THAT is why they eliminate them after the six months or sometime before to avoid the appearance of eliminating them at the CAP. Medicare has recently changed some of the rules. The end result is the same. A 90 day period and then reapply. Those corporations that don't want to reapply because maybe Medicare will look further into their program you won't want to deal with anyway.
21. No matter what Kaiser may tell you the home health payments are NOT hospice payments. If a patient is getting home health services, they are not enrolled in hospice. If they are enrolled in hospice, they get reimbursement under the hospice reimbursement criteria which are detailed. Ask to see the paper work if they try to tell you anything differently. You are not a child, so don't allow them to treat you as such.
22. Hospice patients are entitled to real food - not glucose or sugar water for nourishment. Hospice patients should have their loved ones around. Contrary to "in vogue" industry information people should not be separated from their loved ones to be allowed to die. Besides, if loved ones aren't there they may always wonder what really happened. The whole point of keeping family away from any patient by Kaiser hospice staff is so they will be eliminated faster. It is all about money and the longer a person lives on that program the more company resources are spent. It has nothing to do with any act of kindness or consideration. It is evil being used for financial profit - pure and simple. When a patient is signed onto the Kaiser hospice program, their right to life has been legally removed. The patient can be outright killed and no authority will do a thing about it because legally there is now a document that says they were going to die anyway. The true purpose of hospice is to make the patients remaining days rewarding and comfortable, not to kill them off.
23. For home health services, a different section of the regulations applies and it is NOT paid on a per diem basis. Home health is paid on a fee for service basis, but again there is a CAP so home health agencies will seek to use up the services, i.e., get revenue from providing services UP TO A POINT, then they tell their nurses to make as FEW visits as possible, until the next year kicks in. IT's all a game of money!
24. The home care level of services for hospice, when the patient is IN hospice, is about $100 per day, period, for all services provided. That is not very much money. That's why the hospices skimp on services, ... to maximize net income or revenue. If they get the patient into a facility during a crisis, they get about $400 per day, if a crisis at home with round the clock nursing occurs, it's continuous level of care and they get $500 per day. Again this rate changes periodically, again it is the same old story.
25. Actually if Kaiser is going to continue to run their business in such a manner they might just as well add life and burial insurance as part of their package then they can cash in all the way around. Of course the patient only wins when a relative cashes in the burial insurance after they are dead! For further information on this topic browse over to Hospice Patients Alliance at: http://hospicepatients.org/
LOOKING AFTER YOURSELF
1 Take part in every decision on your treatment. It is your right as a human being.
2 Speak up if you have questions or concerns. Do not be afraid. You are paying Kaiser for your medical care, they should be afraid of you because you may take your business elsewhere.
3 Learn about your condition and treatments. Ask your doctor if your treatment is based on the latest evidence. If he says yes it is then ask to see what that evidence is. If it is Kaiser based evidence then check out what is actually recognized by the rest of the world. You really want to use the Evidence that is recognized by the world and not diluted, on the cheap Kaiser evidence based criteria.
4 Keep a list of all medicines you take - including over-the-counter products, vitamins, herbs.
5 Read labels and warnings.
6 Get the results of any test or procedure as soon as possible and ask questions if you have any. It is your right!
7 Hospitals: Ask your doctor which hospital is best for your condition and then verify his statement. He may be basing his statement on what is really best for his finances.
8 Before you leave any hospital, find out the next steps in your treatment.
9 Surgery. Ask:
Kaiser is a Teaching Hospital - If you wish to not have a student who does have an M.D. as a title operate on you, put that in writing and hand the doctor and his supervisor a copy of it.
Who will be in charge of your care.
What the procedure involves.
What happens afterwards.
Be informed.
Become educated in your own medical care or have a family member oversee this for you. Make sure that family member knows to ask questions and not blindly trust the staff that probably doesn't know much more than you do anyway. The day's of being able to blindly trust are long gone in the medical arena.
10 Make sure you, your doctor and surgeon agree what will be done during the operation.
11 Get in writing who will actually be doing the surgery. Who will be overseeing the surgery and who will be in training during the surgery.
12. If you are really smart you will get medical care outside of Kaiser and not have to be half as concerned about all of the above. Many large HMO companies cost less than Kaiser anyway and give you the freedom to change medical doctors and treatments when you want to. Kaiser is not the largest HMO and it is for profit. See kaiserpapers.com/businesspracticesKaiser's interest is only in itself not what is best for the patient. Old Henry Kaiser himself said that Medicine is a business.