National Public Radio All Things Considered
   ROBERT SIEGEL, host:
The state of California has levied one of the largest fines ever against an HMO for quality-of-care problems. The action was taken against a Kaiser Permanente facility in response to charges that it had delayed emergency treatment in the case of a 74-year-old patient. The patient died as a result. NPR’s Patricia Neighmond reports.
PATRICIA NEIGHMOND reporting:
There have been a number of big, successful lawsuits filed on behalf of patients against HMOs in California, but this is only the second major action taken by the state on a patient’s behalf. And in issuing its penalty against Kaiser, the state Department of Corporations agreed with Terry Preston’s allegations. Her 74-year-old mother had been denied basic medical care. Preston says her mother, Margaret Utterback, began calling Kaiser around 8:30 in the morning after she awoke with a severe abdominal pain. She wasn’t given an appointment until eight hours later at 4:30 in the afternoon.
Ms. TERRY PRESTON (Daughter of Margaret Utterback): She went in early hoping that they would see her earlier, but they made her sit in the clinic waiting room for almost two hours. And the pain was increasing because the aneurysm was expanding. And it’s an incredibly painful process. She went up and complained–not complained, but actually pleaded to be seen about three times, and they kept telling her to go sit down and wait her turn. And so they finally took her in at 4:30 in the afternoon.
NEIGHMOND: Utterback was diagnosed immediately with a dangerous, potentially fatal abdominal aortic aneurysm. Even so, she waited over 30 minutes without pain medication to be transferred to the emergency room. By the time she got there, the aneurysm had ruptured. Utterback died a day and a half later.
Daughter Terry Preston says she’s written books of letters to the state, detailing what happened to her mother. After a 16-month investigation, a number of delays and a change of governorship, the state issued a verdict against Kaiser late last Friday afternoon. Kaiser says it will fight the state’s decision. Kaiser official Lila Peterson(ph) argues the HMO did nothing wrong. She says Utterback eventually did get to see her doctor and did receive emergency care. Peterson adds the state is overstepping its authority by getting involved in doctor-patient interactions.
Ms. LILA PETERSON (Kaiser Permanente): The decisions that were made in this case are decisions that the physician made regarding her care. What the DOC is doing is calling into question the physician’s medical decision-making abilities, and that’s what we have a problem with in this case. We do not believe that the DOC should be telling health plans that the health plan should be in the physician’s exam room telling the physician how to treat the patients.
NEIGHMOND: The HMO has 15 days to appeal its case to an administrative law judge who could overrule the state’s decision. Consumer advocate Jamie Court directs the Foundation for Taxpayer and Consumer Rights. He applauds the state action, saying it sends an important message to all insurance companies in the state.
Mr. JAMIE COURT (Foundation for Taxpayer and Consumer Rights): Any HMO will known that when it allows a patient with a treatable problem to die simply because it doesn’t have the expertise to stop that problem, that company could face a million-dollar fine. That’s an invaluable message to an industry that has not faced very many fines in California history.
NEIGHMOND: And a significant signal that times are changing in California. This July, a newly created Department of Managed Care comes into being. Its mandate: regulate the state’s HMOs. Jamie Court says this recent action against Kaiser suggests California is embarking on a stricter oversight of HMO practices. Patricia Neighmond, NPR News, Los Angeles.
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NOAH ADAMS (Host): In Britain, the prime minister’s wife takes her husband’s government to court. That’s ahead on NPR’s ALL THINGS CONSIDERED.
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