Calif judge rejects HMO contempt motion

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United Press International

A federal judge in Los Angeles refused Monday to charge the head of California’s Department of Managed Care with contempt over a $1.1 million fine against a major health maintenance organization that was based, in part, on the death of a patient who belonged to the federal Medicare system.

Kaiser Permanente had contended that Daniel Zingale overstepped his authority in leveling a fine based, in part, on treatment provided to Medicare patients.

“Today, we won an important battle, but the battle for patients’ rights continues,” Zingale told reporters after Monday’s court hearing.

The Department of Managed Health Care had levied a $1.1 million fine against Kaiser for alleged problems with the HMO’s emergency care system. In defending the fine against an appeal by Kaiser, Zingale used the death of a Medicare patient from a ruptured aortic aneurysm as an example of the perceived trouble at Kaiser.

The HMO responded that Medicare is a federal government program, therefore outside the jurisdiction of a state regulator such as Zingale. The HMO industry in August was granted a court ruling stating that federal oversight of Medicare takes precedence over state regulations.

Kaiser attorneys also said that the California Medical Board must address problems with actual medical care through a medical malpractice complaint.

Zingale, however, contends that incidents of botched or inadequate medical care should not be ignored by his office simply because the hapless patient happened to be on Medicare.

Kaiser‘s emergency response system has not served patients with serious conditions well,” Zingale told the San Jose Mercury News last week. “To make that case and to hopefully improve Kaiser‘s system, we used three examples. One of them is a Medicare patient. I’m not willing to ignore the experience of Medicare patients in California in trying to reform the system.”

Kaiser and other HMOs contend the distinction is needed so that doctors and administrators don’t run into a potential conflict between different sets of state and federal regulations. They also argue that state regulators have authority only over Kaiser‘s health insurance operations and not over actual medical treatment of patients.

A Kaiser spokesman told the Mercury News that the HMO was not seeking a contempt order against Zingale in order to intimidate him, but rather as a procedural means of bringing the issue before a judge.

“It has been characterized as, ‘We’re trying to get him thrown in jail,'” Kaiser spokesman Tom Debley said. “That’s not what we’re after.”

Still, the move was seen by some consumer advocates as a blatant attempt to blunt California’s efforts to exercise authority over the HMOs.

Kaiser is challenging the very notion that it has any obligation under the law to provide access to its emergency rooms and not to kill patients under its roof who could have survived with timely access,” said Jamie Court, executive director of the Foundation for Taxpayer and Consumer Rights, a Santa Monica consumer group that is monitoring the case and has a separate lawsuit pending against Kaiser.

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