Kaiser health plan fined for ‘systemic’ problems in ’96 death of woman

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Knight Ridder/San Jose Mercury News

   SAN JOSE, Calif. _ The state Department of Corporations has assessed a $1 million fine _ one of the largest ever _ against Kaiser Foundation Health Plan for “systemic” problems in its medical services that resulted in the death of a San Leandro woman in 1996.

The penalty is one of the largest the department has ever levied, said Julie Stewart, spokeswoman for the state Department of Corporations. Several years ago, the department did assess a $1.7 million fine. The Kaiser penalty will be placed in the state’s general fund.

State officials also issued a cease and desist order, demanding Kaiser remedy deficiencies in access to care, preventive care and emergency care. A Kaiser spokesman decried the state action and said the HMO will vigorously fight the decision.

The enforcement action capped an 18-month investigation stemming from the case of Margaret Utterback, a 74-year-old woman who died in January 1996 of a ruptured abdominal aortic aneurysm.

Utterback had repeatedly called Kaiser but was unable to speak to a doctor or nurse for eight hours, according to the state. She suffered the aneurysm in the emergency room and died days later.

“The investigation showed systematic barriers to access to health care services,” Stewart said. “This was not the result of a single negligent act.”

One critic of HMOs hailed the penalty.

“This is significant because it indicates a willingness by the Davis administration to issue significant fines in a patient’s case where there is wrongdoing,” said Jamie Court, of the Foundation for Taxpayer and Consumer Rights. “And that should send an important signal to this industry.”

Kaiser denies the state’s allegation and plans to request a hearing before an administrative law judge.

“We are planning to vigorously contest this case,” said Kaiser spokeswoman Lila Petersen. “The reason we’re doing so is that the state medical board has already investigated and reviewed this case and had no adverse finding.”

Petersen said the state Department of Corporations is moving into a “dangerous area” that suggests that health care administrators should second-guess decisions made by doctors.

“We have empathy for the family,” Petersen said. “They suffered a great loss, but we do believe Mrs. Utterback received appropriate medical care.”

Terry Preston, one of Utterback’s four children, said X-rays taken four years before her mother’s death showed an abnormality that should have tipped off doctors to the potentially fatal problem. Her mother also showed other classic symptoms that she could develop an aneurysm, according to Preston.

On Jan. 26, 1998, Utterback tried for hours to get somebody on the phone to listen to her.

But Kaiser officials Monday said they have made changes to how patients can contact nurses and doctors, and to how patients are assessed in emergency waiting rooms _ a decision due in part to the Utterback case. They also said there aren’t clear symptoms that would have called attention to Utterback’s medical condition.

Utterback’s family has not filed a lawsuit against Kaiser and doesn’t intend to, according to Preston.

“I simply wanted to change the system; I didn’t want money, I didn’t want compensation,” said Preston, who has become a consumer activist on the issue.

Though she had hoped for a larger monetary fine, Preston is pleased with the state’s action.

“Hopefully,” Preston said, “this is the beginning of a new era that sends a message to corporations that business is not more important than life.”

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