San Francisco Chronicle

The state agency that regulates health plans says Kaiser Permanente should be fined $1 million for failures in providing basic health care, including emergency services, at its Hayward facility.

The state Department of Corporations’ recommendation, which would be one of the biggest fines ever levied against an HMO, revolved around the death of a 74-year-old San Leandro woman. Margaret Utterback died in 1996 after a blood vessel ruptured minutes after she was admitted to Kaiser‘s Hayward emergency room. The agency said Utterback had spent more than eight hours on the phone and in person trying to see her doctor.

Julie Stewart, spokeswoman for the Department of Corporations, said investigators found that the patient screening system made it difficult for Utterback to speak to a doctor or a nurse. “It’s a major case that uncovered systematic problems that created barriers to care,” she said.

Kaiser spokeswoman Lila Petersen said the Oakland-based HMO would “vigorously contest” the Department of Corporations accusations. “We have a lot of empathy for the family that suffered a terrible loss,” she said. “There are some issues here specific to this case, but this is not a systematic problem.”

The department recommendation will now be referred to an administrative law judge, who will review the state investigation and decide whether to uphold, reverse or modify the findings. That decision, however, may be challenged by the department or Kaiser, and the case could end up in the state courts.

But to Terry Preston, youngest of Utterback’s five children, and the one who has spent the past four years urging the state to act, the Department of Corporations decision late Friday evening came as a vindication.

“The deadline for state action expired on Mother’s Day,” said Preston. “Someone up there more powerful than me was working on this.”

An 18-page department report details how Utterback, a Kaiser patient for 50 years, woke on Jan. 26, 1996, with severe abdominal pain. Around 8:30 a.m., she called Kaiser seeking an appointment with her doctor, Kaiser physician Rod Perry.

The report says Utterback, assisted by another daughter, Barbara Winnie of San Ramon, repeatedly tried to get in to see Perry, but was rebuffed by the Kaiser employees who handle incoming phone calls.

Finally, after 2:00 p.m., they were told the doctor could see Utterback at 4:15 p.m., according to the report. Hoping to get in sooner, Winnie drove Utterback to Kaiser‘s Point Eden clinic about 2:30 p.m., where they waited for two hours before Perry could see them.

When the doctor did see Utterback, the state report said, he immediately and correctly diagnosed that her main abdominal blood vessel was in imminent danger of bursting. The report also said that Perry initially suggested that Winnie drive her mother to the Kaiser emergency room about 1.5 miles away, but soon rescinded that recommendation and ordered an ambulance.

However, the report said, Perry did not put Utterback on intravenous medications to calm her and lower her blood pressure, even though this is supposed to be standard practice for the condition and a nurse twice recommended that it be done.

Shortly after the ambulance got Utterback to the emergency room about 5:15 p.m., the blood vessel burst and blood began flooding into her abdominal cavity, the report said. Doctors were unable to staunch the bleeding or replace the lost fluid despite giving her 24 pints of transfused blood, the report said. She died about 36 hours later.

Dr. Philip Madvig, associate director for quality at Kaiser-Permanente, called Utterback’s death “a terrible situation” with “a terrible outcome,” but disputed many of the state’s allegations.

Madvig said that Utterback had been told to go to the emergency room earlier, but had insisted on seeing Perry, her personal physician. He said once Perry did see Utterback, the doctor made the proper diagnosis.

“The Medical Board of California reviewed this case some time ago and did not make any adverse findings,” Madvig said. Perry has left Kaiser since this incident, but Madvig characterized that as a “personal decision.”

Madvig said Kaiser has made some changes at its Hayward facility that make it easier for patients to see a medical professional if they complain of pain while waiting for a doctor’s appointment. He also said Kaiser is providing callers with more access to nurses.

Madvig said Kaiser would present its side of the case before the administrative law judge, who will review the Department of Corporation’s accusations.

Preston, the daughter who kept the case alive with state investigators, said she persisted in her efforts because Kaiser refused to acknowledge any wrongdoing.

“They said they wouldn’t talk to me because I might sue them,” said Preston, who has not retained an attorney and says she does not plan to.

“There isn’t enough money in the world to compensate for my mother’s loss,” she said. “I really believe you can make a stronger impact” going through state laws designed to assure the quality of health plans.

Stewart, the department spokeswoman, said she could recall one other fine larger than the proposed Kaiser penalty, but said she did not have a record of all the fines the department has levied.

But Jamie Court, a health care activist with Consumers for Quality Care in Santa Monica, said that according to his records, the proposed Department of Corporations penalty would be as large as all 41 fines that the department has assessed against California health plans since 1996.