An Open Letter to Kaiser Permanente Northern California

An Open Letter to Kaiser Permanente Northern California

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I am writing this letter because for two months I tried to get ahold of Darryn Carter, a case manager at your company who was assigned to process a complaint I filed about care I received that I feel was harmful and irresponsible.

The legal and rational reason for this current writing is this: the letter I received from Darryn Carter rejecting my complaint claim stated that I have a legal right to see the documentation and evidence used to make the decision about my case. I would like to see that evidence file, and I have not been able to get in touch with Mr./ Ms. Carter or anyone else at Kaiser to send the file.

The emotional and human reason I want to talk with Darryn Carter–and I think it’s appropriate to share this reason too, given that you are a care provider–is that I believe I received bad care at Kaiser, and yet no one at Kaiser has ever listened to what I have to say about it, despite months of my trying to tell someone. My concern and frustration, which is so strong that it drove me to spend a Saturday writing this letter, is not primarily about the bad care I believe I received but rather the wholehearted dismissal that your organization has levied through an unnavigable bureaucracy. This dismissal has kept me up nights, sometimes crying, sometimes fuming, sometimes brooding, always feeling that special type of indignity reserved for a patient with a care provider who blatantly and systematically refuses to care.

Over the two months that I have tried to contact you, there have been some weeks where I have contacted your team ten times via phone and email. I started by using your web messaging portal, day after day, week after week. For many weeks, “web services consultants” responded that Darryn would call me in three to five business days (see a sampling of messages below). I started calling your help desk, where well-meaning junior associates would promise the same, a callback in 2-5 business days. I heard in their voices a genuine desire to help, earnestly dialing out to Darryn Carter, getting back on the line to let me know that they were unable to reach Darryn, or find Darryn’s direct line, or connect me with a manager, but that they had left a voicemail and would send a message, and I should expect to hear back in 3-5 business days.

Other weeks, like these recent ones, I have done nothing, have not tried to contact anyone from your organization. How could I continue? The few actions I know to take as a patient who needs help and information have proven not just ineffective but painful, like thrusting myself at a brick wall again and again hoping it will break.

So here is another in a long and exhausting parade of attempts to get a response from a person at Kaiser who will listen and speak to me like the person I am, a person who is hurt and dissatisfied but reasonable. I have two requests, and I will spend the rest of this letter providing more context and evidence around these.

  1. I want someone from Kaiser who knows about my case to speak with me on the phone about what happened, how the case was reviewed, and how the decision was made. In short, I want recognition. 

    The sad thing is that, really, this is all I have wanted all along. One phone call months ago could have put this whole thing to rest.

  2. Given some evidence that my case manager, Darryn Carter, is not a current employee at Kaiser, I want confirmation that Darryn Carter is in fact a Kaiser employee, and that he or she was employed by Kaiser at the time my case was reviewed.

    The side effect of my many calls and emails to your organization has been to learn that Darryn Carter is unreachable by any reasonable action. As of this writing, he or she does not exist in the phone directory at the number to which I am continuously directed (925-737-4873), and also does not exist in the searchable Kaiser directory that my primary care doctor uses. There may be a reasonable explanation for this–I would like to know it.

You can stop reading here and get in touch with me to respond to these requests. Or, you can read on to learn the basic details of my case.

On a Sunday in July, I cut open my right middle finger in the kitchen–blood puddles on the floor, that kind of thing. My boyfriend rushed me to the Kaiser Emergency Room on Geary Street, where I was efficiently moved through the administrivia and into an exam room surrounded by a curtain that easily let the stories of those around me pass through. For 30 minutes or so my boyfriend and I sat, listening to the man next to us describe an excruciating episode of back pain, wondering what he looked like, listening to the doctor ask probing questions exploring validity of his pain, delicately investigating whether he was angling for opioids.

A nurse came in to clean my wound, and an attending came in on a round to check in.

“Doctor X will be in soon,” she said, “and if he gets tied in with other things, I’ll sew you right up.

I wish I had understood the nature of the situation at that moment and had the wherewithal to ask her right then if she could please be the one to sew me up. I didn’t realize I was waiting for a resident, and that July is when the new residents start in the ER. Later, someone told me that patients are legally allowed to ask for an attending rather than a resident to provide care. Now I know.

Dr. X arrived after some time. He is tall and Caucasian with big features and thinning hair, like a TV show doctor. He made some small talk and put me at ease. I recognized his voice as the one from the conversation about back pain, and admired his delicate handling of that situation, for which I had a front row seat.

Doctor X began laying out the tools for the stitches. I watched him put on his gloves, lay out two sheets of sterile paper in front of him, and place a series of metal and plastic objects on top of the paper. His actions were noticeably deliberate, his movement notably slow, his gaze notably fixed on his hands. I had a sense of the actions being unnatural to him. An ER doctor is in the business of rushed care, and this plodding seemed odd. But I dismissed it as probably just his style.

Dr. X started on the stitches, with the attending nowhere in sight. It wasn’t until halfway through the job that I noticed his hands were shaking. I desperately wanted to point it out to my boyfriend, who was sitting next to me, but I was silenced by a stronger desire to be polite. That wasn’t my place. Plus, I told myself, stitches are an easy, straightforward procedure. If there’s anything a frightened new doctor should do, it’s probably this. So I waited it out.

When the stitches were done, the attending swept through and looked at them.

“Oh my goodness!” She exclaimed, “those are beautiful!” She used the overly expressive voice of a kindergarten teacher.

“You are an artist!” She continued, “those are the best stitches I have ever seen!” For reasons that you already understand, this statement was more concerning than comforting.

“I’m going to glue the very top of the cut, where there are no stitches” Dr. X said.

“Ok!” said the attending doctor, and she left.

This is what happened next, which I have been trying to discuss with someone at Kaiser for two months:

Dr. X retrieved a glue bottle.

He unscrewed the cap, and aimed it at the top of my finger. He shook it a few times. No glue came out.

He brought the glue bottle back up to his face and examined it. He peeled off some additional layer covering the opening of the bottle, (I learned later that surgical glue bottles have a layer of foam to help apply the glue precisely.) Once the foam was removed, he aimed the bottle back at my finger, and turned it over. The glue, which was a thin liquid, emptied immediately and entirely onto my finger, covering the whole cut and much of the rest of the finger, and dripping down my bloody hand. It dried in an instant, hardening around the stitches and the blood to form a knarly, prosthetic-looking bloody sheath around a big section of my finger and hand. Then Dr. X left and a nurse came in to wrap it up.

Once it was wrapped, the attending came by and saw some of the glued blood on my hand. She quickly asked the nurse with a furrowed brow to please wipe that off.

When I took off the wrapping three days later, I unveiled a finger that was covered in blood and had infectious-looking lumps up and down the cut. I returned to Kaiser twice. During my visits, nurses called in NPs who called in doctors for second and third opinions. The question at hand was: What is causing this unusual Frankenstein finger? Is this an infection? Is this glue?

When I went to get the stitches out, the nurse didn’t know how to approach the project. All my stitches were firmly glued in place. She called in an NP to give me a digital block, to re-anesthetize my hand like Dr. X had during the initial stitching.

“Do you see this a lot?” I asked. The NP answered delicately,

“We do really try to avoid putting glue over stitches, for this reason.”

Even after the stitches were out, I went back to Kaiser again for a glue-related inquiry. One part of the cut had a strange looking growth. The NP who saw me thought it might be a type painful overgrowth of the tissue under the skin that bulges out of a wound. It certainly was painful to touch. He showed me photos and for ten minutes we discussed possible next steps to deal with the complication. In the end, the Medical Director came in and concluded: strange, but just glue.

The only person at Kaiser to whom I have had the opportunity to tell this story was a first line bureaucrat on your crisis management team whose job it was to fill in a rigid form. After telling her my story, she said,

“So you are looking for reimbursement for the charges related to this episode?” I told her that reimbursement would be nice, but more than that, I am looking to speak with the doctors involved, to explore what happened and hear their side, to get an apology if one is warranted, and to prevent something similar from happening to someone else.

“Ok Ma’am. So I’m putting down that you would like a reimbursement for the charges surrounding this incident.”

“There’s that,” I repeated, “but more importantly I’d like to have a human conversation with the people involved here.”

“Um ok. I have recorded your request for reimbursement of charges.”

She told me that my case would get pushed up to a senior case manager, and that person would call me with questions to further explore the case. I figured that when that person called, then I’d really dig in. I had photos and additional details, and all kinds of thoughts to share, which were too far reaching for the crisis form during that first call and the form-filler whose performance may have been contingent on how many patients she processes per day–I don’t know. Surely that senior crisis manager would have a more nuanced conversation with me.

The next and last communication from Kaiser on this was a rejection letter I received in the mail about a month later.

I remember when I read it sitting in the living room, on a sunny Sunday afternoon. The letter had been buried in a pile of mail for that past few days, and I was systematically going through the pile, expecting this to be another meaningless or redundant survey or notification from Kaiser, which came in multiple times a week. After reading it twice, I heaved one big sob as the wind was knocked out of me, held my breath for a moment to try and stop more from coming, and broke down crying into my arm. My boyfriend came in and found me with the letter crumpled in my hands. I looked at him ragefully and said, how could they. The strength of my anger surprised even me. But I suppose we only have our one body and mind, and I had paid Kaiser to be the protector of my body and mind, and this letter, to me, represented a deep disregard for both.

Anyone who has ever been on the phone with Comcast knows what happens next. Here is a small sampling of the written responses from your staff on this issue, to give you a taste. This was also accompanied by many phone calls with well-meaning but powerless phone operators.

I know my case is trivial compared to some. The mistake made in my care, if any, is very far from the horrors of medical mistakes that result in life changing disabilities or death.

Even so, I felt this letter was important to write, because if you are this good at blocking communication from a concerned, persistent, and reasonable patient, I can only imagine the nameless many who can’t advocate for themselves and have been long buried.

Please respond. I don’t know what else to try.

Sincerely,

Rachel Katz

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4 Comments on "An Open Letter to Kaiser Permanente Northern California"


Member
meltoots
Feb 14, 2017

From what I am hearing, is that you want to be heard and you are not being heard, hence the letter to the world here. You learned a hard lesson here. The last US gov administration pushed for big factory medicine, consolidation of MD practices, loss of independent MDs, so they could attempt better control and hopefully reduce cost, at the expense of the patient and MD. This is what you get. But I digressed.
Tips: 1. Find a good primary MD that is independent. You could have easily called them for help, maybe even have them sew it up, or refer you to someone that could do it better, faster, cheaper, with tons of experience. May cost you more, but you will be happier. They will also know you as Rachel. Instead of patient 123-45-6789.
2. To go against the grain in corporate medicine is a real challenge. I think they learned their tactics from the DMV or other government entities. You have been appropriate and they have tried to chop you down at every turn. Write a letter to the C-suite people. Like Chief Medical Officer.
3. If you really feel burned, the local health department, the Joint Commission, all take complaints and are independent checks on hospitals.
4. This belts and suspenders glue over stitches debacle, falls into the”enemy of good is perfect” bin. I do not get the sense that this resident was doing anything but trying to give you the best outcome, albeit with flawed tactics. I think you want to be sure that he gets notice NOT to do that again. Be sure you add this to your letters.

Finally, my bet is that you will now be heard, so be sure to post an update.

Member
Feb 14, 2017

First off, I am truly sorry for your experience. I am an independent physician, much like Dr. Nelson was, and had the same questions come to mind regarding a PCP and tetanus booster. Kaiser is a model that pays physicians to spend less in the way of resources and keep that amount saved for physician bonus at the end of the year. Do you see how this is a conflict of interest to care? The reassuring news is we are moving toward a “value” system in that same vein, so the rest of the country will soon share similar experiences to yours. My best advice: invest in YOU and find an independent doc who truly cares. While we might cost a bit more, you will not find a higher quality healthcare experience anywhere. PS: I never use glue on large bloody finger or foot lacerations. Stitches still provide the best (albeit more time consuming) cosmetic and functional results. I do hope kaiser gets in touch.

Member
Allan
Feb 13, 2017

Years ago when I was more interested in Kaiser abuse I came across this site http://kaiserpapers.org. The site seems to have changed considerably so I am not sure if it can offer the support it might have been able to offer in the past. However, you could try contacting the owner of the website or one of the other people listed in the contact section. Today’s version of the website seems to be stripped down from a decade or more ago so I am not sure what remains on the site.

I always felt Kaiser was an awful organization. It qualifies as a non profit, but that is a tax designation. They advertise that their physicians are paid a salary so there isn’t the incentive to deny treatment, but the last I checked the physician partners in addition to their salaries received half of the profits in the form of benefits and oversaw the non partners to make sure they didn’t spend too much.

Good luck.

Member
pjnelson
Feb 13, 2017

As a Primary Physician for a long time, now retired, I can only say: what a sad story. Sounds like the supervisory process in the Risk Management work environment “fell apart.” For ‘Darryn Carter’ to be there and then mysteriously gone with no coverage continuity, is unacceptable. Hopefully, your Blog Post will find its way to the Supervisor of the Supervisor of the supervisor of……….this person.
.
I am wondering. Was your Primary Physician involved in any of this? And, was your Tdap immune status, up to date, ‘before’ the laceration happened? Just wondering.