Meandering Missive: In defense of Kaiser Permanente

Thursday, November 03, 2005

In defense of Kaiser Permanente

I know Kaiser Permanente (aka Kaiser Hospital, Kaiser HMO) has long been a whipping boy, scapegoat, etc. for many people. I do not doubt for a minute that many people have had bad experiences at Kaiser, and I truly feel awful for them. One of my aunt's neighbors, in fact, was the hapless recipient of many horrid boo-boos by the Kaiser up in Oakland. However, I also know of many people who had very bad experiences at NON-Kaiser hospitals, clinics and private doctor's offices. Several I even know of personally.

In August 2005, a medical mistake caused a young man to die at Kaiser Santa Teresa here in South San Jose, which is the Kaiser my folks go to, as do I. The details of the incident just came out, and already Kaiser haters are using it to further excoriate the HMO. I think what happened is tragic and unacceptable. However, I'd like to remind that according to a statistic I just heard, 44,000 to 98,000 people nationwide die each year as a result of such errors, and that's certainly not all from Kaiser. Of course, such gigantic figures are ABSOLUTELY INEXCUSABLE, and they shock and disgust me!! I never dreamed in this day and age, figures like that would be so high.

Here's what happened, in a nutshell, followed by a brief commentary by me, in the hopes of de-vilifying Kaiser. If that makes me an apologist, so be it.

On Aug. 29, 21-year-old Christopher Robin Wibeto died at the Santa Teresa campus of Kaiser. He had been hospitalized for treatment of non-Hodgkins lymphoma and was mistakenly given an injection of the chemotherapy drug vincristine in his spine. (Vincristine, incidentally, is derived from Vinca rosea, a species of periwinkle whose flowers are pinkish to reddish, rather than the standard periwinkle hue). Wibeto, who happened to be a lifelong San Jose resident, died because vincristine is never supposed to be injected into the spine. I don't know why; I've just read the result is almost always fatal.

It seems this story didn't make the news until Nov. 2 or 3 because investigators with the California Department of Health Services (and those from Kaiser as well) were conducting thorough investigations. Wibeto's family and Kaiser were also in legal negotiations over his death, and recently were awarded an undisclosed financial settlement. That probably was another reason the story was not released to the media until now.

Again, for the record, I think it's tragic and inexcusable what happened to Wibeto, and I wish peace and healing to his parents and brother. However, also for the record, now that Kaiser is again being demonized in public, I'd like to share the consistently EXCELLENT, pro-active and professional treatments and services my folks and I have had from Kaiser. We feel Kaiser's former slogan definitely still applies: "Good People. Good Medicine."

Mom's breast cancer
When my mom found a breast lump nearly 5 years ago, she got a mammogram and biopsy within 2 days, got the results within 2 days and underwent a breast cancer lumpectomy 7 days after that! While in the hospital awaiting surgery, both in the prep area and even in OR, she was asked several times by everyone for her name, what procedure she was having, and where. (Unlike those horror stories of someone having the wrong leg taken off).

All the doctors, nurses, technicians, etc. moved so smoothly and efficiently that month (January 2001) we barely knew what was happening. My mom had nothing but the best follow-up care and advice after the surgery, had doctors who actively listened to her, and together they decided on her follow-up procedures: no chemo, 6 weeks of radiation, 5 years on Tamoxifen, a pill most women with estrogen-sensitive BC take as a precaution. Thankfully her cancer was non-aggressive Stage I. :)

Mom's gall bladder surgery
A few years ago, my mom had some abdominal pain and barely even had to ask her doctor for a scan (I forgot which type) and the doctor was already writing up a referral. The scan showed scars and stones in her gall bladder, which she had removed. At the same time, the very diligent surgeon noticed her belly button had the beginning of a very slight hernia, so she repaired that at the same time.

Mom's migraine situation
I remember one time my mom was in the middle of a 3-day migraine that was one of her worst. The day after she saw her doctor about perhaps changing her migraine medication, the doctor actually CALLED my mom, on the doctor's own time, to ask if my mom was feeling any better. Since my mom was not, she invited my mom to come back that day and she (the doctor) would give my mom a prescription for a calcium-channel blocker sometimes used as daily migraine prophylactic. She said she thought it would be very good for my mom, and she was right!!

Dad's high-risk hernia surgery
My dad has COPD, which for him basically comprises 2/3 advanced emphysema, and 1/3 mild chronic bronchitis. He also has an enlarged heart from this. He uses oxygen sometimes during the day and always at night, and his physical activities have become more and more limited over the years. (Yes, he was a heavy smoker in his youth!) A few years ago he developed a lower abdominal hernia (where the intestines start to poke thru the abdominal wall). We were worried about him having surgery, as he's high-risk due to the COPD and cannot be put under general anesthesia without extreme risk! He's also 82, and age itself is a risk factor. Long story short, he had wonderfully thoughtful and efficient care from his surgeon who left no stone unturned to make the procedure smooth and successful. There were NO complications at all, and barely any pain. It went better than any of us thought.

My upper G.I. series
A few years ago, I was fed up with having acid reflux/GERD symptoms without knowing if perhaps I had a physical reason for it, such as a hiatal hernia (where your stomach pokes up thru your diaphragm). All I had to do was ask my doctor once, and she immediately wrote me a referral to have an upper G.I. tract X-ray series performed. I got that appointment quickly as well, and it went fine. No hernia showed up, or any other abnormalities, so they told me I simply have a weak lower sphincter muscle that doesn't always keep stomach acid down in the stomach. (I'll only have surgery for that if it gets worse!)

My 'almost' emergency
One time, also a few years ago, I went to Kaiser's urgent care on a weekend because I developed a sudden high fever and felt extremely sick! The reason I was worried is because it was also "that time of the month" and I was using tampons, which have been linked to a sudden, sometimes-fatal illness called Toxic Shock Syndrome. (Sorry, I don't mean to embarrass anyone). I was seen very quickly, not at all forgotten or left to "sit around" as many folks say happens to them. A very professional, cheerful doctor saw me, determined it was not TSS because I didn't have the typical body rash and certain other symptoms, and sent me home. I felt a little silly that I bothered urgent care with this, but they were very courteous and said they were glad I came.

My acute rib injury
Another time I visited urgent care because I thought I had a cracked rib and was in intense pain. Again, I was seen almost immediately and treated with great patience and care. The doctor diagnosed it as most likely a torn inter-costal muscle in the rib cage, but said he'd be very glad to refer me to X-ray if I wanted to know whether it was indeed muscle, or bone. Since the treatment for rib cage injuries is basically the same (i.e. they don't "tape you up" anymore, as that can cause lung infections), I thanked him and said I'd do without the X-ray exposure since it wouldn't change anything. He also involved me in the decision on what prescription pain-killers he would prescribe. (I normally have a high pain threshold, but this was PAINFUL!!)

My dermatological procedures
For a few years, I had some little cysts on my back, which my dermatologist examined and said were definitely NOT any type of cancer. However, the cysts slowly grew, and I didn't like them. Two were visible if I wore a swimsuit, which was embarrassing, and one was right at my waistline, which made it annoying to wear certain types of pants. All I had to do was ask my derma if he'd do mini out-patient surgery to remove them, even though technically it was a "cosmetic" procedure, and he immediately said yes. All I got charged was for a standard office visit and a small lab fee. (Whew!) I could have been charged a large amount, since it was an elective cosmetic thing and not a necessary or health-related thing.

My psychiatry/psychology experiences
Even getting into the Department of Psychiatry was a breeze! When I told my doctor, a year or two ago, that I was having problems such as insomnia, anxiety, adult ADHD, caregiver issues (my dad was going thru health problems at the time), and various other things, she took me seriously and without another thought, gave me a referral to psychiatry. It was so easy. I met a very good psychologist who helped me with some of the things. She also suggested I would like a drop-in weekly mindfulness meditation group (which also is something of a stress support group) that I still drop in on to this day, and which is very helpful!! I also ended up switching from the original psych to the psych who facilitates the group, because we got to know one another via the group and I felt more comfortable with him than with her (not that anything was wrong with her).

I could go on, but I won't. I'm sure most folks are bored to tears as it is. *blush* I broke the stories up under bold subheadings to make it easier to read. I hope I was successful. :) At any rate, I'm sure you get the point that even though yes, Kaiser has done some unprofessional and/or stupid things to some people, they are not ALWAYS like that. And there are PLENTY of non-Kaiser hospitals, clinics and doctors who've also done unprofessional and/or stupid things. That doesn't make it right, of course -- not for Kaiser and not for the other medical entities either. Medical mistakes or acts of neglect, especially those that cause someone to die (in Wibeto's case), or to have severe brain damage (in the case of several local people) are inexcusable.

I just wanted to share my 2 cents' worth about what I feel has been the vilification of Kaiser over and above all other medical entities. I simply don't agree with that, but I totally respect the opinions of those people who do.

Today I am feeling not sure.

posted by ScaryShari @ 10:55 AM

5 Comments:

At 9:30 PM, Unknown said…

Hi Shari! Thanks, by the way, for reminding me I should come back to your blog. :) I have it bookmarked; I had just been a bit forgetful.

I really like this post of yours; you've given some good points to show that Kaiser may have screwed up before, but they've also helped many people (aren't they the biggest HMO in California?). My ex-MIL had her breast cancer treatment through Kaiser, too. They treated her very well and everything was done quickly. I have several friends who've had babies at the Kaiser hospitals in this area, and I was surprised to hear that Kaiser Santa Teresa even uses certified nurse-midwives to deliver babies, which is pretty progressive.

I've also heard the horror stories, and I had a couple myself back in the days that I still had Kaiser (prior to Ricky's birth). 1. The time I had horrible lingering food poisoning and no one in the ER there could figure it out. 2. I miscarried (prior to conceiving Ricky) and they just sent me home to do it -- no comfort, blood tests, exams. The one that comes to mind is not mine, though, but the experience of Chad Kunis:

http://www.geocities.com/chadkunis/

Okay, now, that being said, I'm not vilifying Kaiser at all! It's my belief that these sorts of things happen all the time, at many hospitals. I'm not sure why Kaiser's getting all of the media scrutiny. But I'd bet you that all of the hospitals in the area have at least several of these incidents a year. We don't find out about a lot of them because of confidential settlements, etc. So it's a shame that Kaiser's getting all the negative attention because I'm sure this stuff happens all the time (unfortunately).

About the vincristine, I'm pretty sure it's usually given intravenously mixed with a dilution material and piggybacked with other drugs. Someone made a major boo-boo giving it into that poor boy's spine, and yes that was wrong. But IMHO it could have happened anywhere.

And those, my friend, are my $.05. :)
At 10:26 AM, Unknown said…

Shari, have you seen this?

http://www.mercurynews.com/mld/mercurynews/13117889.htm

(requires registration, which I bet you have already done!)
At 10:38 AM, Anonymous said…

I haven't read everything posted here thoroughly, and I don't even know where Kaiser is (is it California?), but I can *assure* everyone reading this that medical mistakes don't only happen in California. I am from Illinois, and I was *almost* dead or a vegetable because of an incompetent neurosurgeon in 1997. I can post my story if anyone would like to read it. It was my *parents* (neither one of whom has ever been employed in the medical profession) who saved my life in 1997.

Briefly, I would like to say that the medical profession has created their own problems, as far as I'm concerned. They knew that our U.S. baby-boom population was aging, but did they increase enrollment in medical schools? Not that I am aware of.

Was enrollment in nursing programs increased? As far as I am aware, this has only begun to happen.

I heard something on the TV just the other day that in Iowa, if you attend nursing school and then get a nursing job in Iowa after graduation, you can have your student loan wiped out. I know that Iowa probably has a national reputation of being a "backwards" state, but I can attest to the fact that they have, in my opinion, one of the best health care systems in the world in Iowa.

Anyway, I just had to add this comment.
At 11:09 AM, Anonymous said…

Hi Shari....May I please share my comments regarding Christopher Wibeto, who by the way is/was my nephew.

My sister was much like you..she defended Kaiser every time someone talked crap about Kaiser. She gave birth to her three children at Kaiser hospitals, they took AWESOME care of our mother when she went through her 3 1/2 year battle with ovarian cancer. Every time my nephew Chris had asthma problems, their ER department took great care of him. In his 21 years he also was at Kaiser numerous times for allergy shots, bronchitis and A.D.D.. We THOUGHT he was in the best hands being in the hospital when a mass was found in his chest. His Dr. gave him aggressive chemotherapy treatments because his cancer was a rare, aggressive lymphoma. I was very happy that the Dr. was treating him that way.

There are SO many things that the media did not know about my nephew's case. First of all, my nephew's untimely passing was most likely leaked to the media by the State Medical Board. My sister and brother-in-law sent my nephew's case to them, to the Joint Accredited Hospital organization and other places (I wasn't involved in sending them out so I am not sure where else they went). I do know that it went out sometime mid-October though.

Let me share something that I witnessed with the Kaiser Dr. that was treating my nephew. The first time they put the CORRECT chemotherapy in the shunt in his head (not spine as the media has said), I walked into my nephew's room where the procedure was taking place. What did I see you might wonder? My nephew laying in the bed, the Dr. was doing the procedure with MY brother-in-law wearing a purple latex glove holding a syringe full of my nephew's brain fluid that the Dr. had just taken out of his head. Why was my brother-in-law holding the syringe?? Because the Dr. asked him to. Is my brother-in-law a nurse? No, far from it. The Dr. was in so much of a hurry, he didn't wait for a nurse to assist him, which was SO wrong.

When the "error" was made to my nephew on August 26th, it took Kaiser 9 hours to move him to Stanford hospital. When the paramedics picked him up they said that Kaiser is always slow to move people. Mind you, if my nephew had gotten there sooner, he most likely would still not be here but we could have had him here a few days longer. And, the Dr. told us that this would just put his chemotherapy treatments behind for a few days. He did not tell us that this "error" would most likely kill him. We were led to believe he would be alright. The Stanford Dr.'s had to share the horrible news with us.

The nurse that gave another patients chemotherapy to the Dr. to administer to my nephew was not a "chemo-trained" nurse. He was a traveling nurse and a few days before the "error" was made, he shared that information with my sister. What was he doing giving chemotherapy to patients if he wasn't trained properly? He was doing the job that Kaiser assigned him to do.

After my nephew passed away we found out MORE things that this Dr. was doing wrong....things that were not reported to the media. My nephew was being overdosed with the vincristine chemotherapy prior to the "fatal error" that was made. His white cell count was SO low because of that overdose. In my own personal opinion, the Dr. was using my nephew as a guinea pig. He was NOT getting any advice from the fellow oncologists that he worked with, he was treating him all by himself. At the time, he had SIX months of experience as a Dr. treating cancer patients.

Why is it that we only hear horror stories about Kaiser? One must wonder…..I know Kaiser is a very large hospital but I, myself have NEVER heard any horror stories from Good Sam, Regional Medical Center or even SJ Hospital when it was around. Today we just heard about a 4th person that died at a Kaiser hospital within the last 13 months.

You are entitled to your .02 cents, everyone is. I just wanted to give you my .02 cents as an Aunt and Godmother that is missing a very important part of my life. We are a VERY close family and we have already lost our parents, (Chris' grandparents), so this is very tough. And yes, mistakes do happen, but...if they were doing their jobs right, my nephew would most likely still be here. This is a mistake that COULD have and SHOULD have been prevented.

Also, thank you for this line that you wrote on your site, "Again, for the record, I think it's tragic and inexcusable what happened to Wibeto, and I wish peace and healing to his parents and brother."

Janice www.xanga.com/loseryesyouare
My nephew Shane's site: www.xanga.com/shaneshadey
My nephew's memorial website: http://www.mem.com/display/biography.asp?ID=983627
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