Finances Dictate Patient Care, Kaiser Enrollees Claim
8-26-2013 23:58:00
LOS ANGELES (CN) - A woman blames Kaiser Foundation Health Plan and its cost-cutting policies for her daughter’s fetal brain damage, in a complaint filed in Los Angeles Superior Court.
Rilesha Haynie was admitted to Baldwin Park Medical Center on May 6, 2012 and gave birth to Myleiah Sellem. The baby, however, was deprived of oxygen during labor and has permanent brain damage as a result.
The blame can be attributed to Kaiser’s money-saving policies that include delaying and cutting back on medical treatment at all levels, according to the complaint.
Part of the problem is the nature of Health Maintenance Organizations such as Kaiser, which offer members a “flat fee” or “capitation” per month in return for medical care, effectively deincentivizing health providers from giving proper care to patients, Haynie says in her complaint.
“The capitation method of compensating for medical and/or hospital care provided to enrollees of Kaiser Foundation Health Plan Inc. created a very serious conflict of interest, which existed ... with respect to the rendition of medical and/or hospital care to Kaiser Foundation Health Plan Inc.’s enrollees, because there was and is a very significant financial disincentive to incurring the expense of providing needed medical and/or hospital care. Each of the defendants derived financial benefit from each failure to provide quality medical and/or hospital services to the plaintiff,” the complaint states.
It has caused medically necessary treatments to be bypassed and caused patients to suffer through long delays in approval for a delivery or medical treatment, to suffer injury or death and to receive treatment from underqualified staff, according to the complaint.
In Haynie’s case, her treatment was delayed and when it did come, it was provided by a woman who was not even a doctor, the complaint says.
The defendants “negligently and carelessly failed to furnish equipment or laboratory or radiological facilities that were necessary for the skillful care and treatment of plaintiff’s health condition,” according to the complaint.
It was because of Kaiser’s policies that Haynie was treated by Mary E. Sheridan, a Certified Nurse Midwife, instead of her doctor, Gayla P. Ivery M.D., that led to her baby’s injuries, the complaint says.
“Under these arrangements medical groups and HMOs often ‘ratchet’ down the level of care/provider actually rendering care, e.g., a nurse will provide care that should be provided by a physician or, as in the instant case, a primary care physician,” according to the complaint.
Haynie sues for negligence in diagnosing, managing and treating fetal distress, providing timely evaluation, obtaining specialist consultation, providing adequate staffing, and failing to investigate competency of physicians and surgeons. She is seeking special and general damages.
Marsha E. Barr-Fernandez, of Heimberg Barr, represents the plaintiff.
