Finances Dictate Care, Kaiser Enrollee Claims

LOS ANGELES (CN) - A woman blames Kaiser Foundation Health Plan for her daughter's fetal brain damage and says cost-cutting played a part, in a complaint filed in Los Angeles Superior Court.

When Rilesha Haynie gave birth to Myleiah Sellem at Baldwin Park Medical Center on May 6, 2012, the baby was deprived of oxygen during labor and has "severe and permanent brain damage" as a result, the complaint says.

While Haynie was hooked up to a fetal monitor prior to the birth, and she and the baby were in distress, the defendants "undertook no actions," according to the complaint.

"Delayed and improper treatment," physically injured both mother and baby, the complaint says.

Haynie and Sellem sued Kaiser Foundation Hospitals; Southern California Permanente Medical Group; Kaiser Foundation Health Plan Inc.; a Kaiser doctor and a midwife.

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 says.

The financial arrangement has caused medically necessary treatments to be bypassed and caused patients to suffer through long delays in approval for delivery of 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 also "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.

"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 employed by the group will render care when the only appropriate care could be provided by a contracting sub-specialist such as a neurologist, neurosurgeon or orthopedic surgeon," the complaint says.

Haynie sues for negligence in diagnosing, managing and treating fetal distress, providing timely evaluation, obtaining specialist consultation, providing adequate staffing, investigating competency of physicians and surgeons, maintaining the highest level of medical care, protecting patients, evaluating medical care provided on defendants's premises, and implementing the chain of command. She also sues for negligence resulting in "medical and administrative abandonment." She seeks special and general damages.

Marsha E. Barr-Fernandez, of Heimberg Barr, represents the plaintiff.

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