November 16, 2001
Kaiser fined $500,000 for not referring patient
The state Department of Managed Care fined Kaiser Permanente $500,000 Thursday for failing to refer a Stockton youth with muscular dystrophy to the UC Davis Medical Center for needed care. The referral was requested in August 2000. Timothy Waters, 19, died six days later.
"It was pretty egregious," said department director Daniel Zingale. "The family had made several attempts to get Kaiser to focus on the case." The family had additional health insurance that would have paid for care at UC Davis, Zingale said, but Kaiser didn't tell them.
Kaiser spokesman Jim Anderson said Waters had been a patient at both UC Davis and Kaiser Permanente for many years. He suffered from an incurable disease known as Duchenne's muscular dystrophy, Anderson said.
"Obviously, we'd like to express our sympathy to the family of the young man," Anderson said. Of the fine, he added that Kaiser is reviewing the case and "analyzing what to do next." He offered no other details.
The fine is hefty because failure to refer patients in a timely manner is part of providing good continuity of care, Zingale said.
The law requires HMOs like Kaiser to refer their patients to another healthcare provider if the patients need services that aren't provided by the HMO.
Under managed care, the health plan is paid a set fee per member per month to provide all necessary services. Therefore, if Kaiser sends a patient to UC Davis � the most expensive hospital in town � Kaiser has to pay the tab.