Medical Record Number Please

Kaiser Permanente Hawaii nearly killed my baby when he was born, and left me with a permanent birth injury that may require more than one surgery because I was refused a C-section. I was in labor for 35 hours without dilation, and had scar tissue on my cervix that a nurse had to physically break with her finger and stretch until I met their ridiculous "4 centimeter rule" for an epidural. I was told I wasn't even considered to be in labor until I was dilating, regardless of the scar tissue. My labor was 46 hours total, my baby was in distress for hours, swallowed meconium and ended up in the NICU for 4 days. I asked the delivery doctor - a resident - if he had given me an episiotomy. No, he said, but I only had a slight tear and it only took one stitch.

 That was all pretty horrible but it worked out OK, at least until I went for my four-week checkup. Even though I had an appointment I was told the doctor was "too busy" to see me, and asked if I was willing to see a nurse practitioner. Sure why not, I had no idea what I was in store for. The nurse was visibly shaken, saying my tear was the worst she had ever seen. She called in a different, more experienced nurse practitioner to look, they showed me in a mirror, then only after I demanded was I allowed to see my doctor. It was all quite humiliating but the worst part was when my doctor told me she wasn't concerned because MY HUSBAND WOULDN'T NOTICE THE DIFFERENCE. She also told me all I needed was an episiotomy to sew the skin back together and that I should wait two years until my son was in preschool. That and I was lucky to have a live baby so I should stop concentrating on all this "negative energy" and enjoy him. After all, some mothers don't get to take their babies home alive.

The two year recommendation is very significant because it just happens to coincide with the two year statute of limitations on medical malpractice cases in the state of Hawaii. I, in the meantime was in no hurry to have the repair done because I felt I'd rather go to my own funeral than let Kaiser touch me again, and all I needed was a simple episiotomy.

I was treated for post traumatic stress disorder related to the birth, also by Kaiser of course, and when I was ready to stop my antidepressant medication my doctor told me to go ahead and stop taking it. Too late I learned of a 3 year old drug labeling change referring to the severe withdrawal syndrome related to stopping the medication, even gradually. I suffered in bed vomiting, head spinning, for two very long weeks. This was preferable to calling Kaiser Behavioral Health with my "crisis," and being told I could be seen in 4-8 weeks!

With that we were done with Kaiser. I did some reading on a midwife website and found out my tear most likely required reconstructive surgery, rather than simply sewing back the skin. The original "one stitch" didn't hold because it wasn't supposed to. I decided to see a non-Kaiser OB/Gyn to find out exactly what was needed before I went back to Kaiser, because I didn't want to be left with a pre-existing condition when we changed insurance. Imagine my surprise when I was told I needed a hysterectomy as well as extensive reconstructive surgery because I was suffering from four conditions too embarrassing to mention here. The non-Kaiser doc actually sneered when I told her the story, but due to the incestuous nature of the Hawaii medical community (they all have worked or will work together at one point or another in their career here), she wasn't willing to even write down her diagnosis. She handed me a booklet with an 80 year old woman on the cover (I'm 39) and sent me on my way.

I had to threaten to picket before anyone at Kaiser would even bother to return my call regarding my complaint, and when I did hear back from Dr. Geoff Galbraith, Vice President, Hawaii Permanente Medical Group, Quality Improvement Management, the head of quality assurance at Kaiser Permanente Hawaii, he seemed so nice, so helpful. "How can I help you?" he said. After listening to every gruesome detail of my story, he agreed to send me to the head of the OB/Gyn department for treatment recommendation, and promised to follow through. I saw her two weeks ago and she seemed very sympathetic, agreeing to refer me to an outside specialist for the surgery. She saw no problem with Kaiser paying for the surgery even if it went into July or August. That was what she would recommend. I waited. No one ever called to schedule the appointment.

In the meantime I called every malpractice attorney on the island and they all said the same thing. There was no getting around the two year statute of limitations, even though the Kaiser doctor gave me medical advice that directly and negatively impacted my legal rights, and I wasn't aware of the extent of the damage until a few weeks ago. I was told Kaiser had never lost a similar case in Hawaii and no one would take the case.

On May 5th, I called the OB/Gyn department head back and was told Dr. Quality Assurance never intended to help me regardless of her recommendations (not in those words but close enough). In fact, he actually REFUSED, then promptly went on vacation, leaving me hanging. He wanted me to see the Kaiser urologist, even though I needed a specialist called a uro-gynecologist, and I would have to wait my turn. They scheduled me an initial appointment for June 30th, which just happens to be our last day with Kaiser. Dr. Galbraith and the OB/Gyn department head knew this was our last day because I told them, naively thinking most doctors are healers, not butchers, and believing that they had "no incentive NOT to help" me (his words).

A few days ago I opened a newspaper and there was an article in the "Leadership Corner" - an interview with the new president of Kaiser Permanente Hawaii, a nurse formerly of Kaiser California. Her name is Janice Head. She flat out states in her interview that their top focus is cost containment. Quality patient care is second and she talks about how she will lower the costs of healthcare by spending "tens of millions of dollars over the next several years" improving their COMPUTER SYSTEM (huh?), and how the consumer (read: patient) needs to bear more of the expense of healthcare to take the burden off the poor underpaid employers. She mentions higher co-pays or paying 20% of the cost of a doctor visit. Excuse me, this lowers the cost of healthcare HOW and for WHOM???? I've written a letter to the editor of the newspaper in response. I'm hoping it will be published, but I'm told the Honolulu Advertiser takes Kaiser's advertising dollars very seriously.

Now I must wait until July 1st to see a new doctor regarding my surgery because we are stuck in the Kaiser contract until the end of June. That's right, they would not even let us out of the contract and we are stuck paying premiums of nearly $400 per month until we switch to HMSA's PPO plan.

If you have read this far, I thank you. It wasn't easy to write this all down but I believe the HMOs count on the fact that we will be too embarrassed to talk about the very personal nature of our problems. We are here to help others do the same.

5/11/03

Update 5/24/03 - Today we received open enrollment paperwork from my husband's employer. To upgrade to the PPO plan at HMSA our premiums will go up to $874.10 per month. Hawaii has mandatory insurance for full-time employees so this figure represents coverage for myself, my son plus $35.88 per paycheck for upgrading my husband's coverage. In Hawaii we must choose between paying for insurance or food. Our Ohana chooses food. As of July 1st my son and I will be uninsured until we can save enough money to move back to the mainland.

My husband will continue on with Kaiser because he is covered on their policy for free, but he has no intention of using them unless he has a life-threatening emergency (God help us). To stay on the Kaiser family plan our premium would have risen to $634.20 per month, which we also can't afford.

Read the latest update here