Kaiser pays $1 million fine, denies access-to-care claim

Though the health plan admits no guilt, its capitulation is seen as a victory for doctors and state managed care regulators.

By Robert Kazel, AMNews staff. Dec. 16, 2002.

After a two-year fight, Oakland, Calif.-based Kaiser Permanente has agreed to pay a $1 million fine levied by the state's Dept. of Managed Health Care.

The agreement is considered a victory for the managed care department and its chief, Daniel Zingale, as well as for the Permanente physicians involved in the case of Margaret Utterback, who died following a ruptured abdominal aneurysm in January 1996 after delays at a Kaiser clinic.

Originally, Kaiser, a staff-model HMO, claimed the state agency had no authority to fine it for inadequate access to care, the central argument of the Utterback case. It had said that any discipline stemming from such cases must be directed not against the plan but against the doctors involved, and that the Utterback matter was under the jurisdiction of the state medical board or Medicare authorities.

"I was never able to get the message out to doctors that this was not about doctors, it was about health plans," said Terry Preston, Utterback's daughter. "I think the big message the case has sent is that health plans can't hold doctors up as scapegoats for what happens. Doctors have taken [the blame] for so long. Responsibility should fall on the shoulders where it belongs."

The fine, initially levied in May 2000, grew out of a visit by the 74-year-old Utterback to a Kaiser satellite medical clinic in Hayward, Calif., in January 1996. Utterback woke up in the morning with a sharp pain in her side and called the Kaiser clinic, asking to be seen that day by her doctor. [...]