WESTPORT, May 17 (Reuters Health) - The California Department of
Corporations has fined Kaiser Foundation Health Plan, the state's largest
HMO, $1
million for "systemic healthcare delivery problems" that resulted in
the death of one
of its enrollees in 1996.
The fine against Kaiser is one of the largest ever assessed by the department,
which
currently oversees HMOs in the state, a department spokeswoman said.
A newly
created Department of Managed Care will assume regulatory oversight
of California
health plans effective July 1.
The fine stems from an investigation into the death of Margaret Utterback,
a
74-year-old Kaiser member who suffered a ruptured abdominal aortic
aneurysm.
Through its investigation, the department determined that Kaiser failed
to provide
access to basic healthcare services, including preventive and emergency
care.
"Mrs. Utterback was exhibiting classic symptoms of the life-threatening
condition for
which her medical history made her a likely candidate," the department
said in a
statement. Although she "repeatedly sought" a same-day appointment
for persistent
back and abdominal pain, she wasn't seen until 8 hours later and died
in Kaiser
Hayward Hospital's critical care unit 1-1/2 days later.
Kaiser spokesman Jim Anderson said that many facts are in dispute and
that Kaiser
plans to fight the penalty. He added that the case, if upheld on appeal,
would
establish a dangerous precedent by requiring health plans to insert
themselves into
medical decision-making.