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originally posted at: http://www.marinij.com/Stories/0,1413,234~24407~2390083,00.html#
Marin Independent Journal
Kaiser losing patience with patient
By Nancy Isles Nation
Thursday, September 09, 2004 - San Anselmo firebrand Sarah Nome, often at odds with City Hall, now is taking on Kaiser Permanente from her hospital bed.
Kaiser officials say Nome shouldn't be in their hospital at all, but Nome disagrees and has refused to leave the Kaiser Permanente Medical Center in Terra Linda - even though she was officially discharged from the acute care unit on Jan. 29.
In the meantime, bills have mounted at a rate of $3,200 a day and now total well over $300,000.
Kaiser officials want her out and have filed a lawsuit seeking her eviction. But Nome, a feisty Marin civic watchdog who tossed barbs at local officials for decades, says she has no plans to leave.
In addition, Kaiser has filed a lawsuit saying Nome fraudulently transferred her home to her daughter, Jane Sheldon Sands of Brisbane, in February, and is asking the court to set the deed aside until the case is resolved. The house, at 77 Alder Court in San Anselmo, is valued at more than $400,000, according to the lawsuit.
Nome says she cannot leave the hospital because she has two broken knees and cannot walk. She also believes she is the victim of elder abuse at the hands of a care facility in Greenbrae, Kaiser and others.
Known for her strong opinions on a variety of topics, Nome isn't likely to budge from her room at Kaiser. She even keeps a June 17 bill for her lodging through May 31 on her bed to show visitors. It was $302,129 then, and it's climbing.
Kaiser officials say the lawsuits were filed as a last resort because neither Nome nor her daughter were willing to cooperate.
Nome isn't able to appear in court and has been represented by Sands, who was granted the family home from her mother shortly after her discharge was ordered by Kaiser. Sands had tried to get assistance from Legal Aid of Marin but did not qualify for services, so she has worked the case herself and plans to hire a lawyer to win her mother a jury trial.
Sands said Nome will remain in Kaiser indefinitely.
"Right at this time, that is true," she said.
Last week, another Marin fixture, attorney Carl Shapiro, agreed to represent Nome at no cost in her battle with Kaiser.
According to the Kaiser suit, Nome was admitted to the hospital on Jan. 22 and, when physicians sought to arrange her discharge seven days later, she refused to go.
The next day, Nome was no longer covered by her Kaiser insurance for the hospitalization because she had been released, and she was told she would be billed for services provided.
Kaiser's lawsuit complains that officials believe Nome's home "was received by Sands with knowledge that Nome intended to hinder, delay, or defraud the collection of the plaintiff's aforementioned claim, and the claims of other creditors."
The suit also contends that Sands has been intimately involved in Nome's financial affairs for many years and alleges a conspiracy because Sands knew Kaiser's claim could only be satisfied with the sale of her mother's home.
In a written response to the lawsuit, Nome acknowledged that Kaiser is legally entitled to remove her from the premises at any time but stated that such removal would "work undue hardship, irreparable harm, or immediate danger" to her.
"The plaintiff would experience little to no harm, injury or damage with such a stay," Nome further stated.
Stanley Watson, senior legal counsel for Kaiser Foundation Hospitals, said Kaiser is not trying to get Nome's home but, instead, is looking out for her welfare.
"This case has never been about the money, this case has been about engaging her in trying to get an appropriate placement," Watson said. "It's a way to demonstrate the inappropriateness of her occupying a hospital bed. We also were somewhat concerned she had transferred her home to her daughter's name."
There is no lien on the home, Watson said.
"There is just a notice that the house is the subject of a lawsuit so it remains available to her," Watson said.
Officials at Kaiser could not comment on Nome's medical situation specifically other than saying her condition is "good," but added patients are discharged only when they are evaluated by a physician and criteria are met.
"The most appropriate place (for discharge) is determined and whenever possible we work with the patients and their families to find the most appropriate setting," said Carol Harris, a Kaiser spokeswoman. "I can assure you we work very effectively."
Harris said that hypothetically speaking, a patient who does not leave the hospital after being discharged is no longer covered by the Kaiser plan because there is no medical need. A patient may follow a process for appeal, however.
If the patient chooses what is called "custodial care," he or she is provided room, board and assistance for daily living at a daily rate. Custodial care is not covered by Medicare, universal health guidelines or Kaiser, Harris said.
If a patient cannot pay for medical costs, Kaiser makes efforts to provide financial counselors to work with families and develop payment plans.
"Kaiser is always ready and willing to amicably resolve any issues and we are always looking for ways to come to an understanding," Harris said.
Nome believes she should be covered by Kaiser for her lengthy stay because under an agreement with her former employer, the National Maritime Museum in San Francisco, she has been kept on payroll because she did not have a pension plan. Her monthly check includes deductions for the Kaiser plan.
Nome, who on Jan. 20 filed a medical malpractice lawsuit against Greenbrae Care Center and named the Kaiser Foundation Health Plan, the Permanente Medical Group and Kaiser Foundation Hospital as parties, believes she is a victim of elder abuse.
She claims she was neglected and abused, and that the facility failed to diagnose her with osteoporosis.
She further complained that caregivers failed to properly manage her medications and injected her with medications against her will.
Kaiser has contracts with Greenbrae Care Center and Hillside Care Center in San Rafael, where Nome also stayed, but is not otherwise affiliated with the centers, according to Harris.
Sands had filed a report with the Twin Cities Police Department Jan. 26, 2003, but an investigation deemed the complaint unfounded, according to Sgt. Steve Fogel.
Fogel said the report claimed that Nome was injected with a drug that investigators found only comes in pill form. The investigation also determined that Nome was treated for cardiac arrest by fire department personnel and not by Greenbrae Care Center staff.
Robert Peirce, chief executive officer of the Greenbrae facility, would not comment on the litigtation.
Nome's lawsuit is pending but her former lawyer, Douglas Fladseth of Santa Rosa, has been relieved from the case by the court at his request.
Fladseth said he declined to continue his representation because medical malpractice lawsuits are involved and expensive.
Nome sees her situation as a warning for other seniors and says they need to be alerted about what can happen when patients are dismissed as feeble-minded.
"I recommend to anybody that is older to think about it ahead of time," Nome said. "They can claim you are not capable."
She also believes her only asset is appealing to her creditors.
"They wait until you are feeble and old and all they want is your real estate - Marin County real estate," Nome said.
Kaiser officials say they just want to make an arrangement to get Nome to an appropriate setting and would consider forgiving part of her debt.
"A global resolution is what we are looking for and forgiving a piece of the debt could be a piece of that," Watson said.
Contact Nancy Isles Nation via e-mail at firstname.lastname@example.org
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