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Charlotte Observer, The (NC) - Sunday, May 12, 1996
Readability: 11-12 grade level (Lexile: 1220L)
Author: NANCY STANCILL, Staff Writer
Edition: ONE-3
Section: MAIN NEWS
Page: 1A

Diane Goodman's pain gnawed at her stomach, back and side.

And as the pain worsened, the Charlotte woman kept turning to her HMO. For 2-1/2 years, she got gas remedies, painkillers and differing diagnoses, a lawsuit charges.

In late 1993, she went outside her HMO to another doctor and got the truth. She had pancreatic cancer. Four months later, she was dead at 42.

``She got mad about it,'' Warren Goodman said recently, wiping tears with a bandanna. ``She said it seemed like they should have tried harder to find out what was wrong with her.''

Goodman, a 47-year-old truck driver, sued Kaiser Foundation Health Plan of North Carolina in December, contending that the HMO didn't properly diagnose or treat his wife.

Kaiser has denied the allegations in court papers filed in the Mecklenburg case. Its top officials said they can't discuss the suit. But they emphasize that they constantly monitor, measure and analyze the care patients receive in the HMO to make sure it's consistent and of high quality.

But the Goodman case isn't the first time Kaiser has drawn legal action from patients and their families. Kaiser , the first large, out-of-state HMO to tap the N.C. market in 1985, has grappled with a spate of patient lawsuits in recent years.

Lawsuits against HMOs over treatment issues are rare, but some N.C. malpractice lawyers say they expect that to change in the coming years, given the rapid growth of the industry and the increasing numbers of dissatisfied HMO patients who call to solicit their services.

Since 1992, 10 Kaiser -related lawsuits have been filed in North Carolina alleging medical neglect or malpractice. Kaiser , with 127,000 members, is the fifth-largest HMO in North Carolina . Enrollments at larger HMOs range from 129,000 to 243,000.

In that period, it has drawn more lawsuits from patients than other N.C. HMOs, according to The Observer's examination of state records, court records in the major cities served by the state's HMOs and information provided to The Observer by the HMOs.

Of the state's HMOs that were operating in 1992, five others disclosed one to four lawsuits each during that time. Most were claims disputes. None of those HMOs were sued for allegedly failing to diagnose or properly treat a patient.

Kaiser has settled five of the 10 recent lawsuits. The terms of the settlements are confidential, Kaiser officials said. Medical case settlements generally mean that the defendant does not admit liability in exchange for making a payment to the person who sued.

The HMO last year won a malpractice claim. Four other cases are pending.

``We would like for the number to be zero,'' said Dr. Henry Russell, Kaiser 's N.C. medical director. ``But if you think of it in terms of over 11 years, hundreds of doctors, a membership of 127,000 patients, thousands of encounters and then we have 10 suits, that's not a bad track record.''

It is difficult to draw conclusions about malpractice suits. Spokesman Dale Breaden of the N.C. Medical Board said that in 1995, 253 malpractice cases were resolved against some of the state's 15,000 doctors.

``The majority of malpractice cases do not involve questions of competence,'' said Breaden.

Kaiser has also been a defendant in 12 other N.C. suits since beginning its operations in 1985, said Myra Joines, a Kaiser spokeswoman. She declined to provide further detail.

Russell stressed that the company has not lost a lawsuit here.

``We have settled some cases and we've tried to always settle those in a very ethical and appropriate kind of way,'' he added.

Kaiser , which began five decades ago in Western states, has 7 million members across the country. Kaiser has faced a tougher market in its 11 years in North Carolina . N.C. consumers were unaccustomed to the plan's restrictiveness - using doctors at Kaiser clinics - and N.C. regulators have periodically criticized Kaiser for service problems like long waits for appointments and fewer than expected members using mental health programs.

President Ted Carpenter said that the company has worked hard to resolve consumer complaints and that patient satisfaction with Kaiser has climbed to 90 percent in recent internal surveys. The N.C. company is on an upward path, he said, building new facilities, offering more programs and adding an option that allows members to use doctors in separate practices.

But while Kaiser has been strengthening its operations, it has also faced lawsuits.

The suits were lodged against Kaiser or Carolina Permanente Medical Group, a Kaiser partner company of more than 200 physicians and other professionals providing exclusive staffing to Kaiser medical facilities.

Russell said Kaiser 's integrated system - its Carolina Permanente doctors are hired solely to staff Kaiser facilities - make the HMO more likely to be sued by name than HMOs that merely contract with doctors who have their own practices.

``We're a highly identifiable group, big target, big name and because of our structure, the suits all fall under the name of Kaiser Permanente,'' he said.

Russell said the number of lawsuits - and the issues litigated in those cases - should be judged as a sign of the times and have nothing to do with the quality of care Kaiser offers.

``We're living in a litigious time, unfortunately, and when things don't go well, sometimes people do resort to suing,'' Russell said. ``We try to be as equitable and fair through that process as we can be.''

The state Insurance Department requires HMOs to annually disclose the numbers of lawsuits filed or resolved, but doesn't probe further, said Bill Hale, a department lawyer.

The five lawsuits filed against Kaiser that have been settled recently allege:

* That physicians treating Tommy Ray Sanders, a Roxboro electrician, didn't discover he had colon cancer for 10 months, despite four doctors' visits for persistent rectal bleeding. Chapel Hill lawyer William Hamilton said Sanders is still under treatment.

* That one of the HMO's doctors failed to respond to repeated requests from nurses to properly monitor the birth of a baby in fetal distress. The Wake County girl, Lindsey Phan, was born brain-damaged in 1991. The family agreed to a settlement, said Raleigh lawyer John Edwards.

* That a physician for the HMO abruptly changed the blood pressure medication of a Raleigh patient without properly monitoring the changes in his condition. As a result, George Wallace of Raleigh had a stroke in May 1990 and was paralyzed. The family accepted a settlement just before the June 1995 trial began, Edwards said.

* That physicians at a Charlotte Kaiser facility failed to diagnose and properly treat a Matthews man for Rocky Mountain spotted fever. Florian Masson died in July 1994, the same week he was examined three times at a Kaiser clinic. The terms of the settlement with the Masson family cannot be disclosed, said Charlotte lawyer Kent Brown.

* That a Wake County physician who contracted with Carolina Permanente left a woman with extensive colon problems because of poorly performed surgeries. Carolina Permanente settled the case, but the allegations against the specialist are pending.

Kaiser denied liability in each case. Kaiser won an N.C. court case in March 1995, when a jury found the HMO wasn't at fault for failing to diagnose a cancerous nasal tumor of a nurse who worked for Kaiser for 25 years.

The nurse, June Dyche, 59, died a few months later in October 1995, said her husband, Norman. The couple had earlier reached a $500,000 settlement with a radiologist who contracted with Carolina Permanente. The Dyches alleged that the physician had misread her X-rays.

While declining to discuss the specifics of the cases, Russell said Kaiser puts a premium on monitoring the quality of its services.

Kaiser has many supportive patients.

On a recent day, Kaiser 's modern medical offices across from Eastland Mall were bustling with a mix of patients. They included mothers with injured children, a husband and wife trying to conceive a child and an elderly woman with a skin lesion.

Grace Thorsen, 82, said she's been a Kaiser member for 10 years, driving from Fort Mill, S.C., to Charlotte for help with skin and bladder problems and such procedures as mammograms.

``They give me very good care,'' she said, as a doctor gently checked for skin cancers.

In another room, Paige Bennett waited to hear about X-rays of her daughter's elbow. Lauren, 10, had gotten hurt playing hockey.

``A lot of people have preconceived ideas of HMOs, but I've gotten wonderful care for my children,'' she said.

N.C. regulators criticized the HMO for service problems in a 1992 audit. But a 1995 followup found that Kaiser had improved, though the report said it needs to work at speeding up telephone and appointment services.

Chris Scott, president of the N.C. AFL-CIO, said he's a Kaiser member who's ``pretty satisfied.'' But his organization recently singled out Kaiser , saying that it should do better.

``It shouldn't be care for the tenacious and a lack of care for the rest of us who are either too timid or too busy to chase a managed-care organization for what they need,'' said Scott.

Warren Goodman says his wife, Diane, told him that the HMO gave her a range of diagnoses in various visits - a hernia, a pulled muscle and gastritis. Goodman's lawyer, Pamela Hunter, said medical records show that she made at least seven visits to get help.

Russell said he couldn't specifically comment on the Goodman case, but added that the HMO's diagnostic record is good.

``We're always concerned about being as aggressive as we can be about diagnosing all diseases in the early stages. Our goal as a health maintenance organization is to prevent them in the first place.''

Goodman said that after his wife was finally diagnosed, the last four months of her life went too quickly. The couple - married 13 years - took a last trip to Atlantic City two weeks before she died on April 21, 1994.

Two years later, Goodman goes by her grave every morning - just to say hello to his ``Bubby.''

``She was a hard worker and a nice person. She was independent and proud. I wish I'd had more time to spoil her.''