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From The Insider - The North Carolina State Government News Service
V. 4, No. 93  Monday, May 13, 1996 18 pages

HMO LAWSUITS RAISE ISSUES:

Kaiser Foundation Health Plan of North Carolina, 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. 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 the state. In that period, the company has drawn more lawsuits from patients than other HMOs, according to an examination of state records and court records (CHARLOTTE OBSERVER, 5/12)

Of the 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. 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.'' Russell stressed that the company has not lost a lawsuit here. 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. N.C. regulators criticized the HMO for service problems in a 1992 audit. But a 1995 follow-up found that Kaiser had improved, though the report said it needs to work at speeding up telephone and appointment services.

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