Life-or-Death Medical Plan Decisions
The information provided here presents
information provided by a former federal agent who spent several years as a
pharmaceutical detail person for a major pharmaceutical firm, four years as
caregiver to a woman diagnosed in 2008 with Stage IV esophagus cancer, and
later, his experience after being diagnosed with Stage III kidney cancer.
A comparison is made between fee-for-service
health plans and HMO plans. Reference is made to the thousands of people that
die every year from medical errors in hospitals. Reference is made to the denial
of contractual care and the unpublicized number of people who die from physician
Two recent books:
Medical Industry's Death Panels: Greek
Tragedy of a Lady Named Glenda.
America's Medical Industry: the Good,
the Bad, and the Deadly.
Fee-for-Services Medical Treatment
In a fee-for-service type of medical treatment,
physicians and other medical care providers order tests and treatments as they
determine necessary. In this form of medical
care the person is free to select the physician and medical provider of his or
There is virtually no incentive for physicians or
other medical providers to withhold treatment. In some cases there is an
incentive to order more tests and more treatment than is necessary, but this
normally does not result in death. There is a risk of a risky treatment, but at
least the patient has the ability to make a decision.
In this form of medical care, the insurance
carrier pays or reimburses the physician or health care provider for the
treatment performed; it does not take a direct role in either selecting the
provider or on determining the treatment. (Further legal explanation at Peagram,
120 Supreme Court, at 2148-49.)
Despite this being in some ways a better type of
health plan, this writer encountered serious problems as he sought medical care
for his "co-pilot," Glenda. She suffered as a result of
what was originally greed on the part of a skilled nursing facility, and that
misconduct was followed by a series of wrongful and probably criminal acts that
resulted in her premature death. A Greek tragedy in America's medical industry!
HMO medical plans operate primarily under a fixed
monthly payment. They are usually relatively satisfactory for people in
relatively good health, and financially satisfactory for the HMO corporation.
They have a strong incentive to keep costs low, and that translates into
avoiding tests to determine the reason for symptoms. Or, to even withhold
universally recognized tests and treatments.
The integrity of the HMO corporation, and of the
HMO physicians, play a major role in whether the plan members receive proper
treatment. In some cases, it becomes a life-or-death situation. And more often
then realized, the outcome is death due to denial of recognized tests and
Where some members may feel that being a member
of an HMO for years gives them assurance of the best of care, they
don't realize that they become a financial liability for the HMO when they develop a
costly-to-treat illness, such as kidney cancer. The sooner they die, the sooner
this financial burden is removed from the HMO group. Denying treatment that
could eventually cure the costly illness, or bring about remissions, becomes
Because of financial incentives, for the HMO
corporation or the physician group, there is a financial interest in providing
less care. (See Pegram, 120 Supreme Court at 2149.) The determination of
life-affecting medical care and treatment depends upon the physician's moral and
legal interest, and whether the life of the patient outweighs the financial self
Cons of HMOs
The benefits include:
All facilities are often at one location. For
people with mobility problems, this is especially important.
Medical records, especially the results of
blood tests, are promptly available for the members.
Different physician specialties are often at
Good for maintaining health.
The negatives include:
Possible denial of universally recognized
medical care, that conveniently increases the profits of the physician group
or for-profit HMO corporation. Integrity is a key determination as to
whether the patient's life is ignored for the benefit of profits.
Some HMOs, such as Kaiser, hired physicians,
often from foreign countries, with demonstrated low competency levels and
difficult language communications.
Inadequate oversight or response by
government regulators to medical misconduct.
The Good, the Bad, the Ugly,
Kaiser Permanente HMO health plan, while
excellent in some area, constitutes a medical crime in areas motivated by
profits. (There are
for-profit segments in the Kaiser Permanente physician
arrangements.) Discover the death panel experiences by this writer while a
member for 50 years with Kaiser Permanente in the Walnut Creek, California
facilities, especially during the time while he was under great stress caring
for the love of his life, Glenda, also a pilot, including while suffering
grief from her recent death on February 1, 2012. See the sordid conduct of
certain physicians at this for-profit groups of Kaiser physicians, the culture
responsible for an unknown number of preventable deaths outside of the 30,000
reported preventable deaths every year in hospitals.
Denying Life-Affecting Treatment
Physicians at most of the HMO corporate health
plans usually operate under a capitated
type of compensation plan. Under that arrangement, the physician group
receives a given amount of funds by the parent corporation based upon the number
of people enrolled. At the end of the year, the physicians receive a financial
bonus based upon the difference between the cost of the tests and treatments
that they have ordered and the amount of the funds allocated.
Therefore, any member that develops a medical
condition requiring a series of long costly treatments, such as some forms of
cancer, becomes a liability for that physician group, as well as the HMO
corporation. The physicians can reduce the costs—and
increase their end-of-year bonuses, by not ordering tests when the enrollee's
symptoms dictate such tests.
When a definite diagnosis is made of cancer, it becomes profitable to lie to the cancer victim and
urge them to do nothing until they experience personal symptoms of the cancer as
it advances unchecked through the body. Or more bluntly, absolutely refused to
provide standard tests and cancer treatment drugs, giving the cancer victim
some ridiculous argument.
Aspects of Withholding Universally Recognized
Medical Care in Prepaid Medical Plans
The need for, and the laws
permitting, criminal prosecutions of HMO denial of care decisions are thoroughly
addressed in an article
written by Ohio State University professor, John A. Humbach with dozens of legal
citations showing criminal offense from HMO withholding of life-affecting
A Boston Globe article at
(April 13, 2011) under the heading, "Woman who withheld son’s cancer drugs found
LaBrie’s attorney, Kevin James, said
yesterday that the jury apparently did not understand the burden his client
experienced in caring for an autistic son who developed cancer. He had also
argued that social workers and doctors at Massachusetts General Hospital,
where Jeremy was treated, should have done more to make sure she was fit to
care for her child and administer the medications.
"What we wanted to get across to the jury is
the tremendous burden my client had to carry, as well as the fact that the
support that should have been in place for her was not in place,’’ James
said in an interview.
James said he asked for the sentencing to be
postponed at least until Friday in part so that he could gather evidence of
support his client has received from many people who never met her, but who
understand the difficulties of raising a developmentally disabled child with
O'Keefe, LaBrie’s sister, said she understood jurors were
required to follow the legal directives given to them, but that her sister
never sought to hurt Jeremy.
“It’s too hard for them to know what my sister was going
through at that time,’’ O’Keefe said, holding back tears. “I don’t think my
sister had any intentions of hurting Jeremy, ever. I never will believe that
in my life, never.’’
Prosecutors said they will not comment on the case until
LaBrie is sentenced.
Legal analysts said yesterday that the case was the most
unusual since prosecutors brought manslaughter charges two decades ago
against a couple who refused to authorize surgery for their toddler, who was
suffering from a treatable bowel condition. The couple, David and Ginger
Twitchell, then of Hyde Park, were Christian Scientists and believed the boy
could be healed by spiritual treatment. He died within several days after
his diagnosis in 1986.
The state Supreme Judicial Court, in reviewing that case,
determined in a landmark decision that parents have a legal duty to provide
medical care for gravely ill children, regardless of religious faith.
Legal analysts said yesterday that the case
was the most unusual since prosecutors brought manslaughter charges two
decades ago against a couple who refused to authorize surgery for their
toddler, who was suffering from a treatable bowel condition. The couple,
David and Ginger Twitchell, then of Hyde Park, were Christian Scientists and
believed the boy could be healed by spiritual treatment. He died within
several days after his diagnosis in 1986.
The state Supreme Judicial Court, in
reviewing that case, determined in a landmark decision that parents have a
legal duty to provide medical care for gravely ill children, regardless of
Boston attorney J.W. Carney Jr., of Carney &
Bassil, said LaBrie’s case was troubling in that she was portrayed as a
mother who was overwhelmed. He said the case should have also focused on the
failure of LaBrie’s doctors to intervene quicker, once it became obvious
that she was not administering medications.
"It can be so overwhelming for a single
parent to deal with a child who is autistic, nonverbal, and developmentally
delayed,’’ he said. “It is cruel to add to that burden a diagnosis of cancer
and a requirement that the mom administer medicine that will cause the child
even more pain."
The attempted murder conviction carries a
maximum penalty of 20 years in prison. Under state sentencing guidelines,
LaBrie — who does not have a criminal record — could face up to 7 ˝ years in
prison, according to legal analysts. That determination will be made by
Judge Richard Welch, who could consider outside factors.
“A judge is authorized to go downward, with
mitigating factors, or depart upward if there are aggravated factors,’’
Boston-based defense attorney Randy Gioia added, “I think
there are mitigating factors and aggravating factors in this case. One of
the aggravating factors is you have a vulnerable victim with a disability in
this case. That is one of the factors the judge is going to take under
Valencia can be reached at
email@example.com; Ballou at
firstname.lastname@example.org. Article at the following address:
Elimination of Safeguards
What should be protections for the health plan
members have been removed by members of Congress or regulators. Legislation has
permitted HMO corporations to be relieved of legal liability from bringing about
the death or harm from denying contracted medical care. Or by requiring binding
arbitration, thereby reducing access to the courts, and relieving the powerful
corporations with their political contributions (i.e.. bribes)
If cancer should be detected, the uninformed
cancer victim is then misled by corrupt HMO physicians that urge the medical
plan enrollee to do nothing, or flat out refuse to do what is universally
Not explained to the cancer victim is that by the
time he or she experiences positive signs of the spreading cancer, the
curative or remission benefits of costly cancer drugs will have been lost. And
for the HMO corporation and physicians, the near-death condition that their
irresponsible denial of care caused to occur, the costs are limited to
relatively inexpensive palliative pain relief, and for a relatively short period
of remaining life.
Criminal prosecution for enabling the death to
occur is possible, but the laws permitting this have not yet been used. Just as
the criminal acts by financial corporation executives are usually settled
through financial penalties rather than criminal prosecutions, the sometimes
criminal acts of HMO corporations go unpunished.
Death Decrees by
Rogue Physicians—With Impunity
Hard to believe for the uninformed, some HMO
corporations and HMO physicians will deliberately withhold tests in response to
symptoms that would reveal the need for expensive cancer-fighting drugs,
especially in those cancers where the primary cancer-fighting drugs are on
patent—and costly, easily costing tens of
thousands of dollars a year. In that case, the quick death of the HMO health
plan member is desired. Therefore, in cancer cases, for instance, the first step
in reducing costs—and increasing end-of-year
bonuses for the HMO physicians in a capitated form of employment group--is to
withhold diagnostic tests.
If cancer is diagnosed, the next money-saving
step is for HMO physicians to deny the periodic blood tests and CT scans and
argue that the treatment plan is to wait until the cancer victim personally
experiences symptoms of the cancer. What the HMO physicians don't tell the
patient is that the curative or remission benefits of costly cancer treatment
drugs and other medical procedures are long gone, and that by that advanced
cancer stage the most probable remaining efforts are end-of-life palliative pain
The cancer victim, who may have been a member of
that HMO for decades, is now a financial liability, and anything done to hasten
the member's death is a financial plus for the corporation and the physicians.
of Appeal to Medicare for Denial Of
Nationally Recognized Cancer Treatment
Like most other federal regulatory groups, the improper or
even corrupt withholding of life-affecting universally accepted medical care
under the flat-fee HMO Medicare policies is aided and abetted by the regulatory
agency personnel paid to provide relief. This is standard aiding and abetting as
found in other regulatory agencies, such as seen in the Wall Street scandals,
the Housing mess, the aviation safety agency, and others. The consequences are
in money lost, homes lost, deaths in otherwise preventable aviation disasters,
or deaths by denial of standard universally recognized care.
In denial of health care such as cancer treatment, a
Medicare HMO policy for which the Health plan is paid a specific financial
amount for providing coverage can easily withhold costly cancer treatment using
sham and medically irresponsible arguments. The primary so-called appeal rights
is to file an appeal with Maximum Federal Service, which is empowered to review
and decide if the health plan was improperly withholding care under the Medicare
HMO plan. This problem is unlikely to occur in a few-for-service Medicare plan.
In one example, the first indication that the appeal procedure
was a sham became obvious when the Medicare HMO recipient was blocked from
seeing the argument presented by the health plan to justify their refusal to
provide cancer care. The HMO health plan corporation can openly lie in response
to the complaint, and the person filing the complaint is unaware of the false
statements and cannot respond to them. Nor could an honest Maximus panel reach a
honest decision under these conditions.
The final decision by the Maximum group can easily omit the
key reasons for the complaint, and by legal trickery aid and abet the powerful
HMO health care corporation. In the appeal number, 1-847801106, the
request to obtain an out of Kaiser cancer treatment referral was based upon the
- The series of Kaiser health plan oncologists that
absolutely refused to provide the standard and universally accepted periodic
blood tests and CT scans for prompt detection of the spreading cancer.
Instead, these oncologists refuse to even consider any "treatment" until.
the cancer patient personally experiences symptoms of the spreading cancer.
- Since cancer is often asymptomatic until it has spread,
become firmly embedded, and beyond the curative or remission stage, the HMO
avoids the costly cancer drugs and other treatment, especially in such
cancers as kidney cancers where the drugs hare not been replaced by generics
and the cost is sky high.
- The Medicare cancer patient is knowingly deprived of
life-saving curative or remission effects by profit-oriented HMO physician
groups, and a death sentence is decreed. Yet, the regulators ignore all this
and deny the appeal, similar to what is common in regulators overseeing the
Wall Street firms, aviation safety, and a host of other scandal-riddled
In the November 14, 2011, decision, Maximus Project Director Janice
Eidem denied the Medicare cancer patient's request for an out-of-plan treatment
determination, claiming that treatment decisions were available within the plan.
She and the Maximum group ignored the fact that a group of rogue oncologists
were refusing to provide the standard and universally recognized treatment, and
using sham and medically ridiculous arguments for their cost-saving denial of
cancer treatment. Fax of
November 27, 2011, protesting Maximus complicity with Kaiser corporation.
In this way, regulators aid and abet the death decree to HMO
Medicare patients, and the ailing, weakened, and often time elderly cancer
victims have no where to turn. Although the cancer patient can file a further
appeal with an Administrative Law Judge, the cost and time consumed is usually beyond
the ability of the suffering and often senior Medicare patient.
Further, even when the HMO Kaiser corporation refused to
recognize denial of care complaints, thereby nullifying the Medicare appeal
process, the Maximum group refused to respond.
Sampling of deception and lies used to withhold mandatory contractual
medical care to kidney cancer patient by Kaiser Permanente physicians and
management, as stated in a December 8, 2011, fax; and sampling (December 12,
2011) of the
deceptive decisions by Medicare's appeal group, Maximus Federal Services,
showing their complicity. One of several notices to U.S. Department of Health
and Human Services making the controlling agency aware of the pattern of
A former Kaiser Permanente doctor is
suing the health care provider. He claims the non-profit
organization denies adequate care to thousands of
chronically-ill patients to save money. At issue is
Kaiser Permanente’s Special Needs population. It’s a
group of about 60,000 people, mainly in California. Some
are chronically ill children and adults, most are
seniors. All are covered by Medicaid/Medi-Cal.
“And Kaiser has what are called Special Needs Plans in
which these members belong," said Dr. Richard Della
Penna. Della Penna worked for Kaiser Permanente for 23
years and coordinated national programs for the health
plan’s special-needs population. The doctor says there
were never any written internal directives, but he says
there was a general consensus to provide minimal care to
about 95 percent of the patient pool to save money.
Della Penna says when he spoke out on behalf of his
patients he was forced to an early retirement. “As
a result of my advocacy for geriatrics, elder care, for
the special needs population, for the people with
advanced illness, I found myself being more and more
Della Penna’s lawsuit against Kaiser lists several
claims, including retaliation against a physician for
patient advocacy and violation of public policy.
Search for Medical Horror Stories
Kaiser Permanente Health Plan
The following are a small sampling of the many
reports found by a Google search under the search words, "Kaiser Health Plan
malpractice" or Kaiser Permanente malpractice.
Army of Lawyers and
Fueled by Kaiser's Victims of Medical Misconduct
Denial of universally
accepted medical care and incompetence by certain Kaiser Permanente physicians
fuels armies of lawyers. The following are sampling
sites for lawyers that have filed malpractice lawsuits against Kaiser doctors or the
Kaiser allegedly not-for-profit health plan or hospital groups, and the
for-profit Kaiser Permanente parent corporation.
Putting Kaiser Permanente
into a Google search engine reveals an endless series of deaths caused by denial
of medical treatment. Further problems at that HMO are revealed in the book,
Making a Killing-HMOs and the Threat to Your Health.
Sampling of Cancer Treatment Sites
Relating to Kidney Cancer
The following sites describe in detail
the standard universally recognized kidney cancer treatment, each of which were
withheld by oncologists at the Kaiser Permanente HMO medical plan, who refused
to provide any treatment, using sham and medically-ridiculous reasons for
decreeing a premature death.
Expectation of Honest Care and Emotional Support
cancer have serious medical problems facing them, and depression; it is a scary
time. They need competent and caring
doctors. Many cancer victims find a cancer diagnosis difficult to cope with,
and go into stages of depression. Many groups are formed for the sole purpose of
providing counseling to cancer victims.
available in various online pharmacies can be adopted to get back the normal sexual health once more at any age. Generic cialis
is also a drug which is highly adopted for the treatment of sexual dysfunction. This drug unlike any online pharmacy
other similar drug does not affect blood pressure of the patient under any circumstances and thus highly appreciated.