Patients often struggle for access to medical records
4/29/2008
By Robert Davis
USA TODAY

In 2001, Sandee Pingatore was determined to find out why her son, Troy, 29, had died
in a California hospital while being treated for a drug overdose just hours after she had
been told he was stable. But Pingatore was unable to get the hospital to produce a key
medical record showing his blood pressure in his final hours.

When the record finally surfaced last year — too late under state law for
Pingatore to file a civil lawsuit — it indicated Troy had been in mortal danger
for several hours while awaiting care.

In 2006, another California woman, Beth Stover, ran into difficulties when she tried to
get medical records to help her understand why her full-term baby had died in her
womb.

When she got the records, she noticed something was missing: a strip-paper
readout from a fetal monitoring device from Stover's last routine checkup.
She
eventually got a readout showing normal activity for a mother and her baby, but in a
lawsuit she says she doubts it came from her records.

The hospitals involved — Fairchild Medical Center in Yreka, Calif., and Kaiser
Foundation Hospital in Walnut Creek, Calif., respectively — deny any
wrongdoing...

But Sidney Wolfe, a physician who heads the health research group at Public Citizen, a
Washington, D.C., consumer advocacy group, says "there is essentially a double
standard" when it comes to accessing medical records.

When doctors or hospitals ask for records to use in making a diagnosis, they usually
get what they ask for, Wolfe says. "If you are in the medical system, it works perfectly
fine.
If it's just the patient who wants the records or the patient's family if the
patient died, it's a whole different story."...

Lucian Leape, a professor at Harvard's School of Public Health, says the medical
culture does not ensure that hospitals are honest with patients
. Leape, one of
the founders of the National Patient Safety Foundation, says it's still a challenge
"getting people to be honest when things go wrong."

Charles Phillips, an emergency physician from Fresno who provides expert testimony
for plaintiffs in court cases, believes thousands of Americans simply give up the fight to
get complete copies of their medical records after a problem occurs with their care,
because doctors, hospitals and their lawyers can make the process so difficult.

Even when records are provided, they sometimes are obscured, Phillips says, a
practice he calls "wrecking" a medical chart.

"I see this all the time. Pages are darkened, they are lightened, they are enlarged,
shortened — put slightly down so you can't see a signature," he says.

In such situations, he says, time is money. "In malpractice there is a time clock working
against the patient." Statutes of limitations for medical malpractice cases are set by
state law and range from one to seven years...

Questions about authenticity

Beth Stover was pregnant and one week past her due date on March 2, 2006, when
she went to Kaiser Foundation Hospital complaining of upper-abdominal pressure, a
headache and concerns that her baby was not moving much.

Stover, a designer and illustrator, told a labor and delivery nurse she thought she was
in labor. Stover was put on a fetal monitor, her medical records show, but was sent
home less than two hours later.

"I thought I was going into labor, because I had never experienced those feelings
before," she says. "I was having contractions, this upper abdominal pressure, that
made it hard for me to walk."

She was given written instructions directing her to call and come back to the hospital if
her water broke, if she was bleeding or if she had chills or fever.

Over the next two days, Stover says, she stayed home and waited for her condition to
change. The unborn child, named Lehna Jordann Brewer, died in her mother's womb
March 4, medical records show. Stover says she tried to find out what had gone wrong.
She asked for her medical records but noticed that a fetal monitor strip from her last
checkup — on the day she had gone to the hospital thinking she was in labor — was
missing.

The paper strip, which documents fetal heart rate and evidence of contractions in the
mother, was particularly important to Stover because she recalled a technician
expressing concern after hearing something unusual on the monitor. When the strip
was missing from the medical records Kaiser gave her, Stover wondered whether the
monitor had indicated Lehna was in some kind of trouble.

Stover asked the California Department of Health for help. It investigated in November
2006.

During that inquiry, Stover says, "I got a call from the Kaiser ombudswoman who told
me that they found the strip."

Unlike the other strips in Stover's file that had her name, date and time, this
documentation — of a healthy baby — had no time or patient data. On the envelope
containing the strip that the hospital said was made days before her baby died is written
"Stover, Beth," and "IUFD" for intrauterine fetal demise, "Female 3-5-06."

Stover and Lehna's father, Andy Brewer, do not believe the strip came from their child.

The state did not penalize Kaiser, although investigators noted some of the records
Stover had sought were missing when they visited the hospital.

It took four hours for the hospital staff to find them, a delay it blamed on a "fairly new"
employee, the state's report said.

In a written response to questions from USA TODAY, David Niver, chief physician at the
Kaiser Foundation's Walnut Creek facility, says the hospital regrets the "delay in
locating one of the patient's records after she received her care, but it's important to
understand that the delay did not affect the medical care that was provided."

The state report does not mention the fetal heart monitor strip, which Niver says Kaiser
is certain came from Stover's visit because it was signed by her doctor and noted in
other records.

Stover and Brewer split up after the death of their daughter. Brewer, a Kaiser
information-technology employee, quit his job in disgust.

Get copies of documents

The best way to avoid a problem with medical records, health specialists say,
is for patients to routinely ask for copies of all documents pertaining to their
care.

When records appear to be incomplete, the patient and their family or other advocates
can turn to the Office of Civil Rights at the Department of Health and Human Services,
Rhodes says.

They also can turn to their state medical board. But Julieanne D'Angelo Fellmeth,
administrative director at the Center for Public Interest Law at the University of San
Diego School of Law, says her review of California's medical board found long delays
and much frustration, like that experienced by Stover and Pingatore.
Her review
found that complaints typically took 2.6 years to investigate.

Wolfe of Public Citizen calls the prolonged delays "a slap in the face of justice.

… The family wants to make sure the doctors did what they said they were doing."

Many lawyers agree.

"The one thing people really want to know is, 'How did my loved one die?' " says William
Campisi Jr., a lawyer in Berkeley, Calif., who specializes in malpractice cases. "I have to
tell these people, 'We will never know why your father or your husband or your child
died.' It's sickening."

Contributing: Marie Skelton and Mark Hannan
See also Kaiser falsifies urology report and hides x-rays
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Falsified and Missing
Records Cover Up
Medical Malpractice
by Will Parker
Injury Board Blog Network
July 28, 2009

Most of trust that doctors and
hospitals will do the right thing
and put us, the patients, first. I
mean, doctors take an oath to
the effect, right? Well, if you do
put all your trust in their
hands...you might want to read
the following:

According to an investigation by the New York Daily News, an outbreak of faked medical records at New York City hospitals have led to 16 state citations over the
past four years. According to the newspaper, doctors, nurses and support staff altered hospital records in an effort to cover up medical mistakes, that if revealed,
could have led to millions of dollars in malpractice suits. In many cases, the patients and family members were never even notified of the medical errors or the state
citations. The investigation proved difficult because many of the records were missing crucial information or were missing completely! For the full story, click on
http://www.nydailynews.com/ny_local/2009/07/26/2009-07-26_hospital_records_were_sometimes_falsified_to_cover_up_medical_mistakes.html?page=0

As an attorney, this is extremely
alarming as this proves medical
professionals can get away and
have already gotten away with
committing malpractice by such
means. While I certainly believe
most medical professionals
would never commit such acts,
the fact it we know it has
happened should lead to
changes. For example, one way
to ensure accuracy is to have
patients sign their medical
charts before they are filed.
That way, the patient knows
what is in their file and, if there
is an error or ommission,
whether accidental or
intentional, it could be
addressed at the time it
occurred. Another idea is to
allow patients to retain a copy
of their medical records after
each visit. Our firm presently
has a case where we believe a
local doctor covered up serious
mistakes which possibly led to a
patient's death, but there is
really no way we can prove it.
Hopefully, investigations such
as this one will lead to more
debate about how to ensure
patient safety and an improved
record-keeping system.
President Obama, as part of his
stimulus package, wants to
reform medical recordkeeping,
making this a prime opportunity
to tackle this problem.
My doctor falsified
my medical
records. Is there
potential for a
medical
malpractice case
here?

Answers

If your physician falsified
your medical records and
you were injured as a
result of his actions, you
most likely have a medical
malpractice cause of
action. To be successful in
your suit, however, you
must prove that the
falsification caused you
injury and that you
suffered damages as a
result.

A Physician’s Duty of
Care

A physician owes a strict
duty of care to his
patients; this duty requires
him to act in a way that will
protect his patient’s health
and safety. Falsifying
records is a breach of that
duty. Laws prohibit
physicians from changing
or creating false medical
records. These laws are
designed to protect
patients from later being
injured because of the
false information in their
medical records.

Additionally, falsifying
records could indicate
that the physician was
trying to cover up
malpractice.
In this
instance, the physician
would have committed
malpractice twice: once in
causing the injury and
another time in falsifying
records.

Proof of Malpractice

Many state, however,
required a patient to
demonstrate injury and
damages from falsifying
records. Without this
proof,
many states will
limit damages in the
lawsuit to only
punishing the
physician, such as by
taking away his license.

If, however, the falsified
records resulted in the
patient being further
injured, he most likely has
a cause of action for which
he can receive
compensation. If the
patient underwent
additional or unnecessary
treatments because the
information in his records
was not correct, and he
incurred financial or
physical losses as a
result, he most likely can
sue the physician for
malpractice.
Medical professionals
and employees hide the
truth as long as it's in
their financial interest to
keep quiet about illegal
actions:

Physician
Accuses ProCare
of Falsifying
Medical Records

In complaint to state, she
alleges that
managed-care firm
instructed her staff to
alter data to pass audit.
CEO denies the charges.
June 13, 1996
DAVID R. OLMOS
LOS ANGELES TIMES
STAFF WRITER

In a case that raises new
questions about
California's ability to
monitor medical care for
millions of Medi-Cal
enrollees who are being
steered into HMOs, a
San Diego physician has
alleged that a
managed-care company
falsified medical records
to pass a state inspection.

Dr. Dianna L. Norman
made the detailed
accusations in a
complaint to state health
officials and in interviews
with The Times. Norman
claims that employees of
ProCare Inc., a San
Diego health-care
company, instructed her
office staff to alter and
forge patient logs and
medical charts to cover
up shortcomings and
enhance its prospects for
winning more Medi-Cal
business.
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Norman said the records
were falsified in
preparation for a January
1995 audit by the state
Department of Health
Services. The audits are
the main tool by which
the state monitors the
quality of health care
available to Medi-Cal
enrollees.

Dr. Robert W. Dukes,
ProCare's owner and
CEO, strongly denied
Norman's allegations.
"We don't do that at all.
It's illegal and there
would be nothing to gain
by that," he said in a
telephone interview late
Wednesday.

Among other allegations,
the state is investigating
Norman's claims that
ProCare employees
altered patient charts to
falsely state that women
had received
mammograms, breast
exams or Pap smears
that had not actually
been given. In the
complaint and interviews,
she also said they
backdated files to make it
appear that patients had
been notified about
missed appointments and
fabricated child lead
poisoning and nutrition
questionnaires and
placed them in pediatric
files.

Norman also contends
that ProCare officials
were able to obtain the
names of patients whose
medical charts would be
reviewed before the audit
took place. To protect
against possible fraud,
the state mandates a
"blind" audit procedure:
HMOs and doctors are
not supposed to be told
beforehand the specific
patient files to be
reviewed.

A senior department
official, who agreed to
speak only if he wasn't
identified, confirmed that
the agency is
investigating the
allegations against
ProCare. Norman said
state investigators have
interviewed her and
members of her staff.

Norman, who had a
contract with ProCare to
treat Medi-Cal patients,
filed her complaint in
November, shortly after
ProCare canceled the
contract for what it called
her financial problems.
Kaiser Permanente
Employee Review

Reviews are posted
anonymously by employees

Mar 21, 2011
Kaiser Permanente Director
Medical Records in San
Diego, CA:   (Past Employee
- 2009)

Kaiser Permanente – “Great
benefits, but managers are the
only ones without
representation”
Pros

Outstanding medical care and
professional ethics. Excellent
advancement opportunities for
professional staff and technical
people. Salaries for staff often
highter because of union
contracts.

Cons

Managers often the only
people without union or
affiliation representation. Even
the doctors are part of a
bargaining entity and most
staff are members of various
unions. As a result, department
managers have a difficult time
getting any support and can be
caught in the corporate
squeeze. It's a great place to
be a medical professional or
support person, but managers
beware if you have never
operated in this environment
previously.

Advice to Senior
Management

Please recognize the bind
that your department heads
are in and provide support
for needed actions that
bring then into conflict with
doctors and union members.
HHS wants to give patients test results straight from
lab
Some physicians say the change could come at a cost, because the information would
be delivered without the context of an explanation.
By Kevin B. O'Reilly
amednews
Oct 3, 2011.

Proposed changes to federal regulations would override existing laws in 20
states and give patients access to laboratory test results without having first
to talk with the physicians who ordered the tests.

The Dept. of Health and Human Services said its proposal, announced in September, could enable
wider deployment of personal health record systems and give patients more control over their health
care information. Yet some physicians say the changes could come at a cost, because life-altering
test results delivered without the context of a doctor's explanation may increase patient anxiety and
degrade the physician-patient relationship.

In 13 states, labs are forbidden from sending test results directly to patients, according to HHS. The
results must go to the ordering physician or another authorized health care entity. Seven states allow
labs to send test results to patients, but only with the approval of the ordering physician.

Twenty-three states do not have laws governing patient access to test results from labs. Seven
states, as well as the District of Columbia and Puerto Rico, say patients can obtain test results
directly from labs without physician consent.

Under the Health Insurance Portability & Accountability Act, patients have the right to copies of all of
their medical records. But the federal law governing clinical labs does not explicitly authorize the firms
to send test results to patients. The proposed rule is intended to set a national standard to clarify the
matter and help speed "meaningful use" of electronic medical record systems.
7 states let labs send test results to patients without physician approval; 7 require doctor consent.

"When it comes to health care, information is power," said HHS Secretary Kathleen Sebelius. "When
patients have their lab results, they are more likely to ask the right questions, make better decisions
and receive better care."

Physician organizations have yet to weigh in on the rule, for which comments must be submitted by
Nov. 14. The American Clinical Laboratory Assn., the trade group for diagnostic-testing firms, also
declined to discuss the proposal.

HHS estimates that the rule will affect more than 22,000 labs, 6.1 million tests and impose $56
million in laboratory compliance costs.

Quest Diagnostics, the world's leading lab-testing company, lauded the proposal and said it would
recognize patients' right to their health care data.

"If you have your blood drawn, who owns that result?" asked Jon Cohen, MD, chief medical officer at
Quest. "We believe it's you, the patient. It's your blood, your data, your results."

In 2010, Quest unveiled Gazelle, a free smartphone app to help patients manage their health
information on the go. Users who live in the states where lab results can be sent directly to patients
also can access them through the app. To protect confidentiality, patients must answer questions to
verify their identity. The same verification process is outlined in the HHS proposal.

"What the rule does is level the playing field," Dr. Cohen said. "Now, in every state you can release
results directly to patients."
Handling sensitive results

Quest first sends test results to physicians. Only after 48 hours are they sent to patients. The
company does not send patients test results that are related to HIV, genetics or show a pathological
diagnosis of cancer.

The company's approach to sharing test results with patients may not be reflected in the new federal
regulations. As written, the proposal does not specify a waiting period before sending test results to
patients and does not declare that any kinds of tests or particular findings should go through a
physician.
Labs are forbidden to send test results directly to patients in 13 states.

Even doctors who favor giving patients access to test results have reservations about giving them
immediate access to all test results upon request. In the last five years, the 3.5 million patients using
Kaiser Permanente's personal health record portal have viewed more than 50 million test results,
said Kate Christensen, MD, medical director of the health system's Internet Services Group.

"Ninety-nine percent of the time, it's a good thing for people to get the information [through the portal],
but sometimes it can be very upsetting, and there could be better ways to learn that information," said
Dr. Christensen, a hospice physician in Martinez, Calif. "There are also cases when it really can do
harm. For example, in some folks undergoing genetic tests you really need to be there in person to
be ready to counsel the person and do a crisis intervention."

Kaiser Permanente typically gives physicians three to five days to view results before making them
available to patients, Dr. Christensen said.

The OpenNotes Project is a portal that allows patients to access their medical records, view test
results and see physicians' notes. It is being used by Beth Israel Deaconess Medical Center in
Boston, Geisinger Health System in Pennsylvania and Harborview Medical Center in Seattle. Even
this highly transparent system delays patient access to x-ray and pathology results to give doctors a
head start, said Tom Delbanco, MD, leader of the project and professor of medicine at Harvard
Medical School.

Physician practices and hospitals will have to adjust to the new rules, he said. "It may be that the
patient sees disastrous news before the doctor can talk to them. The big downside is, 'Oh, the cancer
is back and I've not even heard from my doctor.' Hopefully, we can put systems into place whereby
doctors will get urgent calls from the labs when they get very abnormal results to say, 'Please be
aware of this and talk to your patients.' "
Safety impact

There could be a safety advantage to patients being notified directly of their test results, Dr. Delbanco
said.

"One of the comments we've received from doctors using OpenNotes is that it makes them feel much
safer because there's another set of eyes -- the patient's," he said. "The missed test that winds up
being a lawsuit for the doctor may be picked up in plenty of time. So there's very much a good side to
this. Patients should be part of the safety equation."

Other physicians said the HHS proposal could worsen the problem of poor communication over test
results. Physician practices fail to inform patients of abnormal results about 7% of the time, according
to a June 22, 2009, Archives of Internal Medicine study of more than 5,000 patient records at 23
primary care clinics.

"Does this create a more reliable system or does this create more noise?" asked Gordon D. Schiff,
MD, associate director of the Center for Patient Safety Research and Practice at Brigham and
Women's Hospital in Boston. "This gives a false sense of security, and it defuses responsibility. Is it
the provider's responsibility to get the test results, or is it the patient's responsibility? It's better to have
one reliable system than two halfway systems."

How and whether patients are allowed to access their test results from clinical laboratories depends
on the state or jurisdiction where the tests are performed. If rules proposed in September by the Dept.
of Health and Human Services are adopted, patients across the country would have the right to obtain
their lab results without physician approval.

Lab results are sent only to physicians or authorized health care entity: Arkansas, Georgia, Hawaii,
Illinois, Kansas, Maine, Missouri, Pennsylvania, Rhode Island, Tennessee, Washington, Wisconsin,
Wyoming

Lab results may be sent to patients with physician approval: California, Connecticut, Florida,
Massachusetts, Michigan, New York, Virginia

Lab results may be sent directly to patients without physician approval: Delaware, Maryland, New
Hampshire, New Jersey, Nevada, Oregon and West Virginia, the District of Columbia and Puerto Rico

No state law governs patients' access to lab results: Alabama, Alaska, Arizona, Colorado, Idaho,
Indiana, Iowa, Kentucky, Louisiana, Minnesota, Mississippi, Montana, Nebraska, New Mexico, North
Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah, Vermont,
Guam, Northern Mariana Islands and the Virgin Islands

Source: "CLIA Program and HIPAA Privacy Rule; Patients' Access to Test Reports: A Proposed Rule
by the Centers for Medicare & Medicaid Services," Federal Register, Sept. 14
www.federalregister.gov/articles/2011/09/14/2011-23525/clia-program-and-hipaa-privac
y-rule-patients-access-to-test-reports



"CLIA Program and HIPAA Privacy Rule; Patients' Access to Test Reports: A Proposed Rule by the Centers for Medicare & Medicaid
Services," Federal Register, Sept. 14
(www.federalregister.gov/articles/2011/09/14/2011-23525/clia-program-and-hipaa-privacy-rule-patients-access-to-test-reports)

Gazelle, Quest Diagnostics' smartphone app (mygazelleapp.com)

"Frequency of Failure to Inform Patients of Clinically Significant Outpatient
Test Results,"
Archives of Internal Medicine, June 22, 2009
(archinte.ama-assn.org/cgi/content/abstract/169/12/1123)
Dr. Jenny Devitt discusses
electronic medical records

[Maura Larkins informed
Assistant Area Medical Director
Devitt on Nov. 16, 2011 that
Kaiser had canceled its own
quality review
regarding missing
digitized X-rays.  Dr. Devitt
ignored the letter.  This attitude
could explain Kaiser's failure to
diagnose cancer patients who
later die unnecessarily.]
Kaiser and University of California Health Systems hide critical medical records
from patients, but pass the records about quite freely to others
Hospital fined for
breach of
octuplet mom's
privacy
May 15, 2009
By Alan Duke
CNN

LOS ANGELES, California
(CNN) -- The hospital where
a California woman gave
birth to octuplets in January
has been fined $250,000
by the state because nearly
two dozen medical workers,
including doctors, illegally
viewed her medical records,
according to state health
officials.
Nadya Suleman was the
subject of controversy after
giving birth to octuplets in
January.

Nadya Suleman was the
subject of controversy after
giving birth to octuplets in
January.

Kaiser Permanente's
Bellflower hospital, where
Nadya Suleman's eight
babies were born, revealed
in March that 15 employees
lost their jobs and eight
others were disciplined for
improperly accessing her
computerized medical
records.

There was no evidence that
information from the
medical files was leaked to
the news media, which has
intensely covered
Suleman's story, according
to Kathleen Billingsley,
deputy director of the
California Public Health
Department's Center for
Health Care Quality.

Six of the privacy breaches
happened at other Kaiser
Permanente facilities, which
are linked into the same
computer system housing
medical records.

Suleman -- already a single
mother with six children --
gave birth to octuplets
conceived through in vitro
fertilization, fueling
controversy. News of her
collecting public assistance
for some of her children
outraged many taxpayers.

Suleman lives in La Habra,
in Southern California.
Lynette Seid
San Diego Area Chief
Financial Officer
Ms. Seid tells me she in
charge of medical
records in addition to
being CFO. You would
think that medical
records would be pretty
straightforward, but it
seems there is a lot of
subjective
decison-making when it
comes to "striking out"
(Ms. Seid's word)
undesirable records and
creating new records.  
But what I find really odd
is that Ms. Seid says it
will take
2-4 weeks for
her to find out what
happened to my VUCG
images.
Cindy Guinto
Director of Hospital
records
Mar 10, 2011 – Cindy
Guinto, Director
Of Health Information at
Kaiser Foundation
Hospitals
CA Wildfires: Operation
Evacuation
By Ainsley Maloney
November 19, 2007
Bertha Aviles
Service Area Assistant
Administrator
Medical Office Records
Hospital Medical Records
Bertha Aviles
?
Two views on
electronic medical
records
“Once you get a diagnosis in
there or a medication or
something that's incorrect,
that's an error, it gets repeated
and repeated and repeated,”
Dr. Benson said.

Electronic Medical
Records 'Not Ready
For Primetime'?
Christin Ayers
7NEWS Reporter
April 29, 2009

DENVER -- Critics say some
Denver area hospitals are
moving too quickly to
implement electronic medical
records (EMRs), failing to work
out some major flaws in
software systems that contain
patients’ sensitive medical
information.

At a number of major hospitals
in the metro area and at some
small clinics, when you go in
for a check-up, your medical
information goes, not onto a
paper chart, but into a
computer.

The Obama administration is
offering $20 billion in
incentives for doctors and who
start using electronic medical
records. But some critics say
Colorado hospitals have gone
digital without taking care of
some kinks in their systems.

Dr. Louise Benson, an
internist, has used electronic
medical records. She said
there are documented cases of
EMR systems miscalculating
medication dosages and drug
interactions, which could
endanger patients.

“If you are relying on a
program to tell you what the
interactions are and you
prescribe something and it
pops up OK and it turns out
not to be OK because there's
an error in the program, that
could be deadly for the
patient,” said Benson.

An article in the March Journal
of the American Medical
Association points out that
companies that sell electronic
medical records take no
responsibility if a software
malfunction causes a medical
error.

“Vendors are not responsible
for errors their systems
introduce in patient treatment
because physicians, nurses,
pharmacists and health care
technicians should be able to
identify--and correct--any
errors generated by software
faults,” the article says.

Doctors at Children’s Hospital,
University of Colorado
Hospitals, Colorado Kaiser
Permanente and Denver
Health all use electronic
medical records and have
touted the benefits of the
systems.

In December, the four hospitals
launched a system that allows
them to digitally share the
medical information of
emergency room patients, with
their permission.

“Colorado has been I think on
the forefront in terms of trying
to share information among
various institutions that have
the capability of an electronic
medical record,” said Dr. David
Kaplan, chief medical
information officer at Children’s
Hospital. “Having electronic
medical record has really been
a major breakthrough at our
institution. For the first time
ever, we have everything right
in front of us.”

Dr. Ann Martin, director of the
Longmont-based Colorado
Women’s Care and Medical
Spa, also uses electronic
medical records. She said they
cut down on errors.

“I think the benefits are
everyone can read the notes,”
said Martin. “That's number
one. Some doctors are
notorious for not being able to
read their writing.”

But Benson worries Colorado
hospitals and small
practitioners are moving too
fast with the technology. Dr.
Benson said another major
concern she has about EMRs,
is that once erroneous
information is entered into a
patient’s record, it is nearly
impossible to get erase.

“Once you get a diagnosis in
there or a medication or
something that's incorrect,
that's an error, it gets repeated
and repeated and repeated,”
Dr. Benson said.

Benson said she believes
electronic medical records can
improve patient care, but that
major improvements need to
happen before they go
mainstream.

“They are not ready for
primetime from many
standpoints,” she said.
They can save lives or they
can be deadly
They can be deadly
Medical tests are pointless when results don’t reach the doctor
or the patient
By Michelle Andrews
Washington Post
November 28, 2011

Medical tests can reveal critical information about a person’s health, but only if the
results are communicated to clinicians and patients. Sometimes, the ball gets dropped
somewhere between the lab or the radiology department and the clinician who ordered
the test and the patient.

In Peggy Kidwell’s case, a mix-up over doctors’ names led to a year-long delay in a
breast cancer diagnosis.

After her annual gynecological exam and mammogram several years ago at a medical
center near her Virginia Beach home, she got a letter from her doctor saying the results
of her Pap test were normal. She assumed that she would hear from her doctor if
anything untoward showed up on her mammogram exam and thought no more about it.

A year later, when Kidwell went back for her annual exam at age 59, her doctor, finding
no mammogram results in her chart, asked why she hadn’t gotten a screening exam the
previous year. When Kidwell said she had, the doctor investigated. Five hours later, the
doctor called Kidwell to tell her she had found the results and it looked as though she
had breast cancer.

The test results had been sent to an orthopedic surgeon at the medical center who had
the same last name as Kidwell’s gynecologist. The folder had been sitting on his desk
for a year, according to her gynecologist.

By that time her cancer had spread to her chest wall. Kidwell had a lumpectomy,
chemotherapy and radiation. The following year, the cancer came back and Kidwell had
a mastectomy. She filed a lawsuit and eventually settled the case. (A confidentiality
agreement prohibits her from discussing specifics.) No one, she says, ever said that an
earlier diagnosis might have made a difference in the course of her disease, but she
believes it may have.

Kidwell, who now lives in Silver Spring, blames the medical system for the mix-up, but
also herself. “To this day, I don’t let myself off the hook for not picking up the phone,”
she says.

Financial consequences

There are also financial consequences for providers when tests aren’t promptly
reported: A recent study in the Journal of the American College of Radiology found that
annual medical malpractice payouts for communication breakdowns, including failing to
share test results, more than quadrupled nationally between 1991 and 2010, to $91
million. For patients, the missteps and mistakes can be life-altering.

Patient follow-up could make a difference in many instances. The study examined
medical malpractice claims from 425 hospitals and 52,000 providers.

Of the 306 cases in which test results were specifically cited as a factor in a malpractice
case, the most common problem — it occurred almost half the time — was that the
patient didn’t receive the test results. The second-most-common problem was that the
clinician didn’t receive the results, cited in 110 cases. Other problems included delays
and slow turnaround in reporting findings and test results that were filed before the
clinician reviewed them.

Patient advocates and policy experts say the push for better coordination of patient
care, including the adoption of electronic medical records, should help improve the
delivery of test results to patients from doctors and to doctors from those who perform
the tests.

“Health reform and payment reform are moving us toward integrating care to a degree
that we don’t do right now,” says Diane Pinakiewicz, president of the National Patient
Safety Foundation , a Boston-based consumer group. “The one constant is the patient.
The best chance is for the patient to be part of the process.”

A multilayered approach

Patient involvement is important, but the burden of following up on test results shouldn’t
fall on their shoulders, experts agree.

But doctors need a helping hand. In a given week, a primary-care doctor might need to
review 360 chemistry test results, 460 hematology results, 12 pathology reports and 40
radiology reports, according to researchers at Partners HealthCare system in Boston.
More than half of physicians surveyed some years ago said they weren’t satisfied with
the way they handled test results, which typically took more than an hour each day.

Now many practices affiliated with Partners use a multilayered system that helps them
manage test results. The Web-based system lets them log in and see all the tests they’
ve ordered and the results that have come in, with those that are problematic listed
first. If a test result requires urgent attention, the system generates an e-mail alerting
doctors; if they ignore this warning and subsequent messages, the system alerts the
practice manager, who contacts the physician directly.

The system also generates letters that notify patients of their test results and has a
tickler function that can alert doctors when patients haven’t had follow-up tests as
ordered.

Even so, “nothing is foolproof,” says Eric Poon, director of clinical informatics at
Brigham and Women’s Hospital, part of the Partners system.

“No news is not good news,” he says. “If a patient gets a test done and doesn’t get a
result, he should follow up.”
Patient gets
records at last;
finds "Do Not
Resuscitate" order
that she didn't
authorize

10/6/11

After attempting for two
years to obtain my medical
records from Kaiser
Permanente, I obtained
assistance from Legal Aid
which agency also
encountered resistance.
When I finally received
copies of my records, I
found that on the first page
was "do not resuscitate". I
had never given such an
order. Kaiser has no record
of my having done so.
There are no hospital
records indicating any such
and Kaiser, so far, has
been unable to give me any
explanation as to how,
when and why such a
directive is on my medical
records.

Patricia of San Rafael, CA

UPDATE:
11/23/11
After attempting for two
years to obtain my medical
records from Kaiser
Permanente, I obtained
assistance from Legal Aid
which agency also
encountered resistance.
When I finally received
copies of my records, I
found that on the first page
was "do not resuscitate". I
had never given such an
order. Kaiser has no record
of my having done so.
There are no hospital
records indicating any such
and Kaiser, so far, has
been unable to give me any
explanation as to how,
when and why such a
directive is on my medical
records.

Patricia of San Rafael, CA
Kaiser Permanente Senior
Business Specialist in
Pasadena, CA:   (Current
Employee)
“Project Management
for Electronic Medical
Records System”

Pros

Benefits are great; they have
a pension. Pay is somewhat
aligned with the industry as a
whole. Department i am in
has a superior training
department.

Cons

Department Reorganizations
and layoffs seem to be a
yearly occurrence. A lot of
regular employees are on
two year contracts. seems to
be hard to move from a two
year contact position to a
regular full time position. A
lot of Departments would
rather hire outside the
organization than promote
from within.

Advice to Senior
Management

Give more opportunities to
the employees you have.
How do you make sure
that your employees
don't get a full picture
of what's really going
on?  Promote from
outside the
organization!
Kaiser Said to Drop Ball on Parent Records
Courthouse News Service
December 12, 2011

(CN) - A couple says Kaiser disclosed confidential birth records to an adopted child who
was searching for his birth parents.
The plaintiffs, using pseudonyms, said James Ingraffia showed up on their doorstep,
claiming to be their son. The birth parents say this clued them in that Kaiser had given
their birth son confidential, sealed birth records.
Ingraffia's adopted parents Salvator and Margaret helped James find his birth parents,
the couple says in their complaint in Alameda Superior Court.
"Plaintiffs suffered damages in the form of fear, apprehension, shock to the nervous
system and continuous and repeated episodes of severe emotional distress when they
learned that although they had taken the necessary legal steps to keep information
about James Ingraffia's birth confidential and private, Defendant Kaiser had broken the
seal on such records and disclosed them," the complaint says.
The plaintiffs sued Kaiser Foundation Health Plan, the Ingraffias, and unknown
defendants, seeking exemplary damages against Kaiser of up to $3,000.
The couple is represented by Patricia Turnage.
Kaiser links on this website
Kaiser blog posts
UCLA has
practices similar
to Kaiser's

...The lawyers found that
Olivia's medical records
were incomplete, the
Culls said, and filed more
requests until the
hospital supplied
hundreds of additional
pages
.

... [S]tate investigators
reported that
a
postdoctoral fellow who
treated Olivia removed
her catheters without a
doctor's supervision.
Investigators also found
that a second fellow who
treated Olivia had not
been cleared to treat
patients.

...The hospital made one
change
in response to the
state investigation:
It added
another disclaimer
to the
consent form, warning
patients they might be
treated by doctors in training.
San Diego Education Report
SDER
San Diego
Education Report
SDER
SDER
SDER
San Diego Education Report
SDER
San Diego
Education Report
SDER
SDER
SDER
Kaiser--concealing records
Dr. Jenny Devitt
Medical Records
Electronic records

coding
California Evidence Code Section 1158

1158.  Whenever, prior to the filing of any action or the appearance
of a defendant in an action, an attorney at law or his or her
representative presents a written authorization therefor signed by an
adult patient, by the guardian or conservator of his or her person
or estate, or, in the case of a minor, by a parent or guardian of the
minor, or by the personal representative or an heir of a deceased
patient, or a copy thereof, a physician and surgeon, dentist,
registered nurse, dispensing optician, registered physical therapist,
podiatrist, licensed psychologist, osteopathic physician and
surgeon, chiropractor, clinical laboratory bioanalyst, clinical
laboratory technologist, or pharmacist or pharmacy, duly licensed as
such under the laws of the state, or a licensed hospital, shall make
all of the patient's records under his, hers or its custody or
control available for inspection and copying by the attorney at law
or his, or her, representative, promptly upon the presentation of the
written authorization.
No copying may be performed by any medical provider or employer
enumerated above, or by an agent thereof, when the requesting
attorney has employed a professional photocopier or anyone
identified
in Section 22451 of the Business and Professions Code as his or her
representative to obtain or review the records on his or her behalf.
The presentation of the authorization by the agent on behalf of the
attorney shall be sufficient proof that the agent is the attorney's
representative.
Failure to make the records available, during business hours,
within five days after the presentation of the written authorization,
may subject the person or entity having custody or control of the
records to liability for all reasonable expenses, including attorney'
s fees, incurred in any proceeding to enforce this section.
All reasonable costs incurred by any person or entity enumerated
above in making patient records available pursuant to this section
may be charged against the person whose written authorization
required the availability of the records.
"Reasonable cost," as used in this section, shall include, but not
be limited to, the following specific costs: ten cents ($0.10) per
page for standard reproduction of documents of a size 8 1/2 by 14
inches or less; twenty cents ($0.20) per page for copying of
documents from microfilm; actual costs for the reproduction of
oversize documents or the reproduction of documents requiring
special
processing which are made in response to an authorization;
reasonable clerical costs incurred in locating and making the records
available to be billed at the maximum rate of sixteen dollars ($16)
per hour per person, computed on the basis of four dollars ($4) per
quarter hour or fraction thereof; actual postage charges; and actual
costs, if any, charged to the witness by a third person for the
retrieval and return of records held by that third person.
Where the records are delivered to the attorney or the attorney's
representative for inspection or photocopying at the record
custodian'
s place of business, the only fee for complying with the
authorization shall not exceed fifteen dollars ($15), plus actual
costs, if any, charged to the record custodian by a third person for
retrieval and return of records held offsite by the third person.
Kaiser doctors don't
want to discuss MRI

I have seen 4 doctors at
Kaiser ENT about
headaches and sinus pain,
even the department head.
All said there was no
problem and
they would
not look at my MRI.
Every
doctor that looks at the
MRI gets it dismissed
.
MRI clearly shows a
problem.
David of Stackbridge, GA
11/22/11
Denial of care
Complaint in Los Angeles Superior Court 2010 regarding falsification of medical records:
William Moke v. Amgen, Dr. Vernon Wilson
Earlier difficulties
getting  AMR records

6/26/2015
Maura L.

It's become clear over the
past 2+ months that AMR
just doesn't plan to provide
my medical records as
legally required.

The emergency personnel
are great, but the folks
back at the office are
shirking their
responsibilities. I keep
getting the run-around after
mailing my request for
medical records on April 15,
2015.  They admit that my
request began "processing"
on May 11.  (I think you
have to follow up with a
phone call in order for them
to start processing  your
request.)  

On June 22, 2015 and they
told me they couldn't even
bring up my request on
their computer screens.  
But they did admit that they
can still see that my request
began processing on May
11.  They asked me to mail
a new request to a new
address: P. O. Box
554120,  Los Angeles, CA
90074.  So I did.

Perhaps they have a policy
of ignoring requests until
the patient jumps through a
certain number of hoops.  
Or maybe they don't plan to
give me my records at
all--even though the law
requires it.

The score I'm giving them is
for illegal handling of
medical records, not
problematic emergency
care.
American Medical
Response (AMR)
finally releases
records

7/1/2015
Maura L.

Today I finally got my medical
records from AMR.  I've also
had problems getting medical
records from Kaiser
Permanente, UCLA and
UCSD...

If you want your medical
records [from AMR], keep
submitting your request to
every address or fax number
they give you! Do it in writing,
not just by phone.
I think the nation-wide reluctance to produce records is caused by health
care professionals' efforts to make sure patients are denied
information that might allow them to sue.  It seems that the first
concern of doctors and other health professionals these days is to
protect the bottom line of the organization they work for-and to
maximize their own income while avoiding responsibility.
News, information and ideas about our
education system, courts and health care
by Maura Larkins