Wilfredo Engalla, a 51-year-old Filipino immigrant, claimed Kaiser Permanente doctors misdiagnosed him for years, attributing his health issues to colds and allergies. He later learned he had terminal lung cancer. Engalla passed away before his case could be heard by an arbitrator, a mandatory requirement under his policy. In 1997, the California Supreme Court criticized Kaiser for delay-prone arbitration processes, affecting fairness. Despite subsequent reforms, the system still faces concerns.
Ongoing Litigation and Criticism
Presently, plaintiffs’ attorneys, legislators, and patients raise issues with Kaiser’s arbitration system. They argue it still favors Kaiser over patients in medical malpractice cases. Kaiser, insuring about 25% of Californians, insists its system is equitable for all parties. Assemblyman Robert Garcia introduced a bill for the California attorney general to oversee mandatory health plan arbitrations, questioning the present system’s effectiveness.
Many organizations, including Kaiser, require arbitration instead of courtroom litigation. Kaiser developed its system in 1971, uniquely allowing unlimited disqualifications of arbitrators. Arlan Cohen, a physician and attorney, alleges the system favors Kaiser due to arbitrators’ financial incentives. Kaiser, however, claims arbitrators are chosen lawfully and independently.
The Repeat Player Effect
Experts note a ‘repeat player effect,’ benefiting companies with frequent arbitration cases. David Allen Larson, a dispute resolution expert, argues that organizations like Kaiser have advantages due to regular interaction with arbitration systems. Alan Kang, a lawyer, states arbitrators may rule favorably to continue receiving cases from Kaiser.
Kang’s petition in a case involving Evangelina Aquino’s death highlighted potential biases. An arbitrator sided with Kaiser in her case, arguing her cancer’s aggressiveness made it untreatable. Post-decision analysis suggested potential favoritism for Kaiser among frequent arbitrators. Kaiser remains committed to a fair arbitration system, denying claims of bias.
Reform Efforts and System Evaluation
Kaiser’s arbitration can reduce legal costs, potentially expediting outcomes compared to prolonged court cases. Following the 1997 Supreme Court critique, Kaiser introduced the Office of the Independent Administrator. This office manages a panel of arbitrators, enabling mutual selection by claimants and Kaiser. Critics say secrecy in settlements hides safety issues. The California Research Bureau echoes concerns over arbitration’s confidentiality, contrasting it with public court cases potentially deterring future misconduct.
Cases Highlighting Systemic Issues
Recent cases include Francisco Delgadillo’s, whose family filed an arbitration claim after regulatory bodies highlighted care failures at a Kaiser facility. While the case settled confidentially, patient safety concerns persist. Challenges continue for others like Janene Fowler, who experienced worsened health due to alleged mismanagement of her treatment for vitamin B12 deficiency. Despite UCLA medical records supporting her claim, the arbitrator ruled for Kaiser. Fowler criticized the arbitration process, highlighting perceived biases.
As reform talks continue, Assemblyman Garcia’s proposed bill passes to the state Senate, aiming for a fair and transparent health plan arbitration process. Kaiser expresses concerns about potential oversight overlapping and reporting duplication but remains pivotal in arbitration discussions.