The Kaiser foundation health plan has now grown to the point where it includes better than 10 members throughout the Country more than 8 million members in California. Although Kaiser has membership around the country, it is based out of Oakland, California. Kaiser members have no choice in selecting hospitals outside the Kaiser system, or doctors outside of the Permanente medical group. Neither do they have any choice in prosecuting medical malpractice claims-they are tied to the one-sided Kaiser arbitration system. That system is imposed by a contract typically negotiated by members employers, not the members themselves. The Walkup law firm handles Kaiser medical malpractice cases throughout California, and is one of the few law firms in California to have successfully resolved more than 250 cases on behalf of Kaiser members.
Most Kaiser Permanente HMO members do not know that Kaiser has its own unique rules for medical negligence litigation: since 1978, Kaiser Permanente has included a mandatory provision in their group policies requiring the use of a private arbitration procedure for all negligence, product liability, prescription drug and medical negligence claims against Kaiser Permanente resulting from negligence, carelessness or malpractice of the giant health care provider.
A private dispute administrator, The Office of the Independent Administrator (OIA) functions as a clearinghouse for all of the claims made against Kaiser. There are complex and unique rules which govern the process, timing and disposition of claims for personal injury and wrongful death by Kaiser members. The OIA has set strict time tables for resolving claims and mandates that all claims be resolved through arbitration in less than 18 months from the date the claim is filed. For more information, please see our materials on a general timeline for Kaiser proceedings and About the OIA.
Our Proven Record In Prevailing Against Kaiser: More Than $250 Million Has Been Paid To Our Clients by Kaiser
At Walkup, Melodia, Kelly & Schoenberger, in San Francisco, California, we have been successfully prosecuting Kaiser on behalf of its patients for more than 45 years. Extensive experience representing patients in Kaiser Permanente HMO personal injury malpractice claims. We have arbitrated, mediated or settled over 250 million in medical claims against Kaiser Permanente HMO since 1978. We are experts in unraveling the intricacies of the Kaiser Permanente arbitration procedures and can ensure that you are legally protected.
In 2015 We Obtained A Record-Breaking Kaiser Arbitration Award
Walkup attorneys Michael A. Kelly and Valerie Rose obtained a binding arbitration award of $2,400,000 in favor of the surviving family members of a 42-year-old Alameda County woman who died when her messages for help to a Kaiser advice nurse were never given to her doctors.
The Arbitrator's verdict followed five days of evidence and testimony and came after Kaiser refused to negotiate with the family or make any pre-trial offer of settlement. At issue was Kaiser's practice of using telephone advice nurses for screening and then keeping the information obtained by them secret from treating doctors in order to save time and money. By statute the health care giant must record such telephone calls; but the for-profit Permanente Medical Group decided that involving patients doctors in the information review process would take too much of their time.
The patient had twice called with complaints of worsening symptoms of cough and chest pain consistent with pneumonia. Instead of directing her to an emergency room, she was routed to yet another telephone evaluation with a Kaiser internal medicine physician who decided (without a physical examination) that she did not need to be seen. He knew nothing of her prior calls to advice nurses or her worsening complaints. For that reason he missed the fact she had a rapidly developing strep pneumonia which worsened over the next 24 hours. By the time she was seen in the ER on the fifth day of her illness she was in irreversible septic shock which claimed her life. Kelly commented after the verdict "This advice nurse system is supposed to be the front door to the Kaiser system - the problem is, once you're through the door, the doctors have no idea what information the patient has given to the gatekeeper."
"This tragedy has left a husband who will miss 40 years of his wife's love affection and support, and two beautiful little girls aged 6 and 9 who will miss the nurturing, mentoring , guidance and love only a mother can give" said Kelly. Regarding the California "MICRA" law's requirement that survivors split a total of $250,000 in compensation for the loss of a mother and wife's love, care, comfort, society, moral support and intimate relations, Kelly commented, "It's an insult to this family. This artificial limit makes death an affordable cost of doing business for Kaiser."
Kaiser Patients Need Lawyers Familiar With Arbitration
Kaiser patients need a lawyer who understands how to arbitrate and try a medical malpractice case. Most Kaiser Permanente HMO members do not know that Kaiser has established specific rules for medical claims processing. Since 1978, Kaiser Permanente has required the use of a private arbitration procedure for all medical claims against Permanente group doctors or Kaiser hospitals resulting from negligence, carelessness or malpractice. Arbitration process is unique to Kaiser- patients need a lawyer who understand the arbitration system.
Every Kaiser arbitration requires a comprehensive arbitration brief which outlines the expected testimony, provides a coherent timeline, establishes the pertinent facts which establish causation, and connects to the appropriate CACI jury instructions.
Although arbitrators have the power to handle arbitrations on an informal" basis, it's best to have the arbitrator manage the proceedings consistent with the California Code of Civil Procedure and the California evidence code. More often than not, informality works to the disadvantage of the Kaiser member and to the advantage of Kaiser. The lawyer representing a Kaiser member must stress for the arbitrator that this is the patient's trial-he or she did not bargain for this private arbitration forum, and now that they are here, without any right of appeal in an entirely secret proceeding, only the applicable evidence code and ethics of the arbitrator guarantee fairness for the patient.
Many arbitrators will suggest that they have read the trial brief and don't need opening statement, but a lawyer who knows how to represent clients in Kaiser cases knows that this is their clients only "day in court". The patient's lawyer must take advantage of the opportunity to make an opening statement, and to make a presentation that is the equal of what would be done in trial: use visual aids, play sections of critical videotape testimony, blowup and refer to the key pages in the medical record.
Just as jurors often learn best through exhibits, visual aids, demonstrations, models, charts and diagrams, so do arbitrators. Each witness examination must be conducted as though the lawyer is examining the witness in front of a jury.
In final argument, the lawyer representing a Kaiser patient must marshal the evidence and prepare a verdict form as would be done in Superior Court. A special verdict form gives the arbitrator a roadmap on how to find for the patient. Counsel must highlight and use the critical and applicable jury instructions to remind the arbitrator of the applicable law, the important facts and the burden of proof. The arbitrator must be reminded regularly of the importance of her/his task and that while there are no jurors in the room, and the hearing is not in the county courthouse, it is every bit as solemn and important for this client (whose right to a jury trial was taken away by Kaiser's superior bargaining power.)
When Kaiser adopted its arbitration system in 1975, it told its members that arbitration had a number of benefits: it was alleged to be faster than the traditional court system; it was asserted to be less expensive than traditional court system; it was claimed that it was both more fair and sounder in decisions and awards than the court system, and, it was alleged that it would provide a fairer approach to protecting the rights of individuals to adequate compensation in the event of medical malpractice. Whether the system has historically, or currently, met these goals is open to dispute-but whether the system is likely to change is not. With more than 40 years of invested experience in the process , there is no indication that Kaiser intends to change the system anytime soon. Given that circumstance, lawyers representing patients need to fully understand the unique nuances of the Kaiser arbitration system, and optimize their clients chances for success.
At Walkup Melodia, our lawyers do not just understand the process, they actually teach other lawyers about it! Walkup partner Michael Kelly annually chairs a specialty continuing legal education program for other lawyers on how to successfully prosecute cases against Kaiser. In addition, all Walkup medical malpractice lawyers are involved in the preparation, litigation and arbitration of Kaiser medical malpractice cases.
Kaiser Permanente Locations
Our lawyers prosecute injuries caused by Permanente group doctors, Kaiser foundation hospitals and Kaiser Permanente negligence arising from injuries occurring in numerous areas throughout California and the West , including
Learn More About How To Pursue Recovery
Unlike other firms, Walkup law firm has a dedicated physician-attorney on staff to assist in the screening of medical malpractice cases against Kaiser. We also utilize outside consultants to work with us in the evaluation and preparation of Kaiser claims. Injured patients are the survivors of patients who lost their lives as a result of Kaiser medical malpractice should contact us online or call 415-906-3764 to schedule a free initial consultation. We do not charge a fee for reviewing your Kaiser case, or for prosecuting the case, unless we successfully recover financial compensation for you.
We are on call seven days a week for your convenience.