A Doctor’s Journal of Mismanaged Care

When state authorities in March seized the providers network of MedPartners Inc. because the regulators feared the health care company was insolvent, concerns naturally arose about the quality of treatment the managed care network’s 1.3 million California patients had been getting.

Now, a MedPartners physician, Dr. Jack Thomas, has come forward with a diary compiled over eight months, through February. Thomas contends that the care at MedPartners’ Mullikin Naples facility in Long Beach often was bad.

About 115 patients treated by Thomas, who currently is on voluntary leave, are mentioned in 22 pages of diaries and letters he sent to the state Department of Corporations and the California Medical Assn. on April 20, and released to The Times afterward.

I’m excising the names of the patients to preserve their privacy.

But the issues raised by the 51-year-old doctor are too serious to ignore: He alleges failure to refer seriously ill patients to specialists or perform surgery in a timely manner, a frequent absence of their medical charts, and cuts in the length of their appointments.

William M. Kenefick, acting commissioner of the Department of Corporations, says that on May 5 he asked that a report on the validity of Thomas’ allegations be completed in two weeks.

Dr. Jack Lewin, CEO of the California Medical Assn., has declared, “Assuming its accuracy, I think Dr. Thomas’ diary reflects the ugly underbelly of some forms of managed care, which have been based on predatory pricing and putting profits and investor income ahead of patients.”

MedPartners denies the accuracy of much of the Thomas diary, though its spokesmen found no fault with Thomas as a medical practitioner. More about the MedPartners response later.

To convey the flavor of the diary, I’ll cite some excerpts:

“July 2, 1998--Patient noted to have abnormal EKG and is at high risk for arterial disease. A treadmill stress test ordered several weeks ago is yet to be approved. The patient is placed at risk. . . .

“July 10--Patient with end-stage bladder cancer comes in severely symptomatic and in pain. The drug Destrol, which had been affording patient much relief, was denied. . . .

“July 27--Patient is seen in follow-up for a foot injury. . . . The chart is ‘lost.’ I have no information on the original diagnosis and treatment. . . .

“Aug. 4--Patient seen as emergency walk-in for severe shoulder pain. He has been in severe pain for several weeks while awaiting orthopedic consultation. . . .

“Sept. 11--Patient referred from another office. . . . The patient has a complicated history with multiple problems and medications. There is no chart, no information. . . .

“Sept. 21--Patient in for follow-up of . . . pulmonary embolism, diabetes and hypertension. For the second month in a row, the chart on this complicated case is out . . . for unknown reasons, this despite several attempts to have it returned. Again, the ability to give good care is compromised. . . .

“Oct. 2--Utilization Management Dept. [the office that approves referrals, procedures and medications] is not picking up the phone or even returning calls. Patients are angry, the staff is frustrated. . . .

“Oct. 31--Patient URGENT consultation with gynecology is not approved after two weeks. Patient continues to experience severe dysfunctional uterine bleeding. . . .

“Nov. 16--With no prior notification the doctors’ schedules are now changed to require a patient to be [seen] every 10 minutes, six an hour or 48 per day [despite] . . . problems . . . giving adequate care under the previous system of a patient every 15 minutes. . . .

“Dec. 4--Patient’s . . . emergency surgery for severe symptomatic carotid stenosis [danger of a stroke] has not been approved. . . . He is tearful and frustrated. I can only commiserate. . . .

“Dec. 18--A patient who underwent an extensive gastrointestinal work-up for abdominal pain and rectal bleeding is in with an exacerbation. I have no chart and no way of knowing not only the findings of the work-up but the diagnosis and course of treatment. . . .

“Feb. 1, 1999--Patient noted to have dangerously abnormal Protime [test on thinning of the blood] on Dec. 22 never notified [of results]. Dose of Coumadin [blood thinner] never adjusted, although ordered by doctor. Patient clearly placed at risk. . . .

“Feb. 2--Patient in to report he has been waiting six months for authorization for a hernia repair. Acute pain.”

Thomas says he took a leave of absence because “I could not bring myself to do this any more. I was mentally and physically depleted.”

In responding to his diary, MedPartners made a manager of the Naples facility, Dr. Roger Nash, available, and I also talked to Dr. Guy Pacquet, the only MedPartners executive who Thomas said was ever responsive to his complaints.

Nash, a physician-partner of Thomas for 18 years, disagreed with him sharply on his reports. He said when charts are missing at Naples, a doctor can find them on a computer or by telephone. “I do it, I get it done,” he remarked.

Nash said that since last summer referrals have been streamlined: “We instituted a system where a working physician in every office will have the authority to approve a referral on the spot.” Now, he said, “90% of referrals could be taken care of within 24 hours.”

He also said appointments weren’t changed from 15 minutes to 10, but to a system of 10, 20 or 30 minutes depending on the case.

Thomas emphatically denied the accuracy of Nash’s points.

Pacquet said he met with Thomas for an hour last fall, and, as a result of his complaints about cleanliness at the Naples facility, “all the cleaning [he wanted] was done within a couple of weeks.”

“So . . . I agreed with him on some things,” Pacquet said.

Space keeps me from further recital of MedPartners’ responses, although there were no sweeping claims that its treatment of patients is good, nor any assurance that it would investigate what Thomas said in his diary.

These are serious matters. The state government says it has launched an investigation, and it seems to me the public should be given a full report on its findings.

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Ken Reich can be contacted with your accounts of true consumer adventure at (213) 237-7060 or by e-mail at: [email protected].