The Kaiser Permanente doctor who examined Harun Antwine had worked at least 10 hours that day, seeing 25 patients in his office and 15 more that evening at the HMO's Fontana urgent care center.
The swamped physician didn't spot Antwine's serious bacterial infection, and the 29-year-old patient left urgent care without antibiotics, Antwine's family lawyer says. The father of three young children died two days later.
"It was a classic case of failing to treat a patient [who] really needed it," said lawyer Gregory Patton, who won an $848,000 arbitration award from Kaiser stemming from Antwine's 1998 death. "Their doctors are really, really overworked."
In justifying a $1.1-million fine against Kaiser, state regulators cited three patient deaths and said the cases demonstrated a pattern of problems in emergency care that has put the HMO's 6 million California members at risk.
Similar problems showed up in at least nine other cases since 1995--including Antwine's--in which arbitrators found Kaiser liable for patient injuries or deaths.
Although the number of arbitration awards is small, and Kaiser calls the cases anomalies, critics say they illustrate the same dangers identified by state officials: not enough staff and overcrowded facilities.
Kaiser, the state's largest HMO, denies that it has systemic problems and argues that the state's HMO czar, Daniel Zingale, has overstepped his authority. It is challenging the fine, which was imposed in 2000 and was increased last year.
Moreover, Kaiser said the arbitration awards reviewed by The Times should not be considered a pattern, given the millions of patients who seek care through the HMO.
"These cases are obviously things that everybody wants to pay attention to," Kaiser spokesman Jim Anderson said. "But to suggest anything other than that they represent [nine] individual medical malpractice cases is stretching a long way, we think."
Arbitration awards, though relatively rare, are among the few public avenues available for examining patient complaints against Kaiser. Dissatisfied Kaiser patients seeking damages must go through arbitration, because the HMO requires enrollees to waive their right to sue.
According to the nine arbitration summaries, Kaiser has been ordered to pay more than $3.5 million for lapses in emergency or urgent care since 1995.
